Learn something new every day

I think diabetes is fascinating! Yesterday's post just skims the surface. As I learned today, chronic hyperglycemia causes all sorts of damage over time, yes. But in the short-term, hyperglycemia is barely felt -- it's the ketoacidosis that brings people into the ER. Basically, since glucose stays in the blood instead of getting into cells, cells rely on alternate forms of energy. A byproduct of these "alternative energy sources" are molecules (ketone bodies) that make your blood more acidic. Patients come in breathing rapidly to clear the acid by getting rid of carbon dioxide. Only then do they notice that they're dehydrated (dangerously so) due to the hyperglycemia.

For tonight's dinner, I give thanks to my pancreas. After many years of trying, I finally made tomato sauce that tastes just like my dad's. It's sweet without adding sugar or wine and so simple that all you taste are tomatoes and spaghetti. There's nothing daunting about it, only you can't skip on the butter.

Simple tomato sauce (makes ~2-3 servings):

• 3 cloves garlic, peeled but whole
• 1/2 onion, left whole (you can peel the outer layer or not, up to you)
• 1/2 box or 1 small can of peeled tomatoes (whole or crushed or pureed -- my favorite brand is Pomi, which comes in a small box instead of a can)
• 1 tsp butter
• 1-2 tbsp olive oil

Melt butter and olive oil in a pan over medium heat, then add the garlic and onion and leave it alone for few minutes. The garlic and onion should begin to soften and smell fragrant. Before they brown, add the tomatoes and simmer all together. If necessary, add some water to the pan to keep the sauce from drying out or burning. Simmer under a lid on to cook the onion through. My dad usually discards the onion, but I like to salvage it and eat it sliced with my pasta. Keeps the vampires away.

I may have mentioned this before, but I've learned to undercook the pasta and finish cooking it in the sauce with about 1/4 cup of the pasta water added back in -- this way the pasta absorbs the sauce as it finishes.

Why exercise?

It seems that no matter what's wrong with you, a doctor will recommend exercise as part of the cure. I always thought this made sense in that exercise --> weight loss --> better health. But then I learned that exercise helps independently of weight loss! For cardiovascular disease this makes sense, but why would it be the case for diabetes?

To set the scene: in type 2 diabetes, patients develop insulin resistance: they still make insulin, but cells stop responding to it. After a meal, instead of transporting glucose into cells, glucose remains in the blood. Patients become hyperglycemic, which over time damages organs.

It turns out that everyone has "non-insulin-mediated glucose uptake" transporters that take up glucose from blood regardless of insulin. Because many of these transporters are in skeletal muscle, working that muscle (i.e. exercising) improves the number and efficacy of these transporters. This provides an alternate way to take up glucose even in patients with insulin resistance.

Pretty neat, huh?

This salad is the edible equivalent of the neon gear that runners love so much, and I bet it has a low glycemic index to boot. It's vaguely reminiscent of an "Asian chopped salad." Simply mix together:

• 1 clementine, sectioned
• 2-3 radishes, sliced or chopped
• 1 scallion, chopped
• handful of roasted almonds, chopped
• sliced grilled chicken, optional
• romaine or butter lettuce
• balsamic vinegar & olive oil

Babies & eggs

One of the things that I love about science is that you can be immersed in biochemistry and anatomy when suddenly you stumble into something very moving, and you realize that you are at the crux of life and death. Take this preface to a lecture on growth hormone, delivered by a very old man with a thick Czech accent:

When you get to the delivery room you will understand what a miracle it is that from a fertilized egg such a cute human being is born, and you will be touched by the expression in the eyes in the mother when she sees the baby for the first time.

This week a quiet wave of concern spread among some of the female med students as we were subjected to several lectures about how fertility diminishes with age -- beginning in the late 30s and completed by the early 40s -- with few words of comfort or encouragement about our own futures, given the years of training we have ahead. We had to remind ourselves and each other that many of our mothers had us at those ages; but it would have been nice to hear such reminders from some of the women doctors at school. Instead, one professor (a PhD) told us that her friend in med school had been told "better freeze your eggs now!" -- the underlying assumption being that this was a somewhat offensive warning, but it wasn't really contradicted in the retelling. I guess we should worry less about ourselves and more about our patients: don't take this stuff so personally, that is.

I was just sent a book in the mail about med school and motherhood called This Won't Hurt a Bit (And Other White Lies): My Education in Medicine & Motherhood. The author, Dr. Michelle Au, had a baby during residency. She too kept a blog in med school; she is now an anesthesiologist in Atlanta. Inspiration to us all.

Scrambled eggs (get it?) with scallions and tomatoes:

• 2 eggs, beaten
• 1/2 chopped tomato
• 1-2 scallions, chopped
• 1 clove of garlic, chopped
• dash canola oil
• dash soy sauce

Heat the oil, add the garlic and tomatoes, and cook until soft. Add the eggs, scallions, and soy sauce. One of my favorite meals from the summer I spent in China:

Another raucous Friday night in Albany

Every Friday evening my housemate and I go to an extremely relaxing and yet challenging yoga class; we come home ready for dinner and bed.

White bean soup is one of my all-time favorite dinners. It's so simple and yet it took me a long time to get my version to taste as good as my dad's: the key is to use a LOT of garlic. This recipe makes a delicious base that can be easily modified -- see suggestions at the end.

