Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths

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BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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  • What is childhood dementia? And how could new research help?

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    “Childhood” and “dementia” are two words we wish we didn’t have to use together. But sadly, around 1,400 Australian children and young people live with currently untreatable childhood dementia.

    Broadly speaking, childhood dementia is caused by any one of more than 100 rare genetic disorders. Although the causes differ from dementia acquired later in life, the progressive nature of the illness is the same.

    Half of infants and children diagnosed with childhood dementia will not reach their tenth birthday, and most will die before turning 18.

    Yet this devastating condition has lacked awareness, and importantly, the research attention needed to work towards treatments and a cure.

    More about the causes

    Most types of childhood dementia are caused by mutations (or mistakes) in our DNA. These mistakes lead to a range of rare genetic disorders, which in turn cause childhood dementia.

    Two-thirds of childhood dementia disorders are caused by “inborn errors of metabolism”. This means the metabolic pathways involved in the breakdown of carbohydrates, lipids, fatty acids and proteins in the body fail.

    As a result, nerve pathways fail to function, neurons (nerve cells that send messages around the body) die, and progressive cognitive decline occurs.

    A father with his son on his shoulders in a park.
    Childhood dementia is linked to rare genetic disorders. maxim ibragimov/Shutterstock

    What happens to children with childhood dementia?

    Most children initially appear unaffected. But after a period of apparently normal development, children with childhood dementia progressively lose all previously acquired skills and abilities, such as talking, walking, learning, remembering and reasoning.

    Childhood dementia also leads to significant changes in behaviour, such as aggression and hyperactivity. Severe sleep disturbance is common and vision and hearing can also be affected. Many children have seizures.

    The age when symptoms start can vary, depending partly on the particular genetic disorder causing the dementia, but the average is around two years old. The symptoms are caused by significant, progressive brain damage.

    Are there any treatments available?

    Childhood dementia treatments currently under evaluation or approved are for a very limited number of disorders, and are only available in some parts of the world. These include gene replacement, gene-modified cell therapy and protein or enzyme replacement therapy. Enzyme replacement therapy is available in Australia for one form of childhood dementia. These therapies attempt to “fix” the problems causing the disease, and have shown promising results.

    Other experimental therapies include ones that target faulty protein production or reduce inflammation in the brain.

    Research attention is lacking

    Death rates for Australian children with cancer nearly halved between 1997 and 2017 thanks to research that has enabled the development of multiple treatments. But over recent decades, nothing has changed for children with dementia.

    In 2017–2023, research for childhood cancer received over four times more funding per patient compared to funding for childhood dementia. This is despite childhood dementia causing a similar number of deaths each year as childhood cancer.

    The success for childhood cancer sufferers in recent decades demonstrates how adequately funding medical research can lead to improvements in patient outcomes.

    An old woman holds a young girl on her lap.
    Dementia is not just a disease of older people. Miljan Zivkovic/Shutterstock

    Another bottleneck for childhood dementia patients in Australia is the lack of access to clinical trials. An analysis published in March this year showed that in December 2023, only two clinical trials were recruiting patients with childhood dementia in Australia.

    Worldwide however, 54 trials were recruiting, meaning Australian patients and their families are left watching patients in other parts of the world receive potentially lifesaving treatments, with no recourse themselves.

    That said, we’ve seen a slowing in the establishment of clinical trials for childhood dementia across the world in recent years.

    In addition, we know from consultation with families that current care and support systems are not meeting the needs of children with dementia and their families.

    New research

    Recently, we were awarded new funding for our research on childhood dementia. This will help us continue and expand studies that seek to develop lifesaving treatments.

    More broadly, we need to see increased funding in Australia and around the world for research to develop and translate treatments for the broad spectrum of childhood dementia conditions.

    Dr Kristina Elvidge, head of research at the Childhood Dementia Initiative, and Megan Maack, director and CEO, contributed to this article.

