Dear Readers:

I’m getting all kinds of questions and comments from a variety of places these days.  Some people comment directly to the blog, but others write to LinkedIn, Facebook, or drsukol@teachmed.com.  Some are letters of encouragement, whereas others are better described as letters of discouragement, like the one from the British gentleman who dreads coming to the U.S. on business because he can’t find a decent meal made with real food.  Any takers for that?

I have collected a few of these letters for you — maybe you’ve had some of the same questions or thoughts. 

Happy Holidays!

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Dear Dr Sukol,

“Thank you for your reply. I have now read, with interest, all the posts on your website. I posted comments on a couple of them and also used the calorie counter website to look at the carbohydrate content of plain oats.

As I said in one of the comments, my doctor has advised me that I am borderline diabetic and need to take action, so I am looking for new ideas and will implement various changes. I downloaded your “4 Recommendations,” which is excellent, and will keep checking back for more useful tips.

Thank you for highlighting this information.”
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Dear Dr. Sukol,

“Thank you for your post on “Butter is Better.”  I am obese, having hit my all-time high of 287 pounds in September.  I had put on 22 pounds just in the first nine months of this year.  I have tried all sorts of diets: cabbage soup, Hay diet, Atkins, low-carb and numerous others, but none seemed to provide a lasting solution.

Nevertheless, I always disliked processed food and avoid junk food: I prefer to prepare from fresh ingredients, including plenty of fruit and vegetables, but the problem was always that I simply ate too much.  I still believe that butter is better and that so-called “healthy foods” merit closer inspection and a degree of skepticism.

I have lost the 22 pounds I gained earlier in the year, just in the past two months, by changing what I eat: grapefruit or pomelo for breakfast and lunch, with a small portion of meat and two veg for dinner.  Eggs for breakfast is one of my favourites, but I have cut it out, thinking that it would make me hungry and slow down my weight loss.  Maybe it’s time to re-think that idea?”

My reply?  Yes, definitely.

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“I have to say that the one thing I would dread most about living in the US is the food.  On my frequent visits there,  I am amazed just how unhealthy some of it is.  Even simple foods like bread are sweetened and it must be very difficult to avoid fatty, sugary,unhealthy foods.  In our office I see people drinking huge cups of Coca-Cola (or Pepsi/whatever brand) – literally more than a pint of it in one serving.  It is not surprising that the US has a major problem with obesity and no doubt us Brits are following your lead.  By P-, United Kingdom www.linkedin.com=”” miniprofile?vieweeid=”35450468&context=anet&view””>

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“Yes – I must say that the U.S. just loves processed food in all shapes and sizes. We’re a big society of convenience and laziness! There’s a lot to be said about making something with all natural ingredients not coming from a box. I’m no health nut, but within the last year I’ve given up all table sugar and soda (even diet soda) and it’s made a difference in how I feel in general.”

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Here is my response to someone asking for information about a link between diabetes and high fructose corn syrup (HFCS):

Dear P-,
There is actually quite a lot of evidence demonstrating a link between diabetes and the consumption of HFCS. Here’s an article from Diabetes Health, a reputable journal that publishes especially for informed diabetic patients. http://www.diabeteshealth.com/read/2009/03/10/6113/link-seen-between-high-fructose-corn-syrup-consumption-and-insulin-resistance/

And his response–

“I appreciate the feedback. I understand this subject is quite touchy, especially if commented on by folks with links to the processed food or corn growing industry, which can both be biased. It is nice to have impartial 3rd sources!”
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Dr.Sukol-

I was interested in this product called Chia Seeds. What’s your take on this product and if recommended, how would you use it?

E- S-

Dear E.S.,

I did some checking and learned that chia is an edible seed that is extremely rich in fiber and omega 3 fatty acids.  A native plant of southern Mexico, it is becoming more well known globally. Seeds are available online and in health food stores.  I have never eaten it, but my daughter has, and she was delighted by your question.

If you have ever eaten flax seed, chia has a number of similarities.  It has a nutlike flavor, and can be sprinkled (ground or whole) in yogurt, cereal or salads; eaten plain as a snack; or ground and mixed with flour when making muffins or other baked goods.  It would also make a great addition to homemade trail mix with dried fruit and nuts.

Chia can be stored for very long periods because it is so rich in antioxidants and, unlike flax, it does not need to be ground to make its nutrients available to the body. 

I think I’ll buy some and try it next time I’m at the health food store…

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Last summer we built a chicken coop, and this summer it became home to a few Hamburg chickens and Golden Buffs.  Hamburgs are known for their distinctive, dramatic, black-and-white pattern.  They weigh approximately 5 pounds each, and produce a breathtaking, ivory-colored egg.  Ours are 2 years old, and were delivered to Cleveland this past May from their previous home on my parents’ New Jersey farm.  The Golden Buffs, from a nearby farm in Middlefield, Ohio, are somewhat larger.  They lay a lovely brown egg.  At least that’s what I’ve read.  Just 6 months old, they are still pullets, so we are awaiting their first eggs any day now.

