Food Friday: Vitamin D

Vitamin D is in the spotlight. Is this celebrity justified ? 

Vitamin D is a fat soluble compound that is necessary to human health.Interestingly, it is not widely available in our diet. It is however, manufactured in our skin when the skin is exposed to UV rays from sunshine. It is of course available in supplements, supplemented foods, and a few foods naturally. 

You might wonder how we developed to need something that seems so hard for modern people to obtain naturally. I think it is a good bet that pre-agricultural people especially those along the coast got more sun and UV exposure than we do today. I suspect that plus their intake of vitamin D rich fish supplied their needs. Then as people began to move inland, wear more clothes, eat less fish and live long enough to have to protect against skin cancer, their vitamin D requirements became harder to meet. 

 Vitamin D is historically most “ famous” for its role in enhancing Calcium absorption. Calcium is critical for bone mineralization. Deficiency of Vitamin D leads to rickets and osteomalacia, which are failures of the bones to properly form. 

Those at risk for vitamin D deficiency are breastfed infants who aren't supplemented, dark skinned people, people who wear occlusive clothing, the home bound, the elderly, the obese, vegans, and those whose gastrointestinal tracts are inflamed or cannot absorb properly. 

It seems odd to me that breastfeeding does not supply all the necessary vitamin D a newborn needs. This is simply because the Vitamin D content of human milk is related to the mother’s vitamin D status. The infant cannot get vitamin D though UV exposure since it is not appropriate to expose infants to direct sunlight. There has been a big recent campaign to educate breastfeeding mothers about the need to supplement with vitamin D. 

Vitamin D also affects the general functions of cell growth, neuromuscular function, immune function, and the control of inflammation. These features are why there is more than the average amount of buzz around this mild mannered vitamin. Two hundred and fifty studies on vitamin D and various health parameters were done between 2009 and 2013. These were systematically reviewed by the Agency for Healthcare Research and Quality, and to date, it concluded that it is still not possible to specify a relationship between vitamin D and specific health outcomes other than bone health. As the number of studies indicates, there is widespread interest, or even hope that vitamin D therapy will prove useful for a wide variety of conditions, especially those involving autoimmunity. 

Adults need between 600 and 800 IU of vitamin D per day. It is best not to take more than about 4000 IU per day from all sources, unless specifically instructed to do so by your physician. Vitamin D is fat soluble, can be stored in the body and can, in excess, lead to toxicity. 

It is best to get your vitamin D from a combination of foods, fortified foods, and supplements. The best dietary sources of food are fatty cold water fish such as salmon, cod, tuna and swordfish. (As a side note, pregnant women should restrict their intake to salmon and cod, since tuna and swordfish may theoretically have increased levels of heavy metals. ) Besides these, egg yolks, fortified orange juice and fortified dairy products are the best sources. 

If you are concerned your vitamin D levels are low, ask your doctor about testing your levels. We have been screening patients more proactively lately, and have found some astounding deficiencies. The good news is, they are quite easy to fix. 

Here’s my favorite go-to recipe for a great blast of vitamin D and protein: 

Salmon Salad

Simply mix one drained can of coho salmon with 1-2 tablespoons of olive oil based mayonnaise ( My favorite is called “Lemonnaise”.), Add a table spoon of dill relish, a couple Tablespoons of sliced olives, some capers, finely chopped celery, chopped sun dried tomatoes, and whatever else suits your taste. Mix. Do not feel compelled to put it on anything. Enjoy. 

Refererence: 

National Institute of Health Office of Dietary Supplements 

Food Friday: Gastrointestinal Health, Bloating, IBS and FODMAPS

FODMAPS is the newest of the dietary buzzwords in the blogosphere today. If you struggle with bloating or irritable bowel symptoms, learning about FODMAPS may help.

FODMAPS stands for fermentable oligosaccharides disaccharides monosaccharides and polyols.

FODMAPS include:

Fructose – fruits honey high fructose corn syrup, Etc.

Lactose–regular dairy products

Fructans-wheat garlic onion etc.

Galactan-Legumes such as beans, lentils, and soybeans etc.

Polyols-sweeteners like mannitol, sorbitol, and xylitol; stone fruits such as avocado, cherries, apricots etc.

You will notice that a lot of the foods on this list appear to be what we normally consider to be healthy. However if eaten in excess or by those who are sensitive to this phenomenon, they can produce undesirable symptoms such as excessive gas, bloating, diarrhea, and constipation. Such a situation is uncomfortable in and of itself but may also produce a systemic increase in inflammation.

According to the Stanford FODMAPS protocol, FODMAPS eaten in excess cause problems because they pull water into the intestinal tract, may not be digested or absorbed well and therefore could be fermented by the bacteria which reside in the intestinal tract. Fermentation produces gas and other by products which irritate the lining of the gut. This can produce increased intestinal permeability, also known as leaky gut syndrome. This produces the symptoms of bloating, pain, excess gas, and inflammation.

This sort of thing can happen to anyone who eats these ingredients to excess. However, in those for whom this occurs easily and chronically, and for whom other disease is ruled out, it is called irritable bowel syndrome or IBS for short.

Click below for the Stanford FODMAPS protocol diet handout which will will elaborate on these concepts and give you a handy chart for foods to use and foods to avoid. 

Stanford FODMAPS protocol

Bear in mind that water and fiber are part of this equation. Either too much fiber or too little fiber can aggravate symptoms. You simply have to experiment to find your unique sweet spot. I think a good place to start is a small bowl of soft (not sticky) hot oat bran cereal every day. I have taken a page from the Giada DiLaurentis playbook and take my oatmeal with a little olive oil and kosher salt. This is pleasant in a popcorn kind of way and avoids the sugars that make symptoms worse.

On the other side, drinking plenty of water can fix a multitude of ills. Drinking water all through the day aids digestion, helping to avoid fermentation in the first place. It also flushes out any irritating by products of unwise dietary choices sooner rather than later. It resolves constipation and rehydrates after diarrhea. 

If you are really struggling with symptoms of bloating, abdominal pain, excess gas, diarrhea and constipation, consult your doctor. Discuss the advisability of a low FODMAP diet for you. Remember that this is cutting edge thinking, and pertains specifically to FODMAP induced symptoms. Your doctor may discern other patterns in your clinical presentation that prompt him or her to check lab studies or imaging which they believe may be pertinent to your condition. If in the end, they think this would be helpful, try it with concerted effort for about 6 weeks. After that, you may find you can “ add back" desired items one by one, in small quantity. If your intestinal tract calms down and heals well, things that irritated you before may no longer do so. 

Food Friday: Protein for Healing

Most of you have been following the saga of my son’s recovery from his fractured femur. He is coming along nicely and that is due in part to his fantastic physical therapy support. They have done physical work, cognitive, and have even talked about the nutritional end of things. In particular, they have emphasized the role of protein, along with Calcium and Vitamin D. 

Protein comes from meat, seafood, poultry, and certain combinations of legumes and grains. (Legumes are foods like peas, beans and lentils.) Under normal circumstances, people need about 0.36 grams per pound of body weight of protein. This is about 50 g per day for a women and 70 g per day for a man. However, during pregnancy, athletic training, and recovery from illness, even more is needed. 