White bean soup (1-2 servings):

• 1/2 head garlic, peeled and chopped
• 2 cups reconstituted white beans (equal to 1 can, drained)
• red pepper flakes
• 1-2 tbsp olive oil
• parmesan
• salt & pepper

On medium heat, saute the garlic and red pepper flakes in the olive oil until fragrant, then add the white beans. Add about 1-2 cups of water and simmer for 5-10 minutes. Mash half the beans or puree half with an immersion blender so that the soup becomes thick but retains some texture. Season with parmesan, salt & pepper, and a few drops more of olive oil if you like. Substantial on it's own or with crusty bread.

Variations:

• Caramelize an onion with the garlic at the beginning -- this will make the soup sweeter
• Season with fresh chopped rosemary
• Add chopped kale along with the white beans; do not mash or puree the beans at the end

The multipotent version:

Differentiated to kale-and-white bean soup:

(Vegetarian) comfort food in under five minutes

The dad of one of my childhood friends is a famous diabetes researcher and I tend to Google him every time I'm studying insulin. I recently found this story, which I found very moving.

Melton was a well-established scientist studying frog development in 1993 when his infant son was diagnosed with type 1 diabetes. This more severe form of the disease requires that diabetics take daily injections of insulin to survive. Without insulin, the body can't convert glucose into energy. Hoping to find a cure for the millions who suffer from type 1 diabetes, Melton turned his attention to stem cells. "When my son Sam was diagnosed, I did what any parent would do: I asked myself, 'What can I do?'" Melton recalled. (http://www.hhmi.org/research/investigators/melton_bio.html)

The best I could do at this point is cook something delicious. Thankfully, no kids!

Mushrooms marsala:

• 5-6 mushrooms, the better the better (I used baby portobellos, which are one up or maybe just on par with white button mushrooms, nothing fancy), chopped into small pieces
• 1/2 large white onion, chopped fine
• 2 small garlic cloves, chopped
• 1 tbsp olive oil
• 1 tsp butter (optional)
• generous splash of wine (doesn't matter what kind -- I used cheap cooking sherry)
• dash heavy cream (optional -- we had some leftover from last scones weekend)
• parmesan
• black pepper
• 1/4 box pasta

As the pasta water boils, chop the mushrooms, onion, and garlic. In a frying pan over medium heat, melt the olive oil and butter. Once melted, add the onions and garlic, saute until translucent, and then add the mushrooms. Turn the heat to low and add the wine, cream, and black pepper. Simmer until the pasta is done; turn off if the liquid starts to evaporate.

Once the pasta is done, toss everything together in a bowl or frying pan and season with parmesan and black more pepper.

Not the healthiest dinner, but it can be modified to be more or less healthy -- plus, it's comparable to a mac and cheese with more fiber (and flavor) and a lot less cheese.

The play-by-play:

"I'm in the milk and the milk's in me"

One of the most amazing things we've witnessed this year are the embryological remnants that stay with you throughout your whole life. Our cadavers have hidden within them structures that have not been in use since they were fetuses inside their mothers: umbilical arteries turned into ligaments inside the abdomen; an opening between the right and left heart that closed instantly with the baby's first breaths; etc. Seventy, 80, 90 years later, a glimpse reminds us that these old dead folks were once new.

And the reverse is also true: by four months of pregnancy, a female fetus already carries millions of eggs in her ovaries. Both male and female fetuses develop breast tissue in the first trimester. Crazy, huh?

Today I went to the New York State Public Health Association annual conference and ate grilled asparagus and a mound of cheese and crackers for dinner before sneaking out the back door. More on the conference later, but I will report on the minimalist and yummy lunch I had beforehand.

Homemade "muesli" (barely a recipe, more of an idea):

• 1 Greek or regular yogurt
• 1 banana, sliced
• 2 strawberries, sliced
• 1/4 cup oats
• 1 tbsp each toasted flax seeds, chia seeds, etc.
• dash of milk

This was filling enough to get me through the afternoon and comforting enough to keep me away from snacks!

From In the Night Kitchen by Maurice Sendak

Having escaped maternal rejection

It was a wake-up call to recently find myself scribbling "what happens to sperm not ejaculated? do they die?" without a concern in the world other than whether sperm left in the epididymis are phagocytosed after a few weeks and by what. Makes you want to take a hard look in the mirror at what you've become.

Yesterday we learned that maternal white blood cells can recognize fetal blood cells as "foreign" (if they happen to come in contact) and may then develop antibodies against them. The mother "mounts an immune response" against the developing fetus in her uterus -- leading to problems down the road. "The ultimate maternal rejection," as my professor put it.

But my mother loves me, so why not post a simple recipe that she taught me?

Haroset (technically a dish for Passover, but such a good snack...)

• 2 large green apples
• 1/4-1/2 cup walnuts
• ~1 tbsp cinnamon
• ~1/4 red wine (or grape juice; a smaller amount of balsamic vinegar would probably work too)

Chop the apples into 1-cm or less chunks. Roughly chop the walnuts (untoasted). Toss all together. Makes a great snack! I confess that I brought some to school for lunch, wine and all.

