Sunday, January 31, 2010

the big bad brussel...and the science behind it (with recipe at end so if you hate science but love bacon, there's still hope)

MMM. Brussel sprouts. Who doesn't love them? In the doldrums of winter with very little greenery and little else to look forward to, when the cold darkness slowly eats at the core of every human soul, what else could brighten up my day more than a deliciously prepared emerald brussel sprout? Even if I adore them, brussel sprouts are the vegetable of disdain to many small (and large) children.

It would appear that this seemingly small offender, a tiny cabbage, wouldn't cause so much trouble. But, it seems that the hate of brussel sprouts, and also cabbage, broccoli, cauliflower, tea, coffee, and tobacco have a genetic basis. Although this is not new news, it certainly is to me. What could be better than the interface between food and science? A quick search on PubMed unveils a body of research as to why some children hate vegetables. With genetics to blame, parents are now completely off the hook for the nutritional deficiencies of their children with a diet of mac and cheese and chicken fingers.

Brussel sprouts contain large amounts of the chemical phenylthiocarbamide (PTC) and a related compound propylthiouracil (PROP). No need to worry about chemistry, just know that these compounds cause some foods to taste bitter. Scientists and anthropologists have known for a long time that different ethnic groups have different sensitivities and likes to bitter compounds and foods. Because many poisons and toxins are also bitter, this distaste could potentially have an evolutionary advantage, promoting the forager to pick a sweet berry vs. a poisonous mushroom. It was unknown, however, whether this variance in tastes was cultural, environmental, genetic, or a mixture.

Recently, and by recently I mean 7 years ago, with the advent of improved techniques for studying and isolating genetic material, a group of scientists discovered the gene and its mutations which accounts for the variations in taste of bitter food (1). Without getting too technical, the gene, TAS2R38 has three loci(regions) that have mutated to produce multiple variations of the gene. These mutations were found to account for the majority people's ability to taste or not taste bitter foods. (Of course, these genes do not account for 100% of the ability to taste bitter. Even if in freshman biology genetics seemed so short pea or tall pea, there are so many modifying factors for the expression of a trait that science is simply not that straight-forward.)

This fascinating genetic discovery was followed by many complex and rich studies to explain cultural and age related differences for the dislike of brussel sprouts. An excellent study published in Pediatrics in 2005 attempts to explain why children choose the foods they do (2). They discuss the influence of these choices from genetics, culture and their parents' likes and dislikes. After swabbing the mouths of 143 children to isolate the genetic variant of TAS2R38, looking only at the first of three mutations (A vs P) to stratify the group into homozygous AA, heterozygous AP and homozygous PP, the children were given water flavored with different amounts of PROP. The methodology section, unlike most journal articles, is the best part of the paper:
If the solution tasted like water, then they were told to give it to a stuffed toy of Big Bird (a likable, well-known television character puppet); but if it tasted “yucky” or bitter, then they should give it to Oscar the Grouch, “so that he can throw it in his trash can".

Like previous research, this paper showed variations in the ability to taste bitterness based on their genetic differences. Interestingly though, this project also compares children to their parents and their abilities to taste bitterness, and thus provides a possible explanation for why kids piss off their parents so much. The study shows that heterozygous children are more sensitive to PROP than genetically similar people of an older generation. Not only are children more sensitive to PROP when they carry the gene, but their decisions, unlike adults' decisions, "are less constrained by experiential and cognitive factors, and their taste preferences determine intake." This is why, even if we can taste bitterness, we still love beer, coffee, tea and other adult treats and overlook the potential threats of the toxins and poisons we are putting into our bodies (especially broccoli).

Thus, even if YOU are a carrier of a "taster" gene, as it is so lovingly called, you can make the adult decision to like brussel sprouts, and love the bitterly delicious flavors that waft over your taste receptors. Science shows that fewer people are tasters than before and approximately 20-40% of North American Caucasians are non-tasters (3). In Spain, they studied the El Sidron Neanderthal's TAS2R38, discovering that he was a taster (although with a sample size of one Neanderthal, it's hard to know whether his friends liked cauliflower or not) (4). Even if you are a taster, I am assuming we have evolved from Neanderthals. Thus I leave you with a recipe for these little gems topped with bacon, pine nuts, brown sugar, and lemon.

