YOUR HEALTHY PLATE: UPSIDE-DOWN MUSHROOM OMELETTE

This is my friend Leslie’s favorite breakfast recipe. She adapted it from
http://buttoni.wordpress.com/2010/07/07/mushroom-upside-down-omelet-2/

INGREDIENTS:

2 T. unsalted butter
8 large mushrooms, sliced
2 oz. onion, sliced thin
dash salt and pepper
2 T. heavy cream
3 eggs
3 oz. grated smoked Gouda cheese

DIRECTIONS:

Preheat
oven to 350º. Melt butter in no-stick skillet. Saute the onion and
mushrooms until soft, sprinkle with salt and pepper.  Arrange mushrooms and onions at the
bottom of the skillet.  In a separate bowl, beat together the eggs and cream, and then pour the egg mixture over the mushrooms and onions evenly and gently.  Sprinkle the gouda cheese on top and place the skillet in the oven at 350º for 10-15 minutes or until center is no longer
wet.  Use a large spatula to loosen the omelette from the pan, and then flip it over onto a serving plate.


Brunch at Judith’s

If you think of good health as an investment in three different kinds of activities — eating, moving and relaxing — then I would say that many, if not most, of the human endeavors that best exemplify these activities actually occur at their intersections.  

As the school bus pulled away almost every afternoon when I was growing up in New Jersey, I would drop my bag and head off to spend time in the 600 acres of woods directly across the street from my house.  Those walks that I took in the woods every day after school cleared my mind, calmed my brain, focused my thoughts, and piqued my appetite.  I came inside ready for food, homework, and whatever else was about to come my way.

Last summer there were many days when I started dinner by collecting arms full of Swiss chard and tomatoes, knowing that my daughter and I had nailed together the boards to make a raised bed, had filled that bed with yards of compost and topsoil, and had watered and weeded and weeded some more.  It’s not everyone’s cup of tea, but it certainly is mine.  Watching vegetables grow — I can’t think of a more pleasant way to enjoy a late summer afternoon!  

This morning I was invited to share in a most generous meal.  Plans to spend time with my new friend, Judith, turned into an invitation to eat poached salmon with mint pesto, strained yogurt cheese with za’atar [hyssop] and crusty bread, caramelized Brussels sprouts, carrot and blueberry salad, olives, homemade baked goods and dark chocolate truffles.  The mint for the pesto came from the local supermarket, but it usually comes from her mother’s mint patch, lovingly tended not far from here.  The Brussels sprouts tasted as if they had been sprayed with a light coating of honey.  They had not; patience was the secret ingredient, she said.  We laughed together when I shared my own discovery that nothing cannot be made delicious in 8 hours at 250 degrees.  

Also for brunch we enjoyed an embroidered beribboned table runner, matching milky white serving dishes on pedestals, thoughtful conversation, dreams for the future, sincere admiration for all kinds of work well done and stories well told, and friends, silver and gold.   

Yes, you can purchase food for a few coins through a small window while you remain seated in your car.  You can put that stuff into your mouth, and use it to make hunger pangs disappear for a little while.  But it is not an investment in good health.  It is just calories without history, calories to which you have no connection.  And because it consists of eating without movement or relaxation, you receive only a little bit of sustenance.  At the end of the day, it’s a question of how we nourish ourselves, in the broadest sense possible.


A new feature: “Your Healthy Plate”

