Food Friday: Soup Stock

Our evening temperatures are beginning to dip into the 30s and yet, our outdoor activities continue unabated. This weekend I'm sure we will be out either observing the lunar eclipse or the Northern lights. This means we're going to get chilly. This means we will want soup. 

Soup season is here again. While I love summer with its fruit platters and salads, I adore the soups of fall. A beautiful soup makes a great centerpiece for a meal, and if made well, soups are healthy and appeal to everyone.

What does it take to make a delicious soup? It takes a well-made soup base. Some people call this broth and some people call it stock. I think when you see how it is made you will understand why it tastes so good.

The first thing you should do is roast some chicken. I realize this sounds daunting to some, but it is actually one of the simplest things you can do in the kitchen. Moreover, whole chickens are one of the most inexpensive healthy foods you can buy. Around here, we can get them from our local farmers or you can get a good whole organic chicken at Costco. You will need a roasting pan, but it need not be fancy. It should have a roasting rack. You can usually get these at secondhand stores. You will also need a meat thermometer and these are available for just a few dollars at any grocery store. This is a small price to pay for food safety. Before you start to unpack your chicken, adjust the shelf in your oven and preheat it to 425°. Read through all the instructions first, and assemble everything you need before you start. In French, this is called “ Mise en Place”, or to put in place. 

Start by reviewing food safety. Recall that raw chicken and its juices are a culture medium for bacteria. Keep everything confined to the sink or nonporous cutting boards. Open the packages in your area and do not reuse any of the utensils or surfaces for anything else without thoroughly cleaning them in hot soapy water. Once you get your chickens unpackaged, remove the giblets and rinse them. Set your hollow chickens onto the roasting rack in the roasting pan. Then, discard the packaging, wash the utensils and surfaces and finally wash your hands with hot soap and water.

Brush the surface of both chickens thoroughly with olive oil. Sprinkle them liberally with good kosher salt and freshly ground pepper. Encrust them with whatever other herbs you like. Add about an inch of liquid to the bottom of the pan. This can be water or white wine. Cover the birds loosely with foil. Roast at 425°until their internal temperature is 165 degrees deep in the flesh. For the last 10 minutes or so, take off the foil and brown the tops of the chicken until they are nice and crispy but not burned. This will serve about 10 people or a  small family for several days. 

To make broth, take all of the chicken meat of all of the bones and serve or store it. You can use it to make sandwiches, chicken salad, main dishes, and pasta. Keep all of the drippings in the pan unless they are burned black. Compress the carcasses down in the pan and place back in the oven and either bake them at high temperature or broil them until they are golden brown and dried but not burned. Take the roasting pan out and add several ingredients which will flavor the broth. Here are some choices:

• Garlic cloves, and onion with their skin
• Chopped carrots, Chopped celery
• Older apples that are still good
• Any fresh herbs and peppercorns

Cover all the ingredients with water and bring to a boil on the stove top. Boil for 10 minutes, then simmer for at least two hours.. When finished, strain and transfer to a clean cool container or containers, preparing either to use, refrigerate, or freeze. Consider adding salt at this time.

If the weather is cold, I like to cool my broth outside. This way I don't have to put hot containers of broth into a freezer or refrigerator, compromising the temperature of other items. Either hot broth or cold broth is safe, but warm broth spoils quickly, and should be stored or used promptly. 

I freeze our broth in quart containers being careful to leave about three quarters of an inch of head space at the top. Now I have a delicious base for any number of different kinds of soups or sauces. We have used this to make soups with chicken, red meat and all kinds of vegetables.

Mostly we just make soup with what is on hand. The general principle is this: Pick a soup pot of adequate size. Saute your meats, garlic, onions, and hard vegetables one by one in olive oil and spices. Once they are cooked, cover with broth and add the softer vegetables such as tomatoes and greens. Bring to a boil, then simmer until done. Season to taste. To your health ! 

Wellness Wednesday: Survey Results for your Biggest Health Challenges

Don't you like getting survey results? It's like getting the punchline to a joke or solving a puzzle. Basically you get to compare your anticipation of the results with the actual results. It's even more fun when the results you get are unexpected. 

Many thanks to those who took the time to complete the survey. The number is small, but it is more than last survey I ran.

Here are the key results:

• Approximately three quarters of respondents felt that their health was only somewhat where they wanted it to be.
• The biggest health challenges were divided almost equally across nutrition, fitness, weight, and stress.
• Most everyone who took the survey took the time to write a bit about the biggest obstacle to health maintenance. Time was the most common theme expressed in a variety of different ways. Some people referred to the time demands of their job, partner, kids, house and pets. I doubt very much that these things are ever going to go away. In fact, I hope all of us always have jobs, partners, kids,  houses and pets. It sounds to me that concerted improvements in time management would be helpful across the board.
• Respondents were uncertain and vague when asked open ended questions about what would help them the most with there health. However when given a choice of specific set of health related products, they were able to clearly choose what would help them the most. This is where the surprise came. It wasn't a product at all. Far and away the most often chosen product was a "health coach." 

Fairly recently I ran into a physician friend of mine who I thought had retired. It turns out she had actually gotten certified as a health coach. She is loving it and and really feels like she's making a difference in her patients' lives. So after I saw the results of my survey I called her up to find out a little bit more. It turns out that health coaches are probably the next big thing in preventive medical care. 

It turns out that there quite a few health coaches out there and it turns out there are a lot of courses you can take in person and online by a great many certifying organizations to become one. However, only one organization is approved by the American College of Sports Medicine, the Wellcoaches School of Coaching. (wellcoachesschool.com) It is an evidence based program which uses up to date behavioral, exercise and fitness science to help people improve their life and their health. Luckily for us, my friend was certified in this manner. She works at out local fitness center. 

All well and good. But I called her later and grilled her about insurance coverage for such services. It turns out that, yes, many insurances do cover some health coaching, which struck me as a pleasant surprise. So I am going to start utilizing her and her team for my patients. I and many other doctors do a lot of office based health coaching, but in the setting of providing specialized medical care I can only give health coaching a limited focus. 

I wonder about those without insurance, those with high deductibles, and those with insurance that does not cover health coaching. I still would like to know what resources would be helpful to people who wish to, in effect, be their own health coach. What do you think ? 