Our son’s therapists have noted that his protein requirements have increased to nearly 100 grams per day as an injured young adult male weighing about 175 #, who is trying to rebuild a femur. This is about a 40 % increase. 

Protein is composed of a string of amnio acids. All animal food are complete proteins, in that the ratio and types of amnio acids present meet human dietary needs. Plant sources of protein need to be combined to fulfill this criteria. For more on this see THIS SECTION on the website. 

In practical terms,  I had to help Vale figure out how to meet this nutritional requirement at a time when his mobility was restricted and his time for cooking was nil. Additionally, we had to take into consideration that more protein intake requires excellent hydration, since metabolism of larger amounts of protein in a dehydrated state is hard on the kideys.  We had to make sure he consumed just the right amount, and not too much since metabolism of excessively high amounts of protein can also cause the bodies calcium to be depleted- not what we want. Finally, I had to take into consideration the following: that protein is best utilized when interspersed evenly throughout the day. 

Here is how we set him up. First I made a one page schedule of meals and activities. I posted it all over his house and set up a google doc for the friends and family who would be helping. Secondly, I made a menu. There would be some constants, and some variables. The constants would be as follows: 

• Morning:16 ounces of skim milk with a protein powder
• Midmorning would be a high protein, high fiber oat cereal, and hopefully a hardboiled egg.
• Lunch would be a can of salmon made like tuna fish salad, with olive oil mayonnaise, relish, and olives. He could also have whatever else he wanted.
• Mid afternoon would be another high protein snack like a mozzarella cheese stick
• Dinner would be a traditional cooked dinner with meat chicken or fish, and salad with veggies cooked by family or friends.
• Fruit could be eaten all through the day
• A hospital pitcher would be used to measure water intake which was to exceed three liters per day, titrating to nice clear appearing urine (sorry… i’m a doctor, not a food blogger. ) 
• I had him take a gummy prenatal vitamin and two tablets of Calcium Citrate with D. 
• The items are simple, edible, and met the criteria. Of importance, I created a routine schedule that would be the same every day to foster compliance. I created checklists in different convenient locations. In other words, I have tried to engineer his nutritional success.

So far so good, as he is already crutching around to class, grateful, and enjoying being back at school. 

Food Friday: Food for Healing

As most of you know, we spent the better part of the week nursing our 22 year old son after his ski accident. He sustained a badly fractured femur requiring a long surgery which entailed significant blood loss. He also had a mild concussion, pulmonary contusion, and a broken rib. He is stable and improving. But his course has illustrated several important things about nourishing those who are recovering from illness or injury. I thought we might take a moment and discuss them here, especially since it has been on my mind. 

When people come home from the hospital, most of time, their IV is removed. They will come home adequately hydrated. However, that can quickly change, since their capability to hold down food and drink is often limited. Your job as caregiver is to help minimize nausea which may be interfering with hydration, and to provide appropriate enticing liquids for them to sip. If your “ patient” did not come home with anti-nausea medication, and needs it, do not hesitate to call their doctor. Most of the time this can be prescribed over the phone, but sometimes, nausea heralds a concern, and the patient will be asked to come in for an evaluation. 

Another way to minimize nausea and maximize intake is to avoid overuse of narcotic pain pills. The most common are lortab and percocet, aka hydrocodone and oxycodone. These are necessary with early post ops, but they can cause nausea and constipation. Ask your doctor how they should be used if you are not sure. 

Sick or injured people do not always know what they need. It is up to the caregiver to encourage them in the right direction. In this regard, many patients will not want to drink as much as they ought. So you have to be clever. 

Hydration of the unwell is best accomplished gradually and continually. This way they are more apt to tolerate it. It is also best accomplished by fluids which contain some sugar and some electrolyte (like IV fluid!) . 

For starters, let’s do water. Some who cannot drink water can drink soda water, aka plain club soda. Even more can drink this with a splash of fruit juice or a wedge of lemon or lime. Some do well with dilute fruit juice. Decaf instant iced tea works well. Oftentimes having it quite cold will help, but this is suboptimal if your patient is chilled. Some do better with frozen cubes of the aforementioned drinks. 

On the other hand, many patients prefer hot drinks. Herbal tea is the go-to here. You can make it more appealing by adding honey or agave, and a little lemon. Decaf coffee is not a bad choice, but lots of caffeinated coffee is dehydrating. 

Some patients prefer savory or salty drinks. This is an advantage since it will better expand their intravascular volume. Here broth is the best solution, unless they can take something like Bloody Mary mix, or salted tomato juice. The best of all is a brothy chicken soup, just like tradition teaches us. Nowadays organic broth mix is widely available commercially in chicken, beef, and vegetable flavors. 

You can also hydrate your patient with watermelon if they like it. Most fruits will help, and a smoothie of fruit, ice, water, juice, and even plain yogurt can be very agreeable, even to one who is sick. 

When patients are doing well enough to take solid food, there are a few key nutritional points to bear in mind. Healing from illness and injury takes more resources than ordinary life - lots more resources. A man needing 70 g of protein a day will come to need over a hundred. He will need more nutrients too, though he may not necessarily need more calories. Therefore, everything a recovering person eats should be nutrient rich. Leave the top ramen, Pepsi, and white bread for another day - like NEVER. Present choices such as chicken, salmon and red meat, but prepare them in a way that is easy to eat. For the meat and chicken, cook it well, ground or in small pieces. For salmon, consider getting canned salmon and making it up like tuna fish salad with mayonnaise, relish and olives. But beware, if your patients are picking at their food or dairy containing drinks, the dishes cannot stay out too long, or they will spoil. The last thing you need is a recovering patient with food poisoning. With the same goal in mind, don’t put too much on a serving plate. Start with a small serving and get seconds if you need to. And, for best results, offer small quantities of food quite often. 

Caregiving is hard work. With a little forethought and a few tricks of the trade, your well hydrated, well nourished patient will have the best chance at an optimal recovery. 

Food Friday: Setting the Table

When I was growing up, my parents had a sit down dinner since that’s how they had been raised. My mother had nice china and table linens, but we rarely saw them since she used them only for special occasions. Instead we had everyday plates and cups, often plastic. The margarine was set out in its own tub. (Remember that this was the 70s, when margarine was thought to be healthier than butter. )

My father had business contacts from all over the world and they would come to visit us. In one case, a German guest showed me a photo of his daughter. She was sitting at their table. I would never have thought to take such a picture of a person at a table since our table was nothing special to look at. But their table was beautiful even though they had already finished their meal. Each plate was white glass, and crowded round each plate were clear glasses of various deep jewel tone colors and shapes, some cylindrical and thin, some globular, and yet others like cones. A light went on in my mind, and ever since then I started to see table settings differently. I began to notice the beautiful dishes and table settings in my friends' houses. 

Fast forward to college, when freshman year and dorm food banished all thoughts of table settings. Then came second year, when I moved into a campus co-op named Synergy. The house was organic and vegetarian way back in 1981. We had a big hippie kitchen in a huge hippie house right on campus. Since we were a co-op we cooked all our own food in a big kitchen in rotating teams. There would be no chefs or housekeepers for us.

