I Like My Patients to be Vertical

Throughout my years of practicing medicine, I liked to say that I preferred my patients vertical. As opposed to horizontal.

If and when I could help it, I wanted to make sure that no one got a disease that could have been prevented. Sure, accidents happen. And illnesses, sometimes serious, are diagnosed every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.

Physicians know from the published research that newly diagnosed diabetic patients present to their doctor with about 10 years worth of damage to their blood vessels. What does this mean? It means that we are diagnosing diabetes 10 years later than the disease warrants. It means that the symptoms we are taught to identify come about 10 years after the disease begins.

So, I could wait until a patient begins to complain of frequent urination, unquenchable thirst, and an infection that won’t heal. I could spend ten years ignoring a blood pressure that continues to rise; a combination of high triglycerides and low HDL; frequent car rides to buy fast food; a lifestyle that includes almost no time for stretching, walking or other exercise; a diet consisting largely of stripped carbohydrates (e.g., sugar, white flour, white rice, corn starch) and omega-6 oils; and and multiple pairs of pants that can no longer be buttoned. But at the end of those ten years, I should not be surprised when that patient shows up exhausted, and with a blood sugar of 350.

The Centers for Disease Control (CDC) currently estimates that one-third (33%) of American adults are now prediabetic, and ten percent are diabetic (most of these, 90-95%, with type 2 diabetes). Thirty percent of Americans aged 65 and older are diabetic. Rates of diabetes continue to soar, particularly among racial minorities, ethnic minorities, and children.

Diabetes is, for the most part, a preventable disease. The key is to start preventing it ten years before you are diagnosed. When would that be? Right now. Increase your protein intake at breakfast and skip ultra-processed items to the greatest extent possible. Stop drinking soda — even diet soda appears to be associated with an increased risk of diabetes. Nothing labeled light, lite, quick, instant, or processed food. Eat real food. What’s real? Food that your great-great-ancestors would have recognized as food. If someone has to tell you how to use it, or when to eat it, it’s not food.

We must also find ways to make peace, to relax, to manage the stress that we all feel in our hectic and busy lives. Stress increases body weight, blood pressure, and blood sugar. A while ago, I read a book by Sue Monk Kidd and her daughter Ann Kidd Taylor entitled Traveling with Pomegranates. Sue’s hypertension evaporated once she realized how important it was to balance the time she spent writing with relaxing, walking the marshes near her home and sitting quietly as a part of the nature all around her. She called it a personal recognition that “being” is of equal importance to “doing.” We are human beings, not human doings.

The stakes are high; diabetes can be dangerous. I have never wanted to see my patients in a hospital bed or even a wheelchair, if it could be helped. I have always liked my patients vertical.


Three Kinds of Charoset 2024

At our upcoming Passover seders to be held on Monday and Tuesday nights this coming week, we will be serving a number of different kinds of charoset (kha-ROE-set). In addition to our traditional apples-and-walnuts charoset that I make each and every year, we’ll be serving two other truly extraordinary charoset recipes. I want to share for a moment that my mom and my Grandma Rosie actually taught me to make charoset in a large wooden chopping bowl (such a special memory), a bowl that continued to hold a place of honor in my parents’ house for many, many years after Grandma Rosie was gone. Things go much faster now with the food processor, though I always process each ingredient separately almost to the desired consistency, and then add them all back together for a big stir with a big fork. Otherwise you are likely to get fruit-nut spread, which is a different recipe entirely. 

But this post is mostly about the other two kinds of charoset. For a long time, a couple of decades at least, I annually made my way through a series of Middle Eastern-style, dried-fruit-based charoset recipes. But I never found one I liked enough to make it again until a few years ago, when I prepared a bowl of the first charoset recipe below, which went around and around the table until it had been wiped clean! 

Recipe number one is a mixture of lots of nuts and dried fruit plus sweet spices and a little heat. Note that instead of cayenne pepper you can also use some ground smoked Serrano chili pepper, which I first happened upon at a market in Napa one year. Feel free to be creative with whatever kind of heat you find in your cabinet. Remember that freshness is more important than the particular source. Here is the first recipe:

2/3 cup whole almonds with skins intact, toasted and cooled
2/3 cup salted undyed pistachios, shelled
1 cup dried apricots, coarsely chopped (5 ounces)
2/3 cup Medjool dates, pitted and coarsely chopped
1 strip (~3 x 1/2 inch) orange zest, finely chopped (approx. 1 tsp.)
1/4 teaspoon cinnamon
1/4 teaspoon ground coriander
1/4 teaspoon cayenne pepper

Toast the almonds in a cast iron pan or a cookie sheet in the oven, shaking often, especially once the color begins to deepen. Be careful not to allow them to burn, or you will have to start over. Set aside, and allow to cool. 

Rinse the pistachios to remove most of the salt, and spread out on a towel to absorb most of the water. 

Add the apricots and orange zest to the food processor, and pulse until well chopped. Remove apricots, and set aside.

Add the dates to the food processor, and pulse until well chopped. Remove, and set aside. 