Food Friday: Healthy School Lunches

Think this is going to be a bunch of recipes ? Think again. Here is what it really takes to have your kids' school lunches be healthy. It's not what you think, and it takes a lot more than a recipe. 

A healthy school lunch that is well received by your grade school child is one of the crowning achievements of parenthood. To engineer this amazing feat, you must be ambitious, disciplined, creative and start very early in the game, like before you are even pregnant with the child. Seriously ?

Most depends on you, and this is both bad and good news. It means the obligation is upon you, but it also means you have the power. While you will see that I am emphasizing a strategy that works best if you start early in a child's life, these strategies can work on older children, teens, and in principle, even husbands !

You must lay the appropriate groundwork in your home. Your parenting should have that " just right" touch which is not too lax and not too firm. Your home should run smoothly, so that kids feel secure. Then you must learn what healthy food is, and learn to prepare it so it is easy to handle and appealing to eat. Then you start thinking about healthy school lunches. Here are your tips: 

• Start very early on healthy eating habits for the whole family. 
• Make sure you know about nutrition, and not just what marketers say. 
• Lead by example, i.e. shop, cook and eat healthy yourself. 
• Make superb healthy food a family hobby. .  
•  Know your kids friends.
• Foster this philosophy among your kids' friends by having them over to do cooking projects. Get them involved in the tradition of really nice healthy food. 
• Know about school food situation. (Is there a hot lunch ?) 
• Know about school policy ( Is food trading permitted ? ) 
• Know the school social scene (Are there bullies ? ) 
• Be aware of social sensitivity surrounding home packed lunch. ( Is it cool ? Uncool ? ) 
• Involve children in the school lunch making process. 
• Look up healthy school lunches online together. 
• Make a shared Pinterest album of school lunch ideas. 
• Choose and purchase their lunch containers together. Let the child have a much say as possible.
• Observe Food safety when packing lunches. Consider a reusable ice block. 
• Get kids involved the night before in composing and packing their lunch, at the same time you make yours ! 
• Don’t be a purist. Include some healthier treats like dark chocolate or covered almonds ! 
• Consider the classic note of encouragement. Consider variations such as riddles or anagrams. 
• Enjoy the process ! 

Food Friday: The Healthy Junk Food

What is the secret superfood that shows up at every tailgater, and is served alongside beer and junk food ? Salsa of course. 

Salsa simply means sauce in Spanish. It is usually a tomato based sauce which can be flavored with other vegetables, fruits, and spices. Classically, it contains chilis of some kind and garlic, but the variety from there is infinite. 

Most Americans buy their salsa rather than make it. I would venture to guess it is eaten most often in this country with tortilla chips. I am going to suggest you take a walk on the culinary wild side and make your own salsa. Then take it a step further and serve it with something other than chips. 

Consider mixing and matching the following ingredients. 

Base: 

• red tomatoes, raw or cooked, pureed or diced 
• green tomatillos, cooked 
• avocados, creamed or diced ( always include something acidic with these, i.e. lime juice, which prevents browning).

Heat: 

• garlic
• onions 
• chilis- powdered or fresh, with sweet, fiery and smokey variations.
• black pepper

Flavor: 

• fruits like mango, peaches, pineapple, strawberries 
• greens like cilantro, green onion or fresh mint
• olives 
• chocolate ! for mole

Texture: 

• fresh corn 
• chopped sweet peppers, red, green, yellow, orange
• Beans, i.e. red or black
• cucumbers 
• Jicama

Dressing: 

• olive oil
• vinegar or citrus i.e. lemon, lime, or even orange. 

I think you can see from these ingredients that salsa is rich with healthy ingredients. Now try it on meat, fish, chicken, eggs, or really any main or side dish. Salud ! 

Food Friday: Cooking for One

I have written a lot about the value of meals with others. But what about the single person, student or empty nester who is often cooking for one ? 

In doing some research for this post, I found some unexpected hilarity. One of the best posts came from one of my favorite websites called Greatist.com. They addressed headlong the temptation to have a pity party. They called out tendency to wallow in loneliness and junk food. They described " sad bowls of cereal ". I was laughing and feeling bad at the same time. 

But seriously, loneliness is bad. And if a person finds themselves feeling lonely, they should name it and change it if they wish. I am no expert in this regard since I am most often surrounded by people. But I am a physician and I would encourage any one who suspects they have the corollary of loneliness, i.e. depression,  to reach out to their physician for assistance. 

But let's say you are not depressed. You're just cooking for one. You have several options. 

1. Find someone to eat with. There is a large selection of apps and websites out there to help you find a random stranger to dine with. Seriously ! Check out the HuffPost article below which features several of them. Consider also eatwith.com, mealsharing.com, lunchmeetapp.com, and cookening.com.

2. Go out to a restaurant and at least be around people. This could work if the food was healthy and good choices were made. However one of my sources listed below indicated that, as a general rule, restaurant food is consumed in greater quantities, and contains more saturated fat and sodium compared to home cooked food. 

3. Cook a nice full meal with nice regular sized recipes and have a bunch of leftovers. This is the theme in the Bon Appetite pages cited below. They take the position that you should eat only the best. Tiny little streamlined recipes do not do it for them. 

4. Cook a balanced little meal for one with little mini recipes for one. Most of the links below propose this. 

Notice I did not say have a bowl of cereal or have a TV dinner. I am talking about healthy food here. Here are some tips for literally cooking portions for one. 

Buy food strategically. Here are some examples:

1. Choose individually frozen portions such as cut fish fillets  or chicken tenders.

2. Choose foods that doing not spoil quickly such as broccoli over red lettuce.

3. Choose foods that require very little preparation since let's face it, the time we usually want to spend cooking is directly proportional to the number of people for whom we are cooking. Fresh fruit takes little prep. Sliced tomatoes with fresh mozzarella takes little more. 

4. Accept that you are going to have to add a few different components to your meal to make it nutritionally optimal.   A banana and a glass of milk is not a meal. It is, however, a decent snack. 

5. Buy large quantities of healthy foods an repackage them for easy storage and access. 

This weekend I might, through a series of unfortunate events, be spending some time cooking for one. I'll be all about the can of salmon over the complex giant salad. But you may want to do better. Here are some great recipe collections for one. 

http://greatist.com/health/healthy-single-serving-meals

http://allrecipes.com/recipes/15050/everyday-cooking/cooking-for-one/

http://www.helpguide.org/articles/healthy-eating/cooking-for-one.htm

http://www.bonappetit.com/entertaining-style/trends-news/article/cooking-for-one

http://www.huffingtonpost.com/2013/09/18/dining-app_n_3942874.html

Food Friday: Cold Desserts

It’s hot and fruit is in season. Here’s a little history of your favorite summer desserts and some tips on how to modify them to make them healthier. 

• Frappes- ice, milk of some sort, flavorings, blended as a drink, originated in Greece  in the 1950s, named with the French word for shake or strike. 
• Smoothies-a thick beverage made of  ice, milk of some sort, yogurt, fruit, blended as a drink. Some include vegetables, nut butters or protein powder. Recipes originated in Brasil, and were popularized with the invention of the blender. These became popular in the US in the 1960s. 
• Ice cream - In the US defined as having 10 % butterfat or more, frozen, with lots of air whipped in. Frozen dairy desserts date back many centuries to many countries. The English first published recipes for ice cream in the 1700s. 
• Gelato- Italian ice cream; must be at least 3.5 % butterfat; comes from Sicily since Sicily is near both mountains with ice and orchards with fruit. 
• Sherbet- frozen blend of milk and fruit flavors about 1-2 % butterfat, An lower fat American version of ice cream.
• Frozen yogurt - yogurt with flavoring like fruit, frozen and whipped. Originated in the Us in the 1980s during the fitness revolution. 
• Granita- water, large ice crystals, sugar and flavorings like fruit juice or coffee; also hails from Sicily. 
• Sorbet - dense frozen confection of water, sugar, flavoring, frozen and blended smooth; folklore dates it back to the Roman emperor Nero. 
• Popsicle- originally was frozen flavored ice on a stick. Patented in Oakland California in the 1920s. Modern versions may contain other ingredients like fruit. 

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You can find recipes for these in many places. My favorite sources are :

epicurious.com

Food.com

Foodnetwork.com

 Pinterest

Here are some general principles which will help you create desserts that people will enjoy. 

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• Get a good electric ice cream machine. 
• Get a good blender, preferably a Vitamix. 
• Get some popsicle forms and make your own healthy versions. Make icy or dairy versions; consider adding fruit slices. 
• You may use a simple metal pan placed in the freezer, combined with periodic stirring. Granitas work especially well this way. 
• Use sweet ripe fruit if you are omitting or reducing sugar. Consider adding half a banana or a few sweet grapes to certain desserts to sweeten. Those who like stevia may try that, though be sparing. The point is to taste the natural flavors. 
• Choose coconut milk if you are dairy intolerant. 
• Choose dark chocolate flavoring. 
• Choose decaf coffee for flavoring. 

It is a fun summer family activity to make healthy cold desserts. However, you have to have a good attitude if you are going to take conventional recipes and modify them to make them more healthy. You can’t expect them to taste exactly like store brands, and that’s just fine. 

Food Friday: Treats

This is a health oriented blog. And yet, I hope for all my readers to experience a wide range of culinary delights. Food is for celebration and rich sweet treats are served at celebrations. How can you participate without feeling like you’ve eaten poorly ? Here are ten tips to turn nutrition buffs into connoisseurs too. 

1. Eat properly on all regular days. 
2. Get your workout done before attending your party. 
3. Fill up on healthy foods before the dessert treats arrive. Savor them as much as the treats to come. 
4. Fill up on healthy beverages like water, soda water and herb tea before dessert arrives. 
5. Skip dessert if its not really well done. 
6. Skip alcohol if you chose a rich dessert. 
7. Be discriminating. Chose only the best for yourself, e.g. choose chocolate mousse over a cheap candy bar. 
8. Take a small portion. 
9. Savor your portion; Eat slowly and mindfully. 
10. Enjoy ! 

Food Friday: On the Glories of Summer Fruit

Summer fruit is not just something to eat. It is a family project. It is a creative endeavor, and it is Holiday preparation. Finally it's a great bargain. 

Most people think of boxes of ripe summer fruit as the mere predecessors of pies and cobbler. I love fresh pie and cobbler as much as anyone else, but there is only so much you can eat and stay healthy. 

Consider the price of frozen fruit at the grocery store, even Costco. Frozen fruit is a premium item, and if you have ever tended a tree or picked a bushel of fruit you will know why. But, to go to a produce vendor for a box of ripe fruit in season, you will pay a fair price for an excellent product. But you must buy it by the box or bushel, which might be daunting to some. 

Take courage ! To freeze you need only freezer worthy ziplock bags, some time, and some lemon juice. Freeze by the quart or by the gallon. 

To dry, you need patience, an oven, a very hot day, or a dehydrator. With a little more cleverness and maybe a recipe, you can make fruit leathers, which are a most welcome gift. Now is the time to get some made to give at the holidays. 

Jam has less sugar than jelly and is a suitable treat or gift when home made. Delve into the exotic fruit spiked salsas, and you will have serious trouble keeping it around. 

To be fair, you will need some equipment. First you will need large bowls and pots. You will also  need many hands to help wash and slice. The thrifty among you will want the largest good freezer you can afford. Canning pots and tools are relatively inexpensive, and jars are a common item at garage sales. Just be sure they are in good condition and not chipped. Finally for the connoisseurs, you will want a proper dehydrator. And by all means indulge yourself in one of the many beautiful books about preserving. You may as well get the gold standard, the Ball Blue Book Guide to Canning and Preserving. 

If you do this sort of kitchen magic with the kids, they will be fascinated. Photo document your fun and you will be blog- worthy and an instagram hit ! You will also have a really good spoon to lick. 

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Structure Sunday:The Structure of Back to School Preparation

I loved school. But I always hated those back to school signs in the stores. I still do. It always made summer seem shorter than it really was. And yet, now that I am a seasoned parent, I think there are real benefits to preparing for back to school. 

Just about now, it’s time to check in with your kids about any summer assignments they might have had. Don’t be that parent who declines to ask since they want their child to “ do it on their own”. Ask and get involved. Yes, it is nice when kids are self starters, but each kid is different, and you should at least know what is going on. 

It’s time to get together with your munchkin and deep clean their room. Give them some advance notice so that it is not a shock and so it does not interfere with their remaining summer plans. Let them know you might be willing to make some improvements if a good job gets done. Great examples would be a new bulletin or marker board, or perhaps a cool shelf.

Make sure that once their room is clean that everything truly has a place. Sometimes kid get blamed for having messy rooms when in fact there really is nowhere to put anything. Make sure there are enough hangers, shelves, baskets, boxes, or whatever it takes to fulfill the maxim “ A place for everything and everything in its place. “ And of course, most importantly, set a good example and keep your house clean, tidy and organized. People, especially kids, get used to whatever they’re in. You do your kids a big favor to model organization to them in this way. Being spatially organized does so much to lower stress in the house. 

Make sure to supply what they need for school. Make sure the basics are there, but also try to show you value education by going the extra mile for them with their school supplies. Make sure they have an excellent backpack to carry it all. Allow them to express their personal style. 

Make sure you know about the lunch and PE situation to come. Consider a well done home made packed lunch if school lunch quality is marginal. You can even teach your child to make her lunch eventually. Food is a great place to show kids values in action. Make sure your child has a chance to choose how they carry their lunch. 

Attend any orientations or registrations with your child, all the way through twelfth grade if you ask me. 

Finally, survey the back to school clothing situation. Assuming the room cleanup went well, ill fitting, damaged, or unwanted clothing has been given, donated, or recycled. Introduce the idea of starting your school shopping at a good thrift store such as Goodwill. Offer to take some of your child’s friends along. It is a truly fun treasure hunt. It is hip, green, and cheap.Then after that, check online for any swaps or sales, then get what you must new. 

You are the parent and you have a lot of influence. You can have this influence better by what you do, compared to what you say. Your day to day choices about how you interact with your kids convey your values. These back to school  tips will help you your convey your interest in their education, life habits, and health. They help you convey that you care about them. 

Food Friday: Fast Food

I am loathe to miss a meal and can hardly tolerate missing a snack. My patients know they aren't supposed to either. Metabolism, energy, a bright outlook, ability to exercise, blood sugar control, weight management and sharp thinking all depend on it. So often my patients say they don't have time to eat, especially breakfast. These are the same folks who are struggling with their weight. So instead of repeating this point, I am going to give you my down to earth, personal go to suggestions when you really have next to no time to make and eat food. 

First, however you have to shop correctly. Remember super basic is key, and one real cooking episode is needed: dinner. Most people don't struggle with dinner. Cook extra at dinner so you will have leftover protein rich foods and cooked vegetables. 

Here is my basic grocery shopping list for fast food, by section.

Freezer: 

• Lean meat, chicken, turkey, fish, shredded cheese
• frozen fruits for smoothies: mixed berry, mango, blueberry etc 

Fridge: 

• Milk, cottage cheese, plain yogurt, sour cream, cheese, kefir, eggs
• salsa, condiments like pickles 
• whole grain low carb wraps
• nuts like walnuts and almonds 
• healthy broth mix 

Pantry: 

• whole grain bread, corn tortilla chips, oat bran cereal, healthy cold cereal like muesli 
• canned salmon, canned tomato products, sauce and stewed
• your favorite complete protein powder
• dried fruits like craisins 
• oils - olive and canola 

Produce: 

• cooking greens like chard, kale and spinach
• Salad greens like spinach and lettuces 
• cucumbers, tomatoes, broccoli, green beans, zucchini, carrots, colored peppers, avocados
• Strawberries, watermelon 
• apples, bananas, oranges  
• red and green grapes 
• stone fruits in season 

"Recipes"

Breakfast : 

• bowl of cottage cheese or plain yogurt with any fresh or frozen fruit. optional : nuts, craisins
• healthy cold or hot cereal with dollop of yogurt, and some fruit
• chopped fresh or leftover veggies with a couple scrambled eggs with or without cheese. Dress with salsa, sour cream or avocado. 
• wrap with leftovers 
• 2 cups milk with protein powder 

Snacks: 

• hardboiled egg, cheese, dairy, fish chicken or meat with fruit or veggies like carrot sticks

Lunch: 

• Salad greens with  hardboiled egg, cheese, dairy, fish chicken or meat. Try mixing canned salmon with mayo olives and pickles for a great spread. On a cold day, make soup with broth and leftovers. Make it the blender to speed up the process. 

Dinner: 

• Main protein rich dish, green salad, cooked vegetable and fruit for dessert. Cook extra for wraps later.

Note:

• A hefty blended smoothy with yogurt and protein powder, fruit and even vegetables can substitute for any meal. 

Give some of these fast foods a try. Bon appetite. 

Food Friday: Food Joy and Fat ?

Food joy. Does all this enthusiasm about food contribute to the obesity epidemic ? Consider everything hot now in food : food magazines, the food channel, food trucks, street food, farmer's markets and local food ! Vegan, Paleo, Pegan, organic. 

I say a resounding NO. All this food joy is a great step in the right direction. It does not contribute to the obesity epidemic. I have no data here. I only have 30 years in medicine, most of which is focused on women’s health. 

Those with poor nutrition and problems with obesity are most often those who have not discovered the joys of food. Many times they are those that eat whatever food they can get. This ends up being the stereotypical top ramen, soda pop and boxed mac and cheese, or the iconic white bread. I remember unkind comments from adults I knew as I was growing up, as they wondered how people with so little money could get so much food to get so big. This reflects a profound misunderstanding of nutrition poverty and obesity.

Many times overweight people do not eat very much. They have little and eat little. What they do have is cheap carbohydrate, and they need to eat it as their whole meal since protein sources and fruits and vegetables are or are perceived as less available. Because of this diet, these folks suffer from chronically low metabolism and have low energy. They therefore become less active. Their extra weight compounds their insulin resistance, which results in more fat deposition. It is very hard to get out of this vicious cycle.

Many times I see young women in this predicament while they are pregnant. In this instance they have access to better resources such as food stamps as well as nutrition teaching. I have found that they are as eager and able as anyone else to learn. Once they do learn about the correct composition of meals, as well as the correct timing and quantity, they are astounded about several things. First, they are astounded about how much they enjoy their new diet. The are almost universally shocked at what large quantities they are supposed to eat. And, given this, they are amazed that their pregnancy weight gain levels out appropriately. Finally, they begin to enjoy food preparation, but note that it is a time commitment that they did not have before.

Some have odd reactions from significant others, and find themselves isolated. The partners may not want to change the way they eat. Sometimes partners even make fun of the one trying to be healthy and tease or taunt them back down to their level of poor nutrition. 

Most of the time this change toward nutrition awareness, and eventually toward food joy, is life altering. They never want to go back. Sometimes it becomes a source of pride and accomplishment in the family, and mealtimes become social in a way that they had not been. 

To me, the final stage of food joy is the social and cultural aspect. I took a walk down my own Main Street. I was amazed at what our little town had to offer. We had artisanal breads, real sushi, Thai food, genuine French macarons, and handmade watermelon chili sorbet all on one block. Granted, most of these delicacies were treats. But they were foods that made people appreciate food, other people, and other places. I saw people clustered in cafes, and out on the sidewalls. I saw people working on laptops, socializing, and flirting, all the while over special foods and drinks. They all seemed rather vibrant. 

It appears that people who take the time to walk about to find beautiful food like this are not apt to “ waste” their calories or carbs on junk. They become conoisseurs who are interested in the best for themselves. 

It is always a step in the right direction when people start to focus on quality, in nutrition, food, or even cuisine. When people focus on quality in one dimension of their lives, it tends to spread to others. My favorite part of this whole process is watching patients start to embody quality and enthusiastically take good care of themselves. 

Food Friday: Healthy Substitutions

Eating well is not about dieting or deprivation. It is about understanding food and physiology. It is also about taking a little extra time to obtain and prepare great tasting and healthy food. Some people worry about all the things they would have to give up to eat healthfully. But I’d rather think about all the substitutions that both taste better and are better for you. 

Here are some specific examples to make this easier: 

Drinks: 

• Instead of cheap caffeinated coffee, use water process decaf made strong in a french press. Or, for lower cost, try decaf Earl Grey tea. 
• Instead of sugary or artificially sweetened soda, use club soda, plain Pellegrino or Perrier with a light splash of pure fruit juice and citrus wedges. 
• Instead of a milkshake, have a smoothie with real fruits, plain yogurt, and ice. 

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Snacks: 

• Instead of forgetting snacks for work, bring a week’s worth on Mondays. Include easy things, like raw nuts, cheese, and long lasting vegetables. 
• Ditch the granola bars in favor of sweets like fruits with plain yogurt or cheese. 
• Steer clear of office sweets by having your own vegetables, dips and nuts. 

Breakfasts: 

• Instead of an Egg McMuffin, saute mixed veggies like peppers, onion and tomato then cook with a couple eggs and a little cheese. 
• Instead of a sugary cereal, have a low sugar whole grain high fiber cereal with skim milk and piled with fresh berries or even slivered almond. 
• Instead of no breakfast have the very quick banana and a glass of milk. 

Lunches: 

• Have a breadless sandwich. We call it a salad with meat. 
• Keep things like salad dressing at work so your lunch salads are more appealing. 
• Watch cafeteria soup… it is full of fillers like starch and sugar. Make a big batch from scratch and bring it all week long.

Dinners: 

• Instead of main dish, salad and starch, have main dish, salad and cooked vegetable. 
• Instead of pasta or rice, have Zoodles, meaning noodles made from vegetables such as zucchini. 
• Broil, grill or bake rather than fry. These methods require less tending and cleanup anyway. 

Desserts: 

• Make a crustless or nut crust pie and reduce the sugar. 
• Have plain yogurt or cheese with fruit for dinner. 
• Make a conventional dessert but halve the portion size and make it beautiful. 

To learn more about the principles behind these modifications, see the following sections on our website: 

Nutrition 

Nutrition in Pregnancy 

 

Food Friday: Drink !

I am absolutely compelled to write again about hydration in this, our week of three digit temperatures. I had one reasonable and well intentioned patient who came in with symptoms and was FIVE LITERS short on her hydration ! 

Let us review. Normally, a non pregnant woman needs 2 liters of fluid per day. A pregnant woman needs three. Add another liter for temperatures over 85 degrees, and yet another liter for activity such as hiking. So if you are pregnant and hiking on a hot day, your fluid requirement is easily 5 liters, and that is assuming you are coming to the day adequately hydrated in the first place. 

The human body is about 60 % water. Let's say you weigh 154#. That means you weigh 70 kg. That means you contain 42 kg of liquid or 4.2 liters. Getting short on fluid percentage wise is easier than you think. 

How can you lose so much fluid ? Well there are the obvious ways, but then there is also respiration, sweat, and something short of sweat which is still fluid loss through your skin called insensible loss. It all adds up. Heat and activity increase insensible losses like crazy. 

Here is the interesting stuff: 

" ...fluid loss of 1% impairs thermoregulation (the ability to regulate your temperature), and thirst occurs at this level of dehydration......Vague discomfort and lack of appetite appear at 2 % . Dry mouth appears at 3%. At 4% work capacity is decreased. Difficulty concentrating, headache, and sleepiness are observed at 5%. Tingling and numbness of extremities can be seen at 6%, and collapse can occur at 7% dehydration. " ( reference from the World Health organization) 

Here is the fun stuff: 

Summer is a great time for cold drinks. Try to take the traditional summer cooler and put a healthy spin on it. Here are some examples that will provide you with much needed electrolytes as well as fluid and taste. 

• Club soda with a splash of 100% fruit juice. 
• Mocktails like Virgin Mary, Virgin Daquiris
• Herbal iced tea or sun tea on ice with lemon and mint leaves, sweetened with a little fruit juice 
• Healthy fruit frappes made with fresh fruit, ice, and plain yogurt or kefir. 
• Decaf mocha frappes made with ice, one pump of chocolate, and your milk of choice. 
• Stay hydrated and enjoy ! 