The ethic of this house also required a communal sit down dinner as a deliberate act of culture. However the table settings in Synergy were like none I had ever seen. Since we were all about conservation, with reuse happening before recycling, our cups, plates, and serving utensils were a motley collection of all that had come through the kitchen. We drank from a selection of old jars, such as those from sauces or jam. Our plates were all completely mismatched. Bowls were just old plastic containers from things like bulk peanut butter. Most wonderfully, the center of the table held as many as a dozen great steaming loaves of bread: home made whole wheat bread. It was the signature of the house. We would cut slices or tear chunks, and slather it with butter, jam, hummus, or whatever mystery stew the cooks happened to create. Kids from other dorms would come by just for the bread. There is a reason for the expression, “breaking of bread”. It seems to bring people together.

Greg and I bonded while making this bread since it literally took all four of our hands to knead it. We had met while cleaning the kitchen at Synergy. We took it upon ourselves to clean this hippie kitchen, since he and I seemed to be the only ones who noticed how dirty it was. We met over a filthy sink, and there was something about me turning on the garbage disposal at the wrong time. No one was hurt, but he did have to take a shower after the incident. 

Greg sometimes ate a couple of houses down the row where there was a clean kitchen, a chef, and of course, meat. His sister lived there and she had made friends with the chef. I think they had an arrangement since not uncommonly Greg would go there and use their massive Hobart mixer which would hold a 16 batch of his mother’s chocolate chip cookies. As you could smell the bread of Synergy wafting down the row, you could smell the chocolate chip cookies coming from the other direction. From then on, our collective memory would be infused with the aroma of bread and cookies. 

After graduation, we married and lived in a little farmhouse far away from University life. It was a bit run down, so we repaired and decorated it. Happily, among our wedding gifts were many table linens and pretty dishes, so it followed that the table got set very nicely. The cutting boards were set with bread and platters filled with cookies. When our daughter and the boys came along, they helped with all of this. Ever since then we have set the table and had a sit down dinner. 

Today I believe in the power of the sit down dinner more than ever, to promote communication, coordination and peace in the family. And for me, all my best dishware is out all the time. I think it sets a festive mood and makes people feel valued.

What would I do if I were just starting out, of modest means, and wanted to bring some inspiration to meals ? There are two possibilities. First, I could go minimalist and get all clear glass dinnerware from the dollar store. Everything would match, and design interest would come from the food itself, the table, or the table linens.

A more colorful and more ecological choice would be to thrift. I would have a fantastic set of non matching antique plates. I would shoot for a reasonably common size, and perhaps a common theme, say a color scheme or a design element like birds. A physician friend of mine did it complete with mismatched silverware, and mismatched but coordinating goblets. It was nothing short of magnificent. It was all thrifted, very inexpensive, and truly delightful.

And that is the point: to delight. Making the food and setting the table is a gift to others, and a joy for you. 

Food Friday: Easy Weeknight Meals

Most of us work during the week. All of of us are supposed to exercise sometime in the day. Between all this, children and other responsibilities, it is challenging to pull together a good dinner for the family. Here are some suggestions to help you with easy weeknight meals. 

People often suggest “ Make ahead” meals as the solution for busy cooks. However, I am going to assume that you, like me, have trouble thinking ahead and pulling those together. We will tackle those another day. Instead, today's suggestions will apply to “ on the fly” meals you make on the spot. 

• Keep it simple. 
• Keep it healthy.
• Use fresh or frozen. 
• Cut pieces small for fast cooking. 
• Combine protein with produce. 
• Serve three dishes - a protein based main dish, a salad, and an additional fruit or vegetable. 

The protein dish is usually the most challenging for people to devise. Consider meat fish chicken or eggs as a base.  Meat fish or chicken can be fresh or partially defrosted and cut into bite sited pieces and either broiled, sauteed or grilled with olive oil, salt and pepper. Eggs are quick and can be made any way. Serve your main dish with salsa, or another sauce. 

Vegetables can be washed and cut small and either steamed or sauteed in olive oil or stir fry sauce. Make sure and combine different kinds of vegetables after cooking for good color and varied nutrients. Remember to cook the longest cooking vegetables first. Toss with a healthy salad dressing or sauce and serve in large quantity with your main dish. 

Always have prewashed salad at the ready. Always include some color with the greens, such as tomato, carrot or even strawberry. Throw in some nuts, maybe some cheese, and even some hardboiled egg. 

These are simple preparation guidelines for a main dish, a vegetable side dish and a salad. Provided you have the right groceries in the freezer and fridge, you can whip up this kind of dinner in 25 minutes or less. Key points are the small size of the pieces, which cuts your cooking time, and the healthy sauces, salsas and dressings which you can buy or easily make. 

Have fun with this. See how fast you can get. I’d love to see you post some of your variations of this dinner prep format. 

Food Friday: Spices 101 and the Art of Culinary Armchair Travel

Part of consistency in heathy eating is eating food that tastes good. This generally comes from eating fresh food simply prepared, but it also helps to have some knowledge of spices. Today’s Food Friday is devoted to introducing some spice basics. It is also to introduce the concept of culinary armchair travel. 

I do not get out much due primarily to my work. However, I appreciate many other cultures and many other cuisines of the world, and I like to bring them into my home whenever I can. This can mean something as simple as cooking a traditional dish from another country, or it can mean settling in for a film in Italian while eating a traditional Italian dinner. One time I even gave a French baby shower complete with a French menu, French inspired decorations, French music and pots of live lavender at each place setting. That to me is culinary armchair travel with all the trimmings. 

To prepare, you should think about where you would like to go someday. Then get on the internet and find out about the foods of that place. Check out the every day meals as well as the holiday fare. Find something simply and healthy, then look for recipes. Pinterest, Epicurious.com and food.com are among many great sources of inspiration and recipes. 

Most likely you will already have some basic dishes in mind, such as stir fry for Chinese, tacos for Mexican, chicken curry from India, or spaghetti with meat sauce for Italian. You probably already know the basic recipes. Perhaps all you need is a little help with the spices. For this, I have prepared the following basic guide. 

Spices can be used as individually, but most commonly and deliciously are used as spice mixes.

Some basic spices to always keep around

kosher salt
pepper
lemon pepper
rosemary
thyme
basil
sage
chili
cumin
paprika
garlic, fresh and powdered
ginger, fresh and powdered
cinnamon

Spice mixtures

You can make your spice mix with whole spices and put them in a grinder for frequent use. Freshly ground mixes are far more aromatic than prepared mixes in the store. To do this, you can buy a grinder, but better yet buy a filled pre-made spice mix in a grinder and then just keep the grinder when it becomes empty. Store your spices in an airtight container to keep them fresh. 

