Fish Tacos

A simple slaw for fish tacos. This is a Rick Bayless recipe for easy and tasty fish tacos. What you see here is basically a half head of Napa cabbage chopped in food processor, one half red pepper chopped, handful of chopped cilantro, 2 tablespoons of orange juice, onetablespoon rice wine vinegar, three tablespoons olive oil, a sprinkle of salt, 1/2 tsp sugar and some grind of pepper. Grill up a white flakey fish (tilapia, cod, halibut) with some salt and pepper and wrap all ingredients in a flour or corn tortilla!!

Bulgur Wheat Salad

An interesting grain, actually steam cleaned pulverized wheat. Its good for wheat salads mixed with other grains such as quinoa and farro and also can be used for stuffings. I made a Syrian bulgur salad from Joyce Goldstein which is basically bulgur, parsley and walnuts with a pomegranate and lemon dressing. Tart and salty at the same time. Really unique taste.

The ongoing Bisphenol A saga: more updates

The ongoing Bisphenol A saga: more updates

A cup (or more) of coffee or tea a day could keep Type 2 diabetes away

A cup (or more) of coffee or tea a day could keep Type 2 diabetes away

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Treating disease with the right diet

Time and again patients come to me with mild elevations in their blood sugar and cholesterol and blood pressure. The decision is always whether to start medication or change their diet. Many give in to taking medication as it seems to be the "easy path." Its not. In fact, its probably not the better path either. The problem with medications is for one, people(and often doctors) become dependent on them. Many patients feel that once a blood pressure or diabetes medicines are started, they will never get off of them. People often continue poor lifestyle habits, such as eating the wrong foods and not exercising, and they fulfill that prophecy of never ending medications. Doctors often lose momentum with patients as it takes less time and effort to start a medicine than to intensively discuss diet and exercise regimens. These are big problems. Escalating health care costs are another byproduct of this situation. More medications, more labs to be drawn, more visits to specialists, even gastric bypass surgery... it never ends. But it can be stopped. I've seen it happen. All it takes, as Dr. David Kessler says, it to change the rules. People have to change their rules of eating. Cook more, learn healthy tasty ingredients to use and choose food wisely when eating out. I'm hoping that this blog and its links to interesting cooking and grocery sites will help people find the right path. The time is now!!

Tea

I used to drink soda all day long at work mainly because it was there....we have sales reps bring in lunch almost on a daily basis...lucky us. A few months back I decided to drop soda all together. I replaced my lunch time drink with water which works out fine. For the afternoon I drink herbal tea or regular tea. I realized that in the winter mostly I am much happier drinking something warm and tea does the trick. I drink it straight but many obviously choose honey or sugar and/ or milk. The nice thing about drinking tea straight or water is that there is really no nutritional issues to be concerned with. No calories, no fat, just the sensation of something warm and wet which is all I really am looking for it turns out.

If you choose to drink tea, knwo that there is caffeine in real tea... black and green tea leaves. Herbal varieties will usually tell you that they are decaffeinated.

Another Kind of Oatmeal

I never was a big fan of oatmeal until recently. At a conference last year I tried steel cut oats and found them to be a bit different than the average oatmeal. The flavor is nuttier and the texture to me is less mushy. So what are they? Alton Brown did a nice segment on oats recently and summarized the different forms of oats out there. Rolled oats are what most of us are used to buying in the store in a big round box. Rolled oats take about 10 minutes to cook. When rolled oats are fragmented a bit more they can be purchased as quick oats which cook even more quickly but are a bit mushier. I try to stay away from instant oatmeal as its really mushy, almost pasty and contains all kinds of additives and sugars that you really don't need. Steel cut oats are the oat s prior to rolling them. They look like little nuggets almost, kind of like what the old grape nuts looked like.

You can buy steel cut oats in the grocery store but in bulk at a health food store they are half the price. The problem with them is that they cook up in no less than a half hour so the dish is not easy to pull together if you are rushing off to work in the am. I make a batch the beginning of the week and keep it in the fridge, then microwave a bowl each morning with some maple syrup, raisins and cinnamon and a little milk...great stuff and very filling. Give it a try and let me know what you think!!

LF

an interesting perspective on meat eating and cattle ranching

http://www.nytimes.com/2009/10/31/opinion/31niman.html

Junk food as addicting as heroin?

http://www.grist.org/article/scientists-claim-junk-food-is-as-addictive-as-heroin

validation of Dr. David Kessler's writings.

Falafel Adventures

Falafel is a delicious meal and excellent source of protein. Last night we decided to try the recipe from scratch rather than from a box. We went to Mark Bittman's blog and found a good, easy recipe. I think it would have turned out great but for one error, we used canned chick peas rather than soaking fresh ones. It seems that you can only make falafel with previously uncooked chickpeas, otherwise the falafel balls will just fall apart when you try to fry them. In addition, I mistakenly tried frying the humus my wife made instead of the falafel mix(they look similar!). For your information, it doesn't come together with frying either. At any rate, I would recommend the Bittman recipe for falafel, it tastes great and I think if you use dried soaked chick peas, you'd be fine!

Hearty Lentil Soup

I heard this recipe on a radio show last year. When you're looking for a healthy, cheap, easy meal that keeps you warm on cold fall and winter days and nights, this is it.

1 1/2 cups Lentils cooked and drained
1 carrot chopped
2 tomatoes chopped
8 oz. tomato sauce
1 small onion chopped
3 potatoes chopped
a handful of cilantro
salt and pepper to taste
water
cumin 1/2 tsp

In a large pot sautee the onions for a few minutes with 2 tbsp olive oil until translucent. Then add carrot and potatoes and cumin. Cover with water and bring to a boil. Then add tomato sauce, salt and pepper to taste and cook until carrots and potatoes are tender. Add cilantro and season to taste with salt and pepper.

Easy But Delicious Tomato Sauce

Back in my residency days I ate alot of pasta. I remember one friend of mine always saying that she would never buy a jar of tomato sauce as it never tasted as good as making it from scratch. I didn't really catch on to this until this past year when I began making sauce from fresh tomatoes in season. There is truly no comparison and it's not all that hard to make. Here's a basic recipe. Once you get the basic sauce down, you can add vegetables, herbs, capers, olives, really whatever you like.

3 pounds fresh tomatoes(preferably in season)
1 clove garlic minced
1 medium yellow or white onion diced
2 tbsp pure olive oil
1 carrot diced
1 celery stalk diced
red pepper flakes 1/4 tsp
1/2 cup water
kosher salt

First the tomatoes need to be peeled and seeded. You can always start with 16 oz. of canned diced or crushed tomatoes if they are not in season, but if you have the fresh ones, here's what you do: drop each tomato in boiling water for 1 minute, then remove and place in cold water, the skin will now easily come off. Next remove all the seeds from the tomato. This is a messy job but makes the sauce much sweeter.

Place olive oil in large saucepan and heat med high. Drop in the onions and sautee for 5 minutes until translucent, then add carrot and celery for a minute. Next add the tomatoes and 1/2 cup of water and red pepper flakes. Simmer medium low for 45 minutes. That's it. I like to use a hand blender and make the sauce smooth at this point but you can keep it chunky as well. Season with salt as needed. Keeps for about a week in the fridge or you can freeze it in small containers and use as needed.

Flavor

I am often reminded of a quote I heard from the great chef Alice Waters when she described(I believe) why she opened a restaurant and happened to spark a movement in helathy eating. She said "I was looking for flavor." Flavor is what most food lacks these days, or in some cases flavors are all the same. When we cook at home we use a variety of seasonings, vegetables and aromatics that bring the food alive. If I can pass along one secret to healthy cooking it would be to look for healthy recipes with intense vibrant flavors. Sure plain steamed vegetables are boring, but egglplant covered in pesto or tapenade vinagrette or roasted cauliflower with turmeric are a whole different story. A few dressings that I recently tried are excellent ways to dress up grilled or sauteed vegetables. Here they are:



Olive Tapenade



A full flavored spread or dressing that is extremely versatile.



Ingredients:



1 cup good pitted kalamata olives

1 tablespoon anchovies minced

1 clove garlic minced

5 tablespoons extra virgin olive oil

lemon zest

1 tsp lemon juice

2 tablespoons chopped capers



Blend all ingredients except olive oil in food processor for a few seconds, then slowly add olive oil and process until smooth.

Basil Pesto

Great on pasta as well as tomatoes, zucchini, squash, just about any vegetable.

1 cup tightly packed basil leaves
1 tablespoon toasted walnuts
2 cloves garlic
salt and pepper
1/2 cup extra virgin olive oil

In a food processor blend the basil, walnuts, garlic for a few pulses, then slowly add the olive oil and process for about a minute. This keeps in the fridge for a few weeks unless you eat it all up!!

Tabouleh with chick peas and cucumbers

I'm always looking for new ways to get whole grains into my diet along with some protein. I'm talking about something that tastes good and qualifies as an easy filling meal that I can eat at home or easily take to work. This recipe qualifies. The bulgur is a nutritious, nutty whole grain that's really easy to make. The chick peas add some protein and texture, and of course the tomatoes and cucumbers give flavor and crunch. Making this when tomatoes are in season is always a plus. Here's the recipe:

1 cup bulgur wheat(soaked 1 hr with 1 cup hot or cold salted water)
3 medium tomatoes
1 cucumber
1/2 cup chopped parsley
1/2 cup chopped mint(or more if you like)
1 can chick peas washed and drained
1/2 cup extra virgin olive oil
juice of 1 1/2 to 2 lemons
salt and pepper to taste

Mix all ingredients in a large bowl and let stand for about 1/2 hr.

couscous salad for lunch

Here's an easy dish that gets you some vegetables, grain and protein and it tastes pretty good. I think its great as a snack or to take to work for lunch but it also makes a great side dish with dinner. Keep in mind that you can add or subtract herbs and vegetables(or add fruit) as you like.

1 cup couscous or Israeli couscous
1 medium tomato chopped
1 cucumber seeded and chopped
1 can chick peas rinsed and drained
2 tablespoons extra virgin olive oil
1-2 tablespoons cilantro chopped
1 tablespoon lime or lemon juice
1-2 tsp ground cumin

First cook the couscous. Its pretty simple and you can follow the ingredients on the package, or, take 1 cup couscous, place in a large bowl, then add 1 cup boiling water and let stand 10 minutes. Then fluff with fork. Done! Add the remaining ingredients along with salt and pepper to your taste. That's it! Enjoy.

Lou Friedman

sustainable seafood eating

For information on sustainable seafood visit www.montereybayaquarium.org/cr/seafoodwatch.aspx!! This a great resource for what fish are healthy to eat.

LF

Snacks at Work

I don't like to be hungry at work as I will get grumpy. The problem is that all day long people bring food into my office that I'd rather not eat. Sales reps bring big breakfasts with eggs, bacon, donuts and muffins. Patients and coworkers often bring in cake and donuts as well. Don't get me wrong, I like an occasional cookie or slice of birthday cake as much as the next person but if I'm hungry that's not what I'm looking for. So to counteract this barrage of junk food I bring snacks to the office and keep them at my desk. Here are some of my favorites:

Dried fruit(raisins, apricots, a mix), dried fruit mixed with nuts, nuts, bananas(very filling), other fresh fruit.

While I'm on this topic I will also address beverages. Like junk food, there is a plethora of soda in my office. I actually think that the bottles are reproducing. This stuff is terrible for you. One 8 oz. glass of soda has no nutrition except about 100 calories worth of sugar(these days in the form of high fructose corn syrup). How do I get around this? Prepare ahead of time. One can always drink water and I do. I keep a water bottle at my desk and fill it from our bubbler a few times a day. This also helps to cut down on trash(see: good for the environment). Water gets a bit boring after a while and that's when I break into my tea collection. I never liked tea as a kid but more recently I have found it very relaxing in the afternoon. Any type of tea is ok. If you are sensitive to caffeine you may choose decaf or herbal types. I like the caffeine for a "pick me up" in the afternoons. Some data suggests that herbal teas may help lower blood pressure as well through a mild diuretic effect. Of course there is always coffee. I personally drink it mostly in the morning. Juice can be ok as well but remember that there is a large sugar component in juice as well. As the nutrition expert Marion Nestle has said, you are better off skipping juice and eating fruit if you want that flavor. Fruit juices are usually made from concentrates and leave out the healthiest part... the pulp(slows digestion...its fiber silly!). So go out and get a water bottle, bring a tupperware container and pack some snacks!