In this recipe, I like to slice up the sprouts very thinly so they cook quickly and evenly. If you prefer whole sprouts then blanch them in boiling water for 1 minute before sauteeing so that they cook inside without burning on the outside.

1lb brussel sprouts
2-3 slices thick cut bacon
1 shallot diced finely
1/4 cup pine nuts (other nuts such as almonds or walnuts would work too)
juice of one lemon
1 tbs dijon mustard
2 tsp brown sugar
salt and pepper to taste

1. Wash brussel sprouts thoroughly. Cut off bottom of sprout and discard top few leaves. Slice each sprout vertically and thinly.
2. Mix mustard, sugar and lemon together
3. Preheat large cast iron skillet or other skillet with a small amount of oil on medium-high heat. When hot, add bacon, and cook to your liking. Discard some of the fat (if you want) although not all because this is what you will cook the sprouts in.
4. When bacon is almost finished cooking add shallots and sautee for a couple minutes until translucent
5. Add pine nuts and saute briefly
6. Add brussel sprouts to pan. Salt and pepper to taste. Saute, stirring frequently for about 5 minutes until they are almost cooked (they will turn a bright green and look soft having lost some of their water when they are done)
7. When almost cooked, add lemon/mustard dressing to the mixture and cook out sugar for 1-2 minutes until veggies have slightly caramelized
8. Enjoy!


1. Kim, UK., et al. Positional cloning of the human quantitative trait locus underlying taste sensitivity to phenylthiocarbamide. Science. 299 (2003) 5610:1221-5

2. Mennella et al. Genetic and Environmental Determinants of Bitter Perception and Sweet Preferences. Pediatrics 115 (2): e216. (2005)

3. Guo, SW. and DR Reed. "The genetics of phenylthiocarbamide perception." Annals of Human Biology 28.2 (2001), 111-42.

4. Lalueza-Fox, C., et al. "Bitter taste perception in Neanderthals through the analysis of the TAS2R38 gene." Biology Letters 5.6 (2009), 809-11.

Thursday, January 28, 2010

the match

Oh my oh my! 2010 Match is upon us. For those of you that don't know, it's the gut-wrenching, terrifying process of trying to streamline/cram all 10-thousand something American medical school graduates into residency positions all over the country in all but a select few of the specialties. The idea seems ludicrous. The process begins as a 3rd year medical student (or before) when a medical student picks her specialty. Herein begins the compilation of board scores, grades, research, extracurricular activities, and letters of recommendation, not unlike any of the thousand other applications somebody with too much education has thrown together.

Not unlike any other CV compilation and job application, one applies and is invited for interviews. The BENEFIT of the match, and the ERAS (electronic residency application system or whatever), is that one CV is sufficient. No other essays, cover letters, nothing! And, applying is surprisingly affordable, comparing at least to medical school apps which were insanely expensive. It's something like 60 bucks for the initial fee, which includes 10 applications, then 10 dollars for each additional program, and after 20, then it's 12. Well, this part is cheap...just wait. The most fun part about the ERAS is that all of the programs are just a click away. Dreamed of moving to California? Well, click away! Thought you might want to build an igloo in Alaska as a family medicine resident? it's just one button. Click, click, click, click! Speaks one that only applied to 10 medical schools, I applied to 23 residency programs, even though I am probably way more qualified coming out of med school than into it. This makes it easy to OVER apply (as does the hysteria of the whole match process and the disbelief that you could possibly be as qualified as all those OTHER medical students at even FANCIER medical schools than yours).

Next comes the most stressful, or second most behind match, part. Awaiting interviews. You will get interviews. More than you thought. That's what everybody said to me, and I didn't believe them. Well, out of the 23 places I applied, I got 20. Way more than I could go on. And then you get to schedule them all. My medical school gives us tons of vacation time, so scheduling was only hard because I was going to various parts of the country and needed to try and get to them all in the middle of winter. Why?! WHY do they schedule interviews in the middle of blizzard season! This is not logical and adds to the stress AND fun of the whole process. I did not get stuck once. I am very lucky. Oklahoma had a blizzard this year. Nothing is guaranteed.

You buy plane tickets on your own dollar. What dollar? Yeah, who knows. Med school is expensive and demanding and demeaning, but you love it! You buy plane tickets and rental cars and call people you haven't seen for 5 years to sleep on their couch. You lose 15 lbs to fit into the suit you wore interviewing for medical school (or buy a new one). Then go! There's always a party the night before with Indian food, or so seemed the case for the obstetrical world this year, where there are residents and maybe faculty that want to "get to know you" (make sure you aren't really weird). The interview day is usually fairly long and at least 3 people will talk to you although at least in OB they want to pretend to be nice so most interviews are fairly relaxed. You'll get pretty good at talking about yourself. In fact, when you're done interviewing, you might be in a little you withdrawal.

Then, after smiling and asking the same STUPID questions 1000 times that you don't care about the answer to, eating way too many airplane peanuts, spitting a green bean over a chief resident, denting a resident's car at the dinner, almost missing your connecting flight in Vegas because you were playing the penny slots, and buying a plane ticket for the wrong day entirely and almost getting stuck in Atlanta, you're done. You make your rank list, write emails to your favorite people begging them to employ you, go on second looks if you have time/money/energy. And you're done! Phew. Wasn't that bad. Submit your list to NRMP or whatever the letters are... and certify it.

Here comes the sheer terror. The waiting. The hoping SOMEBODY liked you of the over 100 people you met enough to want to enslave you into the drudges of the hospital spending half of your life with your shoes soaked in blood and amniotic fluid. You spent about $3000 of your Uncle-Sam earned cash to land a job that pays 47 grand a year, which if you average over the 80 hour work week is about 10 bucks an hour. Yep! I'm honestly so excited.

The match seems like an archaic process. And guess what, it is! Only after a little of research, this excellent article published in JAMA (Roth, A. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912) discusses the history of the match process. It was first established in 1952: "That selection [of interns] has now been advanced on the school calendar to the beginning of the junior year and, indeed, inquiries now come to me even from sophomores. The dates of examinations and selection have been pushed farther and farther back, through the efforts of some hospitals to get ahead of others in the choice of candidates, for hospitals can exercise pressure on the selected candidates by requiring acceptance of offers of internship at once or within a short time. The student’s dilemma is understandable; if the first offer of this kind comes from a hospital of his second or third choice, he loses out entirely if he declines and is not selected later by the hospital of his first choice" (Joseph Turner 1945). This presented a significant problem to both programs and applicants as they were not making informed decisions and there was too much pressure on medical students.

The current algorithm has been the same since 1952, with few minor changes including the couples match. The algorithm, which is well explained by the NMRP is in the applicants favor. HA! Finally. This is the other awesome thing about applying to residency. The programs, for the first and last time ever, do not have the upper hand. They can rank you and recruit you, but only YOU have the final say if you rank a program or not. Well, I guess this is always the case, but as little control as you have in the match process, the programs are just as terrified that they won't match. Remember, they need you! You are the future slaves of Hospital X, the pride and joy of the hospital that will do all the scut work for the attendings. You are a valuable asset.

Between now and match day, the computer does it's little beep beep beep, 0101010101111000, a little cinnamon, a little sugar, no cream, and concocts the match list for all the programs. Supposedly it takes mere seconds for the algorithm to run. That's why you have to wait 3 weeks. I swear it's just for the NRMP to f&*# with your head in their diabolical plan to control the minds of 15,000 doctors for just a few weeks of the year. And when it spits out the hospital of your dreams and prints it on a plain white piece of paper, this functions as a contract. WHY DID YOU APPLY TO ALASKA?! You thought it would be fun. You'll know soon enough.

Match day. This year it's March 18th. So, now I just have to wait. But as I tear that envelope open and read choice #13 on the letter and start crying, I'll still be employed. In the end, that's what matters. As long as I match, I get to be a doctor, take care of people, learn how to operate, and deliver babies.