    Kim Hemsley, Head, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University; Nicholas Smith, Head, Paediatric Neurodegenerative Diseases Research Group, University of Adelaide, and Siti Mubarokah, Research Associate, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Most Underrated Hip Mobility Exercise (Not Stretching)

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    Cori Lefkowith, of “Redefining Strength” and “Strong At Every Age” fame, is back to help us keep our hips in good order:

    These tips don’t lie

    It’s less about stretching, and more about range of motion and “use it or lose it”:

    • Full range of motion in lifting exercises enhances joint mobility and stability, whereas strengthening muscles through a limited range of motion (e.g., half squats) can cause tightness.
    • Lifting through a larger range of motion may result in faster strength gains too, so that’s a bonus.
    • Customize your range of motion based on your body type and capability, but do try for what you reasonably can—don’t give up!
    • Lower weights and focus on deeper movements like split squats or single-leg squats, but work up slowly if you have any difficulties to start with.
    • Using exercises like the Bulgarian split squat and deficit split squat can improve hip mobility and strength (you’ll really need to see the video for this one)
    • Fully controlling the range of motion is key to progress, even if it means going lighter; prioritize mobility over brute strength. Strength is good, but mobility is even more critical.
    • Adding instability, such as raising the front foot in lunges, challenges muscles and increases mobility. Obviously, please be safe while doing so, and slowly increase the range of motion while maintaining control, avoiding reliance on momentum.
    • Final tip that most don’t consider: try starting exercises from the bottom position to ensure proper form and muscle engagement!

    For more on each of these plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

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  • The 5 Love Languages Gone Wrong

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    Levelling up the 5 love languages

    The saying “happy wife; happy life” certainly goes regardless of gender, and if we’re partnered, it’s difficult to thrive in our individual lives if we’re not thriving as a couple. So, with the usual note that mental health is also just health, let’s take a look at getting beyond the basics of a well-known, often clumsily-applied model:

    The 5 love languages

    You’re probably familiar with “the 5 love languages”, as developed by Dr. Gary Chapman. If not, they are:

    1. Acts of Service
    2. Gift-Giving
    3. Physical Touch
    4. Quality Time
    5. Words of Affirmation

    The idea is that we each weight these differently, and problems can arise when a couple are “speaking a different language”.

    So, is this a basic compatibility test?

    It doesn’t have to be!

    We can, if we’re aware of each other’s primary love languages, make an effort to do a thing we wouldn’t necessarily do automatically, to ensure they’re loved the way they need to be.

    But…

    What a lot of people overlook is that we can also have different primary love languages for giving and for receiving. And, missing that can mean that even taking each other’s primarily love languages into account, efforts to make a partner feel loved, or to feel loved oneself, can miss 50% of the time.

    For example, I (your writer here today, hi) could be asked my primary love language and respond without hesitation “Acts of Service!” because that’s my go-to for expressing love.

    I’m the person who’ll run around bringing drinks, do all the housework, and without being indelicate, will tend towards giving in the bedroom. But…

    A partner trying to act on that information to make me feel loved by giving Acts of Service would be doomed to catastrophic failure, because my knee-jerk reaction would be “No, here, let me do that for you!”

    So it’s important for partners to ask each other…

    • Not: “what’s your primary love language?” ❌
    • But: “what’s your primary way of expressing love?” ✅
    • And: “which love language makes you feel most loved?” ✅

    For what it’s worth, I thrive on Words of Affirmation, so thanks again to everyone who leaves kind feedback on our articles! It lets me know I provided a good Act of Service

    So far, so simple, right? You and your partner (or: other person! Because as we’ve just seen, these go for all kinds of dynamics, not just romantic partnerships) need to be aware of each other’s preferred love languages for giving and receiving.

    But…

    There’s another pitfall that many fall into, and that’s assuming that the other person has the same idea about what a given love language means, when there’s more to clarify.

    For example:

    • Acts of Service: is it more important that the service be useful, or that it took effort?
    • Gift-Giving: is it better that a gift be more expensive, or more thoughtful and personal?
    • Physical Touch: what counts here? If we’re shoulder-to-shoulder on the couch, is that physical touch or is something more active needed?
    • Quality Time: does it count if we’re both doing our own thing but together in the same room, comfortable in silence together? Or does it need to be a more active and involved activity together? And is it quality time if we’re at a social event together, or does it need to be just us?
    • Words of Affirmation: what, exactly, do we need to hear? For romantic partners, “I love you” can often be important, but is there something else we need to hear? Perhaps a “because…”, or perhaps a “so much that…”, or perhaps something else entirely? Does it no longer count if we have to put the words in our partner’s mouth, or is that just good two-way communication?