For more information see : 

Drinks in Nutrition 

Weathering the Heat 

Food Friday: Fruit Stands and Farmer's Markets

My dad and I didn't always get along. He was an old school businessman from the midwest and I was a California city girl. So much was off base. Nonetheless, I recall our trips to fruit stands with affection.

Whenever we drove out to the countryside in search of fruit stands with beautiful produce, everything became right. My dad had a childlike enthusiasm for such things. He would inspect everything that was set out, checking color and smell, and then speak earnestly to the farmers about the season and their particular varieties and cultivars. He would direct me to examine each astounding thing.

 He was particularly concerned with tomatoes. He could remember all their names, and was thrilled to see the varieties with unusual colors and dense sweet flesh. He liked nothing better than to slice the finest deep red ones onto a plate with a little salt. 

All this is brought back to me at this time of year, as I look forward to the farmer's market each week. I would encourage you to pack up and go. Bring some cash, some bags, a camera and the family.

Here are several great reasons to get out to the farmer's market: 

• You will see what is being produced in your area. 
• You will get the best tasting fruits and vegetables. 
• You can get large quantities for "putting up" ,i.e. canning, freezing, and drying. These projects can be simple like applesauce, pickles or jam, or complicated like salsa, relish or chutney. They can be for your families' delight or for use as coveted gifts at the holidays. 
• You can meet new people and see ones you already know. 
• You can get gardening tips. 
• You can find some unique gifts or get inspired to make your own. 
• You can use your fancy stroller and wear a big hat. 

My dad made the acquaintance of an old Japanese man who sold a particularly fine dense large red tomato. He had brought it from afar, and developed it. It had no name. Late in my dad's life, he saved some seeds from this tomato and put them in an envelope scrawled with the following, " Gina, Hope these seeds produce. If so save some for me. " 

Many years later, after his passing, I found the envelope. I did not trust myself to grow them out, so I gave them to a neighbor who is very careful gardener. To our surprise they germinated and produced the lovely tomato. 

Medical Monday: Insulin resistance

This is one of those chicken and egg things. It turns out that being insulin resistant makes you gain body fat. But, it also turns out that gaining body fat makes you more insulin resistant. What a vicious cycle! No wonder it is hard for people to lose weight. 

Recall that insulin is the hormone produced by the pancreas which is responsible for getting glucose from the circulation and into the cells, where it can be used for energy.

Recall that glucose is the final breakdown product of all carbohydrates (carbs) like bread, rice, pasta, potatoes, etc. If too much glucose is in the circulation, either because too much has been consumed at once, or because the insulin cannot move the glucose into the cell or both, high levels of glucose in the blood stream get turned into triglycerides and fat. Atherosclerotic plaques can form in the vessels and cardiovascular disease results. This is part of what we call metabolic syndrome. 

In a normal person, insulin rises in response to a meal and diminishes in-between. Moreover, it rises in proportion to need. Insulin would spike if you drank a coke, but just gently ebb if you ate some strawberries. Why? Because the sugar of coke just jets into your bloodstream, unnaturally rapidly. Your body cannot cope with it. A strawberry has structure and the sugar and nutrients release slowly. Said another way, the glycemic index of coke is high, and that of a strawberry is relatively low. 

I recommend that my patients eat low glycemic all the time. What about treats? When a person eats low glycemic consistently, their ambient insulin levels decrease. Insulin levels are related to cravings, and their cravings diminish. A "treat" will bring the cravings back, since it may cause insulin levels to spike. If you think you can have an occasional treat and then resume your healthy low glycemic diet and resist cravings, more power to you. 

How do you turn this vicious cycle into a virtuous cycle? First visit with your doctor if you have diabetes, the condition which is the mother of all insulin resistance. Visit with her if you have been told you have polycystic ovary syndrome. This also entails some degree of insulin resistance. 

Second, learn about how to keep your blood sugar low and steady, with three meals and three snacks every day. Add protein each time to buffer your carbohydrates. Add exercise everyday to boost your muscle mass, burn fat, increase your insulin SENSITIVITY and increase your metabolism. 

Here's the flip side of the coin: If you lose fat, you will become more insulin sensitive. And, if you become more insulin sensitive, you will make it easier to lose weight! 

To learn more, check our sections on 

NUTRITION 

CHRONIC ESTROGENIZED ANOVULATION

For more reading check THIS out from Live Science. 

Food Friday: Picnics

Did you know that picnics were once only for the very wealthy? Picnics evolved from outdoor hunting parties in the 14th century in Europe. Such elegant outdoor meals were depicted in artworks and tapestries dating back to the Middle Ages. Picnics themselves became entertainment for the wealthy from the Middle Ages, through the Renaissance, and then into the Victorian era. They epitomized the virtues of the wealthy classes, which extolled sport, social life, the beauty of nature, and elegance. In the Victorian era, picnics became especially popular and extended to the emerging middle classes. 

The Oxford English dictionary defines picnics thus: “Originally, a fashionable social entertainment in which each person contributed a share of the provisions; now a pleasure party including an excursion to some spot in the country where all partake of a repast out of doors; the participants may bring with them individually the viands and means of entertainment, or the whole may be provided by some one who “gives the picnic”. 

Today, picnics are far more casual, though they still retain the aspect of having a festive meal outdoors. In our country, we tend to have picnics primarily in the summer. This poses some risk, since in summer temperatures, food borne illness is more common. Here are some tips to avoid problems: 

Pack safely: 

• Include materials to clean hands, with soap and water, sanitizer or wipes. 
• Pack ice, clean utensils, plates, leftover containers, paper towels and trash bags. 
• Pack cool food with ice packs to stay below 40 degrees. Open infrequently. Pack drinks in a separate cold cooler, since this drink cooler will be opened frequently. 
• Carry coolers in an air conditioned car, not the trunk. 
• If hot food is precooked, do not delay before finishing cooking on the grill. Any time lapse in-between is an invitation for bacterial growth. 
• Cook hamburger and other meats to 160 degrees, and chicken to 165 degrees. 
• Prevent cross contamination with drippings or marinades. 
• Do not reuse marinades. 
• Don’t serve on your prep platter.
• Discard food if left out more than an hour at 90 degrees. 

Pack creatively: 

Consider some alternatives to traditional cuisine. 