Cajun Spice

garlic powder
paprika
 black pepper
onion powder
oregano
cayenne chili powder
thyme

Indian garam masala

coriander
cumin
cinnamon
cloves
cardamom,
pepper
ginger
nutmeg
 

Herbes de Provence

thyme
rosemary
oregano
summer savory
+/- lavender

Thai spice mix

dried ginger
basil
cumin
cardamom
Black pepper
dried lime
dried onion
red pepper

Mexican spice mix

chile powder
cumin
pepper

Italian spice mix

oregano
basil
thyme
rosemary

Chinese spice mix

star anise
cloves
cinnamon
cumin
pepper
+/- fennel,
turmeric,
nutmeg,
ginger
or cardamom

Chophouse

minced dried garlic
chili pepper flakes
dill seed
black peppercorns
coriander seed

It is a shame to reduce spice mixtures to such a simple list, but busy people need to keep things simple. When you mix the spices, start with 1/2 teaspoon of each or one part of each spice. Use quite a bit less of the very hot ones like cayenne. Adjust to your taste from there. Add salt to the dish only at the very end.

Try some culinary armchair travel with these varied flavors from diverse cultures. Use them to make your healthy cuisine more interesting and desirable for the whole family. Bon Appetite ! 

Food Friday: Staples of the Fridge and Freezer

As promised, this week we are going to see how the healthy fridge and freezer look. The lists below are my idea of what you will need to put together healthy meals and snacks all week long for you and your family.

Take a critical look at your fridge and freezer. How healthy are the contents ? Can you tell what the contents are, or how old they are ? Let’s hope so, otherwise send it to the compost. Take a gratifying step further and clean out the whole refrigerator. Here are some tips to having what you need, being sure of it’s safety, and making it easy to prepare healthy meals and snacks. 

• Shop twice a week
• Buy only healthy items such as those listed here. 
• Make a deliberate point to use what you buy. Do not plan a meal without looking in the fridge first. Factor in the what needs to be used as well as the balance of the meal. Do not, however,  be tempted to save a couple bucks and use questionable items. 
• Make sure to have a set of good clean containers to use for subdividing bulk purchases and for storing leftovers. Containers which hide their contents tend to go unused and spoil. 
• Have a couple sizes of ziplock bags also for subdividing bulk purchases and for storing leftovers. Sometimes it’s easier to store things this way instead of in a giant clear box. 
• Label and date all your unlabelled containers. 
• Search for recipes or even techniques which use your healthy ingredients, and keep them simple. 
• Use your freezer to enhance your nutrition. Buy good food on sale, in bulk and in season, divide it strategically and freeze it. 

Here are some healthy contents which should be in your fridge and freezer. 

The freezer

nuts: i.e. cashews, pecans, almonds, walnuts

pestos in ziplock bags

frozen concentrated juices i.e. orange juice concentrate for sauces

chili paste, clearly labelled

coffee or cacao (raw chocolate) bean

bags of frozen fruits, home made or store bought, for pie, cobbler, tarts, smoothies

frozen vegetables such as corn and peas

fish, meats, poultry, in bulk or divided by you into single servings

bulk items like ziplock bags of garlic cloves

ziplocks of good leftovers which you can’t use quickly enough

dried fruits which are moist and apt to spoil

cheeses : block parmesan, shredded cheddar, shredded parmesan

ice creams and sorbets

The refrigerator

Dairy:  

milk, half and half, cream, butter,

certain oils like toasted sesame  

soft cheese: cottage cheese, cream cheese, ricotta, mozzarella

hard cheese: cheddar, pre-sliced and shredded, shredded real parmesan

eggs- at least two dozen

Meats, poultry and fish which are thawing, marinating, preserved, or leftover. 

Cultures for home made yogurt, yeast to make bread

Vegetables:  

salad greens like romaine, spinach, arugula, cooking greens like kale and chard,

Hard vegetables like carrots, beets, cabbage, broccoli, asparagus, zucchini, cucumbers,

red and other various colored peppers

vegetables ad infinitum  

Fruits:

Strawberries, blackberries, blueberries, other soft fruits like pitted fruits, i.e. peaches, apricots, etc (Tomatoes, bananas, apple and oranges are stored at room temperature ) 

Condiments:

pickles, sweet and dill, olives, ketchup, mustards, mayonnaise, salad dressings, opened jams, jellys, chutneys, salsas, Worchestershire sauce, soy sauce, Siracha or other hot sauce, lime and lemon juice, fresh ginger, garlic

It takes some time to adjust your meal planning, cooking and eating habits to include all the good things all of the time and very few of the bad things very seldom. But having fridge, freezer, and pantry filled properly will help. It is also necessary to realize that healthy eating takes a little extra time at first. But healthy cooking, once learned is minimalistic simple cooking, and can be made to be very time efficient. 

I hope these lists will help healthy eating become easy and enjoyable. 

Food Friday: Staple Pantry Goods

As promised, here are my lists of staples for the pantry. You will notice that not everything here is a superfood. That is because there are special occasions like birthdays which require treats. Not only are these events important for family and social life, but it is important to learn how to use restraint and have a small single portion of an indulgent treat made after a healthy meal. Bon appetite ! 

Grains

• Cornmeal for Polenta
• Quinoa
• Oats for baking and hot cereal

Rices

• short or long grain brown ( preferably basmati)
• wild rice
• black forbidden rice
• sushi rice

Pasta

• whole grain and gluten free pasta, i.e. spaghetti or penne
• Oils and fats
• Canola, for higher heat cooking
• olive, extra virgin, for medium heat cooking
• olive, extra virgin, cold pressed, for dipping.
• sesame oil for flavor
• flavored oils
• coconut oil

Some basic spices and herbs

• kosher salt
• pepper, preferably whole peppercorns
• lemon pepper
• rosemary
• thyme
• basil
• sage
• chili
• cumin
• paprika
• garlic, fresh and powdered
• ginger, fresh and powdered
• cinnamon
• cloves

 Canned and jarred goods
 

• tomato sauce
• diced or stewed tomatoes
• tomato paste
• canned olives
• canned pineapple for pizza or stir fry
• various beans, like black, pinto, garbanzo
• pickles
• sauces like soy
• chilis, diced
• canned salmon
• coconut milk
• all the jams, jellies, chutneys, and pickles that you have canned : ) 
• vinegars like apple cider vinegar, balsamic, rice

Dried things

• raisins
• dried cranberries
• sun dried tomatoes in oil

Baking Ingredients

• whole wheat flour, I prefer fine grind for the most protein and the heaviest bread
• whole wheat pastry for pie crust
• unbleached flour if you must have it
• gluten free flour for those who require it
• baking powder
• baking soda
• cream of tartar
• cornstartch or tapioca powder for thickening pies
• sugar, white, brown cubed and powdered
• chocolate chips
• bakers chocolate 2 forms, blocks and powder
• expresso powder
• sweetened coconut
• molasses, agave, honey
• Nuts (see the freezer section in future posts) 

Beverages:

• a complete selection of chai and coffees, including decaffeinated versions of each
• teas: black, green, and herbal
• Soda water, or Perrier or Pellegrino to splurge

Stay tuned for the fridge and freezer sections next week on Food Friday ! 

Food Friday:A New Year's Pantry

It’s time for a fresh start on your nutrition. Here’s an easy way to go beyond intentions and take a SMART (Specific Measurable Attainable Relevant and Time bound) step to better nutrition: 

Clean out your pantry. 

