For K.E.
Last summer, after my patient Mrs. Price heard me say that her blood sugar was 204, a single tear ran down her cheek as she said,  “My eldest granddaughter is getting married next year.”  A blood sugar measurement over 200 is one way to confirm a diagnosis of diabetes.  Her parents had both died in their 60’s from complications of chronically elevated high blood sugars.  Here is what I told her.

“The most important difference between your situation and mine right now is that your body is no longer able to keep its blood sugars in the normal range by itself.  But that doesn’t mean you are going to suffer the terrible complications that your parents did.  Kidney failure, blindness, heart attacks and amputations are not inevitable complications of diabetes.  It’s not diabetes itself that’s the problem; it’s uncontrolled diabetes.”

“There’s good news here: First, we found out about this before it turned into a serious problem.  Secondly, as long as you learn to keep your blood sugars in the normal range, your risk of developing complications will be pretty close to mine, which is to say, low.  A diagnosis of diabetes doesn’t mean that you’re going to have trouble.  It just means that your body can’t control its sugars automatically anymore, and it’s going to need your help.  But as long as you give your body the help it needs, and you learn how to conserve your insulin, the payoff will be huge.  I have no doubt that we will be able to get your sugars in the normal range.  You’re just going to need to involve your brain in the process.”

“You’re not going to be able to keep your blood sugars in the normal range automatically anymore, because if you could, your blood sugars wouldn’t be over 200.  And I can’t keep your blood sugars in the normal range all by myself either.  But if we work together, we can and we will.  So let’s figure out what we need to do to get your sugars under good control.  And then let’s do it.”

When I take care of patients with diabetes, I have lots of goals.  I want to get their average blood sugars under 125.  I have goals for total cholesterol, triglycerides, HDL and LDL.  I want blood pressures below 135/85, and I want kidney function in the normal range.  I want strong peripheral pulses and I want my patients’ feet cared for expertly, at home and by the podiatrist.  I want my patients’ eyes checked at least once a year.  And so on.

“But you, Mrs. Price,” I continued, “have only one goal.  Your goal is to dance at your grandchildren’s weddings.  Not just attend them, but dance at them.  All of them.  Starting next summer.”  She smiled a little.

“Did you know that one hundred years ago, before we had medicine for diabetes, the only treatment for diabetes was a high fat diet?,” I asked.  She did not know that.

I taught Mrs. Price how to conserve her insulin using the “Four Recommendations.”  She stopped buying the cereal and orange juice she’d been eating at 11:30 a.m. for years.  I prescribed a medication “to make my insulin more efficient,” as she put it.  We made an agreement that she would begin to walk 5 minutes every day, and that she would begin to increase that number by 1 minute a month.  I reminded her that “Slow but steady wins the race,” because I certainly didn’t want her to sprain an ankle or get shin splints, two complications that would prevent her from getting much exercise at all for months.  She also made a rainy-day plan — to walk in the nearby mall in bad weather.  This is Cleveland, after all.

We got Mrs. Price a glucometer, and I showed her that she could actually figure out which foods were causing blood sugar spikes by testing before she ate and then an hour afterward.  As time went by, she got better and better at predicting which foods were going to cause unacceptable spikes, and which foods kept her blood sugars in the normal range, more or less.  She stopped buying foods that spiked her blood sugar, except once in a while “special for the grandkids,” as she put it.  She started eating a protein-rich breakfast at 8 a.m., and noticed, to her surprise, that it resulted in significantly less after-dinner snacking.  As the year went by, we watched her 3-month blood sugar averages drop from 190 to 150 to 120.

Last weekend, I am pleased to report, Mrs. Price danced at her granddaughter’s wedding.

When I ask patients what they put in their coffee, they almost always say “cream.”  So I say, “Like from a cow?”  And they usually say no.

What do they mean by “cream” then?  They mean coffee whiteners.   “Cremora Rich ‘n Creamy!”, “Coffee-mate Lite The  Original,” “International Delights Coffee House Interpretations Vanilla Latte,” “Spoon ‘N’ Stir Non-Dairy Creamer,” and so on.  They mean corn syrup solids and partially hydrogenated vegetable oil.  Translation?  Sugar and trans fat.  Some of my patients even have a favorite flavor, now that the folks who make and market coffee whiteners have identified and exploited the consumer’s insatiable desire for variety.

Coffee whiteners are everywhere.  They’re at the office, at meetings, at the workshop I attended last week, and at parties given by folks otherwise committed to fresh food, backyard gardens, and the like.  Like some kind of stealth bomber, they slip in under everybody’s radar.  Coffee whiteners are Trojan horses filled with diabetes, obesity, heart attacks, and strokes.

A visit to my neighborhood supermarket reveals a few interesting facts about coffee whiteners, also known as non-dairy creamers.  In and of themselves, they are a study in advertising spin.  First, although they contain no milk sugar (lactose), they are NOT non-dairy; virtually all of them contain a milk derivative called sodium caseinate.  People who are allergic to milk protein cannot consume them.  That is why the Orthodox Union classifies them as dairy for those consumers, Jewish and otherwise, who purchase kosher food.  And that’s just the beginning.

