Time for some Vitamin D (part 2) Que FLAN-TASTICO!

In my last post, I admitted that I’m not only pale, but a failure.  Well, these two things are about to change.  Sun is coming my way, and my second attempt at flan unveiled a beautiful, creamy delight.  In the last post, I also discussed how vitamin D deficiency and insufficiency are much more common than previously thought.

So what is vitamin D anyway? And why could deficiency affect your health?  Vitamin D, a hormone, can be formed in skin exposed to sunlight or through ingestion.  Vitamin D is involved in an intricate hormonal pathway that helps the body absorb calcium and phosphorus in the gut.  Metabolic derivatives of vitamin D also increase kidney absorption of calcium and promote bone formation. 

Vitamin D is a hot topic in research right now.  Vitamin D is very important in bone health and deficiency is thought to contribute to low bone mineral density and osteoporosis.  Recent studies, including a meta-analysis by the Cochrane review show that supplementation of vitamin D alone cannot prevent fractures in postmenopausal women, but vitamin D taken with calcium can have an effect in preventing bone breaks [1].  A recent randomized control trial of post-menopausal women who were given dietary supplementation of calcium and vitamin D rich foods had less frequent bone breaks than those who were not part of the intervention [2]. A study of women given vitamin supplementation of calcium and vitamin D had decreased bone fractures compared to those untreated [3].

Other effects of vitamin D seem to be less well supported by well designed, randomized controlled trials.  Vitamin D, along with bone health, is although thought to be associated with pain control, muscle health and strength [4].  The Cochrane Review of effects of vitamin D in chronic pain shows that most research is inconclusive [5].  As for muscular integrity, in a small, retrospective study of pelvic floor disorders (urinary incontinence and organ prolapse) in post-menopausal women, those with pelvic floor disorders had a significantly higher rate of vitamin D deficiency, even when controlled for age, race and number of babies born [6].  The proposed mechanism for this finding is related to muscular health. 

There is an incredible amount of research looking at vitamin D deficiency and its effects on various diseases.  It will definitely be an interesting field to follow, so keep your eyes open!  As for my opinions on this, I think little harm can come from increasing vitamin D and calcium intake and supplementation can improve general health, especially if you live somewhere cold.   Eggs and milk are a great way to get some vitamin D, and this flan which I copied exactly from Julia Child has LOTS of both.  I went straight for the fat after my attempts at a healthier, less lipid laden attempt at flan that was ugly and boring and broke like stink.  So, if you want a yummy flan, don’t cut corners, just cut little pieces and share with lots of friends. 

Que Flan-tastico ! Julia Child’s Flan from The Way to Cook with an Elizabethan kick

(left my cookbook back in Cleveland so these are my abbreviated instructions)

For caramel sauce
¾ cups sugar
3 tbsp water

For flan
6 whole eggs
5 egg yolks
¾ cups sugar
4 cups whole milk
1 cinnamon stick
½ vanilla bean scraped and added to milk
1 tsp ground cinnamon
¼ tsp ground nutmeg
Pinch salt

Preheat oven to 350.  For caramel sauce. Over low heat in heavy bottomed sauce pan, swish around pan without stirring until sugar is dissolved.  Once sugar is dissolved, increase heat to medium high, cover and cook until sugar is dark, about 5 minutes.  In 4 inch deep dish or soufflé pan, add half of caramel sauce to bottom of dish and swirl around bottom and sides until coated.  To other half of caramel sauce, add ¼ cup water and reserve for top of flan. 

In saucepan, over medium heat up milk with vanilla bean, cinnamon and nutmeg until steaming.  In large bowl, mix together eggs and sugar until well mixed but not foamy.  Slowly add milk to egg mixture, and whisk until mixed.  Strain mixture over dish.  Put dish in casserole dish in oven and add boiling water to about halfway up the flan dish.  Bake for about 1 hour to 1 hour 15 minutes or until flan is formed but still wiggles in the middle.  Remove from water and allow to cool.  Run sharp knife around edge of flan and invent carefully onto a large plate.  Serve with extra sauce and enjoy!!



1. Avenell, A.; Gillespie, WJ.; Gillespie, LD.; O'Connell, D. “Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.” Cochrane Database Syst Rev, issue 2, 2009, p. CD000227.