Every morning we go out to greet the girls with the previous day’s scraps from our kitchen bin.  “Feed the birds, tuppence a bag…”  In the summer, the girls raced to pick out strawberry tops first, followed by the soft, seeded centers from the cantaloupes.  Now they are gobbling up all the apple cores, leftover bits of bread crust, and greens.  Then they spend the rest of the day working on the banana peels, radish tops, and squash skins.  Not to mention the grass, bugs and worms.  I toss a handful of crushed oyster shell into one corner of the coop, add some fresh straw all around, and sprinkle some scratch corn for good measure.  They recognize me now, and no longer run for cover as I cross the grass toward the coop.  On the contrary, the bravest among them flap their wings madly and make a jump for the coffee can full of chicken feed that I carry in my hands. 

The girls have recognizably different personalities, and use them to great comic effect.  Dora is our most fearless hen.  She has a necklace of white feathers.  She and Nora complained very loudly to me one morning last week after having inadvertently spent the entire night outdoors in a rainstorm.  They reminded me of disgruntled tourists, soaked through to the skin.  I recently heard a story about a hen who used to take new visitors to see her coop, and pecked at the shoes of those who interrupted her during the tour.

No, they are not being raised for meat.  And no, you don’t need a rooster to get eggs.  You only need a rooster if you want fertilized eggs.  Which we don’t.  In contrast to quiet hens, roosters are very noisy and don’t make for friendly, neighborly relations.

So why am I raising chickens?  For the eggs!  One day late last spring, my daughter and I came back from the Chagrin Falls Farmers Market with a bunch of asparagus that had been picked only hours before.  I found a recipe for Hollandaise sauce, which I had never made before, and whisked together 3 separated egg yolks with 2 tablespoons of fresh lemon juice and 2 tablespoons of water.  [Fry the whites separately and feed them to the first lucky person who enters the kitchen. Or the dog.]  Then I placed the mixture in a double boiler and continued to whisk until the contents turned a smooth, glassy yellow.  It took a little bit more water than the recipe indicated, which made me wonder if our homegrown egg yolks are extra-dense.  I removed the double boiler from the heat and slowly added ½ cup melted butter, a little at a time, continuing to whisk gently, until all the butter was incorporated.  I added salt (1/2 t.) and pepper (1/4 t.), poured half the sauce over the steamed asparagus and shared it around.  Three of us ate it for lunch, and and our taste buds and bellies remained satisfied all afternoon until dinner.  We finished the rest of the hollandaise sauce the next morning on scrambled eggs. Liquid sunshine.

My dad has a very hard time with the fact that most national brands of of ketchup list high-fructose corn syrup (HFCS) as the first or second ingredient.  He is on a mission to get people to eat less HFCS without compromising their love for ketchup.  Recently, he asked if I would post an entry about this.  Here it is, Dad!

You can avoid HFCS by buying the costly organic ketchups, which are made with sugar.  But it doesn’t seem practical to recommend them with so many budgets being strained nowadays.  So I’ve decided to teach people how to make their own ketchup instead.  I hope that doesn’t make you groan.  I maintain that it does not take more time to eat healthy, but it does take more planning.  Here’s your first chance to see it in action by trying one or both of these two delicious recipes:

The first, called “Excellent Homemade Ketchup,” can be found at Hillbilly Housewife .  The website says this recipe contains 60 cents worth of ingredients.  Mix a 6-oz. can of tomato paste with 1/3 cup water, 2 tablespoons vinegar, ¼ teaspoon dry mustard, ¼ teaspoon cinnamon, ¼ teaspoon salt, 1 pinch cloves, 1 pinch allspice, 1/8 teaspoon cayenne pepper,and 1/3 cup brown sugar.  Transfer to a container and let cool.  Cover tightly and refrigerate, and use within 3 weeks. 

The second recipe comes from http://kissmyspatula.com/2009/05/31/homemade-ketchup/.   It uses whole tomatoes, a slightly different selection of spices, and a little more time and attention. Wrap 1 bay leaf, 1 stick cinnamon, ¼ teaspoon celery seeds, ¼ teaspoon red pepper flakes, and ¼ teaspoon whole allspice in a cheesecloth bundle(*).  Place bundle in a 4-quart saucepan with 2 pounds roughly chopped tomatoes, 1 ½ teaspoons kosher salt, ½ cup vinegar, 5 tablespoons brown sugar, 1 medium chopped onion, 1 smashed garlic clove, and 1 chopped anaheim chile.  Cook on medium high for 40 minutes, stirring frequently, until the onion and chile are very soft.  Then remove the spice bundle and purée the sauce in a blender until smooth. Strain the sauce through a mesh strainer and return to the saucepan.  Stir occasionally over medium heat until thickened, about 30 minutes. Add more salt, sugar, or vinegar to taste.  Transfer to a container and let cool.  Cover tightly and refrigerate, and use within 3 weeks.  (*)A cheesecloth bundle is just what it sounds like–spices folded up into a square of cheesecloth, and then knotted or tied up with string.

My dad also said to tell people to try mustard or vinegar on their french fries instead of ketchup.  I agree with him.  Golden mustard on french fries is truly delicious, but I will need to remind him that it would also be smart to cut down on the fries.  By the way, jars full of these ketchup recipes, wrapped with a bit of fabric and tied with a ribbon, make a delicious and appreciated gift for hosts and friends.  Attach a note to refrigerate the ketchup and use it within 3 weeks.

Also, as long as you are buying cheesecloth and spices, here is another idea for a homemade gift:  To make sachets of spices for mulling wine or cider, fill squares of cheesecloth with a 1/2-inch cinnamon stick, 1 star anise, 2 cardamom pods, 4 black peppercorns and 1/4 teaspoon of whole cloves.  Tie each sachet with kitchen twine and package in a clear jar or decorative box.  Drop one into 1-2 quarts of warming cider or red wine at least 1/2 hour before serving.  Hearty appetite!

Next week:  Scoop at the Coop, the ongoing adventures of raising nine hens in suburban Cleveland, Ohio…

Last year I read Fat, a celebration of flavor (a cookbook) written by Jennifer McLagan.  A few days later, I tried the sage butter sauce recipe with pasta:  Fry 30 fresh, whole sage leaves in ½ lb. butter on medium heat for about 10 minutes, just until the butter begins to brown and the leaves turn crispy.  Meanwhile, boil ­­­3/4 pound of pasta (I used fettucini) in salted water and drain when done.  Pour the sauce over the cooked, hot pasta and serve with a simple green salad and some fruit.  I added steamed beet greens to the pasta as well.  Dinner was heavenly.  The sage turned from a tangy, sharp, fuzzy herb into something much softer around the edges.  Its gentle, flavorful crunch, next to the chewy, slippery pasta, was unbelievably satisfying, and we ate nothing more that evening — no popcorn, no chocolate, no ice cream. 

One-half pound of butter?!  Absolutely, I tell my patients.  Fat is your friend.  Because we have been indoctrinated with the opposite message, I usually have to say it a few more times.  Fat is your friend.  One hundred years ago, before we had medications for diabetes, the ONLY treatment for diabetes was a high-fat diet.  Fat is dense with nutrients, vitamins, and, most of all, flavor.  Even a small portion is extraordinarily satisfying.  The low-fat, no-fat message is part of America’s diabetes and obesity problem.  We need fat, and we’ll get it wherever we can if we don’t get it where we ought to.  The “French paradox,” the observation that the French remain slender despite the large quantities of butter and cream in their diet, is only a paradox if you believe that fat is not your friend.  There is no paradox.  Fat is your friend.  Good fat, that is.

You already have a frame of reference for such a thing as good fats.  You have probably heard about the good fat in olive oil, dark chocolate, nuts, and fish.  Maybe avocados, too.  What do these fats have in common?  How is one to tell the difference between good fat and bad fat?  It’s easy — good fat is found in nature.  Good fats were here before us.  Butterfat is one of my favorites, and it’s a particularly nutritious food as well, in part because it contains an unusually diverse collection of fatty acids.  These fatty acids serve as building blocks for the ceaseless repairing and remodeling that happen inside us all our lives. 

Any way you slice it, margarine is not butter.  Most margarines are made from hydrogenated soybean oil.  The word margarine is related to the hebrew word for pearl, margalit.  Margarine comes out of the machine colored pearly gray.  My mother, born in 1936, remembers when “oleo” was sold with a tiny bead of red food coloring that she and her grandmother kneaded into the gray, waxy material to turn it a more palatable yellow color that was meant to resemble butter.  In those days, the dairy lobby was more powerful than the soybean lobby.  Now it’s the reverse.

Synthetic fat products like margarine, Crisco, hydrogenated fat, coffee whiteners, and refined oils are found not in nature but in machines.  They are food-like, but they are not food.  We may put them in our mouths, but they do not sustain us.  One way to identify products that are not really foods is by their names.  Instead of being called by names our great-ancestors would have recognized (like butter, broccoli, or peanuts), they have fanciful names with healthful, pseudo-scientific, old-fashioned, or playful connotations that are meant to evoke all kinds of feelings including, but not limited to, hunger.  Margarines constitute one category of products with these creative names.  Smart Balance (seesaw), Blue Bonnet (granny), Promise (not), Country Crock (pickles), Benecol (bene=good, col=cholesterol), and I Can’t Believe It’s Not Butter (why not? we just told you) are not foods.  Your great-grandma would have told you the same.

It’s time to say a great big T-H-A-N-K Y-O-U! to all my readers.  This week, just 2 months after going on line, we logged our 1000th visit!  I truly appreciate your interest and feedback, and I’m very busy preparing essays to address your comments and questions.  Byron and Steve have asked for more ideas on what to eat and what to avoid for breakfast.  Lisa C has sent a request for information about the salt and sodium content in foods. 

What do you need to know? Just ask.  Post your comment and I’ll get back to you.  I also have stories to share about my plans for preparing the produce and other groceries that arrive in my kitchen every week.  Today I’m going to take a pause from talking about processed food and what not to eat, to talk about what to eat, and to share what I’ve learned about squash and pumpkins.

This past year I learned a lot of new things about food. I learned it would be a shame to waste the root of a parsley plant when it adds so much flavor to a pot of soup. I learned the hard way that it works like a bay leaf, which is to say that it needs to be removed before you serve the soup.  I learned to stir fry the leafy tops of beets, parsnips, and turnips with garlic and olive oil instead of tossing them into the compost.  And I learned that butternut squash has the longest storage life of any squash.  So there is no need to despair over the large number that have collected on my kitchen counter in recent weeks.  It turns out that’s exactly where they belong now. 

Squash and pumpkins need to “cure” (or harden) for a couple of weeks so that they keep better after being transferred to a cool place, like my perennially chilly laundry room.  In the wintertime, that’s the coldest spot inside my house, but other places, like entryways, unheated spare rooms, or attics, work equally well, not to mention sheds, porches, and a corner of the garage.  Root vegetables are extremely tolerant, so you can experiment and see what works best.  Unlike potatoes, carrots, turnips, cabbages, leeks, endive, and brussels sprouts, which store best at 30-40 F, squash and onions don’t really need serious cold storage. They can just be kept in any cool spot in the house. 

We’re all experts at cold food storage.  We call it “refrigeration.”  If you have the space, you can store all your pumpkins and squash in a refrigerator. But mine isn’t big enough to store all the produce I’ve carried home lately, so I’m spending the end of this year’s growing season learning about storage.  Here’s what I’ve learned: 

                  1) Never wash vegetables being readied for storage because it significantly shortens storage life.  So just brush off the excess dirt.

                  2) When you store produce in a plastic bag in the refrigerator, suck out as much air as possible from the bag before you close it. 

                  3) If the outer leaves of a cabbage in a plastic bag turn soft and gray, strip them off to find perfect leaves inside. 

                  4) If a white substance appears on carrots, peel it off. As long as the carrots are bright   orange underneath, they will be delicious.  Many root vegetables actually gain sweetness when stored, as starches convert to sugar. Just don’t let them freeze completely. 

A while ago I moved all the potatoes, white and sweet, to a dark place in a kitchen cabinet.  The dark prevents sprouting, and it also protects the skin of organic white potatoes from developing the green color that signifies the presence of a toxin.  I have noticed that the potatoes really do keep better in the dark.  One of these days, I’ll find a cabinet for the onions and garlic, too.

This week I thought I’d also include a recipe for a really fabulous Cream of Broccoli Soup.  This recipe is inspired by Julia Child and her Mastering the Art of French Cooking, which I’ve been reading this week.  The use of heavy cream to enrich the soup (and to offset the bite of the spicy jalapeno) reminds me of her.  Toss into a large soup pot with 2 tablespoons of very hot olive oil: 1 broccoli, 1/2 cauliflower, 1/2 jalapeno pepper (with seeds if you like the heat), 1 medium onion peeled, 3 garlic cloves peeled, and 1 apple (cored but not peeled).  Cut the large veggies into more manageable chunks first.  Fry for a few minutes until everything gets a slightly brown outer coloring.  Add 4 cups water or stock, and cook on medium for 40 minutes until everything is soft.  Add 1 teaspoon of salt.  Now scoop out the soft veggies into a conventional blender and spin until smooth before returning them to the liquid, or use an immersion blender right in the pot.  Stop here if you aren’t going to eat the soup right away.  When ready to eat, heat the soup almost but not quite to boiling, then gently stir 1/2 c. cream into the soup until it is incorporated.  Serve immediately with grated parmesan cheese to taste.  Truly sublime.

Breakfast cereals have a praiseworthy origin.  They were invented by health spa owners who were attempting to offer an alternative to the usual breakfast of the time: eggs, coffee, and meat, usually beef, bacon or sausage.  Coincidentally, the invention of breakfast cereal also provided an economical use for the crumbs that fell to the bottom of the bread ovens at the health spas.  The word “cereal” simply means grain, and is derived from Ceres, the Roman goddess of agriculture.  We’ve gone a long way from that origin, but unfortunately it’s been in the wrong direction.

The first mass-produced cereal, granula, was similar to what today we call Grape–nuts.  The name ‘granula’ was derived from ‘granules’ or ‘grains.’  Granula nuggets were hard, and they needed to be soaked overnight prior to being eaten. The name grape-nuts is derived from the fact that the cereal was sweetened with maltose, then called grape sugar, and that it had a vaguely nut-like flavor.  For several decades, a small number of whole-grain cereals similar to this one predominated.