Coffee whiteners, a very successful form of fabricated calories, are advertised as containing zero trans fats even though they actually contain almost 1/2 gram per serving.  That’s because, according to the law, products containing up to 1/2 gram may be advertised as trans-fat free.  But a teaspoon of powder isn’t very much.  If you use more, whether in one cup of coffee, tea or cocoa (as recommended on the label), or several cups, you get more trans fat.  And even small amounts of trans fat cause damage to blood vessels, increase the risk of heart attacks and strokes, and interfere with fat storage, cholesterol synthesis, and fertility.  There is no amount of trans fat that is safe to consume. 

Okay, so if you use more than the recommended serving size, you’ll get more trans fat.  That’s obvious.  What of it?  Well, I’m having a hard time with the fact that the advertising on packages of coffee whitener actually encourages people to use more than a single teaspoon (powder) or tablespoon (liquid) serving size:  “Pour in a teaspoon or more of Cremora.”  “Savor the rich flavor and smooth creaminess of Cremora, cup after creamy cup.”  “Scoop or pour…”

Remembering that the more manufactured the product, the more creative the names, let’s take a look at the coffee whitener flavors: Coffee-Mate makes liquid versions in French Vanilla (blue), Hazelnut (yellow), Peppermint Mocha (light blue), Vanilla Caramel (orange), and Italian Sweet Creme (purple), this last one part of their special “World Cafe” line.  Linking each flavor to a particular color spectrum improves identification, selection, and loyalty.  International Delight makes French Vanilla (blue), Hazelnut (orange), Hershey’s Chocolate Caramel (brown), Amaretto (pink), Irish Creme (green), White Chocolate Mocha (purple), Caramel Macchiato (light brown), and Vanilla Latte (turquoise), the last three from their “Coffee House Inspirations” (silver) line. 

Coffee-Mate liquid French Vanilla comes in regular, sugar-free, and fat-free versions.  I can’t figure out how it is that all of these list the same first three ingredients (water, corn syrup solids, and partially hydrogenated soybean and/or cottonseed oil) in the same order.  But they do.

International Delights also makes a product called Sweet Buttercream, advertised as Limited Edition, whatever that is.  Sweet Buttercream features a thickly iced cupcake in hues of tan, gold and ivory.  I figured since it had the word “buttercream,” there must be some butter, or maybe cream, in the ingredient list, but I just found the usual — corn syrup solids and partially hydrogenated vegetable oil, i.e., sugar and trans fat.

So what should you do?  Don’t use coffee whiteners.  Put cream (from a cow!), half-and-half, or milk in your coffee.  You will not gain one single pound.  Substitute soy, rice, coconut, or almond milk if you are intolerant of dairy, and stick to the original without added sugar and flavorings.  Or drink your coffee black.  Don’t use “fat-free half-and-half.”  I’m still trying to figure out what that even means. 
 
Don’t buy anything with the words “partially-hydrogenated” in its ingredient list.  “Partially-hydrogenated” means trans fats, and there is no place for trans fats in the diets of your loved ones, friends, or coworkers.  We will not build healthy communities with coffee whitener.

Last year, an old friend from medical school joined with a second pediatrician to launch a friendly, informative blog for parents on the go called “Two Peds in a Pod.”  The founders of Two Peds in a Pod, Dr. Julie Kardos and Dr. Naline Lai, have serious concerns about the food-like products that are marketed to their young patients.  When we spoke recently, I mentioned that my adult patients frequently arrive with their children in tow, and that I often see the rounded bellies of those little ones shrink to normal size as their parents adopt my “four recommendations,” changing how they eat, shop, and feed their families.  When Dr. Julie heard that, she immediately invited me to write a guest post for Two Peds in a Pod!  “The adults you treat are the ones packing the lunches of the kids that I treat,” she said. 

When I asked which products bother her most, she mentioned a new snack designed [yes, designed is the right word] for babies and toddlers.  This package of junk food masquerading as healthy is made from sweet potato powder.  Its target audience is the young “graduates” of pureed baby food, ripe for their first “manufactured calorie” snacks.  I looked at on-line reviews of “Gerber-Graduates Sweet-Potato Puffs.”  Supposedly contributed by parents, they sounded to me like they were written by advertising professionals.  See what you think:

“Gerber Finger Foods Sweet Potato Veggie Puffs are a very good product from this trusted maker of baby foods.”  “Gerber Finger Foods Veggie Puffs are a very good product for introducing soon-to-be-toddlers to solid food.” “Melts in the mouth so you don’t have to worry about choking.” “No staining artificial colors and dyes.” “Great on-the-go, put-in-the-diaper-bag snack!!” “With Gerber Finger Foods, the worries melt away much like the food itself.“ “You just peel off the top and pour when you need some pieces of food, then replace the cap and wait for the next feeding opportunity.” [Are we at the zoo?] “Gerber sells this product in a cylindrical container that is a little narrower at the top to make it easy to grip.” [For parents or children?  Has this package been designed to hand to cranky children so they can finish the entire container’s supply?] “He would eat them all day long if I let him.” [This is not a benefit.  It means that the product is not nutritious enough to satisfy the child’s hunger.]

What else do I consider junk food?  Chips of all kinds, as well as those “100-calorie packs,” which are invariably filled with 100 calories of refined carbohydrate (white flour and sugar) in the form of crackers (®Ritz), cereal (®Chex), or cookies (®Chips Ahoy).

Beware not only of drinks that contain minimal amounts of juice, but of juice itself.  Even 100% fruit juice is simply a concentrated sugar-delivery system.  A much better approach is to teach children to drink water when they are thirsty, and to snack on fresh fruit when they are hungry.  Milk works, too, especially if you are both hungry and thirsty!

Now then, what should we be packing in our children’s lunch bags?  The key to retraining our children to eat real food is to restore historical patterns of food consumption.  My great-grandparents didn’t eat potato chips, corn chips, sun chips, or moon chips.  They ate a slice of whole-grain rye bread with a generous smear of butter or cream cheese.  They didn’t eat fruit roll-ups.  They ate apricots, peaches, plums, and grapes.  Fresh or dried.  Depending on where your family originated, you might have eaten a thick slice of Mexican white cheese (queso blanco), or a generous wedge of cheddar cheese, or brie.  Sunflower seeds, dried apples, roasted almonds.  Peanut butter or almond butter.  Small containers of yogurt.  Slices of cucumbers, pickles, or peppers.  All of these make good snacks or meals.  My mom is proud to have given me slices of Swiss cheese when I was a hungry toddler out for a stroll with my baby brother.  Maybe that’s how I ended up where I am today.

When my own children were toddlers, I gave them tiny cubes of frozen tofu to grasp and eat.  I packed school lunches with variations on the following theme:  1) a sandwich made with whole grain bread, 2) a container of fruit (usually apple slices, orange slices, kiwi slices, berries, or slices of pear), and 3) a small bag of homemade trail mix (usually peanuts + raisins).  The sandwich was usually turkey, mayo and lettuce; or sliced Jarlsberg cheese, sliced tomato, and cream cheese; or tuna; or peanut butter, sometimes with thin slices of banana.  On Fridays I often included a treat, like a few small chocolates. 

Homemade trail mix is one terrific snack.  It can be made with any combination of nuts, seeds, and/or dried fruit, plus bits of dark chocolate if desired.  Remember that dark chocolate is good for you.  Dried apple slices, apricots, kiwi or banana chips, raisins, and currants are nutritious and delicious, and so are pumpkin seeds and sunflower seeds, especially of course in homes with nut allergies.  Trail mix can be simple or involved.  Fill and secure baggies with ¼ cup servings, and refrigerate them in a closed container until it’s time to make more.  I would include grains, like rolled oats, only for children who remain active and slender.

If possible (and I do know it’s a big if), the best way to get kids interested in increasing the amount of real food they eat is to involve them in its preparation.  That might mean smearing their own peanut butter on celery sticks before popping them into the bag.  It might mean taking slices of the very veggies they helped carry at the weekly farmer’s market.  Kids are more likely to eat the berries in their lunch bag if they picked them themselves.  There’s a much greater chance they’ll eat kohlrabi if they helped you peel it, slice it, or squeeze a fresh lemon over it.  That’s the key to healthy eating.

I spent most of the day yesterday on Orchard Street on the Lower East Side of Manhattan.  Not literally.  I was reading Jane Ziegelman’s new book, 97 Orchard: An Edible History of Five Immigrant Families in One New York Tenement.  I wanted to know what they ate in the days before Crisco, Cool Whip, corn syrup, and Cocoa Puffs. 

Besides the foods we commonly eat today, New Yorkers in the 1800’s ate buffalo, bear, venison, moose, mutton, otter, swan, grouse, and dozens of other species, both domestic and wild.  Organ meats included sweetbreads, hearts, livers, and kidneys.  Fish dealers offered eel, 15 types of bass, 6 types of flounder, and 17 types of perch.  Produce included purslane (I’m sure there is some growing in your backyard), salsify (a root vegetable), borage, burdock, beach plum, black currants, mulberries, nanny berries, black gumberries, and whortleberries.  Note the extraordinary variety in comparison to today’s offerings.

Breakfast often consisted of mutton chops, fish steaks, and porridge.  Oysters, whether raw or cooked, were abundant and extremely popular at all meals.  Herring was prepared in a myriad of ways, such as with sour cream and mayonnaise, pickled, fried in butter, smoked, rolled, stuffed with pickles, or as “chopped herring” salad.  I know this salad well because I used to help my Grandma Rosie make it. 

Grandma Rosie was born July 31, 1910, the fourth child in her family, and the first to be born in America.  Yesterday would have been her 100th birthday.  Here’s her recipe:  Soak 12 pickled herrings overnight, drain, remove the skin and bones, and chop fine.  Add 2 cups cooked potatoes, 1 cup apples, and 2 hard-boiled eggs, all chopped.  Mince 2 medium onions, and add to salad.  Add 1 tablespoon each of oil and white vinegar, and salt and pepper to taste.  The book also called for 1 cup of beets and some capers, but I never saw Grandma Rosie put capers or beets in her “chopped herring.”

Signature dishes on New York’s Lower East Side included hash, soups, and pies.  Pie was so popular that immigrants called Americans “pie-eaters.”  Mince pie, oyster pie, apple pie, pumpkin pie, chicken pie, and “sweetbreads in pastry” were among the choices.  Leftover beef, mutton, pork and fish was frequently made into “hash,” and boardinghouse dwellers were called “hash-eaters.”  Soups were made from bones, root vegetables, turnips, potatoes, cabbage, and dried beans.  I learned an old Yiddish proverb:  “Poor people cook with a lot of water.”  In contrast, the American government chose from among pork and beans, beef hash, corned beef with cabbage and potatoes, pot roast, boiled mutton, and mince pie to feed to newly arrived immigrants at Ellis Island. 