Spring is in the air

All the food blogs are talking about ramps today (ramp pasta, ramp pizza, more ramp pizza) and I'm stuck in the library studying endocrine hormone synthesis. 1) I can't even find ramps 2) I can't even afford ramps 3) you probably haven't even heard of ramps. Happily, we learned about erections and orgasms this morning, which is more exciting than ramps any day of the week.

But I still want to celebrate spring, so here's what I'm making for dinner:

Pasta with asparagus and pesto (amounts for 1 serving):

• 1/4 bunch of asparagus
• 3-4 tbsp basil pesto*
• 1/4 box of pasta
• parmesan

Prep the asparagus as you boil the pasta water: wash, chop off the last inch at the bottom, and then chop into 1-inch pieces. There are a few ways you could cook the asparagus: you could steam it above the pasta water, saute it in a drop of olive oil in a pan, or microwave it for a minute or two it in a bowl with some water at the bottom. Cook until it no longer tastes like raw grass, but still retains its crunch (overcooked asparagus is soggy and a yellower green).

Toss your cooked pasta, asparagus, and pesto together in a bowl or frying pan, then serve with parmesan.

Doesn't that look like spring?

*About the pesto: I make my own in large batches and freeze it into single servings using an ice cube tray (tricks for keeping food from going bad!). The internet is flooded with pesto recipes so I won't include one here.

"I cannot responsibly answer this question"

My parents, who are both clinicians, of different sorts, frequently debate how much knowledge one should have before suggesting an answer to a question. There are certain questions (such as, "Daddy, why are there tides?") which they historically refused to answer, and others on which they are happy to speculate ("why haven't we passed gun control yet?").

I have one professor, in his late 70s or early 80s, who seems to revel in the phrase "I cannot responsibly answer this question." Some of my classmates seem frustrated with this answer, perhaps supposing that the professor would be able to answer the question responsibly if he kept up with the latest research. I think, however, that he's trying to be a role model for us, to discourage us from BS'ing when we don't know an answer -- the consequences in medicine, after all, are significant. Yet the key difference is that this elderly gentleman has the confidence and authority to profess ignorance -- whereas we, still unproven and largely incompetent, are going to be spending the foreseeable future getting asked "pimp questions" (pop quizzes) to which we will have to come up with reasonable answers on the spot. You can see how bullshitting seems tempting.

What do I know a little bit about? Cooking. Running at a nice easy pace. Tidying up the apartment. Etc. It's nice to have a few arenas where I feel some confidence, to which I can retreat for a few hours when the facts being thrown at me seem overwhelming.

Here's a nice Sunday evening supper.

Roasted eggplant parm (also simplified from Mario Batali):

• 1 eggplant, sliced into strips or rounds about 1/4-inch thick
• 1 ball of fresh mozzarella, also sliced thin
• tomato sauce, or:
• 1 can tomatoes
• 1 clove garlic, chopped
• few tbsp olive oil
• olive oil
• salt & pepper
• basil optional

Preheat oven to 400 degrees. Arrange eggplant slices side by side (not overlapping) on a baking sheet, then brush each one with olive oil and sprinkle with salt and pepper. Flip slices over and repeat on the other side. Roast in the oven for 10-20 minutes, until eggplant is soft (some pieces may be crispy) but not burned.

If you are making your own tomato sauce, heat the olive oil in a pan, add the garlic, cook for a minute or two, then add the tomatoes and simmer for a few minutes until the eggplant is ready.

Layer eggplant: eggplant-sauce-cheese (and throw basil in there if you like) in a smaller pan and bake at 300 degrees until mixture is bubbly. Serve with bread or pasta to mop up the sauce.

More spice, less salt

As with cholesterol, learning about hypertension earlier this year really scared me. Controlling your blood pressure is not a theoretical recommendation: high blood pressure stresses blood vessel walls, increasing their risk of rupturing. Plus, your kidneys, which normally regulate body fluid volume and therefore blood pressure, readjust to whatever new blood pressure you set for them via your diet. I'd rather my kidneys not get used to anything too risky!

Not to sound snotty, but the best way to avoid salt is to avoid processed and prepared foods. As I think of it, restaurants don't have your best interests in mind! They want you to enjoy the food and come back. Only you, cooking at home, have your best interests in mind.

One way to cook with less salt is to seek out more flavorful herbs and vegetables. For example: fresh ginger and garlic instead of soy sauce; toasted instead of salted nuts; roasted vegetables. This means branching out a little, experimenting with some new vegetables and finding a way to use up a bunch of herbs before they go bad, but with practice anyone can get there.

Fennel is anything but bland. Why not try it as your experimental vegetable-of-the-week?

Braised fennel and white beans:

• 1 fennel bulb (sold in packs of two at Trader Joe's)
• 3 cloves garlic, chopped
• 1/2 cup white beans, reconstituted, or 1 can white beans
• 1-2 tbsp olive oil
• dried red pepper flakes
• salt & pepper
• optional garnish for the end: chopped parsley, parmesan

Cut the fennel bulb in half, cut out the hard white core in the middle, and slice the fennel into thin strips (varied thickness is fine). Heat olive oil in a pan, add the garlic and pepper flakes, and cook at medium heat for 1-2 minutes before adding the fennel. Saute until the fennel becomes softer and the garlic is fragrant, adding water as needed to keep from burning (it's okay to let the fennel brown a bit -- it adds flavor and according to our professor is only marginally carcinogenic!). Add the white beans and about 1/2 cup of water (or no-sodium chicken broth) and simmer on low heat for a few minutes. Season with salt and pepper and parsley or parmesan if you like. Maybe you're starting to notice a theme with these recipes.