This is a way of taking stock of your eating habits as they really are. I suggest the following plan for success in this endeavor: 

• Put your family on notice so they can prepare.
• Have a simple plan for your healthy meal while you get all this done
• Take everything out of the pantry and sort it into
  • Keep 
  • Donate 
  • Compost 
  • Trash 
• Be ruthless and keep only what fits into the plan of healthy eating. If you are unsure, then review our section on Nutrition. 
• Clean the whole pantry. 
• Replace the good stuff which made the cut.
• Now that you have a detailed overview of what you have and what you lack, make an excellent list of your healthy pantry staples. Keep the list on your phone and make a couple laminated copies for the pantry itself and for your wallet. 

You will feel such a great sense of satisfaction, and you will be on your way to dietary honesty. Stay tuned next week for my preferred list of staple pantry goods. 

Food Friday: Holiday Menu Planning

I don't know about you, but right now I am trying to figure out the menu for not one but several holiday dinners to come in the fairly near future. To try and minimize stress with these events which are supposed to be fun, I've decided to do a little advance planning and let you in on it too.

Sometimes it's best to stick to tradition, and include menu items you know are family favorites. But particularly when you have more than one meal to present during the holiday season, you can afford to be a little bit creative. Let's take a quick look at four different cuisines which you might consider. Christmas is really big in each of the five countries which I will present, but you can probably think of many more countries that cherish the holiday as well. You can explore their cuisines too. Suddenly there is no shortage of menu ideas when you consider it in this framework. The challenge will be choosing what to leave out ! 

A Mexican inspired Christmas “ Navidad” 

• Virgin Margaritas
• Quesadillas with fresh salsa for starters 
• Ponche - a hot fruit and cider punch 
• Mexican Christmas Eve Salad _ this is colorful salad mixture of lettuce, beets, apple carrot, pineapple, jicama, pecans and pomegranate seeds. 
• Tamales with a chocolate chili mole sauce. 
• Rosca dee Reyes- A sweet spicy fruity bread containing assorted dried  or candied fruits. 

A French Inspired Christmas “Noel” 

• Champagne, Perrier
• Amuse bouche ( hor d’oeuvres) - olives, seasoned nuts, vegetable platters with dips etc. 
• Boeuf (beef) Bourguignon ( A thick stew made all day with red wine and meat cooked until fork tender eaten with crusty baguettes. ) 
• Haricots Verts ( green beans roasted with olive oil) served with lemon 
• Salade Nicoise - Tomatoes, boiled eggs, and tuna on a bed of greens 
• Diverse fruit and cheese platter 
• Buche de Noel- An amazing rolled chocolate sponge cake filled with mocha cream, frosted with chocolate buttercream to look like a log and garnished with meringue mushrooms
• Sorbet 

An Italian Christmas “ Natale” 

• Pellegrino 
• Antipasti- tuna, fresh salmon, cured meats, olives, cheeses, bruschetta, crostini, Caprese salad- with fresh mozzarella, basil and tomatoes
• Pasta, such as ravioli filled with extravagant fillings, such as meat, spinach, ricotta, figs, and even chocolate and candied citron. 
• Parmesan chicken in red sauce 
• Lemon tart 
• Gelati

 

Scandinavian Christmas recipes “ Yul” 

Glogg- spiced mulled wine 

• A “ julbord” , meaning a smorgasbord especially for Christmas
• Cold foods like Gravlax ( salmon cured in sugar, salt and dill), cured meats, cheeses, pickles, beet salad, breads and butters
• Warm foods like meatballs in berry sauce, potato dishes and cabbage dishes. 
• Desserts like Pepparkakor ( gingerbread cookies) and saffransbullar ( sweet buns)

One traditional Christmas in America, with some twists

• Turkey
• Mash potatoes
• Cranberry sauce
• Green salad 
• Asparagus
• Pie À la mode

Turkeys is front and center at Christmas time as well as at Thanksgiving. But this time give it a little twist. Consider encrusting the bird with herbs, or having it smoked. For the stuffing, go beyond simple breadcrumbs and try wild rice stuffing. Try a twist on traditional cranberry sauce and add orange. For your salad, add every favorite salad ingredient you can think of from olives to capers, dried cranberries, two colors of tomatoes, and even candied nuts. For the mashed potatoes, consider the very exotic purple potato, or for a very healthy twist, sweet potatoes. If you really want some color on your table try all three. And whatever you do with the potatoes, flavor them well with olive oil, butter, sour cream, salt, pepper and even herbs, garlic, or cheese. Regarding your traditional pie, consider one two fruits not one. Great combinations are apple raspberry, or rhubarb strawberry.

Warning: Each of these menus require several days preparation and several people to accomplish. But, as I read through all my material about holiday and meal traditions the world over, I realized that the affectionate time and extra effort spent preparing these magnificent celebratory meals together is the essence of the holiday. 

Merry Christmas all week long to all the cooks ! 

Food Friday: Fruit Muffins 2.0

Fruit muffins were originally an attempt to use up borderline fruit and to make regular muffins (Fruit muffins 1.0) more healthy. They have since become a family favorite. 

You may not need to make fruit muffins before Thanksgiving but you will most definitely need to make them afterwards. That is why I am giving you the recipe this week. You see, you will have left over items from Thanksgiving, and most likely you will make soup out of these premium ingredients. It follows therefore that you will need muffins to go with your soup.

Fruit muffins 2.0 is a flexible recipe. You will see a lot of variations and there are a lot of workable substitutions. 

Adjust your shelf to the upper third of the oven and preheat to 350 degrees F. 

Equipment

• Two cupcake tins each holding 12 cupcakes.
• Unbleached cupcake papers, usually available at a natural food store

Ingredients

• 3 1/2 cups whole wheat pastry flour or whole wheat flour fine grind ( use white if you must but the result is less rich.. you may need more flour too) 
• 2 teaspoons baking powder
• One half teaspoon salt
• One and 1/2 half teaspoons baking soda
• 1/2 cup butter, or one half cup coconut oil can be substituted
• 1 1/2 cup sugar, can be cut to 1 1/4 cup
• Two eggs
• 4 tablespoons lemon juice (equals one quarter cup)
• Six bananas
• or 3 bananas +3 cups mixed fruit such as strawberries, diced fresh apple, dried cranberries.
• Zest of one orange if you have it

Most baking recipes like this one proceed along a typical pattern:

• Cream the liquid ingredients first starting with the butter in the sugar by themselves.
• Add eggs at this stage and whip mixture until fluffy. 
• Add the lemon juice and whip again. 
• Mix in all the fruit and the zest. 
• Whisk together the dry ingredients so they are thoroughly mixed. 
• Stir or fold them thoroughly into the wet ingredients. 
• Scoop with a large ice cream scoop into the muffin papers. 
• Bake 19 -24 minutes ( usually 23) until golden and slightly firm, and passing the sharp knife test. 

Transport in their tins to serve warm to happy friends and family, or to crabby ones and watch their mood improve. These are great served with cold milk. 