Smoked salmon is now considered a delicacy, but a century ago it was a food of necessity.  Without refrigeration, food was kept fresh and edible with four agents: heat, smoke, salt and acid.  Meats, fish and fowl were smoked, salted, or pickled.  Fruits and vegetables were pickled, jarred, or dried.  Corned beef, so named because of the large “corns” of salt used in its preparation, also belongs to the large family of preserved meats and fish. 

Here’s a recipe for turning cucumbers into dill pickles.  It’s very similar to the recipe Grandma Rosie gave me.  Pack 30 kirby cucumbers of approximately the same size into 1 large or 2 small jars, alternating the layers of cucumber with layers of dill (20 sprigs total).  Boil ½ cup kosher salt in 2 quarts water, and turn off the heat.  Add 2 tablespoons white vinegar, 4 cloves garlic, 1 dried red pepper, ¼ teaspoon mustard seed, 2 coin-sized slices of fresh horseradish, and 1 teaspoon of mixed pickling spice to the boiled liquid and pour over the cucumbers.  If necessary, add more salt water to completely immerse them.  Cover and keep in a cool place for a week.  If you like the cucumbers green, try one after 5 days. 

New York was famous for a squishy and gummy white bread called the “New York split loaf.”  In contrast, German immigrants made less expensive whole-grain rye and pumpernickel breads with dense, chewy textures and a sour, mildly nutty flavor.  These latter ones were the breads my family bought to slather with real or vegetarian chopped liver, depending on who was coming to visit.  Here’s Grandma Rosie’s recipe for vegetarian chopped liver:  Saute 3 chopped, medium onions in 3 tablespoons of oil until soft and golden.  Mash the contents of 1 large can of drained sweet peas (or 2 cups of fresh cooked peas), and add to the onions.  Add 1 ½ cups chopped walnuts and 2 chopped, hard-boiled eggs.  Chop by hand to desired consistency.  Season with salt and a generous amount of freshly ground black pepper.

As Grandma Rosie often said, “Hearty appetite!”

Have you ever heard anyone say that all you have to do to have a more nutritious diet is to stop eating white flour and sugar?  That seems pretty radical to most people.  What’s the point?  What’s wrong with white flour and sugar?  And what would such a change accomplish?  Simply put, why? 

By now, if you’ve been following the blog regularly, you probably know me well enough to know that I’m not going to say you can never eat white flour and sugar.  I’ll never say never — moderation is my motto.  I think that most people can tolerate a little bit of most things now and then.  But that’s not what’s happening.  Let’s look at what the standard American day looks like, food-wise. 

If you’re like more than 80% of American households, there is a broad selection of “breakfast cereals” in your kitchen.  On a typical morning, you and the children eat a bowlful.  Then you head out to work.  At the office, sweet Dora has brought in a box of doughnuts, and you enjoy one with your coffee, to which you have added non-dairy whitener.

At lunchtime, the group heads down to the cafeteria and you select baked ziti.  It comes with 2 small meatballs, a small packet of parmesan cheese, and a small, anemic-looking salad that consists mainly of iceberg lettuce, with 2 thin slices of cucumber and 1 grape tomato.  You add “a little bit” of salad dressing.  The ziti also comes with garlic bread, made from a white flour roll and margarine. 

Or you decide that you’d prefer a burger and fries.  Or today you’re going to “eat healthy,” and you select a container of low-fat, peach yogurt, and a granola bar.

Later in the afternoon, you head back into the break room hungry, and eat “just half” of the last doughnut.  Or pretzels.  Or chips.  Maybe baked ones.  Or a peppermint patty.  Or another granola bar.  And a can of soda from the machine down the hall. 

Dinner?  Fish sticks, instant mashed potatoes, and frozen peas and carrots.  Chicken nuggets, tater tots, and canned tomato soup.  Pizza and more garlic bread.  [I have nothing against pizza, but store-bought, frozen pizzas are generally not made with a whole-grain crust, generous amounts of real mozzarella cheese, and tomato sauce that contains no sugar or corn syrup.]  Cookies, jello, or chocolate pudding for dessert.

We’re not eating just a little bit of white flour and sugar.  We’re drowning in them.  No wonder cruising the cabinets after dinner is one of America’s favorite pastimes.  We’re really hungry.  Two-thirds of us are overweight or obese.  Why?  Because the standard American diet is so nutrient-poor that most people are literally hungry all the time.  Then they eat.  It’s not about willpower.  It’s about nutrition. 

White flour and sugar are relatively recent inventions of human beings.  And herein lies the problem.  We aren’t designed to eat them.  We didn’t evolve to eat them.  And our bodies don’t know what to do with them when we do.

Recent inventions?  How so?  In nature, carbohydrate is almost always found with its fiber matrix intact.   It’s human beings who have figured out how to remove the fiber and eat what remains.  The main industrial sources of sugar include dates (high-fiber), beets (high-fiber super food), and sugar cane, a grass.  The sugar in these foods isn’t absorbed fast.  We make it that way.  In Cairo many years ago, I once saw a man on a bus chewing on a stalk of sugar cane.  It occupied him for hours.  The same amount of sugar in crystal form, extracted from that piece of cane, would have been eaten and absorbed in a matter of minutes.  He was kind enough to offer me a taste, but I declined. 