This would make a great side dish for fish or chicken; being a poor, busy, carless med student, I'm going to eat it on top of barley or pasta. Looks pretty good, no?

The play by play:

Meanwhile, in med school...

With the TV blaring about my hometown in the student lounge today, I was forced to retreat upstairs for the last dissection of the year. Honestly, scooping out the rectum (like a pro, I might add) was nothing compared to anxiously hitting reload on NYTimes.com all day. Just goes to show that it's all relative.


How are we celebrating tonight? With a homemade-dumpling party, of course! These are actually quite simple: a chopped base of veggies and/or meat, wrapped up into little pre-made wrappers, and boiled, steamed, or fried. Having grown up around dumpling parties, they are delicious and not too intimidating.

A few interesting comments by professors this week about the female reproductive system. Yesterday an endocrinologist showed us a graph demonstrating that the age of onset of puberty has gone down over the past ~125 years, and then pointed out that the age of adulthood, for social intents and purposes, has gone up dramatically (we're in our 20s and in med school). I realized that a hundred or so years ago, puberty and adulthood aligned, and we had no need to ask the kinds of social questions that we're debating now as a society.

Today, our anatomy professor explained why a "coathanger" abortion poorly done, rather than irritating the uterus as intended, pierces into the cavity above, leading to infections, bleeding, and often death. He commented that clinicians used to see more of these, but since Roe v. Wade the number has gone down.

(photo courtesy of a classmate)

But it's not all male professors. Our histology professor yesterday described for us the sensation of breast feeding from a mother's perspective, as it relates to the cells and mechanisms on her slides. Pretty interesting!

Hard truths

This week I learned why I am short despite having once felt tall. Apparently, and this makes sense, kids who start puberty earlier have higher levels of estrogen (or testosterone), which makes them grow taller and develop more at a younger age. But these same hormones hasten the end of puberty as well, marked by the closure of growth plates (epiphyseal plates) in the long bones (arms and legs) at a younger age. This leaves fewer years for a growth spurt. Thus, I went from center to guard (to bench, if I'm honest) between fourth and sixth grades. I wish, instead of wracking their brains and the family tree for tall relatives, that someone had told me this when I was 10.

Tomorrow is the big day: the healthy food contest (and, continuing the theme from last week, my last and grossest gross dissection of the year)! Just to prove that it could be done, I made my chicken and chole curry from two weeks ago. I will serve it with cilantro and a choice of couscous or brown rice. Feels like the night before Christmas around here... And new recipes next week, I promise!

Comfort food

After I heard about the marathon on Monday, I felt a strong, seemingly random, craving for ice cream. Halfway to Stewart's (the local ice cream joint) I turned around to get a diet root beer instead, my other indulgence.

But I still had to eat dinner, and peering over into the steaming pots my housemate had on the stove, I decided to go for noodles, my comfort food of choice. I basically imitated what she had going on.

Housemate's miso noodle soup:

• 1-2 tbsp miso paste or mix
• Handful of dried noodles (whole wheat soba, udon, etc.)
• Napa cabbage or lettuce (this is a point of contention: housemate says she "hates lettuce"; I used iceberg and think it came out great)
• Vegetable such as mushrooms (she used enoki) or edamame
• Tofu cubes optional
• Additional seasoning optional: cilantro, hot sauce, sesame oil, soy sauce (use just a drop)

According to my dad the food writer, the proper way to make a miso soup is to boil kombu (thick dried seaweed) and bonito (dried fish) flakes in water, fish them out, and then add your miso paste. Sometimes I'm feeling too lazy for the additional 3 minutes this requires and just skip to the miso paste. Tip from Japan: pushing the paste through a strainer as you add it to the water allows it to diffuse in the soup rather than clump together, and the result is that you can use less miso (and sodium) overall, since it mixes better.

Add water to a pot, add your veggies, boil, then add your noodles (cooked separately) and season with miso and other sauces. Lettuce (or napa cabbage) is an ingredient I noticed my Chinese-American friends using; when I tried it for the first time, I was surprised at how much flavor it added. My housemate makes this at least once a week.

I bet this would also be great with some fried garlic or ginger sprinkled on top. From a restaurant in Cambridge a few weeks back:

The finish line

Feeling awful about what happened in Boston today. Thank goodness everyone I know who was in the area today is okay. Just thinking about the physical state I've seen friends in at the marathon finish line -- exhausted, elated, bodies stressed and pushed so far to the brink that I wonder if the runners today had any adrenaline left to deal with the explosions, and I wonder what happened in the bodies of those who were injured. I have a friend and some indirect acquaintances who I know were working in the finish line medical tent, and I've heard reports of missing limbs and bodies -- too soon in our training to deal with that. And then the runners whose marathon-completed high has been denied to them. But I'm glad that everyone I know is fine.