Have fun cooking this week. Clean , decorate, cook, and forget perfection. Make cooking a fun group activity. Make it healthy with selected treats and family traditions. Get along with everyone as best you can. Most of all, be grateful. 

Food Friday: Wild Rice Stuffing

You will not believe the ingredients for this recipe. When you assemble the ingredients, it looks like you're going to make a salad. But the result is as hefty and savory as the Thanksgiving turkey itself.

This recipe is best made by crowd since there are a lot of ingredients to prepare. Additionally it is best to start a day ahead. On Thanksgiving day, ingredients should be prepped two or three hours ahead of when the turkey will be done. Finally, be advised that this stuffing does not actually stuff the turkey. It is much safer, much quicker, and just as delicious to bake the stuffing in its own separate pan, which incidentally, is anything ovenproof, such as metal, glass, or ceramic.

For cooking you will need at least two large frying pans, prep bowls, and a big bowl for mixing.

Budget at least one cup of stuffing for each guest. This recipe makes at about 8 cups.

Ingredients

• At least 4 cups of cooked wild rice, cooked the day before
• 2 cups dried fruit soaked overnight in the wine of your choice, and minced. Our favorites are craisins, dried pears, dried apples, or dried plums. 
• One cup sliced or slivered almonds, toasted carefully on a metal pan under the broiler. Be careful since they go from perfect to burnt in a few seconds.
• Two tablespoons minced garlic
• Two onions diced 
• One generous bundle of parsley chopped
• Two bundles of green onions chopped
• 2 cups celery chopped
• One green apple and one red apple, diced
• Zest and juice of one orange
• 2 cups mushrooms, sliced if desired
• 1/4 cup dried spice of your choice; See my recipe for "family spice" below
• About 2 cups strong turkey or chicken broth
• Olive oil to sauté
• Kosher salt and freshly ground pepper to taste

Directions

As a general rule, you will begin sautéing the ingredients one by one or in groups from hard to soft. That is to say, you cook the ones that take the longest first. Cook each of these until they are almost perfectly done. Sauté the minced garlic, onions and celery in olive oil. Go slowly enough so that they caramelize and do not burn. Set these aside and sauté the apples. Add green onions and parsley and sauté these. Set aside. Sauté the mushrooms until slightly browned. Salt and pepper each batch lightly as you go. You can always add more at the end.

Mix all of this with the rice, the dried fruit, the flavored wine, the almonds, the zest and juice of the orange, and the spices. Mix everything thoroughly. Adjust seasonings. Press the mixture evenly into the pan or pans. Moisten everything lightly with the broth. Do not feel compelled to use all of the broth. 

At first, you will be cooking the pan with foil on top at 375° to finish cooking the ingredients and blend all the flavors. This will take somewhere between 30 and 45 minutes. The mixture should end up moist but not soupy. In the last 15 minutes you will want take take the foil off and watch carefully to brown the top. 

Serve beside the turkey or separately. Once served, refrigerate promptly. It reheats very well.

Family spice

• Two parts ground rosemary
• Two parts thyme
• One part basil
• One part tarragon
• One part of oregano

Happy cooking ! 

Food Friday: Carbohydrate Intolerance

“ Hey wait, I thought food Friday was supposed to be a celebration of good food and eating !” Of course it still is. I just want to talk a little bit about how to understand your own metabolism and to leverage it for your health and for your enjoyment. Bear with me for a little science.

Carbohydrate or carbs is a term we hear frequently in popular media. But what exactly are they? A carbohydrate is a compound that contains carbon, hydrogen and oxygen. These molecules are linked together in such a way as to store energy. In their simplest form, they are sugars like glucose. When they are linked together like Legos they become starch, which is really just a storage form of glucose. 

Glucose is the body's principal energy source, its fundamental fuel. But as with most things,too little or too much is a problem. A young, healthy, non-pregnant body will manage its fuel very efficiently. The silent internal workings of the body's physiology will keep circulating levels of glucose within a close ideal range, even during periods of dietary excess and periods of dietary scarcity. The main regulators here are insulin and glucagon. Insulin is a pancreatic hormone that brings glucose from the circulation into the cell where it can be used for fuel. Glucagon has the opposite effect. When blood sugar levels go low, though lack or food or periods of high demand, glucagon goes into action and mobilizes stored starch to be broken down releasing glucose into the bloodstream. 

When we become overweight or pregnant or older, this process works less well. In particular, the cells do not respond as well to insulin. I am not speaking of diabetics here. This tendency is true of everyone. When we do not process our blood glucose efficiently, specifically when we become less sensitive to our own insulin, we are said to be carbohydrate intolerant.

A vicious cycle can then ensue. When we cannot bring glucose from the bloodstream into the cell by the action of our insulin, the concentrations of glucose in the bloodstream becomes abnormally high. This leads to the formation of fat in our tissues and in particular our arteries. This of course, leads to cardiovascular disease.

Under these circumstances, our insulin levels also become chronically high in an attempt to bring the blood sugar down. This is called hyperinsulinemia, and it is thought to be a precursor of type 2 diabetes. Moreover, hyperinsulinemia alone is associated with “ Metabolic Syndrome” , the unholy quartet of hypertension, obesity, high cholesterol ( or triglycerides) and glucose intolerance. 

How can you short-circuit this vicious cycle? Well, no one can avoid aging if they're lucky, and many people choose to become pregnant. Avoiding obesity is the best way to avoid carbohydrate intolerance because, as you have no doubt gathered by now, obesity leads to carbohydrate intolerance, and carbohydrate intolerance leads to more obesity, a vicious cycle. That is one of the reasons why it is so hard for people to lose weight once they have become obese. It is far easier to avoid obesity in the first place than it is to correct it after the fact.

But there are many obese people who are intent on losing their weight and getting healthy. Here's the good news for them, and for the rest of us wanting to prevent these problems. If we minimize sugars and simple carbohydrates (like starch) in our diet and keep a steady intake of meals and snacks with high quality fruits, vegetables, proteins and fiber, our blood sugar levels will trend toward the steady and normal, both necessary to avoid the development of carbohydrate intolerance.

If we add steady increasing levels of physical activity every day and, as a result develop increased exercise tolerance and increased muscle mass, we will have synergistically increased our metabolic rate. We will feel more energetic, and as a result be more active. A virtuous cycle will set in! 

Here's the real newsflash: I am asking all my patients to pay more attention to food. In fact, I am almost certainly asking them to eat better food, in greater quantities, more frequently. In fact I would be thrilled if all of my patients made healthy food a lifelong hobby. Sourcing high quality food, searching for recipes, trying new things, and entertaining with healthy recipes is a lot of fun.

So with the holidays approaching, do not worry. Get excited about finding some great healthy recipes. And maybe plan a frosty family walk outside on your Thanksgiving morning, or between dinner and pie. 

Food Friday: Trick or Alternative Treats

Ever wonder what you could give out instead of just candy ? I have worked on this challenge before at Easter when filling eggs, but have not until now considered what alternatives I could do at Halloween. 