White flour is made from grain that has been stripped of its germ and bran, the fiber-rich seed coat.  The germ and bran contain valuable nutrients and are essential to normal gut function.  Remove them, and the rates of absorption (and constipation) skyrocket.   That’s why food made with whole-grain flour has a lower glycemic index than equivalent items made with stripped flour.  Stripped white flour makes a great glue for papier-mache.

So what’s the attraction?  White flour is lighter in color than whole-wheat flour.  The fragile oils in the germs of whole grains are the first thing to become rancid, so white flour has a longer shelf life.  White flour looks cleaner and lasts longer.  It’s a decision based on economics, not nutrition. 

Remember that you are voting each and every time you purchase items that are made from fabricated foods.  If we stop buying them, the message will echo loud and clear.  Our nutrition is on the line.  Our health is on our plates. 

I am pretty excited this morning, because today’s the day that the grounds manager from a small local college is coming over to spend a few hours helping me salvage a row of overgrown, antique quince bushes and convert a small corner of my yard into an edible garden.  I expect that we’ll be working pretty hard, so before he gets here I need to eat breakfast, and that’s what we’ll be discussing today.

Well then, what’s for breakfast?  In one word? Protein.  In three words?  Not refined carbohydrate.  For more on why not, read here,  here, and here.

When I stayed in a youth hostel in Cairo, Egypt, many years ago, breakfast consisted of steaming bowls of mashed fava beans.  In Germany the breakfast tables were filled with plates of thinly sliced cheeses and meats.  In Israel, we ate soft cheeses, cucumber and tomato salads, and roasted eggplant.  Where refrigeration is less common, people typically eat the leftovers from dinner when they awaken. 

The six major categories of protein include meats, eggs, fish, beans, nuts and dairy.  Now I’m not saying you have to eat them all.  Just pick what you like from among all these choices.  Want some examples?  OK — here goes.

In the meats department, you could have a leftover hamburger.  Or ribs.  Or heat up some chicken wings from last night.  Yes, for breakfast.  In the Midwest, you know, a typical breakfast 150 years ago might have been a pork chop and a cup of coffee with real cream.  They didn’t have a diabetes epidemic then.  Want something more exotic?  Check your refrigerator.  Chopped liver maybe?  Anything goes, from aspic to venison, or veal, if you prefer. 

Don’t care for meat?  What about fish?  There’s smoked whitefish, catfish, tuna (straight from the can if you’re in a hurry), sardines of course, kippered salmon, leftover trout, cod or shellfish, though I expect the chances are slim that you’d find much leftover lobster.  Still…

Eggs.  My favorite, hands down.  Boiled, fried, scrambled, poached.  You can crack one into a little ramekin containing a spoonful of basil pesto. Put the dish into a water bath (loaf pan with 2 inch water) and stick it in the toaster oven at 350 for 15-20 minutes.  You cannot believe how extraordinary this recipe is until you taste it.

For really busy people, nuts are a mainstay of healthy breakfast eating.  When my children were younger, particularly the one who did not usually appear downstairs until 2 minutes before the bus was scheduled to come, I would run plastic spoons along the surface of the peanut butter and hand them over, calling them “peanut butter lollipops.”  A short time later, on my own way out, I would collect the empty spoons from the mailbox at the top of the driveway.  Peanuts not your thing?  Try almond butter, or cashew butter.  It’s not cheap, but then again you don’t have to eat it every day.  I also keep a jar of peanut butter at the office for the 11 a.m. and 4 p.m. hungries. 

Then there are the nuts themselves.  If you keep a bag of nuts in the car, you can eat a handful or two on the way to work.  This has to be the easiest way to eat breakfast!  If your excuse is that you don’t have time to eat breakfast, this is the way to go!  Don’t care for peanuts?  No problem.  Try almonds, cashews, brazil nuts, pecans, walnuts, pine nuts, hazel nuts…did I miss any?  Buy a different kind each time, or make a trail mix from a few.  The more the merrier.  Don’t buy coated nuts.  Make sure to avoid salted nuts, especially if you have salt-sensitive high blood pressure.  You want to buy pure, unadulterated nuts.  I would also suggest storing large bags in the refrigerator or freezer to protect their fragile oils.  They will keep fresh a lot longer. 

Allergic to nuts?  No problem.  Substitute sunflower seeds and pumpkin seeds.

Now let’s talk about beans.  Maybe there’s some lentil soup in your refrigerator, or a three-bean salad.  If you have refried beans, you could heat them up in the microwave with some cheddar melted on top.  Hummus and tahini are great choices for breakfast.  Scoop them up with slices of cucumber, celery sticks, carrots or even apples. 

What about a burrito?  Is it ok to eat a whole-grain tortilla for breakfast? 
Here are your guidelines for eating grain at breakfast time:  If you are 1) diabetic, 2) pre-diabetic (at high risk), or 3) more than 30 lbs. overweight, do not eat grain for breakfast.  Can’t deal with that?  OK, maybe one serving once a week, like at a Sunday brunch, or on another special occasion.  Otherwise, stay away.  It’s making you sick. 