2. Moschonis, G.; Katsaroli, I.; Lyritis, GP.; Manios, Y. “The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study.” British Journal of Nutrition,, 2010, p. 1-8.

3. K, et al. “Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS).” Osteoporosis International,, 2010.

4. Venning, G. “Recent developments in vitamin D deficiency and muscle weakness among elderly people.” BMJ: British Medical Journal, v. 330 issue 7490, 2005, p. 524-6.

5. Straube, S.; Derry, S.; Moore, RA.; McQuay, HJ. “Vitamin D for the treatment of chronic painful conditions in adults.” Cochrane Database Syst Rev, issue 1, 2010, p. CD007771.

6. Badalian, SS.; Rosenbaum, PF. “Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey.” Obstetrics and Gynecology, v. 115 issue 4, 2010, p. 795-803

Why I Cook--A Heartfelt Manifesto

Being a medical student isn’t exactly an easy task.  Certainly there were months where I goofed off, ignored my duties, and just enjoyed life.  But there were also months, lots of months, where I went to the hospital at 4:45 in the morning, barely ate lunch, and felt like a complete, total and utter idiot all day.  I would come home, collapse on the couch at 7:30 and feel like my soul had been slowly devoured by my seeming lack of purpose on the hospital team, overwhelmed by the extent of disease and suffering that I was bearing witness to all day.  When I would try and talk about struggles with classmates or teammates, they would often dampen these deep feelings and say “that’s just part of medicine”.

Don’t get me wrong, I loved medical school.  It was an incredible experience to learn such a depth and breadth of information so quickly.  It was amazing to see myself grow in my abilities to manage patients.  It was awesome as a 4th year to teach the 3rd years how to evaluate a post-surgical patient on Gynecologic Oncology, and to give an effective assessment and plan.  When I was called to a room with a sick patient alone, I at least could feel confident at the first steps to take to manage their illness.  It was a great opportunity to work with a variety of people at all levels of training and meet so many incredible patients who were struggling with debilitating diseases.  It was fantastic to improve my presentations and feel like I could communicate less emotionally and more effectively than I ever could before. 

Even so, medical school can make you feel really unimportant.  Every exam you do is repeated, every note you write scrutinized, every patient you see is asked the same question at least twice.  I’m not complaining; I think that medical education is extremely effective and that no medical student should have any real power.  My point is that it’s important to feel important. 

It’s important, no matter how tired you are, to come home and have a hobby.  It’s important to do something that has nothing at all to do with your job (no matter how hard I try to make food and medicine related) that keeps your hands and mind active but that you can mentally drift in and out of.  It doesn’t matter what this is.  If you love working out, go to the gym.  If you like crossword puzzles, do that.   Dr. Bates, a plastic surgeon in Arkansas loves to quilt and blog about it. 

I don’t cook because it’s healthier than eating out.  I don’t cook because it’s cheaper.  I appreciate these benefits, but these are peripheral rewards.  I cook because I love to cook, it’s easy and fun, and it makes me feel good about myself.  I love the surprise of opening the fridge and discovering half an onion and some chicken and making a delicious and warm meal.  I love the sensation of running my knife through a red pepper, and I love the feel of mashing up raw meatloaf with my bare hands.

Don’t cook because somebody else tells you you should.  Cook because you love to, and because you love to feed the people around you.  Yeah, it might be healthier, or not, if you bake a lot like I do.  If you don’t like to cook, then don’t.  There are plenty of other ways to find food. 

My advice for all of you, whether you’re doctors or not, is to find a hobby that is just for you, and make sure YOU like doing it no matter whatever anybody else tells you to do.  Find your hobby and do it.  No matter how much you eat or how little you exercise, as long as you have things that you like to do, being happy, productive and fulfilled is the healthiest thing you can do for yourself.

 I’m sure I’m not alone in feeling overwhelming pressure to be skinny with perfect test scores, friendships, communication skills, a clean bedroom and a happy family life.  I have to remind myself that I have survived medical school and done a good job, which in itself is an enormous feat.  I’m not perfect, but I love to cook and I love what I do, and for right now, that’s good enough.

Time for some Vitamin D (Part 1—with FLAN FAIL!)

Fiesta!  Time to celebrate!  I’m done with classes in medical school and just hanging out until graduation on May 16.  This includes some much needed sun in Mexico (we leave on Sunday) with my best friend from high school. 

When I went home last month to visit my mom, I had a skirt on to honor springtime.  She was aghast the pastiness of my white legs.  We went on a walk that night and my two stumps were aglow in the moonlight.  

While this complaint of lack of sun seems vain, it elucidates the negligible amount of time I’ve spent in the sun in the past three years.  Not only have I lived in Cleveland, voted by Forbes to have the worst winter weather in America, but seemingly, for the past two summers, I have done my absolutely hardest rotations during peak summer sun hours.  Going into the hospital before the sun’s up and catching only the twilight zone at the end of the day just does not help. 

Even though basking in the sun puts people at increased risk for deadly skin cancers, one benefit from our favorite burning ball of gas, besides sanity, is that the skin reacts with sunlight to produce vitamin D.  Vitamin D, if you haven’t noticed, is all the rage right now.   A quick literature search reveals research blaming vitamin D deficiency for everything from heart disease to diabetes, low birth weight babies, chronic pain, pelvic floor disorders and neurologic deficiencies. 

Obviously this is a rapidly growing area of interest, but is the hype real?  Even three years ago in my first year of medical school I was taught the vitamin D deficiency was quite rare and remember the lecturer saying that “only some old lady who doesn’t eat anything and is locked up in her bedroom all year” could lack this essential nutrient. 

Vitamin D deficiency is actually much more prevalent than once previously thought.  When I did an endocrinology rotation all of the fellows who are young and healthy tested their vitamin D blood levels.  They were all insufficient.  In the National Health and Nutrition Examination Survey from 2001-2004 of 6275 nationally represented children from ages 1-21, 9% were deficient and 61% were insufficient [1].  A study of 2500 mothers and infants in urban Boston showed that 58% of infants and 35.8% of mothers were severely deficient [2].  People of darker skin color and colder climates are at the highest risk.

In the next post, I’ll discuss the role of vitamin D in the body, and review some of the literature about the health effects of deficiency.  I’m sure you’re wondering how you can boost your own vitamin D levels.  Get outside and get some sun.  Supplemental tablets  (the Institute of Medicine is about to release new dosage guidelines) and foods with vitamin D such as fortified milk products, eggs and fish, are also good sources. 

To prepare for my Mexican adventures and to boost all of our vitamin levels with eggs and milk in a sweet way, I tried to make some cinnamon infused flan.  I just love anything custardy.  In fact, my very first memory wasn’t of my parents or our cats but of custard that our neighbor made.  And the donuts we ate at the beach.  I’ve been a life-long food lover, and now I want to share it with you. 

Well, you see, I wrote this post and had a FLAN FAIL!  It looked great until I tried to flip it and it turned into a puddle of soupy caramel egg mush.  So, for the next post, I’ll try a new recipe that is guaranteed to succeed.  For now, I give you my stages of flan grief. 

1.  Kumar, J., et al. “Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004.” Pediatrics, 2009.
2. Merewood, A., et al. “Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers.” Pediatrics, v. 125 issue 4, 2010, p. 640-7.

Mi Favoreet Foood Ees Mango

My life has been laced with mangoes.  My most endearing mango-related memory took place the year I took off between college and medical school.  Before I left for Chile, I worked odd jobs including a daily volunteer job teaching adult Mexican immigrants English. 

The class was designed to teach these vibrant adults survival English.  We taught them their addresses, the different coins and money, body parts and the doctor’s office, how to take the bus, and how to navigate the grocery store.  One of the sentences we taught the students to say was “my favorite food is” and had them fill in the blank.   Invariably, every person would say “mi favoreet foodd ees…mango” regardless of how many other food words we taught them.

Well, can you blame them?  Mango is one of the most addictive foods I have ever encountered.  When my family lived in Asia when I was in junior high, my dad used to bring the most amazing mangoes back from the Philippines by the dozens, and we would heartily devour them.  Those Philippine mangoes are the best ones and they come dried and pre-packaged by the kilo at Costco.  I can only keep the bag around for about one day, and for the sake of my tummy and my blood sugar, I only buy them about once a year.

Since I’m done with medical school and on vacation until I start residency, I’ve decided to screw science for this post and just give you a recipe for yummy mango fried rice.   I’m sure mangoes have amazing scientific, nutritional and genetic properties, but I just think they taste really good.  So there!

The trick to mango fried rice is to use slightly under-ripe mangoes.  They are tart and cook up to be tender, with the slightest bit of sweetness.  This recipe balances tartness, sweetness, spiciness and saltiness and has lots of veggies.

Mango Fried Rice

1 lb pork loin finely chopped (optional) you could also use chicken, shrimp, tofu...or nothing
3 tbsp vegetable or peanut oil
1 under-ripe mango cubed
3 scallions sliced into ½ inch pieces
4 cloves garlic smashed
1 large shallot diced
¾ cup green beans cut into ½ inch pieces
1 carrot diced
1 inch of gingerroot peeled and finely chopped
2 tbsp cilantro chopped
1-2 red finger peppers sliced with seeds (depending on spice level desired)
1 egg
4 cups cooked jasmine rice
Juice of one large lime
¼ cup soy sauce
1 tbsp sugar
2 tbsp oyster sauce
¼ cup cashews toasted and ground

In separate glass, combine lime juice, soy sauce, sugar and oyster sauce.  With wok or large cast iron skillet, preheat 1 tbsp oil over high heat.  When oil is smoking, add pork and cook until pink is gone.  Remove pork and juices onto plate.  Add another 2 tbsp oil and allow to reach smoking heat again.  Add mango, scallions, garlic, shallot, green beans, ginger, carrot, red pepper and cilantro and cook, stirring frequently until green beans are slightly tender, about 7 minutes.  Add about ¼ of the soy mixture and stir.  Add egg and scramble.  Add pork and allow to reheat throughout.  Add rice and incorporate.  Add rest of soy mixture.  Stir until rice is hot and has started to brown on sides.  Put in bowl or on plate, and add cashews to the top.  Enjoy!

Grillin' Cheese

What was the first thing you were ever good at cooking?  If the answer is “nothing”, then I don’t believe you, because as said in the brilliant movie Ratatouille “anyone can cook!”  For me, my gourmet debut was grilled cheese.

I started grilling cheese probably around the age of 8 or 9.  By 8th grade, I was a master.  I made a grilled cheese for anybody that walked in the door.  My parents had this awesome Circulon grill skillet that made beautiful marks on my creations.

My obsession for gooey dairy enveloped in buttery bread was profound; my father, in his speech to me at our father daughter banquet in 8th grade said that he imagined me opening up a piano bar/grilled cheese restaurant in Kathmandu.  The concept was a bit like the set-up in Casablanca but instead of having Ingrid Bergman walk into the bar and ask for some sort of gin cocktail, I would have some lost hippie stoner from the 70s who had escaped to Nepal in revolt of society hungrily walk in with the munchies and be instantly cured by my delicious creation.  I would then play him some Chopin on the piano and everybody would be happy.

Somehow the dream fizzled, and now I’m marrying an engineer and I live in Cleveland.  But my sense of adventure isn’t lost!  Nor is my sense of grilled cheese, which has only grown more acute with my semi-permanent inhabitance of the kitchen. 

The most important part of grilling cheese is the cheese.  I hate to be a hater, but I hate American cheese.  This processed crap should not touch your beautiful lips, and instead I recommend cheddar, gouda, edam, or really anything else. 

Different cheeses have different properties.  A study at The University of Wisconsin determined the “softening points” of various cheeses using the UW “Meltmeter”[1].  They determined that the higher the fat content of the cheese, and the greater the age of the cheese (hence having less moisture) the lower the melting temperatures.   Thus, the best cheese to pick would be something very old and fatty.  Old and fatty.  Yum.

The one benefit of American cheese is that since it is mostly oil, it melts fairly easily whereas another cheese might need to get a bit hotter, especially if your grilled cheese sandwich has special additions.  I propose two methods to the non-melting cheese conundrum (especially if you put other things in the sandwich): one, put the cheese in the microwave for about 30 seconds before putting it on the bread, and two, use my old world adaptation for a Panini press.