We’re starting a new feature on the blog!  In response to all the many requests for real food recipes, Your Health is on Your Plate is adding a recipe corner entitled “Your Healthy Plate.”  After this week’s debut, “Your Healthy Plate” will add a new recipe toward the end of each week.  That way, you’ll have time to gather your ingredients and get ready for some weekend cooking!
“Your Healthy Plate”  is exactly that.  YOURS.  Send us recipes that you love, and we’ll post them along with your comments.  Tell us what what worked, and — more importantly — what didn’t.  Send your own made-up recipe, a recipe you inherited, or (like Ellen below) something you enjoy making from a well-loved cookbook.
What challenges are you finding?  Is there a chance that you are still using Crisco or non-dairy (pareve) margarine?  Need some alternatives?  Can’t get your little one to eat zucchini?  Share your challenges, and let’s find out what other people in this informed, committed, and hungry community have tried when faced with similar situations.   
We’ll kick off “Your Healthy Plate” with one of Ellen’s favorite recipes adapted from the Moosewood Restaurant Low-fat Favorites Cookbook.  Not that I’m a fan of removing nutritious fat from cooking, but that’s what they named the cookbook.  It’s on page 169, if you’re interested.  
1 large onion, diced
1 red pepper, chopped
1 1/2 cups cooked chickpeas
10 oz. frozen (or 1 large bunch fresh) spinach
2 cups plain yogurt
juice from 1 lemon
garlic
mint
cumin
coriander
salt
Saute the onion in olive oil on medium heat until soft and clear.  Add a few shakes each of cumin and coriander.  Add one chopped red pepper.  Add 1 and 1/2 cups of cooked chickpeas.  That’s one can, if you’re using canned chick peas (also called garbanzo beans or ceci).  Add approximately 1/4 cup of the chickpea water (or tap water), plus more if necessary to keep the mixture moist.  Cook until the red pepper softens.  Add the chopped spinach, and when it wilts, sprinkle it right away with the lemon juice and salt.  
Add minced garlic plus mint to 2 cups of plain yogurt to make a tangy, spicy sauce.  My friend Ellen, who sent this recipe, said she didn’t have any mint on hand, so “I raided a teabag.”  Yeh, that definitely sounds like her.
The recipe recommended serving the chickpeas and spinach over orzo, but Ellen chose bulgur wheat.  She also suggested brown rice and pita as other possibilities.  Another alternative might be to steam or stir-fry some more greens separately, and then to serve the chickpea mixture on a bed of wilted greens.
Bon appetit!  …and thank you, Ellen!

Why You Should Drink Whole Milk

After medical school, my friend Brian moved to Baltimore, MD, and became a pain management specialist.  He’s been working with my Four Recommendations for about a year now, but he recently wrote to ask for more information about why I recommend whole milk over skim milk.  In his own practice, he sees that the diabetics and pre-diabetics (with metabolic syndrome) seem to struggle with more pain and arthritis than the patients without these diagnoses.   Here’s what Dr. Brian wrote last week:
 
“I read your four rules to live (eat) by. I get them except for the whole milk vs. skim milk. Do you have something I could read to understand that better?  I’ve been sending lots of people to the blog, great stuff.” 
 
This week I’ll talk about why skim milk is no kind of improvement, and why whole milk is far and away the better choice.
 
The tried and true answer, the one I’ve been sharing all along, is that fats (natural only, in case you were wondering) decrease the rate of food absorption, which decreases the amount of insulin that you require to metabolize your food.  Since insulin is the fat storage hormone, the less you use, the less fat you store.
 
The latest information is more specific and more compelling.  Dairy fat contains a fatty acid called trans palmitoleic acid.  Research from Brigham and Women’s Hospital, Harvard Medical School, and Harvard School of Public Health, published just two weeks ago in the Annals of Internal Medicine, suggests that trans palmitoleic acid is protective against new-onset diabetes. The study, which ran from 1992 to 2006 in four U.S. communities, followed 3736 adults.  Whole-fat dairy consumption was most strongly associated with higher trans-palmitoleate levels, which were associated with higher HDL, lower triglyceride, lower C-reactive protein, lower insulin resistance, and a substantially lower incidence of diabetes.
 
As Dr. Brian has observed in his pain management practice, diabetes is causing pain and inflammation even more far-reaching than what we typically associate with it.  
 
Try switching to whole milk yourself.  In fact, let me suggest you run an experiment:  run a tape measure around the widest part of your waistline and mark down the number.  Then recheck it in a few weeks.  Send me your numbers, and let’s see what we learn!
 