Why?  Because grain requires a ton of insulin to metabolize.  Even whole grain.  Worse, stripped grain requires even more insulin.  Stripped (refined) grain requires an absurdly enormous load of insulin to digest and metabolize.  Remember that insulin works less efficiently in the morning, and learning to eat smart is all about learning to conserve your insulin.  So if you eat refined carbohydrate at breakfast time, not only are you wasting your body’s insulin, but you are wasting it at the exact time of day when it works worst.  That’s like hitting a man when he’s already down.  Don’t do it.  Eat plenty of fresh produce with your high-protein breakfast instead.  Especially vegetables.

Now, as long as you do not fit into one of the above 3 categories, you should feel free to incorporate some grain into your breakfasts — BUT it must be a whole-grain product. 

Lastly, let’s discuss dairy.  Last week’s post about yogurt works.  So does cheese, and milk.  Less well known, but just as good, are kefir, clabber, and so on.  Goats milk works, just like all the other mammals whose milk is consumed by humans, although not commonly in America.  What kind of cheese?  You name it, as long as it doesn’t contain the words “processed” or “food.”  If someone has to tell you it’s food, it probably isn’t. 

So what did I choose for breakfast?  Leftover guacamole, tomatoes, and 3 generous slices of jarlsberg (a type of swiss) cheese.  A cup of tea with real cream.  And 1 banana for good measure.  Now watch me garden!

When we no longer have good cooking in the world, we will have no literature,
nor high and sharp intelligence, nor friendly gatherings, nor social harmony. 
Marie-Antoine Carême

Eat wonderful meals brimming with taste.  Dance, drink, laugh, love. 
Think Zorba the Greek meets Julia Child. 
W.C. Willett

Eating with the fullest pleasure —
pleasure, that is, that does not depend on ignorance —
is perhaps the profoundest enactment of our connection with the world.
In this pleasure we experience and celebrate our dependence and our gratitude,
for we are living from mystery,
from creatures we did not make
and powers we cannot comprehend. 
Wendell Berry

Seize the moment. Remember all those women on the Titanic
who waved off the dessert cart. 
Erma Bombeck

It’s the fourth of July today, and my sibs and I have converged on the family home for the great annual bash.  Five strong grandsons have been carting cartons of beer, soda, wine, water and iced tea upstairs to the deck on and off since yesterday evening.  Great drums of ice stand ready to receive them all. 

I walked upstairs this morning to see my mother arranging a mountain of rolls (from the local Italian bakery) in a huge basket lined with a striped blue cloth napkin.  My dad was driving around in his kaboda, a mini-tractor, positioning grills, chairs, and recycling bins.  Tall piles of burgers (from our own steer) were thawing in the kitchen, and my mother’s delicious homemade cole slaw and potato salad were blending their flavors in the refrigerator.  The gorgeous, cool green cabbages for the cole slaw were harvested from my mom’s garden last night.  I’ve been assigned to cut and arrange trays of peaches, plums, and mangos for the celebration.  There are blueberries, raspberries and cherries to add, too.  The raspberries are everywhere around my parents’ farm this time of year. 

Across the street, our neighbors Connie and Duane are compiling several magnificently marinated salads.  They arrived the other night for a different meal with a large tray laden with marinated asparagus on one side, haricot verts on the other, triangular slices of Parmigiana, whole basil leaves, lettuce leaves, and thickly cut tomatoes sprinkled with oregano and fresh black pepper.  Humble and generous, they would have you believe they tossed it together in just a few minutes.  Connie, the daughter of a fireworks scion from the Midwest, makes me feel like a kind of July 4th royalty is in our midst. 

A last-minute trip down to the vegetable garden yielded the last of the season’s lettuce greens.  Here’s a recipe for a delicious homemade ranch dressing with no secret ingredients.  Add 6 T sour cream, 2 T mayonnaise, 1 chopped green onion, 1 t each of honey and mustard, 1 T chopped celery leaves, 1 t finely chopped fresh Italian parsley, 2 t apple cider vinegar, 2 chopped garlic cloves, salt and fresh pepper to taste.  Puree the ingredients for a minute, and add shredded Parmesan for more taste if desired.  It can be stored in a covered container in the refrigerator up to 1 week.

In a few hours, the table will be piled high with cornucopias of plenty.  I saw the fixings for a gallon of black bean, corn and cilantro salsa on my sister-in-law’s counter yesterday morning.  If we’re lucky, Aunt Gerda will show with a reprise of the same extraordinary arborio rice pudding she brought to my wedding 30 years ago.  Libby always brings a beautiful fruit pie, some years peach and some years strawberry-rhubarb, and sometimes her guitar, too.  And my sister, a cantor, has invited a bunch of her musician friends.  So in addition to the great sights and smells, there should also be some great sounds coming from here in a little while.  The music, food and friendship should last late into the night.

I indulged a desire for a bucket of silly bands to share with all the children we’re expecting today, and picked out a few red, white and blue ones for myself.  Some of the bigger kids will spend the afternoon playing cribbage in the air conditioned living room.  A few years ago, the grandparents taught their grandchildren to play cribbage, and now they attend competitions together.  The annual soccer game will be played in the field, and it will most likely end with a large influx of young people doing cannonballs right into the pool.  I expect that the pool will see even more activity than usual today, with temperatures expected to reach the mid 90’s. 

I hope you enjoy all of your celebrations today.