I love kitchen equipment and I have quite a bit.  Besides a waffle maker and toaster though, I try to avoid buying appliances that only serve one purpose, such as a Panini press.  The brilliant thing is that you can make your own.  All you need is a cast iron pan and a brick covered in foil.  If you’re lucky to be like me and your apartment building is crumbling, there might be a brick hanging out in the parking lot. 

Panini sandwich with gouda, avocado and turkey

Makes 2 sandwiches
1 tbsp butter softened
4 slices whole wheat bread
Gouda cheese, sliced
Shaved smoked turkey
Mayo (optional)
Tomato/chile relish (from previous post), salsa, or sriracha
Avocado sliced thinly

Preheat stove on high and heat cast iron pan with brick in it until smoking about 5 minutes.  Butter the outsides of both pieces of bread.  Add cheese to microwave for about 20 seconds.  Assemble sandwich.  In sauté pan large enough to fit cast iron pan inside, turn on heat to medium high, add sandwich, cover with tin foil and then cover with hot cast iron pan and brick.  Press down.  Cook on one side 3-4 minutes or until sizzling, flip sandwich and cook covered with cast iron pan for about 2 more minutes.  Slice and enjoy!

1. K. MUTHUKUMARAPPAN, et al.  Estimating Softening Point of Cheeses.  1999 J Dairy Sci 82:2280–2286

The Laws of Attraction

Scientists have been attempting to understand what makes one human being crave another human being.  Recently, studies have shown that it’s true; primal instincts and pheromones are a key part to promoting human desire. 

Since I’m in the business of taking care of the end result of a passionate embrace (ahem, birth), understanding human attraction is deeply important to me.  The research behind human attraction is fascinating.  There are well methodized studies and theories to show that scent is a powerful factor in sexual desire and that attractive smells are genetically mediated. 

Theory suggests that people, as well as mice, fish, lizards and birds, are attracted to the smell of those who have different genes for building the immune system (the HLA and MHC system) [1].   This theory concludes that mating with somebody who has a different immune system will create more diverse offspring, hence promoting evolution of a more immunologically robust generation.  Each person has her own “body odor fingerprint” according to a study chemically analyzing sweat of 197 Austrian Alp dwellers, and this is thought to be related, at least partially, to a person’s genetic makeup. [2]

All of the major studies on scent revolve around women or men smelling unwashed T-shirts of those of the opposite sex.  In one fascinating experiment published in Nature Genetics, women smelled T-shirts that men wore for two days without deodorant [3].  They were unaware of what they smelled, and were asked to rank the odors in terms of pleasantness.  Women found the t-shirts to be pleasant smelling, and each woman was attracted to the scent of a different t-shirt whose wearer had a unique genetic makeup similar genetically (but only slightly) to the HLA inherited from her father. 

While important for professional and social interactions, showering is optional in love.  In another experiment, 58 Brazilian students, 29 male and 29 female participants, were allowed to shower but they were only allowed to use neutral smelling soaps while wearing a garment over their sternums for five days.  When smelling the garments, there was again a significant correlation between genetics and attractiveness, but only with women smelling men.  Men’s noses are not quite as attuned [1].    

When it comes to eating, sometimes primal behavior wins too.  Men and women do have some similarities when it comes to basic instincts.  Sometimes you just want to rip into a hunk of flesh (and if you don’t, forgive my vulgar words). 

While this meal might not spark passion between your partner and yourself, it will certainly be an intense relationship between you and your meal.   Here I prepare T-bone steak, medium rare (although tragically I overcooked mine) simply prepared with a tomato-chili relish, black beans, and buttery rice.  It has whiffs of a worn T-shirt, in a good way.  It’s time to turn down the lights to the kitchen and have a romantic evening with the skillet, open your nose, and your mouth.  MMMMM

T-bone steaks with black beans, rice and tomato chili relish

Relish
3 long red chilies
1 jalapeno
1 medium tomato
¼ large red onion
4 cloves garlic
2 tbsp cider vinegar
½ tbsp salt
Pinch oregano
½ tsp honey
2 tbsp (plus) water

Preheat oven to 425.  In large baking dish place chilies, tomatoes, onion, garlic and bake for about 25 minutes or until skins are peeling on peppers and veggies are fragrant.  When cooked, remove from oven, cool, peel tomatoes and peppers and seed peppers to taste.  To blender add all ingredients, blend until smooth adding water until desired consistency.

