I spent the morning in the garden.  I put in a new blueberry bush, and spent several hours trimming, pruning, and weeding.  New lettuce is coming up, and one of these days we’ll have sweet and hot peppers, cucumbers, tomatoes and squash (zucchini, butternut, and spaghetti) in abundance.  I am looking forward to seeing how the watermelon, cabbage and cauliflower turn out.  After many years of a nice little garden, filled mostly with herbs and a few vegetables, I finally have the garden I’ve always dreamed of having.  Alongside the garden, under a beautiful slender magnolia tree tucked into a corner of the house, sits a little table with 2 chairs.  Late in the day the garden is flooded with light, but I can sit in the shade under the magnolia, and drink a glass of iced tea.  It hardly sounds like Cleveland, Ohio.  But it really is.

Lately I’ve been meeting lots of people who are being charged with working on reversing the childhood obesity epidemic.  It looks like we’re finally getting the message:  If present trends continue, we expect 30% of current 10-year-olds to become diabetic.  From so many standpoints, that is not okay.  The cost of suffering on that scale will be staggering.  

This week I was remembering the children who used to come along with their parents to their appointments at my former job.  I cared for many adult patients, and taught them to decrease their risk of becoming diabetic and/or obese.  My patients were very pleased to discover that their pants were fitting better and better, their complexions looking healthier and smoother, their double chins disappearing very quickly once they began to make smart (and relatively simple) changes in their diets.  But they also noticed that they themselves weren’t the only ones to benefit.  An additional, unexpected side benefit was that their children were losing weight and becoming healthier as well.  

I taught patients to increase the nutritional density of the meals they were eating and, when possible, to take more pleasure in preparing and eating their meals.  Patients slowly changed the way they shopped and cooked those meals.  Some of my patients cooked only for themselves.  But some of them weren’t preparing meals for just themselves.  They were feeding everyone in their family, including, of course, the children.  So when they changed their own purchasing and eating patterns, the children did, too.  And once the children began to eat differently, their bellies, too, began to disappear. 

Abdominal obesity, you may recall, is a marker for high insulin levels, which increases one’s risk of developing diabetes, high blood pressure, and coronary artery disease (heart attacks).  The bigger your belly, the greater your risk.  And vice versa.  The risk shrinks with your belly.

The children are the thing I’ve been thinking about this past week.  It came to me just this week that the unit of change for our society’s obesity problem is not the individual.  It is the family. 

The person who is responsible for purchasing and preparing meals is the one to be identified and supported.  This person, often the mom but not always, is the one who, ultimately, will effect the greatest change in a family’s way of eating.  

We can begin to move resources in this direction, providing education and support for the individual in each family who maintains primary responsibility for purchasing and preparing meals.  This is a way to establish a foothold in communities across the United States so that we can begin to reverse the diabetes and obesity epidemics.  Remember:  the time to think about healthy eating is not when you start dinner but, rather, when you make your grocery list or start shopping.  Shoppers, start your engines!
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I once knew a guy named Jeff, from Montreal, who used to say, “First I fry up the onions and garlic, and then I decide what to make for dinner.”  These recipes remind me of that guy. 

These recipes were all contributed by Molly Singer, Harvard Class of 2012, with the following commentary:  “Here are some recipes my roommate and I have been making.  Money’s tight, so these are not only healthy, but also cheap.  If I can get 3 pounds of onions for the same price as a bag of chips, its inevitable that we’re going to eat well.  Enjoy!  You’ll notice that almost everything we make starts with our trifecta of onions, garlic, and olive oil.  How could you go wrong from there?”  Indeed — I could not agree more!  Each one of these recipes is fabulous. 

I’ve known Molly since she was in middle school, and it is a pleasure to introduce her, and her cooking, to the readership of Your Health is on Your Plate.  Thank you, Molly, and feel free to send in more of your fabulous recipes whenever you’d like!

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Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

Some time ago it came time for us to replace our 300-foot-long driveway, so we hired some able-bodied cement guys.  They put a date on the calendar for the following spring, and we waited patiently until the next May came around.  When it did, they showed up one day and ripped out the old driveway, fully intending, of course, to replace it in the days ahead.  Alas, as my grandmother used to say, “Menschen tracht und Gott lacht.” That means people plan and God laughs.

I could start a long explanation here about how the original driveway’s footprint veered unexpectedly close to a property line, but I would prefer not to go into it.  So let’s just say there were technical difficulties.

And that is how I found myself parking out on the street for the better part of three months, while we gathered the necessary information, and then waited through the dog days of summer, to allow the city to make the ruling that would allow us, finally, to replace, in August, our exceedingly long driveway.

Although I often find things amusing that other people might not, this was not one of them.  In retrospect, keeping the wheelbarrow parked by the street for groceries and the like now seems pretty funny.  But it did not feel very amusing at the time.

But here’s something that did interest me:  Within a couple of weeks, my pants were fitting a little more loosely.  Now as you’ve certainly already discerned, we have a very long driveway, at least in comparison to all the other homes on our suburban street.  But it’s not like we’re set back a mile or anything.  Even still, just being required to walk that extra 300 feet 2-4 times a day more than previously was obviously enough to make a difference in my physique.  [Not a word I usually use when speaking about myself.]  Believe you me, it wasn’t much more than that either, because I made it my business to be very efficient about the number of trips I had to make to get out to my car that summer!

I believe that I may have written on this theme before.  It goes by other names, such as “the excellent is the enemy of the good,” or “every little bit helps,” or “every little bit counts,” or “you don’t have to do everything right, just pick the first right thing,” or “whatever you do, please just stop drinking soda/pop,” or “can I talk you into eating a high-protein breakfast instead of that candy they call breakfast cereal?” or “what do we have to do to get kids walking or riding bikes to school again?,” and so on.  Just pick one thing — it’s a great way to start.

No one was more surprised than me to discover that just a few more steps a day made a real, measurable difference in how my clothing fit.  So if you’re not up to walking 10,000 steps a day, I can understand.  But try answering this:  how many steps can you take?  More importantly, how many steps can you add to your current usual daily number?  Can you add 300?  600?  That works for me.  And it will work for you.  Promise.

In each of the past three weeks, I have been delighted to find garlic
scapes in the weekly box of produce I receive from the CSA
(community-supported agriculture) I joined this year.  Because those firm,
green, curly-cues of flavor come only once a year, and then they’re
gone, this is the time to enjoy them!  As I’ve said before about
belonging to a CSA, I appreciate the zucchini, onions, and tomatoes, but
I adore the kohlrabi, Swiss chard, chamomile (jam it into a small mug
and pour boiling water over it) and the things whose names I learned
only recently.  Like garlic scapes.

You may be one of those people who is asking right now, “What exactly are garlic scapes?” Here is what I’ve learned:

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/beige color
of a garlic peel.  That’s the status of several garlic scapes in my
garden currently.  Oh well, better luck next year.  As the scape absorbs
its share of energy from the plant, it also prevents the garlic bulb
from growing large and fragrant.  So farmers harvest the scape in full
curl, before it straightens, when it is still tender and delicious.

Here are a few ideas for what to 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 raw 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.

Yesterday I fried a full bunch each of approximately 10 garlic scapes
and 10 scallions in some olive oil until they were starting to turn a
bit brown around the edges.  I added a bunch of kale [rinsed, leaves
sliced from the rib, and then sliced again into thin strips].  My co-cook
stirred it around a bit until all the leaves were bright green and
shiny.  We sprinkled in some hot curry powder for flavor, just two
shakes, plus a few generous shakes each of salt and pepper.  Then we
poured in 10 scrambled eggs, put the cover on the frying pan, and turned
down the heat.  The first time I checked, the eggs were still wet, but
when I checked it again in after about 15-18 total minutes of cooking, it looked perfect.  I
turned off the heat and left it to sit a few minutes to absorb the kale
liquid, and then served it in slices, straight from the pan.  Leftovers went into the refrigerator to be eaten later, cold.

I’m captivated by the mythical plant creation that Barbara Kingsolver
calls the “vegetannual.”  Kingsolver’s vegetannual is what a single
plant would look like if that single plant were a representation of the
entire cycle of germination, growth, and ripening through which a garden travels from early
spring to the end of the growing season.  It’s real life, producing
all food in its proper season, in its own time.  Like all gifts from
the garden, garlic scapes have their own season, so get some now if you
have the chance.

Let’s
just say that you’re not diabetic and, of course, you want to keep it that way.
But then let’s say that one (or both) of your parents is
diabetic.  Plus you have a brother, and your mom says
the doctor just told him that his blood sugars were a little
too high, and he’s pre-diabetic.  Now you’re
wondering if it’s inevitable that it’s going to happen to you, too.
It’s not.