***********************Upcoming Events***********************

Log on to WCLV.org FM 104.9 tomorrow Monday July 5th, Wednesday July 7th, and Friday July 9th, at 5:45 p.m. to hear Dr. Roxanne Sukol speaking about  preventing diabetes and obesity on Healthlines, the award-winning project of Cleveland’s Academy of Medicine.

Most of the time I feel like we’re really making progress.  Patients are looking younger, losing inches, feeling better and decreasing their medications.  Still, not a day goes by that Angie, Barb, Chuck, Doris, Elijah, Fritz, or Gayle doesn’t tell me proudly that they have switched to “wheat bread.”  I thought I covered that, I say to myself.  I thought we discussed the fact that practically all bread is made from wheat.  That buying “wheat bread” is the same as buying “bread.”  That the word “wheat” means nothing in terms of good nutrition unless it is prefaced by the word “whole,” as in “whole wheat.”  That someone is trying to confuse you, and they are succeeding.  That’s when I feel as if I’m climbing a mountain with a Wonder Bread truck tethered to my backpack.

If nothing is working, no matter how hard you try, it’s time to reexamine the fundamentals.  So let’s go back to the beginning, and take a careful look at the words that are being used to sell bread. The goal here is to understand what you are choosing to eat.

When I enter a Subway, the sandwich maker asks me, “White or wheat?”  What are my choices again?  White bread or wheat bread?  But white bread is made from wheat.  And wheat bread is made from wheat.  Both white bread (always) and wheat bread (usually) are made from the starchy core, or endosperm, of a wheat kernel.  So what’s the difference?  Near as I can figure, the major difference is the color. 

I checked out the nutrition information for the white and wheat breads.  They both contain 200 calories, but white bread has less fat (0.5 versus 2.5 g), less carbohydrate (38 versus 40 g), less fiber (1 versus 3 g), and less protein (7 versus 8 g).  So how can they both have 200 calories?  Something isn’t adding up.  The only thing that white bread has more of is sodium, at 470 versus 360 mg. 

What is white bread?  It’s bread made from wheat kernels that have had their bran fiber coat and oil-rich germ stripped out.  What is wheat bread?  Same.  So why are some wheat breads tan instead of white?  Usually because they have had caramel coloring added.  What else can we learn about “wheat bread?”  Well, manufacturers use a variety of descriptive words to make bread seem better for you, including “enriched,” “unbleached,” and sometimes even “organic.”  “Enriched” was the name given to flour to which vitamins and minerals were added, after it became apparent that stripping grains caused anemia, beri-beri, and other nutritional deficiencies in the people who consumed them. 

The only time bread is really made from whole grains is when the first ingredient is WHOLE wheat or WHOLE grain flour.  The very FIRST ingredient.  Not the second.  Why is it important for you to know this?  Because there is virtually no place in a nutritious diet for refined (i.e., enriched, stripped) flour.  Yes, it’s that serious.  The standard American diet (SAD), based as it is upon refined flour, is one of the major contributors to the diabetes and obesity epidemics.

Now, just for the record, I will restate that folks should eat very little (if any) grain at breakfast.  I’m not saying that we should never eat refined wheat products.  I’m not really the “never” type.  Like Julia Child, I prefer moderation.  I think people can handle a little bit of refined flour now and then.  But not at breakfast, except on very, very rare occasions like your birthday, or your niece’s wedding brunch.  It just doesn’t make any sense to waste large amounts of insulin at the very time of day it works worst. 

Remember that some people need to be more strict about their intake of grains (like “wheat bread”) than others.  Who?  Those people who are 1) inactive, 2) more than 30 lbs. overweight, 3) pre-diabetic, or 4) diabetic.  This short list includes around 85% of Americans.  That means no toast, bagels, muffins, waffles, pancakes, cereal, biscuits, bread, grits, leftover mac & cheese, at all.  Even if they are made from whole grains.  Why?  Because grains are absorbed very rapidly, which raises your blood sugar quickly, which means that you need to release a huge load of insulin to catch the sugar.  And insulin works worst when we wake up in the morning.  We can’t afford to waste our insulin like that.  So don’t eat foods made from flour (which, as you have learned, is almost always wheat flour) for breakfast.  The remaining 15% of us can have a little bit, sometimes.  Not every day, unless we are very active.

As for “wheat bread,” don’t let anyone fool you.  Call it by its more correct name — bread– and switch to “whole-grain bread.”  Avoid it for breakfast always, and don’t eat it every day in any case.  Send me your questions if you’re still confused.

                                    ***

And…now…finally…the results of our 10,000-hits Contest [even though we’re past 11,000 already!].  Thank you to everyone who sent an entry.  The stories you tell inspire and encourage me to continue to spread the word, teaching more and more about the difference between real food and manufactured calories. 

The grand-prize winner is: Maggie Henry, whose eloquent entry says it all!!  Maggie, claim your prize at www.sarvasoap.com.  Maggie’s winning entry is posted below, along with honorable mentions from ZW and Teresa Downum.  Thank you to all who participated.