 

 

 


Processed Food is a Menace to Satiety

A dear friend came through town a few months back and told me that she’d been discussing my recommendations with her clever boyfriend.  He spent some time mulling them over, and this is what he said: “Processed food is a menace to satiety.”
Did you ever think about the fact that you might be able to eat your way through several pounds of potatoes in the form of potato chips, but not in the form of baked potatoes?  How many pounds of baked potatoes do you think you could eat?  Don’t forget about the butter; after all, potato chips are usually fried.
My husband and a bear-sized buddy of his used to joke that the best way to eat Thin Mint Cookies was to open the cellophane and slide an entire sleeve right into your mouth all at once.  Yeh, well, that’s how you get to be as big as a bear.
What’s the record number of bowls of breakfast cereal — just name your brand — that you’ve ever eaten at one sitting?  Three?  Four?  How about a whole box?  Could you eat that many bowls of whole grains?  I really doubt it.
Why?  Because real food fills our bellies.  Real food tells us, “You’re full now.  Stop eating.”  Processed food-like products don’t.  They bypass the exquisitely sensitive systems that were designed to keep our bodies working right.  They hijack our appetites.  We can’t tell when we’re full.  We keep eating.
So when you’re hungry, it’s not a good idea to eat something that’s been processed into a form that is no longer recognized by your body as real food.  Hold on just a sec, I need to go get something to eat……OK, I’m back.  I chose a couple of slices of swiss cheese, and a bunch of leftover asparagus from last night.  And guess what?  My belly is happy — I’m not hungry anymore!
I decided against the cauliflower & cheese soup, the ripe avocados, and the turkey breast.  Those would also have been good choices, but everything doesn’t need to be eaten all at once.  Real food is satisfying.

I Like My Patients Vertical

I like my patients vertical.  Not horizontal.
 
If I can help it, I want to make sure that nobody gets a disease that could have been prevented.  Sure, accidents happen.  And illnesses show up every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them.  But not all illnesses.
 
Physicians know that newly diagnosed diabetic patients present to the doctor with about 10 years worth of damage to their blood vessels.  What does that mean?  That we diagnose diabetes 10 years later than the disease warrants.  It means that the symptoms we learn to identify come about 10 years after the disease begins.  
 
So, I can wait until a patient begins to complain of frequent urination, unquenchable thirst, and an infection that won’t heal.  I can spend ten years ignoring a blood pressure that continues to rise; a combination of high triglycerides and low HDL; frequent car rides to buy fast food; a lifestyle that includes almost no time for stretching, walking or other exercise; a diet consisting largely of refined carbohydrate (sugar and white flour) and omega-6 oils; and and multiple pairs of pants that can no longer be buttoned.  But at the end of those ten years, I should not be surprised when that patient shows up exhausted, and with a blood sugar of 350.
 
This past week brought with it news from the Centers for Disease Control (CDC) that 35% of American adults are now prediabetic.  Half of Americans aged 65 and older have prediabetes and just over one-fourth are diabetic.  Rates of diabetes continue to soar, particularly among racial and ethnic minorities. 
 
Diabetes is, for the most part, a preventable disease.  The key is to start preventing it ten years before your diagnosis.  When would that be?  Now.  Eat protein for breakfast and skip food-like products made from white flour.  Stop drinking soda/pop — the research shows that even people who drink diet soda have an increased risk of diabetes.  Why?  We don’t know yet, but as soon as I learn anything I’ll share it here.  And no more light, lite, quick, instant, or processed food.  Eat real food.  What’s real?  Food that your great-great-grandparents ate.
 
We must also find ways to make peace, to relax, and to manage the stress that we all feel in our hectic and busy lives.  Stress increases body weight, blood pressure, and blood sugar.  I just finished reading Traveling with Pomegranates, by Sue Monk Kidd (author of The Secret Life of Bees) and her daughter, Ann Kidd Taylor.  Sue’s hypertension evaporated once she realized how important it was to balance the time she spent writing with time she spent relaxing, walking down to the marshes near her home and sitting quietly as a part of the nature all around her.  She called it a personal recognition of the fact that “being” is of equal importance to “doing.” 
 
The stakes are high; diabetes can be dangerous.  I don’t want to see my patients in a hospital bed.  Or even in a wheelchair, if it can be helped.  I like my patients vertical.

Colorful Vegetables

We’ve been eating more and more produce at our house:  Yesterday at lunch we had broccoli/cauliflower soup, a tossed green salad, a tomato salad, sour pickles, guacamole, baked apples stuffed with dried figs and shredded coconut.  There was also homemade bread and local butter, and a cheese tray with chevre, cheddar and blue cheese.  Most of the credit goes to my husband; he baked the bread and thought up the baked apples.  Can you hear me cheering?