Louis Friedman, DO

Herb Pesto

OK, here is last night's pesto.:

One large or two small garlic cloves minced
2 tablespoons extra virgin olive oil
1 tablespoon ground pine nuts or walnuts
2 tablespoons fresh basil chopped
1 tablespoon fresh chives chopped fine
pecorino romano cheese grated
kosher salt(optional)

Heat olive oil in a nonstick pan, toss in garlic, pinch of salt, a few red pepper flakes and cook until garlic is aromatic(about 3 minutes). Be careful not to burn the garlic as it will get bitter. quickly add the basil and chives and pine nuts. Immediately take off heat and let sit a few minutes. Then pour over pasta of your choice and sprinkle generously with pecorino romano cheese. Enjoy!!

Lou

Eat Less Meat

Why do we eat meat(red meat, chicken, fish, turkey, veal, pork) every day of the week? Where did that start? Do we need that much meat. I don't believe we do. There are plenty of vegetarians out there who do just fine. I agree with Mark Bittman, Michael Pollan and many others who advise cutting down on the amount of meat we eat. Not only is it healthier but its better for the planet as well.

Raising cattle for red meat is particularly detrimental to our health and the planet. Most beef cattle in this country are fed corn, a substance they were never meant to eat. Think about it, did you ever drive down the road and see cattle grazing on corn by the side of the road? No, cows were meant to eat grass. Cattle have an amazing digestive system that can turn grass into muscle(meat). If you feed them corn instead of grass, cows get terrible indigestion and they get fat as well. This indigestion they get only worsens global warming through these thousands of cows expelling gas and the fat they gain makes both them and us less healthy.

Why not go meatless two days a week? Think about it, substitute meat with pasta/vegetables, eggs or dairy. Don't be afraid of missing protein, that is not a problem in this country for the most part. You will most certainly get enough protein in the eggs, dairy and vegetables you eat. For some great vegetarian recipes see my last post and also the many blogs linked to this site.

Simple Dinner

I went home yesterday, frustrated and amazed once again at the number of overweight diabetic patients in my practice who appear more content to pay their pharmacy and the drug companies $100 or more per month for their medications, than to change their diet and pay a bit more for good food. Then there was the unhealthy lunch delivered to our office by a pharmaceutical rep. who also brought in a speaker from some large institution touting the benefit of statins for almost everyone. I'm not sure what the answer is but something will have to happen sooner or later or the healthcare system will bankrupt this country.

Dinner for us last night was simple but delicious. Small amount of whole wheat pasta with a simple pesto/herb sauce(recipe follows), some left over grilled zucchini and squash slices dipped in Joyce Goldstein's amazing romesco sauce and a little chianti. Perfection.

Thoughts on Food and Chronic Disease

One of my first patients yesterday was a young man who I diagnosed with diabetes two years ago. At that time he weighed over 200 pounds and admitted he did not watch his diet or exercise much, if at all. We found his sugar to be high, and in time, started him on medications for both his diabetes, cholesterol and diabetes at no small cost to him.

During follow up visits we talked about diet and exercise and lifestlye changes he could make. Initially, there was not much change in his condition, but somewhere along the line, something clicked for him. He began watching his diet, exercising and dropping the pounds. We stopped his medications one by one until at last he came to see me this week. His weight was now down 60 pounds in 2 years and his diabetes, high blood pressure and high cholesterol were gone. No medications needed!

This unfortunately. is a rare scenario in my practice and I would venture to guess the same for many other internal medicine practices across the country. Rare as it may be, it brings home the point that these diseases in ,most cases, are caused by intake of the wrong foods and practice of the wrong lifestyle. It confirms what has been said over and over again by progressive thinkers such as Michael Pollan, Marion Nestle and Mark Bittman. Yet as these writers have said, this is a public health problem as much as it is an individual problem. People need to make the right choices when it comes to food but food policies must change so that it is easier to make those choices.

As I watch the primary care model morph into a quality assurance system where we are increasingly required to document medications started for lowering sugar, cholesterol and blood pressure, I am concerned that the focus is misguided. I am hoping that the slow food movement, the Obama Administration and a whole host of food activists will make a differencenbefore this poor eating epidemic bankrupts our healthcare system completely. Now, let me get to work to make this a useful resource!

Louis Friedman, DO