Classic American picnic foods, as for Fourth of July 

• fried chicken
• hot dogs
• macaroni, egg or potato salad
• corn on the cob
• iced tea, lemonade
• apple pie 

French picnic foods, as for Bastille Day 

• Baguettes and baguette sandwiches
• pate foie de gras or tapenade 
• Salade Nicoise 
• Perrier Sparkling water 
• macarons
• mousse or pots de creme

Italian picnic food: 

• salads: pasta, caprese, arugula
• bruschetta with toast
• limoncello soda 
• layered torta or pizza 
• salami, ricotta, fresh fruit 

Swedish picnic food for Midsummer celebration:

• grilled marinated lamb
• Gravlax
• pickled herring with sauces 
• seeded crispbread
• cheesecake with berries 

If you don’t recognize the dishes, google them or search on Pinterest. You have some pleasant culinary surprises in store for you. 

References: 

Chow.com

Food Timeline 

Pamphlet: Pack a Family Picnic

Foodsafety.gov

Home Food Safety 

FDA

Structure Sunday: The Structure of Grocery Shopping

I am interested in grocery shopping since it has a great deal to do with what we eat. What we eat has a lot to do with our health. Since this is all so very important I am going to break it down into ridiculous but useful detail. The following is a primer on how to go grocery shopping. 

First reflect: 

First and foremost, think about your nutrition goals for the week. Remember that Dr. Gina wants you to consume primarily meat, fish, chicken, vegetables and fruits in three meals and three snacks every day. Review our Nutrition section if you have questions. Think about some of the awesome healthy dishes you would like to make. Include those ingredients on your list. 

Inspect, tidy and make lists: 

Be brave and look into the depths of the fridge. Find any science projects (spoiling food in containers) and get rid of them. If you consolidate things like ketchup bottles and wipe out the refrigerator shelves a little bit it will make you feel so much better. You will see that feeling better is actually important, since it will help you avoid buying things you don’t need. Look in the freezer, and all the cabinets too. Make room for the new groceries. Go to your laundry room and your bathrooms, and check and tidy there as well. After you are done inspecting and tidying, make your lists of all the things you need to buy. You can group them any way you want, either by store like I do, or by store section. Make your list on paper or on your phone. I tend to lose paper lists. 

The idea here is that with a list you will buy only what you need, and nothing that you don’t need. Sure enough, you may run into excellent and discounted produce you didn’t know was in season, and that I believe is a legitimate reason to go off list, but just any old bargain is not. 

Prepare yourself to shop: 

Research clearly shows that we often suffer from “needs confusion”. When we are tired, hungry, bored or angry, we soothe ourselves with retail therapy. Buying, like many pleasant things, produces a surge of potent neurotransmitter, not dissimilar to those felt with accomplishment or good fortune. In unpleasant states, we are more vulnerable to marketing ploys and subliminal suggestion, and we are anxious to resolve our uncomfortable state. So, I suggest that you work out, shower, dress and eat at least a healthy snack before going out to shop, hereby calling up happy neurotransmitters in more legitimate ways.  

Pack for the trip: 

Make sure and collect all your reusable and attractive shopping bags. Get rid of the ugly downer bags, my goodness. Life is too short for ugly shopping bags.

Bring healthy snacks so you will not fall prey to the samples. Bring all the equipment and healthy snacks you need to keep kids happy. This will help both kids and parents resist child-initiated impulse buying. 

When to go: 

I am a firm believer in twice per week shopping. Any more is onerous and any less results in a lack of fresh food, which is so important. I have chosen Sundays and Wednesdays since that is easiest for me. 

Where to go: 

Assuming you have already gone to your own garden, your own freezer, and your own farmer’s market first, you must then consult your list. To get exactly what I want (and I am very picky) I have to go to at least two stores. Usually one is Costco, which has more organic food all the time. The other is my local organic/natural/whole food store. 

 

Once you get there:

Understand that everything in the store environment is designed to get you to buy. This goes from the print, the colors, the displays and the music. Use your own mind. You have already decided what you need.

• Be skeptical, stick to your list, and be a label reader.
• Be wary of health claims on product packaging.
• Stick to real fresh food, which is mostly located on the periphery of the store. Stay out of the middle of the store without good reason.
• Be cautious about budget brands. They may be cheaper for market reasons, or because they use cheap fillers which are not healthful. 
• Be cautious about coupons and sales. Do not let these cause you to buy something you don’t need or more than you can use. 

Enjoy yourself: 

Your nervous system is right. You have every reason to feel a thrill right down to your neurotransmitters when you pick up you a big crate of ripe strawberries. Eating is one of the great joys of life. To be able to acquire beautiful varied foods as we do is unprecedented in human history. Think about what it takes to bring us this food: all of the people and places and knowledge that come into play. It is nothing short of amazing. 

 

 

 

For more reading : 

How to Buy Food, at Bon Appetite

The Psychology of Shopping: How Grocery Stores Make Rational Shopping Nearly Impossible

Supermarket Psychology, by Weight Watchers 

Surviving the Psychology of Sneaky Supermarkets, at National Geographic 

A Few More Ways that Supermarkets Mess with Your Mind, at Business Insider 

11 Psychological Tricks of the Supermarket Trade, at Food Network

Ten Ways your Local Grocery Store Hijacks Your Brain, by Psychology Today 

Food Friday: Cool Dinners for Hot Days

It’s summer and the weather is hot. It’s great to turn to festive cold dishes. But they often contain lots of simple carbohydrates, which most of us should avoid. Here are some tips to help you avoid the same old sandwiches, crackers and pasta salads. 

Some recipes, especially these which are high in protein, require a little preparation in advance. 

With advance cooking: 

• Prepare any kind of meat, chicken or fish in surplus. Use in any of the following ways: 
• Season liberally and toss into a leafy green salad for a balanced meal, e.g Taco salad. Serve with fresh corn rather than chips.
• Season liberally and toss with firm vegetables such as cubed carrots, steamed broccoli, carrots, peas, corn, peppers, tomatoes. Dress with a vinaigrette in advance to marinate, flavor and soften. Add raw nuts to any salad but be sure about allergies. 
• Make wraps and include vegetable, garnishes, salsas and condiments. Consider rice, seaweed or iceberg lettuce wraps with toothpicks. 
• Use hard boiled eggs as a protein rich garnish to leafy salads, or mix with olive oil vinegar, mustard lemon and spices to make a rich dressing. Traditional Cobb Salad and Salade Nicoise are made this way. 
• Make an egg salad with lots of vegetables like celery, pickles, relishes, peppers, etc. 
• Make “meat” balls of chicken, meat or even fish (called gefilte fish traditionally), and serve on sticks with flavorful cold sauces for dipping. Find recipes that have high flavor since flavor is more subtle in cold dishes. 
• Make chicken salads, e.g. curried chicken salad or Waldorf salad. 