Sunny salad for a Sunday morning

This week has been stressful in an unusual sort of way: there's no time crunch, we're not studying any tragic diseases or injuries, and yet preparing to dissect genitalia is stressful. It's unpleasant, and it can't be avoided. Friday evening we unwound a bit by attending "Grand Rounds," a parody show put together by the fourth-years celebrating their four years of med school, with all its pros and cons. The most notable feature was a long, long slide show of students napping at all times in all places: definitely humorous, but a little sad if you think about it. It's daunting to imagine what we have ahead of us, even if much of it is exciting and will bring our class closer together.

Another way to unwind, other than eating high-fat food and drinking and dancing, is to eat fresh and delicious food. Chopping vegetables is cathartic. I hated fennel as a kid, but now I've rediscovered it with a vengeance.

Mario Batali's recipe for fennel and citrus salad (Vitamin C, I just learned, enhances iron absorption in the gut, which is great for preventing anemia!):

• 1 fennel bulb (sold at Trader Joe's in packs of two)
• 1 orange or small grapefruit, or 2 clementines
• juice of 1 lemon
• olive oil
• pepper

Slice the fennel as thin as possible, cutting around the solid white stalk in the middle. Discard the center stalk. Section the citrus: for the orange or grapefruit, you'll have to remove the segments from their casings; clementines are fine as they are. Toss with lemon juice, a drop of oil (too much doesn't taste as good), and pepper.

Help! Seeking ideas.

Next Friday there's a healthy food competition for students, with prizes for Best Meal, Best Snack, Best Dessert, Overall Tastiest, and Overall Healthiest.

Suggestions? Comment below.

Middlesex

Hormones are nuts. The adrenal glands resemble small clumps of fat on top of the each kidney. Yet they synthesize hormones that control metabolism and sexual characteristics: and what is more important than food and sex?

I just learned that if you have a defect along the pathway that makes cortisol (a 21-hydroxylase defect, to be exact), your body will go into overdrive to produce all the intermediates in the pathway on the way to cortisol. It's like if someone doesn't return your phone calls: you may call and call again until they call you back and you know they've received your message. While the missing end-product (cortisol) is one thing, excess of these intermediates can wreak havoc all over the body: in particular, the excess testosterone in females (especially fetuses) leads to male characteristics (such as male or ambiguous genitalia). Treating the mother with the end-product -- returning the phone call -- will signal to the fetus that everything is OK. The overdrive will recede, and a female baby will end up normal.

Last night I had a pasta primavera for dinner (makes two servings):

• 4 small zucchini or 1/2 large zucchini, cut into rounds
• 1/2 cup English peas
• 2 chopped scallions or other herbs (parsley, etc.)
• 3 sliced or chopped garlic cloves
• ~1 tbsp olive oil
• 1/2 tbsp butter (optional)
• dash of white wine (optional)
• 1/2 box spaghetti
• parmesan
• hot chili flakes
• salt and pepper

The key to this, I think, is to barely cook the vegetables. To barely cook the pasta, even. As the pasta water boils, heat the oil and butter in a frying pan and add the garlic (and wine if you're using it). Cook at medium heat until fragrant; add the zucchini and herbs and cook for 1-2 minutes. Turn off the heat and wait for the pasta to finish. When the pasta can bend but before it's fully cooked, drain almost all of the water and pour the pasta plus some pasta water into the frying pan with the zucchini. Add the peas and cook at high heat until the water has evaporated and the pasta is done to your liking. Season with parmesan, chili flakes, salt and pepper.

Cooking for speed

Not every meal has to be elaborate. When I walk into the house hungry and stressed out, it's nice to have something that I can cook so fast it leaves me no time for snacking. After the lecture that I just sat through (see below), today was one of those days. For those of you with jobs that prevent you from coming home midday for lunch (school has its perks!), I think this would make a delicious weekend breakfast!

Too simple to be a recipe, consider this as more of an idea: English pea omelette (English peas are in season right now and it's nice to have them in everything). Heat and butter a frying pan, pour in a layer of uncooked fresh peas, beat 2 eggs together and pour them over the peas. Season with salt and pepper, and herbs or cheese if you like (I used about a tablespoon of leftover homemade buttermilk salad dressing). I can vouch for this being really good.

(Unfortunately the omelette collapsed. I think in my enthusiasm for spring I overdid the pea:egg ratio.)

The Big Day

All year we have been avoiding and yet slowly marching towards certain sticky topics. In the fall, we started out politely studying bones and muscles, followed by the largely theoretical, intellectual study of the nervous system -- with an icky, Halloween-like brain lab thrown in. Then we got to renal, and GI, and learned to calmly discuss urination and defecation, even to palpate the colon and the rectum as tubes inside of our cadavers.

So although we are nearly done with dissection forever, tomorrow is The Big Day: dissection of the male pelvis, followed by the female pelvis next week. In preparation, today we were treated to a rather graphic, though entirely matter-of-fact, lecture on the pelvis and genitals, complete with cartoons as drawn from the viewpoint of a physician giving a pap smear. I was filled with admiration for our professor, who managed to set a tone that was entirely non-creepy, respectful, and informative. With the occasional ironic joke: "the anal triangle is filled with fat -- those of you doing dissection tomorrow will be able to appreciate that."