First of all your Halloween alternative offerings should not break the bank. Secondly they should be age specific. In my family and group of friends, everyone from young children to old adults go out for the holiday, usually in costume. Halloween has always been a big holiday for our family, but especially since our youngest child was born on that day 22 years ago. When he was tiny he used to think the whole town came out for his birthday. 

I am for a strategy where you actually hand out the treat rather than have people take it from an unattended bowl on your porch. You will see why when you see my list of alternatives. Some are definitely age specific. Plus you ought to get to know your neighbors.

I think it is important to have some candy at Halloween. Always choose something that is wrapped so that the parent or child can be sure that has not been handled. You might think that the candy would get cherry picked out. This will not be the case if you were the one doing the handing out. Moreover, at Easter, I have found that some of the other non-food items are actually more popular than the candy.

Here's the list:

• Tiny boxes of raisins
• Trinkets you've purchased for cheap at the thrift store
• Interesting buttons purchased by the jar at garage sales or thrift stores
• Tiny spools of thread purchased by the bag at the fabric store
• Craft items such as decorative pipe cleaners or pom-poms
• Glass “Jewels”, meaning the pretty glass rocks you put in the bottom of a vase of flowers, Usually available at the dollar store in a selection of sizes and colors.
• Stickers
• Glow bracelets usually available at the dollar store.
• Poems quotes or sayings written decoratively and in tiny envelopes
• My favorite: beads, especially large ones.
• Tiny rolls of ribbon
• Tiny toy soldiers or animals 
• Office supplies such as decorative clips, rubber bands, tip erasers, or pencils
• Tea light candles

Basically I pick things I would like to get. Speaking of me, as you can see from the picture, I am still working hard on my costume. Guess who I am going to be.  

Have a safe happy Halloween. 

Food Friday: Travel Food

As I recently wrote in my post on travel wellness, discretion and restraint is advised in matters of travel food. Nonetheless, I think it is incumbent upon all travelers to try as much of the local cuisine as possible.

​How is this accomplished? For one, through small portions and for me as you will see, through photography. I need not eat my food to enjoy it, though I certainly do my fair share of  eating. 

For me, travel food also encompasses experiencing food with people. That is to say, the people are part of the recipe, part of the menu. For me, even the food preparation, the utensils and even the dishtowels add to the experience.

 ​And so, since I am traveling, I will share with you some of my food experiences.

Structure Sunday: The Structure of Prevention

Here’s a simple question: Is it hard or easy to stay well ? 

Staying well is two things: avoiding disease and optimizing health. I’ll be the first to tell you that there are some diseases you simply can’t avoid. I’ll also be the first to tell you that most diseases are a preventable. 

What is prevention ? Is prevention hard or easy ? Prevention is not one thing. It is collection of different actions. Most importantly, these are done over time, on a meaningful schedule, and so we call them habits. I find that lots of people do certain few healthy things once in a while. Oftentimes these same people wonder why they do not see gains in health or fitness. What they are missing is the element of time. Taking one, two or ten habits and performing them in perpetuity over time is what makes the changes. If I could change just a few ideas in my patient’s minds, this would be one of them. 

Prevention requires you to harness the element of time. Time gives your actions power. Most prevention habits are simple easy acts in and of themselves. By themselves they don’t so much. Multiply them by months and they make significant and long lasting changes. 

Here are some super simple acts which you can multiply over time. 

Mind: 

Record three things for which you are grateful before you go to bed. 

Read them upon arising. 

In a conversation, listen first then respond with “I” statements. 

Think and take two full breaths before responding during a conflict. 

Meditate for 10 minutes per day. 

Have about 6 close friends. 

Consider having a partner. 

Have a pet of whom you take good care. 

Ensure your work is meaningful. 

Don’t overspend. 

Take your allotted vacations. 

Body: 

Wash your hands at work and when you get home. 

Get your required vaccinations. 

Sleep at least 7-8 hours a night. 

Wear seat belts. 

Use sunscreen.

Eat three meals and three snacks each with protein and produce. 

Avoid simple refined carbohydrates. 

Use olive oil and green tea. 

Ban soda, smokes and drugs. 

Limit to one wine or beer per day. 

Drink 3 liters water per day. 

Brush twice a day, floss and use a peroxide mouthwash before bed. 

Exercise for half hour 5-6 times per week combining cardio and light resistance. 

Incorporate yoga every week. 

Super basic, right ?

Super powerful.

That’s what these habits are when repeated over time. 

Prevention doesn’t hurt, it’s not expensive, and you can do it anywhere. It does take a plan to carve out the small slots in the day to do these things, but it really isn’t hard. Just keep the list handy, do the items, and you will wake up in a few months and notice some pleasant changes. 

Food Friday: Soup is Soul Food

Every cook should know how to make homemade soup, especially those on a budget and those interested in eating healthy.

Two weeks ago I wrote an unusual post about how to make soup stock. It might seem like an unusual post for blog on Obstetrics, Gynecology, and healthy lifestyle, but not when you take a closer look.

One pillar of healthy lifestyle is healthy eating and another pillar is a healthy home life. Home cooked food can help with both. Soup is one of the most comforting and potentially healthy home cooked foods. It is also one of the easiest, of course once you know how. Homemade soup is also one of the thriftiest things to make since you can utilize leftovers and assorted ingredients from the refrigerator, garden, or pantry.

How to start? As always, start by cleaning up any stray dishes in the kitchen, organizing, and assembling your ingredients. Thaw any broth you have frozen. If you have not made frozen broth you can obtain good organic broth in three different flavors at any natural food store. You can also get a jarred  broth concentrate, also organic, at most grocery stores and at Costco as well.

Determine the vegetables you want to include. I'm a fan of great variety, But you can also make a vegetable flavored soup and emphasize one or two flavors such as red pepper. Prepare all of the vegetables by washing trimming and cutting them to the appropriate size.

I try to ask my patients to emphasize the protein in their diet. Decide what the protein in your soup will be. Consider chicken, red meat, fish, seafood,or even eggs. Cut your choice into bite-size pieces.  If you can tolerate legumes like beans and peas and can handle the carbohydrate that they bring, those can be included as well. Prepare all these ingredients so that they are ready to put in the pot.

I like to try to make my soup with only one pot. Choose your pot based on the volume that you want to make. Make sure it is extra large so that when you stir it with a long wooden spoon nothing will spill out.

Use a good cooking olive oil to sauté your first ingredients.These would include garlic, onions, or chilies if they are in your recipe. You will do them first so that they will flavor the oil. Make sure to use enough olive oil on the bottom of the pan. After this, Add your meat, chicken, or fish. Sauté until golden brown, but not fully done. I like to add fairly heavy spices to the cooking meat at this point since the flavor seems to penetrate better than adding it later. Then add your vegetables one by one and cook them until partially done, going from the hardest such as carrots to the softest such as spinach at the last.

When everything seems partially and evenly done, add liquid. I usually add a a half a cup of either red or white wine first. This adds to the depth of flavor. Then I add my broth, at least enough to cover all the hard ingredients, and usually more. I may or may not add a can of diced or stewed tomatoes, depending on the flavor I want to achieve. All you have to do at that point is bring it to a boil briefly, then simmer until the hardest vegetables are fork tender. If you intend for your meats to get very tender, they will have to simmer at least a couple hours. 