Add the almonds to the empty food processor, and pulse just a few times until the nuts begin to break apart. Add the pistachios and spices, and continue to pulse until the two different types of nuts are well mixed but just (barely) distinguishable. Return the apricots and dates to the bowl, and pulse until all is well mixed, but still chewy and a little bit crunchy. Empty into a beautiful bowl, decorate with an almond or two, and cover until Seder.

The second recipe comes from my son, who was looking for a charoset with bright and unique flavors, when he happened upon this beauty. The flavor of this nut-free charoset is nothing less than spectacular, and I encourage you to try it. You can make it by hand for a more rugged result, or with a food processor. 

1 cup Medjool dates, pitted and coarsely chopped
1 tsp. fresh ginger (approx 1/3 thumb, peeled and chopped fine)
2-3 heaping Tbsp. shredded coconut
1 strip (~2 x 1/2 inch) lemon or grapefruit zest, finely chopped (approx. 3/4 tsp.)
2-4 tsp. sweet white wine (or white grape juice)

Mix together the ginger, coconut, and citrus zest. If using a food processor, pulse no more than two or three times to allow at least some of the ingredients to remain visibly separate.

Then add the dates and pulse just a few more times to mix all the ingredients. Remove from the food processor. Add 2 teaspoons of white wine and mix by hand. If the charoset seems dry (like trail mix), add more wine, just one teaspoon at a time, until the mixture is very slightly moist and sticky. The amount of wine you end up using will depend mostly on the type and age of the dates, so it’s hard to predict in advance, and each batch may be slightly different. Empty into a beautiful bowl, decorate with a sprinkle of coconut and a thin strip of citrus peel, and cover until Seder.

If you’ve never eaten charoset, or if you’re wondering what to do with leftovers (if there are any), you can spoon it onto matzah, chicken, fish, or eat it right off a spoon. I have eaten charoset on matzah for breakfast almost every day of Passover since I was a child, so I doubt I will stop now. Confession: I always make a huge container of apple-and-walnut charoset so there’s enough to last the whole week!

Chag sameach, happy Passover to everyone! Enjoy!


Slow Living & Horseradish

A few years ago I received a message from a friend asking if I knew where she could find some fresh horseradish. Now, as it happened, I had planted a horseradish root, a left over from our Seder plate, a few years prior. Then I had forgotten about it completely until I got her message. So I happened to know the answer to her question. Continue reading


The Zen of One Fried Egg

This is one of my favorite old posts. Last fall, my sister came to Cleveland for a visit and for the wedding of an old friend’s daughter, and I enjoyed seeing the smile on her face as she mentioned this post from years back. Ever since then, I’ve been thinking about reposting it. In honor of my sister, and in memory of the chickens we used to have before a few raccoons and other wild things destroyed our coop one miserable day a few years back, I repost it here today. We are hoping to get our coop back on line this year so that we can resume telling stories about our chickens.  Continue reading


Is it Really Food?

While talking with patients about how to improve the nutritional value of their meals, we used to talk about real food that had not been processed, refined, stripped, polished, fortified, enriched or otherwise modified. Fruits, vegetables, legumes, nuts, seeds, grains, fish, eggs, dairy products, and meats. And that’s about it.

Here are some guidelines: The first is not to eat anything you have to be told is food. If you have to be told it’s food, it isn’t. Like “processed American cheese food.” Talk about truth in advertising. Some products at the supermarket have names that have nothing whatsoever to do with food. Like Miracle Whip®. Or Cool Whip®. These are not foods either, and that’s why I’m not buying. Continue reading


Some Exciting New Developments

A lot has been happening lately in the field of research into the the health effects of ultra-processed items, and that’s what I want to talk about today. Last month, the results of a huge study, involving almost 10,000,000 (ten million!) individuals, were published in the BMJ [British Medical Journal], “one of the world’s most influential and respected general medical journals,” and they were…shall we say…most informative.  Continue reading


YOUR HEALTHY PLATE: Two Kale Salads

This past Monday we had bookclub at my house, and it was really nice. We read Homegoing, by Yaa Gyasi, and ate a whole bunch of delicious things, including a fantastic sweet potato soup (from Amy Chaplin’s Whole Food Cooking Every Day), rainbow carrots and baba ganoush from the West Side market, and Lynne’s fantastic kale salad, which she throws together with tahini dressing and a homemade mix of spiced almonds, sunflower seeds, and pumpkin seeds. One of these days I’ll have to get the recipe, but I can already see her laughing and tossing back her head as she says, oh I don’t know, I just toss it all together! So, at least for now, your guess is as good as mine.

Continue reading



YOUR HEALTHY PLATE: Bob’s Red Mill Quinoa Salad

You may or may not have heard, but last month, on February 10th, Bob Moore, a founder of Bob’s Red Mill Natural Foods, passed away at the age of 94. And I felt the need to write a post about this man who made such a remarkable difference in our food supply. Continue reading


Walking With Wellness

Some time ago, I received my first pedometer with which to track my daily steps, and I could not have been more thrilled. Attached unobtrusively to an elastic wrist band, it ventured forth with me every day as I plotted my path, set my course, stepped up, or took a hike. Continue reading