With no advance cooking: 

( Remember, deli meats are not for pregnant women.) 

• Meat deli trays.  
• Cheese Deli trays. 
• Smoked fish or poultry platter. Any of these can go with all the trimmings, i.e.fruits, vegetables, condiments. Try not to resort to all the crackers. Build hor d’oevres on slices of cucumber, small tomatoes halves or slices of firm cheese.
• Toss cubes of feta, mozarella or other cheese with leafy or firm vegetable salads. Dress attractively with flavored vinaigrette or a creamy homemade dressing. 
• Make cold fruit soup with a yogurt or kefir base. 
• Use canned salmon or your favorite canned meat fish or chicken to make spreads, dips and additions to salad. Think "tuna salad” but better. 

Once you’ve got a protein rich cold main dish figured out, it’s easy to think of cold side dishes. Make any kinds of fruit or vegetable salads; try your hand at a cold Gazpacho. Those who can tolerate legumes (beans, tofu, etc) can make many more protein rich dishes, though one must bear in mind that to constitute complete protein, legumes must be combined with whole grains. 

To keep your cool dinner healthy, steer clear of soda, fruit juices and excess alcohol. Lightly sweetened herbal iced teas flavored with lemon wedges and mint leaves are always appreciated. You can also use just a splash of fruit juice with cold and very economical club soda, at a fraction of the price of commercial gourmet sodas. 

Finally, cool desserts are easy. Try fresh berries, melon or pitted fruit with cow’s milk or coconut cream. If you are feeing ambitious, prepare an exotic sorbet. Simple reliable ice cream makers are commonly available these days at any big box store, and make your recipe into ice cream in 45 minute or less. Just remember to freeze the cylinder well in advance of using it. 

Food Friday: Healthy Barbecue, Grilling, and Picnics.

Everybody loves to play with fire, especially people who like good food and who don't want to be stuck in a hot kitchen in the summertime. 

Check out this comprehensive list of tips for barbecue, grilling and picnics and you will be the smartest flamethrower on the block. 

Grilling: 

• 7000 people each year suffer grilling injuries. 
• Read your grill's owner's manual. 
• Use propane and charcoal grills outside only.
• Use in a well ventilated area, away from combustible material and at least ten feet from a structure. 
• Ensure the grill is stable. 
• Do not move a hot grill. 
• Have long handled cooking utensils.
• Have fire extinguisher, baking soda, a bucket of sand, or water handy. 
• For propane grills, check fittings to make sure they're tight. Check propane hose for gas leaks by applying soapy water and checking for bubbles. 
• Never turn on a gas grill with the lid closed or you will risk explosion ! 
• For charcoal grills, use a chimney or electric starter. Never add lighter fluid to a flame. 
• Dispose of cool coals in a metal container. 
• Keep younger children away from the grill. 
• Never leave a grill unattended. 

Food Handling: 

• Buy cold foods like meat and poultry last, when you are about to head for home. Bag them so liquids cannot contaminate other foods that will not be cooked. 
• Wash hands with soap before handling food, and keep surfaces and utensils clean. 
• Thaw in the refrigerator or the microwave NOT the counter. 
• Keep raw food separate from cooked food. 
• Marinate in the fridge, not on the counter. Poultry and cubed meat may marinate only 2d, other types 5 days. 
• Trim fat to minimize hazardous flares and unhealthy charring. 
• Consider precooking to shorten grilling times. 
• Consider buying a food thermometer. They're inexpensive. 
• Cook food thoroughly. 

Poultry 165 degrees

Ground red meat 160 degrees

Beef pork lamb and veal 145 degrees, and allow to rest three minutes. 

Reheat cooked meat like hot dogs to 165 degrees. 

• Keep cold food cold and hot food hot. 
• Don't let cooked foods sit out more than an hour if the temperature is greater than 90 degrees. 
• Discard food left out more than 2 hours. 

Healthy Grilling recipes: 

Cooking Light 

Food Network

Eating Well

Fitness Magazine

Food and Wine 

Health

ENJOY ! 

References:

FDA Barbecue Basics

UDSA on food safety

National Fire Protection Safety Association 

Food Friday: The Joy Lunch Club

Who doesn't look forward to lunch during a busy day tending kids at home or a hard day at work? I look forward to lunch. However, when I interview patients about their eating habits, I find all too often that patients skip meals, especially breakfast and lunch. 

I understand. We're busy. Sometimes we're not even hungry. We think skipping meals will help us lose weight. But as I have mentioned before, skipping meals actually causes us to lose muscle and slow down our metabolism and our thinking, making us feel sluggish and perform poorly. If we skip breakfast we are even less hungry than we would be had we jumpstarted our metabolism with a good breakfast. 

So, I have decided to promote the idea of a homemade workday lunch by issuing a challenge called the Joy Lunch Club. I will give the readers of this blog two weeks to submit a picture of their awesome lunch on a typical busy day. The best workday lunch photo at the end of two weeks will receive a custom "yoga girl" lunch box complete with containers and ice. To qualify, the lunch must be healthy, contain protein and produce like fruit or vegetables, be homemade, and if  brought to work, be in suitable containers. Photos may contain the lunch itself or you with the lunch. They should be posted to my office Facebook page linked to this website. Finally, to be eligible for the prize, you have to be subscribed to the site. (Please see the "Subscribe and Comment" section in the menu.)  At the end of the two weeks I will announce the winning photo, who's owner will then need to Facebook message me for the prize. Unfortunately I need to limit this offer to the US and Canada.

Others can order this unique lunch box through our Zazzle Store found HERE. Have fun, enjoy your lunch and good luck!