    Bottom line:

    There’s a lot more to this than a “What’s your love language?” click-through quiz, but with a little application and good communication, this model can really resolve a lot of would-be problems that can grow from feeling unappreciated or such. And, the same principles go just the same for friends and others as they do for romantic partners.

    In short, it’s one of the keys to good interpersonal relationships in general—something critical for our overall well-being!

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  • Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help – and where it probably won’t

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s that time of year when many people are getting started on their resolutions for the year ahead. Doing more physical activity is a popular and worthwhile goal.

    If you’re hoping to be more active in 2024, perhaps you’ve invested in an activity tracker, or you’re considering buying one.

    But what are the benefits of activity trackers? And will a basic tracker do the trick, or do you need a fancy one with lots of features? Let’s take a look.

    Why use an activity tracker?

    One of the most powerful predictors for being active is whether or not you are monitoring how active you are.

    Most people have a vague idea of how active they are, but this is inaccurate a lot of the time. Once people consciously start to keep track of how much activity they do, they often realise it’s less than what they thought, and this motivates them to be more active.

    You can self-monitor without an activity tracker (just by writing down what you do), but this method is hard to keep up in the long run and it’s also a lot less accurate compared to devices that track your every move 24/7.

    By tracking steps or “activity minutes” you can ascertain whether or not you are meeting the physical activity guidelines (150 minutes of moderate to vigorous physical activity per week).

    It also allows you to track how you’re progressing with any personal activity goals, and view your progress over time. All this would be difficult without an activity tracker.

    Research has shown the most popular brands of activity trackers are generally reliable when it comes to tracking basic measures such as steps and activity minutes.

    But wait, there’s more

    Many activity trackers on the market nowadays track a range of other measures which their manufacturers promote as important in monitoring health and fitness. But is this really the case? Let’s look at some of these.

    Resting heart rate

    This is your heart rate at rest, which is normally somewhere between 60 and 100 beats per minute. Your resting heart rate will gradually go down as you become fitter, especially if you’re doing a lot of high-intensity exercise. Your risk of dying of any cause (all-cause mortality) is much lower when you have a low resting heart rate.

    So, it is useful to keep an eye on your resting heart rate. Activity trackers are pretty good at tracking it, but you can also easily measure your heart rate by monitoring your pulse and using a stopwatch.

    Heart rate during exercise

    Activity trackers will also measure your heart rate when you’re active. To improve fitness efficiently, professional athletes focus on having their heart rate in certain “zones” when they’re exercising – so knowing their heart rate during exercise is important.

    But if you just want to be more active and healthier, without a specific training goal in mind, you can exercise at a level that feels good to you and not worry about your heart rate during activity. The most important thing is that you’re being active.

    Also, a dedicated heart rate monitor with a strap around your chest will do a much better job at measuring your actual heart rate compared to an activity tracker worn around your wrist.

    Maximal heart rate

    This is the hardest your heart could beat when you’re active, not something you could sustain very long. Your maximal heart rate is not influenced by how much exercise you do, or your fitness level.

    Most activity trackers don’t measure it accurately anyway, so you might as well forget about this one.

    VO₂max

    Your muscles need oxygen to work. The more oxygen your body can process, the harder you can work, and therefore the fitter you are.

    VO₂max is the volume (V) of oxygen (O₂) we could breathe maximally (max) over a one minute interval, expressed as millilitres of oxygen per kilogram of body weight per minute (ml/kg/min). Inactive women and men would have a VO₂max lower than 30 and 40 ml/kg/min, respectively. A reasonably good VO₂max would be mid thirties and higher for women and mid forties and higher for men.

    VO₂max is another measure of fitness that correlates well with all-cause mortality: the higher it is, the lower your risk of dying.

    For athletes, VO₂max is usually measured in a lab on a treadmill while wearing a mask that measures oxygen consumption. Activity trackers instead look at your running speed (using a GPS chip) and your heart rate and compare these measures to values from other people.

    If you can run fast with a low heart rate your tracker will assume you are relatively fit, resulting in a higher VO₂max. These estimates are not very accurate as they are based on lots of assumptions. However, the error of the measurement is reasonably consistent. This means if your VO₂max is gradually increasing, you are likely to be getting fitter.