The most amazing thing about medicine is that as much as it changes, it really is the same as it was in 1952. It's a bunch of neurotic 20 somethings, waiting for the opportunity to learn from the people before them. It's being taught a beloved and semi-secret set of skills and to seek knowledge. It's to take care of people and improve the health of those around them. It's an opportunity to be at the forefront of medicine, "in the trenches" as they say, and get your hands dirty, just like they did 50 years ago. Match day is nothing more than gaining a little control on something, like medicine, that nobody can truly control. And that little morsel of order in a world of complete chaos, blood, sweat, birth and death truly stands for what gets us (or at least me) out of bed everyday.

Monday, January 25, 2010

for the love of a lemon

So, I've thought about starting a blog for a long time. Part of the problem is that, frankly, I suck at taking pictures and since as written above am insanely disorganized, always forget to photograph my food. I am fairly impulsive, and thus cook whatever I feel like when I want it, and by the time it's hot, no time to wait, change the light, position the food. No, damnit! I want to eat it right then and there. I also never write anything down. I just kind of chop, throw, pour and grate whatever I find in the fridge/pantry into a pot, and out comes dinner.

Fortunately, and very excitingly, I got engaged to a wonderfully patient and nothing like me at all (well that's not quite true, but he harbors very few of my bad qualities) man a few weeks ago. And, as a modern women, I thought it would only be fair to reciprocate the wonderful gift of a diamond and emerald 3 stone ring with a lovely Canon SLR camera. Since fiance is very good with lighting, heck he invents lightbulbs, and very calm and dutiful, I have asked him to photograph the food that I make, not only as a catalog of our love and life together, since the kitchen is a large part of our relationship, but also, perhaps, so that I could more obsessively talk about myself into the black hole of the internet.

Thus, I leave you with my first post, the love of the lemon, since it is the most beautiful picture he has taken yet and give you an outline of ideas of delicious lemony recipes for our lovely citrus season.

When I lived in Chile for a year, I was amazed at the wonderful salads they had there. They were so simple. One vegetable, shredded into a bowl, with immense amounts of lemon juice, salt and vegetable oil. The grace and freshness of the vegetables was beautiful.

Idea #1: Carrot salad
Take 2 carrots (or however many you have in your fridge) and shred them finely into a large bowl. Take the juice of 1 lemon, or 2, again however many you have and squeeze this into the large bowl. Salt liberally, at least a teaspoon or 2 of kosher salt. Add 2-3 tablespoons of vegetable or olive oil. Mix. Refrigerate for a couple of hours to let the flavors marry, or if you didn't plan ahead, don't worry! Just eat it now.

Iterations of carrot salad
Make it Latin style:
  • instead of lemon, add lime (or keep the lemon, they eat lemons south of the border)
  • add a generous amount of cilantro
  • add some green onions, chopped up (or chives, or red onion, or whatever)
  • add a clove of freshly chopped garlic
Make it Asian style
  • keep the lemon, or substitute for rice wine vinegar (unseasoned)
  • add some toasted sesame seeds, black, or white, or both
  • add some chopped up green onions (as above)
  • instead of salt, add soy sauce (just don't sauce too liberally otherwise your salad will be salty brown)
  • instead of veggie oil, add half sesame/half veggie oil...delicious!
Ok. Seems as though I have to go save some lives at the pediatric emergency department. haha, I mean, give kids tylenol, and if they are actually sick, run the other direction looking for a real doctor.

Thank you for the first installment of...OB cookie!

Hello World

To everybody out there--I know that there are a lot of food blogs out there. Way too many. So, why may you ask, am I wasting everybody's time (probably including my own) to write my own food blog? Because, how many food writers are also soon to be vagina doctors, wedding planning, work-obsessed while simultaneously being lazy as hell, insanely disorganized and messy? Well, maybe you know a lot, but in my romps around the globe, I haven't met so many. So here we go, my spin on the world as I see it. I'm a liberal girl with an obsession with cooking as well as other things creative. I'll also give you my take on medicine and reproductive health. You can just call me OB cookie...a uterus loving, crunchy, chocolate filled, fragrant, 20 something girl. Soon to be Mrs. MD something scary. Enjoy!