**Grand Prize Winner**
In the last 5 years my life has changed dramatically. The documentaries about our broken food system and the adulteration of food in general have completely changed how I eat and feed my family. I now farm organically and grow all my own food. Grass-fed beef and pastured chicken, eggs, pork and goat are all I will eat. Crazy thing is what word of mouth has done. Lots of people want good clean food. I always gardened and grew our veggies but now I help feed my community.  Maggie Henry

**Honorable Mention**
Since receiving “Your Health is on your plate” emails, I take a closer look at what is on my plate and how much is on my plate. I have taken steps to reduce the amount of calories, carbs, cholesterol and sodium I put on my plate. I can now exercise up to 30 minutes a day and I feel better. My 8 pound weight loss and eating the right foods has given me a new confidence in myself; and being more in control of my health has empowered me to continue losing the next 42 pounds I look forward to losing!   Teresa Downum

**Honorable Mention**
As a teenager, my body has always been at the forefront of my mind, yet I was so misinformed about being healthy that I ate bars and 100 calorie packs and expecting things to change for me.  They didn’t.  However, a few months ago I read about the health benefits of a mostly whole foods, plant based diet and quickly became a vegan. I began going on more walks, eating more natural foods, and really coming to love the body I have.  In 3 months, I have only gotten a cold once and I have virtually no acne anymore.  This year in school, I started a club to teach grade school children, along with my club members about healthy snacks and food, so that young children can enjoy the foods they eat while never having to face the troubles that are involved with childhood obesity that often is followed into adult life.  ZW

Last week, Gene [not his real name] the computer guy showed up at my office for the first time in a while.  Right away, I knew something had changed.  I said, “Gene, how are you?  You’re looking very well!”  He responded with an uncharacteristic grin, and answered by telling me one thing all of us know, but few believe (despite numerous confirmatory personal experiences!).  I sat up fast when he said, “Diets don’t work.”

He motioned to a small machine on his belt that I had noticed only peripherally, assuming it was a cell phone, or pager, or maybe even an insulin pump.  It was a pedometer.  He said that he had started slowly, satisfied at the start with even 8,000 steps per day.  In the beginning, his goal had been to get to 10,000 steps every single day.  That was then.  Now he frequently walked close to 20,000 steps a day, and related that “if I have time, and I feel like going a little further” he was walking even more.  His pants had gotten loose, and he, proudly, had taken in his belt a notch.

Change begets change, and health begets health.  It wasn’t long before Gene realized that the daily fast-food lunches he had eaten for years were not part of this new program.  He decided to try eating a bag of nuts instead and discovered, to his amazement, that it satisfied his hunger.  He took in his belt two more notches.

Tip O’Neill, the longtime Speaker of the House of Representatives in Washington, D.C., once said, “All politics is local.”  He meant that all members of Congress bring the concerns of their hometowns to their offices in the Capital.  The issues they consider most important are the ones that affect them most deeply.

In the same way, I would say that all nutrition is personal.  One size never fits all.  I know: I’m barely 5 feet tall and 110 pounds, and “one size fits all” never fits me!  Some of us enjoy the taste of cilantro; some truly despise it.  It amuses me to see that some people at my gym carry their water in gallon jugs, whereas others carry small bottles or none at all.  Some folks seem to thrive on a vegan diet, and others have never been able to manage their weight unless they cut their carbohydrate intake to just about nil.  If you have a mini-food processor and you like dill, then you loved last week’s post about dill pesto.  Otherwise, maybe you scrolled down to find out what else I’ve posted lately.

The same goes for exercise.  It’s not just about food.  If you live close to a track, or in a safe neighborhood with sidewalks in good repair, and you enjoy walking, then you may be wondering, just about now, where to buy a pedometer.  If your knees are giving you the blues, and you have always loved being in the water, maybe you’ll check this week to see if there’s a pool nearby.  Or maybe the idea of checking out a yoga or tai chi DVD or videotape from the library sounds good.  The point?  Do what appeals.  Work with, not against, your inclinations.  You can’t fight City Hall.

What is the secret to Gene’s success?  The main thing is that he is not trying to make change based on “a diet.”  He understands that diets don’t work.  As I have been known to say, a system built on deprivation will never provide a basis for constructive change.  Secondly, Gene figured out which aspects of his lifestyle were most troublesome, and he fixed just those.  One step at a time.  Literally.  And then one meal at a time.  Small changes.

Gene increased his activity in a way that was pleasurable to him.  Then he removed one major source of refined carbohydrate and trans fat, the daily fast food lunch.  Finally, he stopped drinking soda pop.  And that did it.  He continues to feel better and better as these changes settle in for the long haul.  He didn’t stop eating all processed carbohydrate.  He didn’t say that he will never again drink a soda.  He just decided that he will no longer be doing it every day.  And what keeps him going?  The fact that he feels so much better.  And his son.

Almost all my patients tell me that the changes they make for themselves go on to be reflected in their entire families.  Gene said that he now gives his 6-year-old son only water (or milk) to drink.  He says to him, “If you don’t want water, you’re not thirsty.  If you want something sweet, eat a banana.  If you’re really thirsty, you’ll drink water.”  He has a great point here, and one I intend to share around.  Plenty of my patients complain that they don’t like to drink water.  I believe that this is a learned response, and one that can be unlearned.  I advise them to dilute their drinks by ½, then ¼, then 1/8, and so on, until they no longer use the sweet stuff.  Small changes, always.  Gene is right.  If we’re really thirsty, water is fine, even desirable.

Change is reflected first in the way we think about it, whatever it is, and then in the way we go about it.  Change occurs first in our minds, and then in our bodies.  As our conversation came to an end, Gene said, “I still have a long way to go.”  I guess he means how far he intends to walk.  Mentally, I’m delighted to report, he’s already there.