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.