If
you read last week’s post, you may recall that I recommend to people
in the situation I just described that they get themselves a glucometer.  One of
the best ways to prevent diabetes in people at high risk (and everyone
else, for that matter) is to check your own blood sugars after you eat
and figure out for yourself which foods and situations keep your blood
sugars from recovering normally.

You can get a glucometer, a
machine for measuring your blood sugar, at the drugstore without a
prescription.  Or you can ask your doctor for a prescription, and
perhaps decrease the cost a bit that way.  If you’re only planning to try it once
or twice, you can even ask your brother, or a friend, if you
can borrow theirs for an experiment.

The
next time you’re not sure whether something you ate made your blood sugars spike, check them about 60 to 90 minutes after you’re done eating.  If your
sugars aren’t back in the normal range, say 80-120, that meal (or
snack) had too much carbohydrate for your body to cope with.  Maybe it
was too much refined carbohydrate (white flour and sugar), or maybe it
was too much carbohydrate, period.  Or maybe there wasn’t that much of
any one single thing, but when you added up everything together, that
was too much.

So how can you keep your blood sugars from spiking a little too high for a little too long?  Here are a few ideas:

#1
Don’t make your insulin do all the work of getting your blood sugar
into the cells!  Make your muscles do their share — run around, play,
toss a ball, get some exercise!

#2  Eat something that you absorb slowly before you
eat something that you absorb fast.  There are three things that we
absorb slowly — protein, fat and fiber.  There are two things that we
absorb quickly — sugar and white (stripped) flour.  I can think of two
benefits to eating something absorbed slowly first.  The first is that the
protein, fat or fiber mixes in your stomach with the sugar and/or white
flour, and decreases its absorption.  The second is that your stomach
is fuller to start with, so you eat more of the “slow-absorb stuff” and
less of the “quick-absorb stuff” to begin with.

#3  Eat
something highly acidic before you eat something sweet.  I have some
ideas about why this works, but to be honest I have not seen any
research on it.  It’s one of those old wives tales that really seems to
work.  The idea would be to drink a glass of water with a teaspoon
of cider vinegar mixed in before you eat your meal.  Try eating the
identical meal on two different occasions, at the same time of day, in
as similar a circumstance as you can arrange.  Change only one
variable:  one time have a glass of water and vinegar first, and another time have the identical meal without.  Don’t forget to check your blood sugars 90 minutes after you eat, both times.
Then send me your results.

#4
Save refined carbohydrates for later in the day, when you aren’t so
insulin resistant.  We are all naturally most insulin resistant when we wake
up in the morning.  As the day goes by we become less resistant and more insulin
sensitive.  So if you really enjoy oatmeal but you discover that it spikes your
blood sugar, try it for dinner with something that increases the meal’s
protein content, like some nuts.  You could actually stir some peanut butter into the oatmeal instead, if you’d like.

#5  Choose carbohydrates that
come with the fiber attached instead of eating ones that have had the
fiber stripped away.  Whole grains instead of stripped, refined grains.  Oranges instead of orange juice.  Dates instead of sugar.  And so on.

#6  Drink water or iced tea instead of soda pop.  Enough said.

#7
Load up your plate with fruits and vegetables, and leave room for one
brownie, instead of two, or three, or four.  Notice that in nature you
don’t normally find carbohydrate without the fiber attached.  With very few exceptions, refined
carbohydrate is a recent human invention, and it
is one of the major causes of the obesity and diabetes
epidemic.

#8  Drink a glass of milk before you head on over to
your friend’s house to hang out and eat snacks.  This gets back to filling your belly with protein
before you eat refined carbohydrate.  And fat, if you drink 2% or whole
milk.

#9  Eat a handful of peanuts before you leave for a party.  Peanuts are rich in protein, fat, and fiber, a three-in-one
winner all around!  If you are allergic to peanuts, try almonds, walnuts, sunflower seeds or pumpkin seeds.

#10  See #1.  The more we move, the more we will
protect our blood sugars.  Think big.  See if you can organize a group
at work to walk together at lunchtime.  Find out what it would take to
put in sidewalks in your town.  A community garden.  Maybe you can talk your family into a weekly ball game after Sunday dinner.

Don’t take
my word for it.  Compare your blood sugar with and without these kinds
of interventions, and see what you get.  Figure out which kinds of
changes work best for you, and stick with them.  Teach them to your
friends, your siblings, and your parents.  Diabetes is not inevitable,
and pre-diabetes is reversible.  You can get yourself off the road to diabetes.