This is a good general recipe for a variety of different kinds of soup. You can make it with a large variety of different vegetables and if you add beans and a little pasta it turns out like a minestrone. If you add only a few vegetables and a lot of beans, tomato paste as well as onions and chilies, you have chili. You can pick a vegetable theme such as green vegetables and limit yourself to just a few onions, leeks, spinach, and kale. If you make a broth-y chicken soup with napa cabbage, ginger and green onions, you can drop whisked eggs into it and have egg drop soup. You can do the classic pumpkin soup especially at this time of year. Or you can go with the popular roasted red pepper soup.

If you have athletes, children or adolescents in the home, you can afford to serve this soup with a good whole-grain bread. Otherwise, it should stand on its own. You can always add a side salad and cold glasses of milk, to round it out.

Have fun with your soup and add some garnish. Garnishes can be anything from grated cheese or sour cream to minced green onions, parsley, crumbled hard-boiled eggs, sliced almonds or Siracha sauce. 

You will find that people tend to gather around a kitchen table with a good homemade soup. Having a sitdown family dinner with soup is good for health and good for the soul. 

Food Friday: Fasting and What To Do Instead

Fasting and cleansing make headlines. They are dramatic trendy measures taken by those seeking improved health. But do they work ? Are they safe ? 

Fasting is generally regarded as going off food for at least a day. Cleansing involves the same but with some sort of liquids and juices added back. Sometimes enemas are part of the “cleanses”.

Proponents state that they get past their hunger, and that they eventually feel good, even high. They state their bowel movements show they are getting cleaned out. Their stomachs flatten and they feel light. Who wouldn’t want all this ? 

Unfortunately, it doesn’t last. Our physical and mental vitality depends on a flux of matter and energy through our body. It is true that our body is designed to weather the temporary hardship of relative drought or famine, but under these conditions it cannot thrive. 

So many people participating in cleanses or fasts are doing so to achieve optimal health and high performance. However, to really thrive, we need optimal nutrition and optimal activity as much of the time as possible. Fasting and cleanses are not compatible with this. 

What do fasting and cleanses really do ? In many cases, they are dehydrating. This can be dangerous, especially if subjects are very young, old, or unwell. The body does burn fat and glycogen for energy, but in more prolonged fasts, muscle mass is lost. This types of metabolism actually produces more “ toxins”. It does not detoxify. 

All this provides a substantial stress on the body. Stress hormones are activated. Neurotransmitters  which help us cope with stress are activated as well, accounting for the feeling of elation and capability. 

Weight does indeed get lost, but mostly in the form of water, stool, fat and and muscle. When a normal dietary and fluid intake is resumed, most of the weight is regained. Muscle of course can be rebuilt, but this requires exercise and surplus protein in the diet. 

Colon cleanses can be dangerous. The colon has a normal bacterial flora. The importance of the balance of this flora is becoming better understood these days. Colon cleanses disturb this balance and can lead to problems with digestion, dehydration and serious electrolyte abnormalities. 

I have noticed that purveyors of these unproven and dangerous methods charge high prices. I have also noticed that they advertise to vulnerable populations, including those undergoing cancer therapy. I find this very concerning. 

The answer to all of this is very simple. It is common sense evidence based medicine and health maintenance. It is Friday, and I am thinking about the weekend. So instead of going on about this downer topic, I would like to tell you my alternative version of a quick health boost. 

I call it a “spa weekend". To me, this means I will arrange to do several key things this weekend in a concerted spirit of boosting wellness. They are as follows: 

• Get the ideal amount of sleep all weekend. 
• Do morning yoga. 
• Drink green tea each day. 
• Drink 3 liters of water each day. 
• Do longer afternoon workouts each day. 
• Have 3 ideal meals and 3 ideal snacks each day all weekend, heavy on protein, veggies and fruit. 
• Soak in the tub each day. 

I might even do my own pedicure. 

That is my idea of a plan to boost wellness. I hope you can take a spa weekend sometime soon. 

Wellness Wednesday: Getting Real about Wellness Coaches

"Are health coaches a real thing? What do they actually do? Something like that sounds really expensive.” In our survey two weeks ago you said the most helpful thing for your health improvement would be a health coach. Here is the lowdown on this very real and up-and-coming service.

There are a lot of coaches out there. There are a lot of health and wellness coaches out there too. As you know, I have hung out my shingle as an "evidence based" practitioner. Accordingly, if I were to get a wellness coach, I would want one that practiced evidence based coaching. 

I have done a little homework on our behalf, and found that the American College of Sports Medicine certifies only one coaching program in the country at this time, wellcoachesschool.com. Lucky for me, the medical fitness center (health club) associated with my hospital utilizes wellness coaches certified by this school.

However, I too assumed this would be on the expensive side. Here's what I found out. First of all all, prices are cheaper if you are a member of the health club, which stands to reason. Secondly, they offered different packages. The cheapest package without membership was $200 and consisted of eight sessions over eight weeks. This would provide personal training in a small group. This sort of thing would be an out of pocket expense.

On the other hand, I was pleasantly surprised to find out that the more extensive packages involving weight management and wellness coaching for those with serious or chronic medical conditions might be covered by insurance. These programs range from $250-$750 and take place over several months time. Of course any coverage by insurance would have to be determined beforehand and would have to be based on documentation in the patient's medical record by a patient’s physician, someone like me. 

Although I was encouraged by all of this, I did come away from my fact-finding with the impression that my patients who need this most are simply not going to be able to have access to this, afford it or obtain coverage for it. 

This led me to the idea of being your own coach. This is not my idea or a new idea. A simple Google search revealed several reputable sites which deal with this topic. I will share them with you now.  

How to become your own life coach with 14 simple strategies

10 ways to be your own life coach

How to be your own life coach in four easy steps

And my favorite,

Tips from the pros: how to be your own life coach

I am thinking about getting wellness coach certification from wellcoachesschool.com. So much of what I do in the course of the day with my patients is wellness coaching. While it is true that I deliver babies and perform female pelvic surgery, I spend a lot of time and energy trying to get my patients to be well. I would like to be as good as this as possible.

Organize Your Mind, Organize Your Life: Train Your Brain to Get More Done in Less Time

$12.96

By Margaret Moore, Paul Hammerness

Buy on Amazon

I looked into the course curriculum, and I noticed they had two key textbooks, one you get when you register for the classes, and is rather costly. The other is available on Amazon.com for a modest amount of money ( At this time a used one is $0.43 plus $3.99 for shipping. ) It is called "Organize your Mind, Organize your Life” with the subtitle,”Train your brain to get more done in less time”, by Margaret Moore and Paul Hammerness. I think this is a great place to start for people who want to be their own life coach. I know I am going to crack open this book as soon as possible. 

Beyond that I am still going to be giving continued thought to what, in practical every day terms, could help people meet their basic health goals in nutrition, fitness, and stress management.

Stay tuned for more tips on achieving wellness on next weeks Wellness Wednesday.