Even though the meal did not exactly have a theme (like Thai, or Mexican, or even Chesapeake), it did have a lot going for it.  I’m talking about vegetables.  And color.  It had red, green (light, medium, and dark), white, yellow, brown, orange and blue (of sorts).  That’s a lot of colors for one meal.  And, as my mom taught me, the more colors at a meal, the better.

Colors are indicative of different kinds of nutrients, and so the greater the variety, the more likely you are to get what you need.  Also, the deeper the color, the more nutrition.  That’s why you keep hearing so much about including dark greens (kale, chard), rich oranges (sweet potatoes) and purple/reds (like beets) in your meals.

We’re not the only ones who benefit from eating vegetables.  Especially at this time of year, when there is no grass to be found, I make an effort to toss substandard lettuce leaves, pits and shells with bits of avocado still clinging, carrot ends, and anything else I can think of, into the chicken coop.  Yesterday I gave the chickens a piece of aloe that I pruned from a plant in the kitchen.  We’ll see what they think of that — if they didn’t care for it, I will find it still on the ground when I go out to check on them this morning.

A story on the joys of vegetables would not be complete without a couple of great recipes.  Here are some especially colorful ones from Cleveland’s noted Kosher cook and author, Joan Kekst, who was kind enough to submit these recently, along with a beautiful story that you should look for soon on these pages.  Apologies for deleting 1/2 t sugar from the ingredient lists of these recipes — you can certainly add it back if you’d like, but I have a feeling that they will be sufficiently delicious without it!

BROCCOLI SLAW
1 lb. shredded broccoli stems, julienne (can be purchased in some supermarkets)
2 large carrots, julienne
2 red onions, julienne (approx. 2 cups)
1 cup kalamata olives, pitted
Juice of 1 lemon
2-4 T olive oil
2 T fresh lemon thyme leaves
2 T flat leaf parsley, chopped

Combine broccoli, carrots, onions and olives in a mixing bowl. Toss with lemon juice and olive oil. Season to taste with pinches of salt and freshly ground black pepper. Add thyme. Allow to blend for 30 min, stir occasionally. Serve at room temperature or chilled, garnish with parsley leaves. Serves 8. Keeps well for 5 days.

COLORFUL VEGETABLE SLAW
1 lb. Chinese or green cabbage, cored
1 large carrot, peeled
1/4 lb. snow peas
1 red bell pepper, seeded
1 yellow bell pepper, seeded
1 green bell pepper, seeded
12 green beans
1 small red onion
2 ears fresh sweet corn, shucked
1/4 cup cider vinegar
1 T olive oil
1 pinch celery seed

Shred cabbage as thinly as possibly. With a vegetable peeler, shred carrots thinly to make curls. Use remaining carrot scraps elsewhere.  Julienne pea pods, peppers, green beans and onion. Remove corn kernels from the cob.

Combine all vegetables in large mixing bowl and flavor with vinegar, celery seed, oil, salt and pepper to taste. Allow to blend for 20-30 min. [NOTE: Use shredded zucchini or yellow summer squash, if desired.] Keeps 3 days.

TOMATO BASIL SOUP
1 T olive oil
1 large carrot
1 large celery stalk
1 large leek, white only
1 large garlic clove, cracked
2 lb. plum tomatoes, peeled, seeded and chopped
4 cups water or vegetable stock
1 T tomato paste
1 bay leaf
6 to 8 fresh basil leaves, more to garnish
Several sprigs of thyme
salt and pepper to taste
1/2 cup sour cream [optional]

In a non-corrosive pan, heat the oil and cook the carrot, celery, leek and garlic until softened, 5–7 min. Add remaining ingredients and simmer for 20-25 min. Cool and discard the bay leaf and thyme sprigs.

Puree soup in batches, strain into a pitcher or bowl, and chill. Adjust salt and pepper. Stir in sour cream just before serving, and do not reheat once sour cream is added. Serve warm or cold, in goblets or mugs.  Garnish with fresh basil leaves. Makes 6 C. Keeps 3 days chilled.

Bon appetit!


Our Grandmothers’ Old-Fashioned Wisdom

Before the holidays, a few weeks ago, I had a wonderful chat with Joslin Poston from the Occupational Health Department at the Cleveland Clinic.  I told her about my interests in preventing diabetes and obesity, and getting folks back to basics [by teaching them how to tell the difference between real food and manufactured calories].  She just loved it.  I don’t know if she’s a musician, but I definitely struck a chord.  Hey, she told her co-workers, check this out!  They had so much to add, and I promised them right then and there that I would write about our conversation.
We got talking about our grandmothers’ old-fashioned expressions, beliefs, and bits of advice.  Stuff like “Kids should play outside.”  Adults, too.  A family practice doctor I know sometimes uses Facebook, especially on nice days, to remind people to play outside and get some sun.
“Eat your vegetables.”  Now isn’t that the truth?
“Breakfast is the most important meal of the day.”  What a difference it makes to walk out the door with something flavorful and protein-rich in your belly.
“Chew your food slowly.”  That means you are tasting your food and relaxing.
Joslin added a few more:  “Kids should have gym at school every day.”  “There should be some quiet time for reflection.”  Yeh, what she said.  I started jotting these down in a hurry.
I remembered one that my mom likes to say:  “The more colors on your plate, the better.”
These sayings all reminded me of how we, as human beings, learn.  It’s common to hear parents bemoan the fact that their children have to experience consequences themselves in order to learn, and to wish that children would simply listen to their parents’ admonitions.  Wouldn’t it be easier?  But that’s human nature.  We, all of us, have to learn for ourselves.  We have to imprint the memories inside our own bodies in order for them to become knowledge, to become real.
Hearing something isn’t the same as knowing it in our gut, or in our bones.  Even our language shows that we understand the learning to happen deep inside.
So…as a society, we began to ignore our grandmothers’ advice.  We began to skip breakfast, stay indoors, stop exercising, eat no produce [count ketchup as a vegetable!], wolf down our meals, and NEVER stop to smell the roses.  And where did that land us?  Right in the middle of an epidemic of diabetes and obesity.
There are some things that no one can tell you, that you just have to learn for yourself.  But now you know.  We may have thought these little expressions were quaint and old-fashioned, but they are really much more.  They are the collected wisdom of our ancestors, the people who survived.  Ask Joslin Poston.

 


I Drink 2 Pots of Coffee and I Don’t Do Breakfast

Originally posted 12/12/2010

When I was home for Thanksgiving a couple of weeks ago, I got to spend time not only with my family, but also with some old friends I hadn’t seen for a long time.  This week’s mail brought some interesting questions from one of those old friends, who gave me permission to share them with you.

Dan wrote that he does not normally eat breakfast.  He’s not that hungry early in the morning.  He does, however, drink copious amounts of coffee.  He described himself as “very overweight,” and said that he’s considering going on a “very low carb diet” to drop the weight.  I asked exactly how much coffee he’s talking about, and he said close to 2 pots of coffee a day (7-8 mugs).  He adds only half-and-half.  No sweeteners.

Here’s what I say about skipping breakfast: Our bodies need a certain amount of energy to get through the day.  If we have not eaten that amount of energy (calories) by the time we get up from the dinner table, we will eat the rest AFTER dinner.  By and large, calories eaten after dinner are snacks, so they are not as nutritious as meals.  Also, the later you eat them, the less likely it is that they will be completely digested by the time you go to bed.  And then you aren’t hungry when you wake up.  So you skip breakfast.  Vicious cycle.

The way to put an end to this is to eat protein in the morning.  It sends a message to your body to turn on your daytime metabolism.  It doesn’t have to be King Henry VIII’s breakfast.  Just a cheese stick.  A hard-boiled egg, a leftover hamburger.  No time?  Eat a handful of nuts in the car on the way to work.

Now the coffee.  Dan said each 12-cup pot of coffee makes 4 mugs of coffee, and that he doesn’t quite finish the second pot.  So figure each mug is around 2 1/2 cups.  I have a couple of mugs that big around here.  American-sized.  One tablespoon of cream?  Yeh, right!   Let’s assume Dan puts 4 tablespoons of half-and-half in each mug of coffee.  If each tablespoon contains 2 1/2 grams of fat and 25 calories, Dan is drinking 700 calories of half-and-half every day.  Even though the fat is more nutritious than you might think, there’s no two ways about it: that’s a lot of food.  I’m guessing he eats at least a couple of meals, plus snacks, in addition.

