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: