Happy New Year!

Chinese, that is. My entire life I've had Chinese-American friends, so at this point the holiday seems as regular and relevant to me as Rosh Hashana. Just sayin'.

This week we've been studying lung cancer, pneumonia, tuberculosis... all disturbing diseases that eat away at you, leaving you breathless and in pain. I suppose the latter two are success stories, in the U.S. at least, but I think of the people who died of those diseases before there were cures, or those who health care successes have yet to reach. As in the first 100 pages of "The Magic Mountain" that I managed to get through this summer, with young (rich) people slowly dying of tuberculosis in the Swiss alps.

Lung cancer is still terrifying, of course, with about a 14% five-year survival. My grandmother on my mother's side died of lung cancer, and I've been wondering what that must have been like for my mother, a doctor, as the most healthcare-literate person in the family. I imagine that most people want to be hopeful when they receive a devastating diagnosis, but that such optimism would evade a doctor familiar with the numbers and the process. I wonder if it's unfortunate that she died just a few years before a ground-breaking pulmonary adenocarcinoma drug, or if it wouldn't have mattered anyway. These are not things we talk about.

Anyway, do you ever notice a paucity of salads at potlucks? That's often the case here, and anything raw is usually appreciated. Here's my contribution to a New Year potluck, scrapped together from here and here and what I happen to have in the cupboard.

Napa cabbage salad:

• 1 Napa cabbage, sliced as thin as possible
• 2 carrots (or peppers, sweet peas, bean sprouts), sliced as thin as possible
• handful of peanuts
• 2 garlic cloves
• 1 bunch scallions/green onions
• handful of cilantro, chopped
• rice wine vinegar (I substituted rice wine and white vinegar)
• soy sauce
• chili oil or chili flakes
• sesame oil
• sugar
• white pepper

Slice all of your veggies. Chop the garlic, scallions, and cilantro. Stir together about 1/2-1 tablespoon of each of your sauces, sugar, and chili, adding each to taste (the recipes cited above may help you here). Toss in your garlic and herbs, then cabbage and veggies. Enjoy!

P.S. Suggestions welcome if anyone has a favorite cabbage slaw recipe! I wasn't able to find any one recipe that looked perfect.

Healthy fried rice

I am not one of those people who can walk in the door and instantly get back to work. Rather than pretending, I've started relaxing for a few minutes when I get home instead of opening my laptop. Lying down, reading my book--or tonight, chopping vegetables. Since receiving a second lesson from my friend Xin, I decided to try fried rice again. I noticed that last time I started by frying the rice first, which I don't think makes sense.

This version of fried rice is heavy on the vegetables, with stir-fry "stuff" dominating over the rice. Plenty of brown rice though, still, to lend a heartiness to this dish on a cold day like today. This is also a good dish for when you're raiding the pantry, in those busy weeks just before an exam (I usually have carrots, celery, and onions in the fridge).

Brown rice vegetable fried rice (~2 servings):

• 1 carrot, peeled and sliced into matchsticks
• 1 celery stalk, sliced crosswise on a diagonal
• 1 onion, sliced
• 4-6 mushrooms, sliced
• handful of spinach
• 1" piece of ginger, washed with the skin on, finely chopped
• 3 cloves of garlic, peeled and finely chopped
• 1 scallion, chopped
• 1 egg
• tofu, in 1-cm cubes
• 1 cup brown rice, cooked
• canola oil
• soy sauce
• rice wine vinegar
• white pepper

In a wok or large frying pan, scramble the egg in about 1 tsp of oil. Set aside. Add more oil to the pan and then the garlic, ginger, and onion; after a minute or two (when fragrant and just gaining color), add the tofu and rest of the vegetables (add the vegetables in the order in which you want them to cook, saving those barely-cooked vegetables for last). After another few minutes, when the vegetables are just softer but not mushy (add spoonfuls of water as needed to keep from burning), add your rice and the scrambled egg. Continue frying until parts of the rice and tofu crisp up a bit, seasoning with soy sauce, rice wine vinegar, and white pepper to your taste. Garnish with scallion before serving.

I feel better. 

Fish: don't be afraid to cook it!