Tomorrow should be fine -- we've managed to get through every distasteful obstacle we've encountered thus far, and it's never as bad as the anticipation.

Luscious legumes, indeed

Sitting in the student lounge scarfing down hot, flavorful soup, it seems almost cruel not to share the recipe. The people to my left are playing foosball and pool; the women to my right are studying; others wander around in short white coats (short coats indicate students, not yet MDs). It's low-key.

Black bean soup:

• 1/2 bag dried black beans, reconstituted, or 2 cans of black beans
• 1 onion, roughly chopped
• 2-3 cloves garlic, peeled but whole
• 1 celery rib, in half
• 1 chopped carrot, optional (will make the soup sweeter)
• 3-4 tbsp ground cumin
• chili flakes
• salt
• canola oil

Heat the oil in a large post, then add onion, garlic, celery, and spices, and saute until soft. Add carrots and beans, then cover with lots of water and simmer for about an hour (enough time to watch one lecture). Puree with an immersion blender (or a food processor) such that the soup is about half whole beans, half pureed beans. Season with salt and more spice, and continue to boil off water as necessary to thicken the soup. This is hearty enough on it's own, but you could also serve it on top of quinoa or brown rice, or garnish it with some cilantro, hot sauce, and/or shredded cheese.

You'll notice a theme to these recipes: this is not that different from the chicken-chickpea curry below. To make split pea soup, skip the spices and use dried split peas -- otherwise the recipe is the same. For white bean soup I skip all the vegetables and increase the amount of garlic to about half a head... etc. So easy even a med student can do it!

Endocrine

Day 2 of endocrinology is mind-blowing. Some teasers:

• Ever wonder why 55 degrees feels practically tropical in the spring but freezing in the fall? It turns out that prolonged cold -- such as several months of winter -- stimulates thyroid activity, increasing your metabolism to keep you warmer at any temperature.
• Lack of sleep stunts growth: growth hormone, which promotes bone and soft tissue growth and energy availability (think increased metabolism again), is released in several peaks throughout the day. The largest of these peaks occurs in the middle of the night, and will be smaller (less growth hormone will be released) if you don't get your nightly rest.
• Physiology of hangovers: alcohol (ethanol) suppresses vasopression, which is responsible for preventing dehydration by increasing water reabsorption in your kidneys. When you drink, vasopression function is diminished, and your body is able to run into dehydration.

Conclusions? Get ready for a slow summer metabolism, aim for adequate sleep, and drink lots of water!

Honesty

A few weeks ago, I bought a huge head of cabbage with the intention of recreating the delicious vinegar-based coleslaw that I'd had at the 2nd Ave Deli in NYC the weekend before. I chopped up the cabbage with some carrots, added white vinegar and sugar, and left it in the fridge to marinate and soften. But no such magic happened: the resulting slaw was crunchy, cold, and bland. So what to do?

Mark Bittman's recent piece on cabbage gave me some ideas: basically, cabbage can be used as a substitute for noodles, or to add some crunch and substance to any old meal. Always craving Chinese food, I thought, why not try Moo Shu Cabbage? I will admit that this recipe is not for everyone (*cough, mom*): but if you are inclined to crave greasy late-night Chinese food, perhaps try this healthier, homemade version... And no more cabbage posts for a while, I promise.

Moo Shu Cabbage:

• 1/4 head white cabbage, cut off of the core and thinly sliced
• 1 carrot, peeled and shredded or thinly sliced
• 1/2 onion, sliced
• chopped garlic and ginger optional
• 1 scallion, chopped
• ~1 tbsp canola oil
• ~2 tbsp white vinegar
• pinch of sugar
• drop of soy sauce
• Hoisin sauce
• 2 eggs, beaten

Heat the canola oil, then add the veggies, vinegar, and sugar, sauteing until soft and adding water as necessary to keep the vegetables soft without burning. The cabbage should be cooked through with only the slightest crunch at the end. Add the eggs and scallion, then adjust soy sauce to taste. Serve with about a teaspoon of Hoisin sauce.

Shoutout to a joke on my dad's blog

Like father, like daughter. My dad is a very serious food writer:

Bread Two Ways

Slice the bread twice.  Place one slice in a toaster.  Reserve the other slice.  When the bread is toasted, butter it.  Butter the untoasted slice.  Serve immediately.

www.shrinkinthekitchen.com

Cooking with less meat

The most surprising thing that I've learned in nutrition so far this year is that most of us need less protein than we think we do. I think that many of us young pseudo-athletes who grew up in the age of Atkins and South Beach were under the impression that we should eat mostly protein and vegetables. For me, doubts began to creep in when I observed Asian cooking, which is heavy on carbs and vegetables but still feeds mostly thin and healthy people. According to one of my professors, "there is no physiological advantage in consuming excess protein," because that protein will be broken down and converted to other products anyway (not made directly into muscle protein). In contrast, he says, "higher carbohydrate consumption preserves body protein" because carbohydrates, rather than muscle protein, can serve as your main source of energy. Apparently, we should aim for 45-65% of our daily calories from carbs, vs. 10-35% from protein.