One thing he could do would be to put cream in just the first cup or two of the morning, and drink it black for the rest of the day.  And remember to have a high-protein breakfast.   Or he could admit that he’s drinking one-and-a-half to two meals worth of calories a day, and factor that into what he chooses for lunch.  Celery?

Now to answer the very-low-carb diet question.  Do I recommend it?  No, I don’t.  At least not yet.  I don’t believe in sudden change.  I say he should take a careful look at the rest of his diet, and figure out the single largest source of processed carbohydrate – be it white flour, chips, high fructose corn syrup, or sugar.

His pants will get loose pretty fast once he identifies and decreases the amount of processed carbohydrate in his diet.  He doesn’t need to do it all at once.  He can pick one problem at a time, and see what happens.  Two or three months of eating peppers and cucumbers with lunch, instead of chips, would be a great start.  If he becomes a breakfast eater, a nutritious, high-protein breakfast instead of Frosty Crunchos would be a very good idea.  The best answer depends on the the biggest problem.  Soda/pop every afternoon?  Donuts?  The drive-thru for a sausage-on-the-go-go every morning?  Everybody has different issues.  At least we know Dan’s not ordering the extra-large sweet latte made with non-dairy whitener.

Next week (posted 12/19/2010) , we’ll be talking about another set of questions from Emily, who’s working on following Weight Watchers and my “Four Recommendations” at the same time.


What Happens in December Stays in December – Reprise

Here’s a repost of a popular entry from last December — it’s that time of year!

This month, a lot of people weigh more than they did in the fall at their last appointment.  The problem is so widespread that, especially in people who are working to lose, I make it a point to applaud their efforts even if they have simply maintained their weight at the same number over the last few months. That’s because December is probably the single time of year in which people are most likely to eat large amounts of sugar and white flour.

Some folks don’t want to know what they weigh, so we make an agreement.  I get the number, and I don’t tell them what it is.  I remind them that I don’t really care about the number itself; I’m just looking for changes, up or down, from the last visit.  I really care a lot more about how their pants fit.  Are they looser, or tighter, or the same?  That’s a lot more important to me.   

Why is December such a problem?  It has to do mainly with the amount of desserts.  What happens when you eat a lot of sugar or starch?  You use a lot more insulin.  What happens when you use a lot more insulin? You store fat more efficiently, and you lose the ability to tell when you are full.  Then you increase your food intake accordingly.  In other words, you eat more. 

In my experience, about three days after you start eating a diet that requires less insulin, you notice that your appetite decreases a little bit.  Here’s why:  When you eat a diet like the standard American diet, which requires a lot of insulin, the high insulin levels coat the satiety centers in your brain and make it very hard to tell that you are full.  When you make changes like the ones in my “Four Recommendations,” you end up using less insulin.  On the third day after you start using less insulin, your body finally gets the message that it doesn’t need so much insulin anymore.  That’s how long it takes your body to begin to respond to the fact that it doesn’t need as much insulin.  Then your pancreas “downregulates” insulin production.  Then you’re not as hungry anymore.

Less insulin means less hunger. Three days after you start eating an “insulin-conserving” diet, you wake up noticeably less hungry than you used to be. 

So don’t worry about what you weigh.  That the number will take care of itself as you get back on track making smart choices.  And it does.  It’s okay to celebrate the holidays.  It’s okay to have a piece of wedding cake.  Or birthday cake.  It’s probably okay to have a slice of pie every weekend.  But you can’t have it every day.  Our insulin levels will manage fine if we let them spike only once in a while.  The problem comes when we eat foods that make them spike every day.  Every meal.  Because when your insulin levels are rising every day, they are no longer spiking.  Now they are just high. 

That’s why I say that what happens in December stays in December.  It’s not what we do once in a while that gives us trouble.  It’s what we do all the time.  You can’t live in December and expect to remain healthy.  But you can visit it from time to time.