    So what’s the take-home message? Focus on how many steps you take every day or the number of activity minutes you achieve. Even a basic activity tracker will measure these factors relatively accurately. There is no real need to track other measures and pay more for an activity tracker that records them, unless you are getting really serious about exercise.

    Corneel Vandelanotte, Professorial Research Fellow: Physical Activity and Health, CQUniversity Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    The Conversation

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  • Watermelon vs Cucumber – Which is Healthier?

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    Our Verdict

    When comparing watermelon to cucumber, we picked the cucumber.

    Why?

    Both are good! But in the battle of the “this is mostly water” salad items, cucumber wins out.

    In terms of macros they both are, as we say, mostly water. However, watermelon contains more sugar for the same amount of fiber, contributing to cucumber having the lower glycemic index.

    When it comes to vitamins, watermelon does a little better; watermelon has more of vitamins A, B1, B3, B6, C, and E, while cucumber has more of vitamins B2, B5, B9, K, and choline. So, a modest 6:5 win for watermelon.

    In the category of minerals, it’s a different story; watermelon has more selenium, while cucumber has more calcium, iron, magnesium, manganese, phosphorus, potassium, and zinc.

    Both contain an array of polyphenols; mostly different ones from each other.

    As ever, enjoy both. However, adding up the sections, we say cucumber enjoys a marginal win here.

    Want to learn more?

    You might like to read:

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  • Healthy Butternut Macaroni Cheese

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    A comfort food classic, healthy and plant-based, without skimping on the comfort.

    You will need

    • ½ butternut squash, peeled and cut into small pieces (if buying ready-chopped, this should be about 1 lb)
    • 1 onion, chopped
    • ¼ bulb garlic
    • 2 tbsp extra virgin olive oil
    • 12 oz (or thereabouts) wholegrain macaroni, or similar pasta shape (even penne works fine—which is good, as it’s often easier to buy wholegrain penne than wholegrain macaroni) (substitute with a gluten-free pasta such as buckwheat pasta, if avoiding gluten)
    • 6 oz (or thereabouts) cashews, soaked in hot water for at least 15 minutes (but longer is better)
    • ½ cup milk (your preference what kind; we recommend hazelnut for its mellow nutty flavor)
    • 3 tbsp nutritional yeast
    • Juice of ½ lemon
    • 2 tsp black pepper, coarse ground
    • ½ tsp MSG, or 1 tsp low-sodium salt
    • Optional: smoked paprika, to serve

    Note: if you are allergic to nuts, please accept our apologies that there’s no substitution available in this one. Simply put, removing the cashews would mean changing most of the rest of the recipe to compensate, so there’s no easy “or substitute with…” that we can mention. We’ll have to find/develop a good healthy plant-based no-nuts recipe for you at a later date.

    Method

    (we suggest you read everything at least once before doing anything)

    1) Preheat the oven to 400℉ / 200℃.

    2) Combine the butternut squash, onion, and garlic with the olive oil, in a large roasting tin, tossing thoroughly to ensure an even coat of oil. Roast them for about 25 minutes until soft.

    3) Cook the macaroni while you wait (this should take about 10 minutes or so in salted water), drain, and rinse thoroughly in cold water, before setting aside. This cooling increases the pasta’s resistant starch content (that’s good, for your gut and for your blood sugars, and thus also for your heart and brain), and it will maintain this benefit even when we reheat it later.

    4) Drain the cashews, and tip them into a high-speed blender with the milk, and process until smooth. Add the roasted vegetables and the remaining ingredients apart from the pasta, and continue to process until again smooth. You can add a little more milk if you need to, but go easy with it.

    5) Heat the sauce (that you just made in the food processor) gently in a saucepan, and refresh the pasta by pouring a kettle of boiling water through it in a colander.

    6) Optional: combine the pasta and sauce in an ovenproof dish or cast iron pan, and give it a few minutes under the hottest grill (or browning iron, if you have such) your oven can muster. Alternatively, use a culinary blowtorch, if you have one.

    7) Serve; and if you didn’t do the optional step above, this means combining the pasta and sauce. You can also dust the top with some extra seasonings if you like. Smoked paprika works well for this.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

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