Then, after World War II, breakfast cereal companies hired advertising agencies, expanded their vision, and began to target children.  The once whole-grain cereals evolved into a completely different kind of product.  To appeal to children’s young taste buds, the new breakfast cereals were made mainly of white flour (stripped of its bran and germ) and sugar.  Staggering amounts of sugar.  Kellogg’s Sugar Smacks, created in 1953, was 56 per cent sugar by weight.  Froot Loops was 41 percent sugar by weight.  There are brands of cookies with less sugar than that.

Breakfast cereals are what economic analysts call a “high margin-to-cost business.”  Gross profit margins in the breakfast cereal industry are on the order of 40 to 45%.  The product is found in an estimated 90% of American homes.  JP Morgan estimates that marketing, one of cereal’s biggest costs, typically accounts for 20 to 25% of the sales value.

For more information on the connection between the amount of television advertising and the sugar content of cereals marketed specifically to children, check out The Sugary Brands Doing the Most Kid-Chasing, in this week’s TIME Magazine, at http://www.time.com/time/specials/packages/article/0,28804,1931891_1931889,00.html

Breakfast cereals are one of a select group of products that layer different kinds of sweeteners in and among their lists of ingredients.  David Kessler, in  The End of Overeating: Taking Control of the Insatiable American Appetite, explains that “If a food contains more sugar than any other ingredient, federal regulations dictate that sugar be listed first on the label.  But if a food contains several different kinds of sweeteners, they can be listed separately, which pushes each one farther down the list.”

This requirement results in an ingredient list that appears to have less sugar than actually exists in the product.  Kessler adds, “Cereals often include some combination of sugar, brown sugar, fructose, high-fructose corn syrup, honey,and molasses.”  The curious thing, to me, is that the offerings at the supermarket don’t really fool any of us.  We all know that most breakfast cereals are a poor substitute for a nutritious breakfast.  Icons of popular culture such as Calvin & Hobbes, the Simpsons’ Krusty the Clown, and even the Berenstain Bears, remind us exactly what breakfast cereal is.

Calvin eats Chocolate Frosted Sugar Bombs, “tasty, lip-smacking, crunchy-on-the-outside, chewy-on-the-inside [that] don’t have a single natural ingredient or essential vitamin to get in the way of that rich, fudgy taste.”  Hobbes says they make his heart skip like “eating a bowl of milk duds.”  They make us laugh, and we buy still more.  Krusty the Clown, from the Simpsons, endorses Chocolate Frosted Frosty Krusty Flakes with:  “Only sugar has more sugar.”  Frosted Krusty-O’s were actually sold in 2007 to promote The Simpson’s Movie.  Other cereals featured on The Simpsons include “Frosting Gobs” and “Count Fudgula,” an obvious reference to Count Chocula cereal.  “Coco Chums” cereal is mentioned in the Berenstain Bears book Too Much Junk Food.  So let’s call it what it is — breakfast candy.

In talking with patients about how to improve the nutritional value of their meals, we often talk about “real” food.  What is “real” food?  It’s food that has not been processed, refined, stripped, polished, fortified, enriched or otherwise modified.  Basically, we’re talking about fruits, vegetables, legumes, nuts, seeds, grains, fish, eggs, dairy products, and meats, like poultry, beef, and game.  And that’s about it.

Here are two guidelines: The first is not to eat anything that you have to be told is food.  Like what?  Like “processed American cheese food.” Talk about truth in advertising. I mean, if you have to be told that it’s food, it probably isn’t.  On the flip side of this guideline, some products at the supermarket have names that have nothing whatsoever to do with food.  These products are not food; they are food-like products.  Miracle Whip comes to mind.  I don’t know who thought of that name, but it certainly makes me hesitant to swallow.  The same goes for Cool Whip.  These fake food-like products contain a variety of substances that are anything but food.  And these substances aren’t just in food-like products either. Last month I was stunned to discover a fake food-like substance in the ingredient list of a container of brand-name cottage cheese. The offending agent? Food starch. See guideline number one above.

Why is there food starch in cottage cheese?  It’s a cheap way to make cottage cheese thicker.  Thicker seems richer. That’s especially important if the cottage cheese is made from low-fat milk. You will also find plenty of food starch in Cheerios, which has long been touted as a smart and healthy breakfast choice.  It even has a reputation as an ideal snack choice for babies who are learning to feed themselves.

So what’s my beef?  Check the ingredient list.  First on the list is whole oats.  The words ‘whole,’ ‘hale,’‘heal,’ and ‘health’ come from the same root. So far, so good.  Next comes ingredient number two — food starch.  Uh-oh.  Then modified food starch.  Huh? How is “modified food starch” different from “food starch,” a processed food-style product modified from something else?  Though common sense tells you that they are similar,the food manufacturing industry actually differentiates between them.  If they were not listed separately, there would be more food starch than whole oats. It would have to be listed first. That wouldn’t be good for business. Ingredient number four, by the way, is sugar.

Which words have been coopted to make processed,manufactured food-style products more appealing?  Words like “buttery,” “creamy,” or “chocolatey.”  When did we begin to skip butter, cream and chocolate in favor of flavor substitutes that approximate, but never come close to matching, the real thing?  It’s no accident that America’s favorite after-dinner pastime seems to be cruising the kitchen cabinets.  That’s what happens when your body doesn’t get the foods it craves, and the nutrients it needs, in the first place.

