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. 

             When I got home from picking up my weekly share one day back in the spring, I sliced some beautiful, new pink and white radishes as thinly as I could, laid them on small, thickly buttered whole-grain crackers, and set them on a colorful tray on the kitchen counter while I prepared to wash strawberries and lettuce.  Everyone helped to make them disappear.  Sweet and spicy, soft and crunchy, the combination of textures and flavors was as supremely satisfying as such an earthly pleasure can be.  The spicy, crunchy radish; the fragrant, seeded crackers; and the sweet, warm butter.  Bright yellow butter from cows who eat grass growing in bright yellow sunshine.

Real butter?  Are you kidding?  Doesn’t butter contain saturated fat?  Yes it does. And isn’t saturated fat supposed to be bad for you?  On the contrary.  Here are a few interesting tidbits for you to digest:  Olive oil is 13% saturated fat.  Cocoa butter, the main fat in dark chocolate, is one of the most highly saturated fats on the planet.  And trans fat, which has been absolutely and incontrovertibly identified as a cause of premature coronary artery disease, is an unsaturated fat.  It cannot, therefore, be true that unsaturated fats are good for you and saturated fats are bad.  William Castelli, director of the Framingham Heart Study, which initially enrolled 6000 people from Framingham, Massachusetts, and has been running since 1948, reported that the data indicate the more saturated fat one eats, the lower that person’s serum cholesterol appears to be.  The study has found that people who eat the most saturated fat weigh the least and are the most physically active.  So don’t deprive yourself–deciding not to eat something simply on the basis of its saturation gets you nowhere.

Here are a few more facts about saturated fats. We are made of saturated fat.  Because they are highly stable, they give our cells their integrity.  They play a vital role in bone health by promoting incorporation of calcium into the skeletal structure.  They lower Lp(a) [also called “lipoprotein a”], a substance in the blood that is highly correlated with premature heart disease.  The short- and medium-chain length saturated fats (found mainly in butter, chicken fat, coconut and palm oil) have antimicrobial properties; they enhance immune system function.  In other words, maybe it’s more than just the steam in chicken soup that makes it such a fine choice when you’re under the weather.

A more useful way to understand fats is to consider whether they are natural or synthetic.  Dr. Mary Enig, a lipidologist at the University of Maryland and the first to blow the whistle on trans fats back in the 1970s, has studied fats for her entire career.  She points out some of the fundamental changes that occurred in the American diet through the 20^thcentury.  Previously, most consumed fats were either saturated (butter, lard, tallow (beef), coconut) or monounsaturated (olive oil).  Today, the majority of fats are polyunsaturated, derived from soy, corn, safflower and canola.  Because polyunsaturated fats are inherently unstable, most are hydrogenated or refined to extend their shelf life.  Hydrogenation is the process by which manufacturers turn liquid oils into shortening and margarine by adding hydrogen.  This is how trans fats are created.  Trans fats act like saturated fat in cooking (think of Crisco), but they work more like plastic once they get inside you.  They aren’t really food, they just act like it.  That’s what I mean by synthetic fats.  Bottom line:  If it isn’t found in nature, don’t eat it.

In view of these interesting ideas, let’s talk more about butter.  Butter has just about the widest variety of fatty acid lengths and shapes of any food.  Why?  Well, let’s think about it.  Where is butter found?  In milk.  Who drinks milk?  Babies.  Like humans, goats, kittens, deer, water buffalo, calves, and yak.  Developing mammals.  Developing organisms need high-quality food that’s going to provide all the raw materials necessary to build the tremendous variety of tissues in their bodies.  Bone, heart and skeletal muscle, brain and nerves, corneas, kidneys, liver, nails, hair, you name it.  Butter also contains conjugated linoleic acid, a fatty acid that normalizes fat distribution and decreases truncal obesity.  Truncal obesity means abdominal fat, the kind that collects at the waistline and is a risk factor for diabetes and heart disease.

Here’s one more reason to eat butterfat, which you can also get by drinking whole milk.  Vitamin D is a fat-soluble vitamin.  This means that it is found in fat.  No fat, no Vitamin D.  Along with decreased sun exposure, the large drop in whole milk, cream and butter consumption has resulted in an epidemic of Vitamin D deficiency throughout the country. Not only does Vitamin D enhance calcium absorption and protect your bones and teeth, it improves your insulin sensitivity and lipid profile.  It also helps protect you from diabetes and other autoimmune diseases.  If you have concerns about your own Vitamin D status, ask your doctor to check your levels. 

One of the things I like best about my CSA (community-supported agriculture) is the surprise. There’s nothing like opening a bag to discover something I haven’t seen before, something whose name I don’t know, or something I wouldn’t have purchased under other circumstances.  This is nothing new; I’ve always felt like this, even before finding recipes was as simple as typing the name of an ingredient and tapping the ‘enter’ key.  And it appears that it’s no secret, either; I was asked about my plans for the Swiss chard before I’d even left the parking lot this past Thursday, and there was a similar question by phone within a few minutes of arriving home!  I shared my favorite plan: wash thoroughly, place the soaking wet, chopped stems under the leaves in a frying pan, steam for a minute or two just until the leaves begin to wilt, and then add a generous dollop of butter.  Or olive oil if you insist although, in my humble opinion, it is not the same.

I don’t ride roller coasters and I don’t like scary movies.  I’ve always felt that real life provides all the excitement I need.  But I do enjoy traveling, particularly to places that I would never otherwise have chosen to go.  To me there is nothing more fun than going along for the ride, cheering on people as they trust their instincts and follow the threads of their passions wherever they lead.  I like ending up in places, physical or otherwise, that I myself would never have chosen.  These have always been the greatest adventures of my life.

Even though it’s on a much smaller scale, my weekly share of produce gives me a similar feeling.  I appreciate the zucchini, onions, and leafy green lettuce, but I adore the Swiss chard, the chamomile (jam it into a small mug and pour boiling water over it) and the things whose names I don’t know yet. They take me somewhere I have never gone.  And that brings me to the subject of garlic scapes.

Earlier this season, you may have been one of many who asked, “What exactly are garlic scapes?” Garlic and its Allium family relatives (leeks, chives, scallions, onions) begin their underground lives as soft bulbs. As garlic bulbs harden, a shoot rises up and curls above the ground.  This shoot,or flower stalk, is called the scape, and I read that it appears only on the finest hardneck varieties of garlic.  If left unattended, the scape eventually straightens, hardens and turns the opaque white/beig
e color of a garlic peel.  As it absorbs its share of energy from the plant, it also prevents the bulb from growing large and fragrant.  So farmers harvest the scape in full curl, when it is still tender and delicious.

Here are a few things that you can do with garlic scapes.  You can 1) grill them like asparagus; 2) chop them up and add them to eggs, vegetables, salad, rice, pasta or a stir-fry; 3) cut them to green bean size, saute them in butter and salt for 6-8 minutes, and add a teaspoon of balsamic vinegar the last minute of cooking; or 4) make garlic scape pesto.  Toss pieces of 4-8 garlic scapes into a food processor.  Add grated parmesan cheese and walnuts, toasted if you’d like.  Use pumpkin seeds if you don’t eat nuts.  Pour in 1/4 cup olive oil, 2 tablespoons lemon juice, some salt and pepper, and give it a spin —> voila, garlic scape pesto!  Spread pesto on toast, add it to pasta, or place a tablespoonful in a little ramekin with a raw egg (cracked open, no shell).  Bake in the toaster oven at 350 for 10-12 minutes.  The flavor of this simple recipe is so heavenly that if you make it for breakfast, it will put a glow on the rest of your day.

The last entry I wrote was about the vegetannual, the mythical plant creation of Barbara Kingsolver that represents the gardens that, like in real life, produce all food in its proper season, in its own time.  Like all gifts from the garden, garlic scapes have their own season, so don’t miss your chance to eat ‘em up next time they come around!

©2009 Roxanne B Sukol

              Welcome! to “Your Health is on Your Plate.”  This is where I, Dr. Roxanne Sukol, a practicing internist in Cleveland, Ohio, explain how I care about what you eat.  I spend my days teaching folks how to tell the difference between nutritious food and the rest of what’s out there.  It’s not what you think: The American diet is causing obesity in 2/3 of the people who eat it, and diabetes in 13% of Americans. Thirty percent of current nine-year-olds are projected to become diabetic. Something is wrong with this picture. Diabetes and obesity are preventable diseases– so let’s prevent them.

Remember, your health is on your plate.