From a taste and price perspective, adding chickpeas to this chicken curry adds variety of flavor and texture, and is cheaper, than using chicken alone. This recipe was inspired by my upstairs neighbor, originally from Kerala by way of Long Island, who has recently been trying to recreate her father's curry and generously sharing the rejected versions with me. Her dad makes a mean curry, her mom is a professor at Columbia Medical School: we both get teased by our moms for our fledgling knowledge of medicine; we both raid our dads' spice cabinets when we visit home.

Chicken and chole curry (this ingredient list may look longer than most but if you look closely it's really quite minimalist; these ingredients are good to have lying around):

• 2-4 tbsp ground cumin
• 2-4 tbsp curry powder
• dried chili flakes
• 1-2 tbsp grated fresh ginger
• 1-2 tbsp minced fresh garlic
• 1 onion, chopped
• 1 cup canned tomatoes
• 1 cup dried chickpeas, reconstituted, or 1 can chickpeas
• 1/2 lb chicken breast or thighs, sliced
• canola oil
• salt & pepper
• couscous or rice for serving

In a pressure cooker or pot with a lid, heat a few tablespoons of the oil. When hot, add the ginger and garlic, then onion, then spices. Stir constantly and add water as needed so that the mixture becomes creamy and uniform without burning. Next, add the chicken and cook until the outside becomes white. Add tomatoes, chickpeas, and plenty of liquid, and cook on low pressure or low heat (with a lid) until chicken is cooked through and completely tender. Adjust spices as needed. Should be a brothy stew that can be served with couscous or rice.

From Old Delhi in 2005, not Kerala:

Mulling on lipids

I'm guessing that not many of you have had the privilege of feeling an atherosclerotic vessel (calcified due to cholesterol plaque buildup) between your own fingers. It provides a visceral understanding of cholesterol that, stronger than any biochemistry or randomized control trials, makes me want to run in the other direction towards fiber and vegetables. Instead of rubbery like most arteries, the vessel feels hard: forgive the metaphor, but it is like old plumbing with years of grime collected on the inside. If you press down, you can feel the calcification crack and crumble between your fingers.

So, what are we going to do to avoid cholesterol? I recently learned what everybody else already knew: the first thing to do is attempt for control with diet and exercise, and if that's still not working, then to use drugs to bring levels down. For those of us in our 20s, it's diet and exercise. I also just learned that signs of future high cholesterol can be seen even in adolescents!

Hearty and healthy barley and beet-green salad:

• Beet greens from the tops of ~3 beets (beets are sold in bundles of three at my grocery store); or any green vegetable such as chard, spinach, kale, or even broccoli
• 1 other vegetable, such as sliced mushrooms, carrots, etc.
• 1/2 chopped onion
• 1 cup pearled barley, cooked in a rice cooker
• 2 tbsp pesto
• olive oil

Cook the beet greens as you would spinach: blanch for 2-3 minutes in boiling water, then drain and chop finely. Saute onion in the olive oil, then add the mushrooms and cook to your liking. Add beet greens, barley, pesto, and some water, and cook for 1-2 minutes longer, until the mix becomes creamy. Makes about two servings. I pack it as my school lunch!

Walnut and zucchini pasta

There's nothing like studying the biochemistry of omega-3's to whet your appetite for some walnuts and flax seeds. Combine that with a few nutrition lectures on PUFA's and MUFA's (poly- and mono-unsaturated fats) and you've got yourself a meal.

As it turns out, cells build fatty acids as long saturated molecules like this:

Then process them by de-saturating some of the bonds (adding a double bond) to make a variety of different molecules used in the body:

But cells can't just add a double bond anywhere they'd like: in particular, they can't add double bonds 3 or 6 carbons down from the far end. Thus, we can't make omega-3's or omega-6's ourselves, but we still need them, so we have to acquire them through the foods we eat!

Salivating, I know. But don't get me started on saliva, I've just finished studying that too...

The following recipe is not particularly original (see Mario Batali's ambitious Pansotti -- ravioli -- with Walnut Sauce and Smitten Kitchen's zucchini strand spaghetti) but it's so easy and delicious that every busy cook should be making it.

For one large serving:

• 1/8-1/4 cup walnuts, toasted (good source of omega 3's)
• 2 cloves garlic, minced
• 1/2 zucchini or 4 baby zukes, sliced into rounds
• 1/4 box of pasta
• olive oil (good source of monounsaturated fat, which lowers LDL cholesterol)
• parmesan
• red pepper flakes
• salt & pepper

Prep the vegetables as you boil the pasta water. Heat the olive oil in a frying pan and add the pepper flakes and garlic for about a minute, then zucchini rounds. Cook for just a few minutes, until the garlic is toasted and the zucchini is slightly soft but still has some crunch. Cook the pasta until just before it's ready (still fairly al dente), then drain. Add the pasta and walnuts to the frying pan and toss everything for 1-2 minutes until the pasta is to your liking. Serve with salt, pepper, and Parmesan.

 

Chicken soup for the modern med student

It continues to snow, so I will continue to talk about soup. I love soup: it's easy to cook, usually healthy, and makes enough food for several days. These recipes are really from last week, when I made chicken matzoh ball soup for a Seder, then gave the leftovers a makeover later in the week.