Another way to identify real food is to ask yourself if your great-grandparents would have recognized it as food.  Real food hasn’t changed in the past few thousand years or more.  Peanut-butter crackers?  I don’t think so.  But peanut butter?  Yes, absolutely.  Coffee whitener or liquid delights without a speck of dairy?  Never.  But cream? Of course.  I can think of only a few “convenience foods” that don’t make me cringe.  Cheese sticks are good.  Dried fruit, which may be the original convenience food.   Nuts, any and all kinds, just as long as they aren’t coated with some kind of processed food-style product.  Sunflower seeds and pumpkin seeds are good, especially if you are allergic to nuts.  What about artificial sweeteners?  The jury is still out on these, but we do know that people who drink lots of diet soda are at high risk of developing diabetes, just like those who drink lots of conventionally sweetened soda and pop.  So I’m going to reserve judgment until I know more.  Until then, I’d like a glass of unsweetened iced tea, please.  With a slice of lemon, if you have.

A few years ago a patient came into my office complaining of migraines.  He said, “You might think I’m crazy, doc, but I only get these headaches when I eat certain vegetables.”  Which ones? It was hard to be sure.  Salads gave him a headache only sometimes, and usually only in restaurants.  Cole slaw gave him a headache no matter where he ate it.  The list seemed completely random, and included Brussels sprouts, watercress, broccoli, and radishes.  I grinned like an amateur holding a royal flush.  The patient was naming only cruciferous vegetables. 

Many common vegetables belong to the cabbage family in the plant genus Brassica.  Edible plants in this family are called cruciferous vegetables, so named because their four-petaled flowers look like a crucifer, or cross.  The importance of this family of crops for food cannot be overstated.  Some cruciferous veggies include arugula (or rocket), bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, chard, collard and mustard greens, daikon radish, horseradish, kale, kohlrabi, radish, rapini (broccoli rabi), rutabaga, turnip, wasabi, and watercress. 

The Triangle of U theorizes that all the modern-day cruciferous vegetables evolved from three different ancestral plants that combined, in various configurations, to create many of the common vegetables known today.  The wide variety of cruciferous veggies available today was also probably influenced by gardeners who, through the ages, selectively bred those plants that exhibited appealing characteristics.   That is why some, like kale, are grown for their leaves, whereas others, like kohlrabi, are grown for their (swollen) stems, and others, like broccoli and cauliflower, for their buds.

Arugula’s unmistakably appealing and spicy flavor makes it a great addition to mixed salad greens in restaurants.  A few years ago it seeded itself in my garden, and I loved it so much that, for a few glorious weeks, I headed straight for the garden after work every day to grab a few handfuls and stuff them into my mouth before entering the house.

Luckily, except for the patient whose unusual story I’ve shared, most of us get to enjoy cruciferous veggies without suffering any negative consequences.  Their versatility makes them a great addition to stir-fries, salads, soups and stews.  Not only do they taste great alone, but their strong flavors also stand up against lots of distinctive spices, herbs, and garnishes.  The sweet, spicy crunch of a pure, translucent slice of radish or kohlrabi is like nothing else.

Last year I found this fantastic sauce for chicken or salmon.  First you layer the meat or fish over a thick bed of chopped, rinsed bok choy and cabbage.  Then mix 1/4 cup of balsamic vinegar with a tablespoon of honey; one teaspoon each of garlic and ginger chopped fine; one teaspoon of olive oil; one small tomato; and a few shakes each of salt and pepper.  Spin together the ingredients in a blender, pour the sauce all over everything, and bake it at 350 until done.  Cook approx. 30 min for salmon, 1 hr for chicken depending on the amount.  Cover the pan loosely with tin foil about halfway through. 

Or you could break apart a head of cauliflower and place it in a deep pan with ¼ cup water and 2 T olive oil.  Add any combination of toasted sesame seed oil, lemon juice, soy sauce, cumin, coriander, anise or chili pepper, and cook on medium high heat for about 10 minutes. All of these additions have strong, distinctive flavors that taste great with cruciferous vegetables.  Or you could grate lots of cheddar cheese over the cauliflower and cover the pot for the last 5 minutes of cooking.  In my opinion, just about everything tastes better with cheese melted on it. 

I am not a fan of ‘nutritionism,’ the widely shared but unexamined assumption that it is the scientifically identified nutrients in a food that determine its value in the diet. Nevertheless, for those who are interested, cruciferous vegetables contain lots of soluble and insoluble fiber, vitamin C, vitamin B9 (folate), potassium, selenium, and numerous phytochemicals. Cruciferous vegetables are also rich sources of sulfur-containing, cancer-fighting compounds known as glucosinolates.  I am going to guess that those sulfur-containing compounds were the cause of my patient’s headaches. 

The scientific literature provides evidence linking the eating of a diet rich in cruciferous vegetables to decreased rates of a variety of cancers, including breast, pancreatic, lung, bladder, prostate, and colon cancer. Possible mechanisms of action include the presence in cruciferous vegetables of several enzymes that protect cell DNA from damage, protect against oxidation of microsomes (a cell organelle), and counteract the cancer-causing properties of products of incomplete combustion like nitrosamines and polycyclic aromatic hydrocarbons.  Researchers at Oregon State University have found that sulforaphane – a compound found in high levels in broccoli, broccoli sprouts (sold next to the alfalfa sprouts), bok choy, and brussels sprouts – may play a major role in preventing prostate and colon cancer. 

So increase your dietary intake of broccoli and other cruciferous vegetables.  It can’t hurt, and it might help.  And they taste so good.  As Michael Pollan says, “There’s something terribly wrong when it’s cheaper to buy a double cheeseburger than a head of broccoli.”  Don’t let that fresh broccoli go to waste.

Last year an article in the New York Times caught my eye. The article was about fructose, the main kind of sugar in fruit.  This article was not discussing the fructose in fruit however but, rather, high-fructose corn syrup (HFCS), a cheaper-than-sugar sweetener used extensively in all kinds of processed foods, including ketchup and barbecue sauces, breakfast cereals, snacks, breads, and manufactured drinks of all kinds.  One single tablespoon of ketchup or barbecue sauce contains a teaspoon of HFCS. Some brands of low fat, fruit-flavored yogurt contain up to ten teaspoons of HFCS. 

That’s why I recommend buying plain, whole milk yogurt and adding your own fruit, nuts, seeds, vanilla extract, cinnamon, or cocoa powder.   

The article in the NY Times, which reviewed a small study from the Journal of Nutrition, discussed how different the metabolism of fructose is from the metabolism of glucose, which is the main sugar into which foods are broken down.  The article reported that the body converts fructose into stored body fat by a much more direct route than it converts glucose. 

When glucose is absorbed into the bloodstream, the liver determines whether the glucose needs to be used immediately for energy, or whether it can be stored for future use.  When fructose is absorbed, however, it is quickly converted to a type of fat called triglyceride.  High levels of triglycerides are strongly associated with impaired sugar metabolism, insulin resistance, and diabetes. 

The study found that when a person ate fructose at breakfast, the body was more likely to store not only the calories eaten at breakfast, but those eaten at lunch as well.  The diversion of fructose calories to fat storage was evident not only in the meal at which the fructose was consumed, but in subsequent meals as well. 

This article was extremely popular.  Readers had posted more than 150 comments after only a few days.  I noticed that many were confused about whether the warnings about consuming high-fructose corn syrup extended to fruit as well.  They did not.  But why not?  Why is it all right to eat fructose from fruit but not from corn syrup?  The difference between high-fructose corn syrup and fructose-containing fruit can be summed up in a single word — fiber. 

It seems to me that the faster we absorb a food, the more difficulty we have metabolizing it.  We evolved to eat foods that are absorbed slowly.  Which foods are these?  Protein, fat (natural only) and complex carbohydrates.  Fruits, vegetables, whole grains and beans are the sources of fiber, or complex carbohydrate.  Simple carbohydrates, namely sugar and starch, are the substances that are absorbed rapidly.  Foods that are absorbed slowly also slow the digestion of other foods eaten at the same time.  These are the foods that, in general, constitute a more healthful diet. 

So it should not surprise you to learn that almost all the simple carbohydrates are manufactured, man-made products.  They are not found in nature.  Sugar is not found in nature as crystals; industry makes it that way.  The primary industrial sources of sugar — beets, dates and sugar cane — are all rich in fiber. The manufacturing process separates the fiber from the sugar. 

In contrast to what you learned in school, however, sugar is not the only simple carbohydrate.  Starch, a simple chain of glucose molecules, is so easily separated into its individual component glucose molecules that eating a slice of white bread (made from flour that has been stripped of its fiber and wheat germ) raises blood sugar levels just as fast and high as the same number of calories of table sugar.  The processed food industry uses enormous amounts of simple carbohydrate.  They are all absorbed rapidly, and they are called by names such as maltodextrin, dextrose, food starch, maltitol, glycerol, white flour, glycerin, cane syrup, modified food starch, wheat starch, sorbitol, and, of course, high-fructose corn syrup. 

A molecule of fructose is and always will be a molecule of fructose, no matter what its source.  But its rate of absorption will be affected dramatically by the presence of other foodstuffs, like fiber, that are ingested along with it.  The fiber in fruit is essential to slowing the digestion of the fructose present in the food.

So I recommend to my patients that they avoid not only HFCS, but that they skip the glass of juice and eat the whole fruit instead.  Why? If juice is, as you may know, a good way to increase one’s blood sugar rapidly, then you can assume it contains little or no fiber. 

So eat that apple, kiwi, strawberry, melon or peach, and let the fiber do its job, slowing the absorption of fructose, or fruit sugar, in those delicious pieces of fruit.  And eat plenty of vegetables, beans, whole grains, dairy and meats in their natural, unprocessed forms.  None of these will ever contain any high-fructose corn syrup. 

I talk a lot about eating real food, the kind of food our great-grandparents ate.  Food that comes straight from the ground (or air, or water).  Unadulterated food, as opposed to “food-style products.”  I’ve heard similar ideas expressed as:  “Eat close to the garden.”  “Eat food that’s been through as few machines as possible.” “Eat nothing that contains more than four ingredients.”  “Don’t eat anything your great-grandparents wouldn’t have recognized as food.”  “Be wary of foods that never go bad; if the bugs won’t eat it, it’s not food.”  Many different ways of saying the same thing– eat real food. 

We spent the July 4^th weekend this past summer in the Watchung Mountains with my parents and extended family.  My mom and dad have been raising steer since 1973, when they moved their family to a 10-acre slice of heaven in rural, northwest New Jersey.  My mother also tends a small (her word), ½-acre,vegetable garden.  In past years there have also been sheep and goats, but no longer. Too labor intensive.  At any given time now, they usually have a couple of steer plus chickens, peacocks, and French guinea hens.  Believe it or not, steer are a lot less work than sheep.

My parents’ trips to Cleveland are usually accompanied by bags of produce and a few dozen eggs.  Sometimes a peacock feather or two.  They stumble out of the car into the arms of grinning grandchildren, and immediately hand over their gifts from the farm with strict instructions to ‘take these inside.’  Then, after the preliminaries, they head straight to the kitchen to empty their bags of produce onto the kitchen counters for everyone to inspect and admire.  And admire we do. This is what my family always does with newly picked produce.

             So when I got home from picking up my share one day, I spread out my new produce all over the kitchen counter.  Bok choy and kale.  Cabbage, potatoes, and onions.  Yellow squash, zucchini, patty pan squash.  Tomatoes, cucumbers, green beans.  Scallions.  Basil and cilantro.  Wow, I thought, we’re in full swing now.  Only a few leafy crops left on that proverbial vegetannual.  I set to work.

              First, I sliced ½ head of cabbage into thin strips, and left it on the cutting board.  Then I mixed ¾ cup of mayonnaise with ¼ cup of thyme vinegar left from last summer, plus a pinch of sugar to cut the acidity.  I grated in most of a lonely-but-otherwise-healthy-looking carrot I found at the bottom of the refrigerator.  Then I slid the cabbage, carrot and mayonnaise dressing into a large plastic bag, and placed the bag in a bowl in the refrigerator.  I turned the bag a few times over the next 2 days, and the resulting homemade cole slaw became a perfect addition to a
summer meal of barbecued chicken, corn on the cob, and fresh tomato salsa. 

              To make the salsa, I entered ‘tomato cucumber onion’ into Google’s search engine, perused the resulting recipes, and picked one whose remaining ingredients matched the contents of my refrigerator.  I started by adding a mashed garlic clove to a few tablespoons of lime juice.  I chopped the tomatoes, cucumber and ½ of a large onion into very tiny pieces.  I chopped up cilantro leaves very fine.  I slid everything into a beautiful pottery bowl, mixed it together, and added just one shake of salt and two grinds of black pepper to achieve summer nirvana. 

            The potatoes went into a saucepan with lightly salted water.  They cooked until they became quite soft, at which point I dumped the water.  I added a few tablespoons of olive oil, along with a generous bunch of coarsely-chopped Italian parsley from my herb garden, plus a teaspoon of kosher salt.  I placed the lid on the pot, and then shook the contents as hard as I could for about 30 seconds.  In my home, we call this recipe “smashed potatoes.”  It is delicious hot, cold, or warm. 

            I rinsed the kale and removed the thick, central ribs with a sharp knife.  I wrapped the wet leaves into a tight bundle, and then sliced cross-wise to make strips. These I tossed into a pan sizzling with a bit of olive oil.  I stirred the leaves occasionally until most were beginning to turn bright green (less than a minute), and then sprinkled them with a little balsamic vinegar.  This simple recipe is fabulous served warm, but it also tasted great straight from the refrigerator two days later. 

            Dinner time was calling.  I rinsed the green beans, sliced off the tips, and added them, along with slices of onion, red pepper, and the remaining cabbage, to a frying pan with some olive oil.  The mix of colors and textures was beautiful, and the onion, cabbage, and pepper softened just moments before the beans brightened.  I pulled the pan off the stove, and served the veggies right away with grilled cheese sandwiches (New York cheddar, whole-grain bread) followed by blueberries and fresh peach slices. 

            After dinner, I had one more project in mind — to make a dip out of zucchini and onions.  I sautéed the vegetables until soft, and then pulsed them in a food processor with parmesan cheese and lots of pepper until they were well-mixed, but not pasty.  There was still basil, squash and bok choy on the counter, but that was enough for one day. Simple food.  Simple recipes.  Simply delicious.