Over the past 24 hours, I have been attempting to learn the pharmacology of cardiovascular disease. There in my review book, listed in between the statins and "bile acid resins," were the nutritionist's beloved omega-3's, abundant in fish and effective at lowering triglycerides and preventing heart disease. Natural (and delicious) products in there with the best of pharmacology!

As I mentioned previously, my dad sent me home to Albany with fish, which I love, but which I don't like to buy inland (either too expensive at the co-op or too mass-produced-and-frozen-looking at Pricechopper. I'm picky). These are thick steaks, tuna and swordfish, suitable for pan searing and the roasting (rather than frying as I might a thinner piece of fish).

Pan searing and roasting fish: preheat oven to 400 or thereabouts. Roll fish in olive oil, salt, and pepper. Over high heat, add drop of olive oil to a cast iron or other oven-safe pan. Sear fish on one side for 2-3 minutes (until a crust has formed but nothing has burned), then on the other side. Move pan to the oven and cook for 4-5 minutes until fish is medium-rare. (Recipe courtesy Shrink in the Kitchen.)

To make the fish last longer and because I honestly can't eat a huge piece of fish at once, I've been serving it along with a vegetable and starch: over soba noodles and miso soup, alongside Japanese rice and garlicky spinach, over an Italian garlic-and-olive tomato sauce.

 

Tuna over soba noodles and miso soup and alongside Japanese rice and garlicky spinach

Best find this week: bits of lox, though not as pretty, much cheaper at the co-op

Eating more fat (and protein)

Home over winter break, my parents picking up the tab, I found myself eating more protein. Instead of ordering soup out (usually the cheapest item on the menu), I'd order a salad with chicken or a fish sandwich. At home, we had protein every night: lots of fish, tofu, turkey, and bacon, duck, and lamb for the holidays. I felt more full at the end of each meal, and then noticed that I was snacking less throughout the day. My net intake seemed to be about the same.

As a med student, it's easy to develop a fear of fat, both in your food and on your body. (See Mulling on lipids from last April.) When I described my typical school diet to my mother, a family doc, she noted that it's strikingly low in fat--leaving me at risk for staying hungry throughout the day and eating more overall.* That rang true.

Since returning to school, I've made it my goal to eat more protein and to finish each meal feeling satisfied. It helps that my dad sent me back with two beautiful pieces of fish--tuna and swordfish steaks--which I cut into small pieces (about 3 oz) and served on top of noodle soup or with an Italian pasta dish. The nice thing about high fat fish? You can eat a small piece and feel full. The additional protein does not have to dominate.

Instead of a purely vegetarian split pea soup, this week I made split-pea soup seasoned with chicken sausages. Absolutely the easiest recipe I know. This comes from my dad but it is also the recipe on the Goya bag (sorry, dad!).

Split pea soup with sausage:

• 1-1.5 cups dried split peas
• 1 onion, sliced in half or chopped
• 1 carrot, sliced in half or chopped into large chunks (optional--makes the soup slightly sweeter)
• 1 chicken sausage, in large pieces
• tablespoon olive oil

On high heat, saute all of the ingredients in the olive oil. Add several inches of water and boil until the split peas are soft, adding more water as needed. Season with salt and pepper.

Food for tonight and the week: swordfish, tomato 

sauce, pasta pot, split pea soup with chicken sausage.

(*In terms of weight loss, low fat diets are no more effective than other diets, according to the American Academy of Family Physicians. In terms of heart disease, low fat diets are more effective at lowering total and LDL cholesterol, while low-carb diets are more effective at lowering triglycerides and raising HDL cholesterol--both are important strategies.)

Staying fresh in December

It's that time of year when the heavy comfort food is getting old, the number of layers one needs to wear to stay warm indoors sizeably increases one's bulk, and the necessity of end-of-year productivity limits physical activity. In addition, I'm on a running hiatus right now not due to weather but due to exacerbation of an old injury -- I don't want talk about it.

So how to eat in a way that helps you to feel fresh, despite the chronic dry skin and static? I think citrus helps, but I'm not yet ready to bid goodbye to apple season. So I tried this quite simple salad, which is not exactly seasonal but is also not too appallingly unseasonal either (no miserable unripe tomatoes!).

Fresh winter salad:

• butter lettuce, arugula, or both
• radishes, quartered
• toasted walnuts*
• goat cheese (optional, I skipped it)
• juice of half a lemon
• olive oil

Toss all together and dress with lemon and olive oil. Serve with a hard boiled egg, cheese on toast, a yogurt, etc. for a more substantial meal.

*I've been craving walnuts since their health benefits were all over the yuppie and medical news last week.

Sources of iron

Med school often feels like that book or movie I read or watched when I was a kid, where whatever the characters read about in a book came true for them in real life (was it "Jumangi"?). To illustrate, I got a headache the day we studied headaches and reflux the day we studied reflux.

Since taking hematology in September, I've been convinced that I have iron-deficiency anemia. I sleep all the time, I hardly any meat, I eat a lot of fiber and drink a lot of tea (both inhibit iron absorption). Three months later, we're studying GI and I find myself reviewing mechanisms of iron absorption. I was reminded that we absorb heme iron (Fe2+) much better than nonheme iron (Fe3+), and that what matters is not just that we each iron-rich foods, but that we eat foods containing the right form of iron.

Well, I looked up heme and nonheme iron here, and it turns out that I eat virtually no heme-iron-rich foods regularly (they are all meats). However, I do eat a lot of nonheme iron, such as oatmeal, lentils, raisins, and kale.

Tonight's dinner is super easy, will last you the week, is a perfect antidote to the snow, and is centered around nonheme iron. Some iron is better than none!

Lentil soup (consider this a 'kitchen sink' recipe: these ingredients are just suggestions)

• 1 large onion
• 4 cloves garlic
• 1" piece of fresh ginger
• olive oil, chili flakes, cumin, salt, pepper
• 2 tablespoons white vinegar or lemon juice
• lentils (I used about 2.5 cups, but didn't measure)
• 1/2 can chopped tomatoes or 1 chopped fresh tomato
• 1/2 sweet potato, cut into large chunks (or 2 carrots)
• 2 celery stalks, cut into 1/2" pieces
• 1 bunch of kale, parboiled and chopped
• chicken stock

Chop the onion and garlic into large pieces and the ginger into small pieces. In a large pot, saute onion, garlic, ginger, chili flakes, and cumin in a few tablespoons of olive oil. (In retrospect I think caramelizing the onion first would add a lot of flavor, so do that if you wish.) Add in lentils, celery, and sweet potato and continue to stir at high heat, then add several cups of water and chicken broth to cover. Simmer at high heat, adding water as needed, until lentils are soft to your liking. Add in the tomatoes, kale, and vinegar/lemon along the way and season as needed. Garnish with cilantro and feta cheese, if you like.

My friends can cook!

Friday afternoon I saw my third hospital in-patient: this woman was sicker than the previous two. Fifty-seven going on 75, she had profound edema and venous stasis as a result of congestive heart failure and acute kidney failure; the suspected underlying cause is amyloidosis (abnormal protein formation and deposition in tissues), possible of multiple myeloma form. I have already been introduced to amyloidosis and multiple myeloma this year, but of course I remembered nothing about them until I looked it up Friday night. And I found, contrary to what I might have expected, that spending time reading up on these diseases online--dwelling on this woman's condition in a scientific sense--made me care more about her in a human sense. This caring happened subconsciously, until I landed upon the prognosis and sat back, surprised and sad.

In happier news, last night we had a Thanksgiving potluck at our place. In case you thought med students couldn't cook, here's a list of our spread (all homemade):

Dinner items:

• poutine with mushroom gravy
• stuffed mushrooms
• potato latkes and apple sauce
• sweet potato fries
• spicy stuffed sweet potatoes
• purple mashed potatoes
• some cranberry-whipped cream-gelatin floating concoction
• veggie loaf "brisket" with veggies
• roast broccoli
• roast green beans with crispy onions and almonds
• sausage, bean, kale, and sweet potato soup
• salad with walnuts and cranberries
• dinner rolls
• naan

Dessert items:

• pumpkin and apple pies
• apple crisp (two versions)
• rhubarb crisp
• baklava