In school, we've recently been talking about cultural competency and the use of interpreters. Unsurprisingly, it turns out that many of my classmates are fluent in an Asian language. I'm trying to learn Spanish. Asian languages are intimidating, but Asian home cooking less so; between friends and my dad's interest in Japan, I've tried to pick up some tips. Familiarity with food and holidays is a start towards cultural competency: maybe one day I'll learn some language skills as well.

Jewish doctor soup:

In a large soup pot, boil the following vegetables with a whole chicken until the meat falls off the bone and the soup tastes brothy.

• 1 large carrot, peeled and cut in half
• 1 celery stalk, in half
• 1 onion, in half
• 1 or 1/2 celery root
• several cloves of garlic, optional
• handful of fresh parsley
• handful of fresh dill
• whole peppercorns

At the end, season with salt and pepper and serve with rice, pasta, or matzoh balls. I prefer to make the soup the night (or a few hours) before serving so that I can chill it in the fridge overnight and skim off (and discard) the layer of fat that rises to the top.

Asian doctor soup: Starting with the leftover chicken soup from above, reheat chicken broth with chopped mushrooms and celery and shredded leftover chicken. Serve in small bowls with hot sauce and a drop each of sesame oil and soy sauce, plus cilantro or lime if you have it.

Check out Guatemalan doctor soup here.

Interesting day

It began with one of our deans telling us that the greatest risk to success in medical school is distraction; our obsession natures can lead us down either path. My mind leaped guiltily to this blog.

Then we sat through two hours of supposed bioethics lectures on obesity and bariatric surgery, in which the conversation took a disturbing turn towards overly simplistic ("we may have the principle of autonomy but it is as simple as, 'no, you can't eat the foods that you want'") and mocking ("don't you hate it when you see people on the treadmill reading a book?"). It's not exactly groundbreaking to say that obesity is a complicated topic with entrenched socioeconomic and cultural issues, but I don't feel that our lectures today moved us anywhere towards an answer. How can we, mostly thin, mostly white, all privileged, help our patients who struggle with their weight? I felt a little ashamed of ourselves and glad that no patients were in the room to witness the discussion, or lack thereof.

Let's all try to enjoy food, cook quickly, eat more fruits and vegetables, and avoid saying and thinking nasty things about the people around us.

Exam week

Too panicked (positive spin: focused) to do anything but study the week before an exam, we regress to a hunter-gatherer state. There's often free food in the student lounge if you can be there in the 30-second-to-two-minute window before it disappears. If you sign up for a lunch-time talk or panel for visiting students, the school will supply you with cold wraps and stale cookies to sustain you until dinner. There's the 10% staff discount at the hospital cafeteria: my roommate prefers the $0.89 mac-and-cheese deal.

I've identified the fresh-food options at the convenience store and Italian deli on my block: eggs and dairy at Stewart's; onions, cabbage, and green peppers at Sainato's. It's not like living in a big city, but neither is the rent. Combining these with whatever produce I have left on the bottom shelf of my fridge usually gets me through the week. This recipe makes a lot, all the better to share with your stressed-out friends.

Cabbage soup:

• Head of cabbage, cut off of the core and sliced into thin strips
• 1 onion, sliced
• 1/2 head of garlic, cloves peeled and sliced or rough-chopped
• some other chopped vegetable: I used half a celery root; you could use a potato, carrot, or celery rib
• something sour: white vinegar or half a lemon (I used both)
• cooking wine if you have it
• salt and pepper (whole peppercorns if you have them)
• herbs on hand, such as chopped dill, parsley, thyme, or rosemary
• white beans, rice, pasta, or crusty bread optional
• few tablespoons of olive oil
• 1-2 tbsp butter

In a large soup pot with a lid, melt the butter and olive oil at medium heat, then add the garlic and onion. Saute for a few minutes before adding the cabbage plus vegetable. Add the vinegar and wine, then cover the vegetables with cold water. If you're using thyme or rosemary, add them now; dill or parsley can be added at the end instead. With a lid on the pot, cook at low heat for 30-60 minutes until the vegetables are soft (or until you reach a good study break). Separately, cook the beans, rice, or pasta, or toast a few slices of bread. Before serving, season the soup with lemon juice, herbs, salt, and pepper, and serve with the starch of your choice! 

A little bland-looking, but then again so is mac-and-cheese, and I'd argue that this is just as comforting:

Easter salad

Before I move on from the arugula-beet-lemon combo that I love so much, I thought I would add a couple more salad ideas:

Easter salad, named for the egg:

• 1 hard boiled egg (cooked while I was making my coffee and oatmeal before lecture this morning -- place the egg in cold water and boil the water and egg together, 10-12 minutes)
• 1/2 beet, peeled, sliced, and cooked through (you can drop this in the water with the egg or steam it in advance)
• handful of toasted almonds, chopped (popped in the toaster for 5 minutes)
• arugula
• 1/2 lemon to squeeze over the salad

This salad is fresh and colorful and adds almost no time to your morning. Other variations include arugula, beets, and lemon with steamed lentils (cooked in a rice cooker the night before) and sauteed mushrooms (sliced thin, cooked in some chopped parsley and olive oil for 2-5 minutes on the stove top). Excellent with a slice of bread or a yogurt.

Happy birthday!

Happy birthday to my mom! I made her this flourless chocolate cake during halftime of an NCAA basketball game:

First wet:

 Then dry:

Before that my dad planned a walk on the beach: