Yesterday I didn’t eat until nightfall.  It was Yom Kippur, the Jewish Day of Atonement.  Putting aside for now the reasons why someone might do such a thing, I’d like to talk about the results of such an endeavor, the what happens when you fast.  Well, for one thing, I didn’t do a whole lot of anything else.  Fasting really takes it out of me.  I certainly didn’t have enough energy to go for a walk, for example.  So, except for a short mid-afternoon nap, I spent almost the entire day sitting still.  A lump on a log.  Starvation mode. 

I spent most of the day yawning, which is something I tend to do when I’m hungry.  It can be a bit problematic for patients whose appointments fall between 11 and noon.  But I promise I’m not bored; I’m just hungry. 

When I dressed in the morning, I picked out a large woolen scarf to wear over my clothes.  I do this every Yom Kippur, whether the outside temperature is 40 degrees or 80.  That’s because I spend most of the day freezing cold.  Basically, I left home yesterday morning wearing a wool blanket.  It was large enough to cover not only my own shoulders, but also those of others who might happen to be seated close by.  I was very grateful for the ability to wrap myself up and stay warm. 

I’m starting to see a pattern.  I skipped breakfast, didn’t feel like moving, was freezing cold, and exhausted.   I was conserving energy.  What does that sound like?  Well, I’ll tell you — it sounds like some of my obese patients.  And that’s not a coincidence.

Now I’m going to guess that the thought has entered your mind that obese people would do themselves a world of good if they would go for even a short walk every day.  One stereotype of obesity is that people get that way because they’re lazy.  Well, I’m going to challenge that assumption.  What if heavy people aren’t lazy at all?  What if the reason they don’t move around much is because they’re starving?  I skipped my walk yesterday, remember?

You may have heard some people say that they can’t understand why they are fat, because they eat so much less than everyone else.  “Yeh right,” you may have said to yourself.  Well, guess what?  I believe them.  Notwithstanding those folks battling a serious addiction to potato chips, soda, and doughnuts, many obese people are struggling along on 1500 kcal/day of nutrient-poor, manufactured calories. 

Obese patients are routinely deficient in B vitamins, magnesium, Vitamin D, and other nutrients.  In medical school, I learned that these were markers of malnutrition.  Think alcoholism when you see these deficiences, I was taught.  But a much more common cause, it appears to me, is obesity.  Normal levels of Vitamin D run around 40-50, but I routinely see Vitamin D levels below 10 in my most obese patients.

I don’t think this is just about vitamins either.  I think it’s about protein and fat as well.  I’ve written in the past about how some people seem to need more water, or calories, than others.  So it does not seem far-fetched that some people need more protein than others.  Or fat, for that matter.  What if a low-fat diet is well tolerated by some people, but causes others to go into starvation mode?  What if some people get enough total calories, but not enough protein?  What would that look like?  How many calories of protein does it take to sustain a body that weighs 300 pounds?  A lot more than you might think. 

Many overweight people carry their extra weight in their abdomen and below their chin, a sign of insulin resistance, which is caused by excessive amounts of processed carbohydrate.  Their skin, especially around their eyes, looks very pale and puffy.  This is a sign of protein deficiency.  As people increase the amount of quality protein they eat, that puffiness resolves.  Their skin becomes bright and smooth.  Their friends sometimes ask if they’ve had a haircut, or even a face lift! 

People who get adequate nutrition become less lethargic, and begin to move around more.  Maybe, instead of sending a child, or waiting until they’ve saved up a list of reasons to make the trip, they’ll surprise themselves by going upstairs to get a different sweater, or downstairs to change a lightbulb.  Believe it or not, many of my obese patients need to eat more, and not less, food.  Some people are obese because they are in starvation mode, conserving energy and calories to the greatest extent possible.  It’s wrong to assume that laziness causes obesity.  If anything, I believe, it’s the reverse. 

And that is one of many things I pondered on Yom Kippur this year.

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“The more things change, the more they stay the same.”  J.A. Karr

I have a dear friend who was diagnosed with Type 1 diabetes as a child.  I have learned more from her about caring for patients with diabetes than from any other single source.  She is an expert at every aspect of being diabetic.  It’s not just about the food, in case you’re wondering.  It’s about taking care of your insulin pump and your toes.  It’s about protecting your sleep.  It’s about getting the right amount of exercise, and learning to ride the waves of blood sugar ups and downs due to a sinus infection.  It’s about accepting the fact that seeing the doctor for that sinus infection does not take the place of regularly scheduled appointments for diabetes care and medication refills.  It’s about helping friends and relatives to understand that accepting or declining to eat a special treat or a second helping has everything to do with health, and nothing to do with friendship.  And it’s about understanding that these examples are just the tip of the iceberg.  Having a chronic disease affects absolutely every aspect of your life.

In case you’re wondering, diabetes is not the only chronic condition that falls into this category.  All chronic conditions are better managed with careful, ongoing vigilance.  Which problems can be considered chronic?  Anything that isn’t expected to resolve any time soon.  Like high blood pressure, arthritis, asthma, colitis, and obesity.  And eczema, lupus, HIV, psoriasis, emphysema, anxiety, depression, celiac, and nut allergies.  There are a great many chronic conditions.

At this time of year, when the days get shorter and the weather gets cooler, my diabetic friend prepares to make a number of changes.  In the warm weather she takes her rambunctious dog for a long walk virtually every day, and often twice, morning and afternoon.  But by late fall, in anticipation of those long weeks when the weather is simply uncooperative, she switches to her treadmill.  The dog will have to be content to run free in a snowy yard surrounded by an invisible electronic fence, so my friend’s to-do list probably includes a fresh battery for her dog’s collar.

I myself look forward to walking at least 2 miles a day during the months that I arrive home from work in daylight.  I also enjoy yoga, but that is usually a cold-weather activity.  It’s not that I don’t enjoy yoga classes in the summer; it’s just that I crave the sunlight.  I always want to be outside if I have a choice.  So, along with gardening, walking is my main summer activity.  Yoga is my main winter activity.  Routines developed for the summer will not serve in the winter.

Another friend has a son with a different chronic condition.  His illness is in remission, but it takes a lot of medicine, and that medicine has to be taken on a very particular schedule.  Last year, when he went off to college for the first time, it took a fair amount of thinking to figure out how to structure his classes and activities so he wouldn’t miss his meds.  This year, with a new part-time commitment, he has had to make a few additional changes to keep things on track.  “It’s all about the pill counters,” he would tell you.  He worked it out before he left for school.

With every season, we must once again become conscious of the coming changes.  This is true not just for those of us with chronic conditions.  We all benefit greatly from rethinking how our eating and activity patterns will change, and then preparing.  With fall comes the ripening of produce with a higher carbohydrate content, such as squash, beets, and potatoes.  Before the age of refrigeration, these foods were harvested, stored and then expected to get us through the winter.  Eating foods with a higher carbohydrate content is sort of the default setting for winter.  It makes sense if you think about the cycle of the seasons.  Centuries ago, food was harder to come by in the winter.  Carbohydrate-rich foods helped us survive.  If we don’t want to eat that way, we have to make plans and compensate.

Recently, my sister was telling me about her neighbor with a vegan daughter who has just moved back home following many years abroad.  Her diet contains no animal products whatsoever, not even eggs or dairy, and consists mainly of produce, nuts, beans, and whole grains.  The daughter generously offered to take on the task of preparing all the family’s meals, but that is turning out to have some unintended consequences for the neighbor, who is highly sensitive to the amount of grain in this diet.  So now they are working on a better solution for both of them, trying to be conscious of what is actually being cooked, and figuring out substitutions where necessary.

Changes to our environment  always change the routines of how we care for ourselves.  Figure into this equation a chronic condition that affects every aspect of one’s life, and you begin to realize how thoroughly seasonal change affects us.  At this time of year many things are changing, and they all have a myriad of consequences.  Acknowledging those changes, and making plans to address them now, ahead of time, will noticeably improve your ability to take good care of yourself.

Change requires us continually to reassess, to ask ourselves how best to maintain our health.  Seasons pass one into the next, children move in and out, people become ill and then heal.  Change is the one constant.

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!