Buttery rice
1 tbsp unsalted butter
1 tsp olive oil
½ carrot finely diced
3 green onions using whites and first part of greens, finely sliced
½ tsp salt
1 cup red rice (or other whole grain rice)
2 cups water

Melt butter and olive oil on high heat, sauté onions and carrots until soft, about 3 minutes, add rice and salt and cook rice until starts to stick to pan.  Add water, bring to boil, reduce to low and cover.  Cook until tender about 45 minutes.  Do not stir!

Beans
¼ cup chopped red onion
1 clove garlic finely diced
1 tsp ground cumin
15 oz can black beans with liquid
¼ cup loosely packed chopped cilantro

With a splash of olive oil on medium high heat, sweat onions and garlic until tender about 5 minutes.   Add cumin and cook for about 1 minute.  Add beans with liquid and cilantro, cook until liquid reduced, about 10 minutes, and mash with potato masher.

Steak
2 ¾ lb T bone steaks (or whichever cut you like)
Over medium high heat add splash of oil into skillet, cook salted steaks 3-4 minutes on each side.

1. Santos, PS.; Schinemann, JA.; Gabardo, J.; Bicalho Mda, G. “New evidence that the MHC influences odor perception in humans: a study with 58 Southern Brazilian students.” Hormones and Behavior, v. 47 issue 4, 2005, p. 384-8.
2. Penn, DJ., et al. “Individual and gender fingerprints in human body odour.” Journal of the Royal Society, Interface / the Royal Society, v. 4 issue 13, 2007, p. 331-40.
3. Jacob, S.; McClintock, MK.; Zelano, B.; Ober, C. “Paternally inherited HLA alleles are associated with women's choice of male odor.” Nature Genetics, v. 30 issue 2, 2002, p. 175-9.

Tastes Sweet to Me

Alas, the beautiful strawberry.  There it is, neatly packaged in a plastic carton atop a cardboard display in the market.  The dimpled berries aren’t even refrigerated because they will be quickly swept into every cart, basket and recyclable bag that walks by.  A spring strawberry, red, juicy and luscious is a glowing red omen that summer just may come.

Strawberries are quite nutritious and they have high amounts of antioxidant activity.  A study of 21 women showed that after eating frozen strawberries for three weeks, anti-oxidant levels in blood were significantly elevated and showed some positive biochemical effects including increased lipid peroxidation lag time [1].   Strawberries also have shown to have positive effects on neurons.  Rats fed extracts from strawberries, spinach and blueberries had slowed effects of aging on neurons and even improved some neurologic function such as increased motor abilities [2].

More importantly than being nutritious, however, is that strawberries are delicious.  The tart, juicy, tongue tickling bites make you slurp when you eat them and afterwards quietly pluck the seeds from between the teeth.   The sensory delight that encompasses consumption of the strawberry has actually been studied quite extensively in scientific literature. 

In the fascinating journal, Chemical Senses, scientists explore the chemistry and physiology behind taste and smell.  In an experiment of 20 students, with the goal to detect diluted sugar water versus plain water, scents of both strawberry and ham (while ham smells plenty good, I can’t really imagine ham scented body lotion or lip gloss) were sniffed while the participants tasted dilute sugar water or water.  Participants were also asked to imagine the odor of strawberry or ham while tasting sweetened or unsweetened water.  Interestingly, smelling or even imagining the scent of strawberries increased the detection of sugar water significantly over tasting sugar water alone, and the smell or imagined smell of ham decreased significantly the taste of the sugar.

Our brains tell us that strawberries are sweet.  Not only has it been shown, like in the experiment above, that smelling or even imagining a strawberry makes sugar taste sweeter, but simply seeing the color red can make a strawberry smell stronger [4].   Our sensory experience is so much more complex, richer, and more unknown than we could ever imagine.  The best thing we can do for our senses is fill them up with enticing stimuli, such as in my take on strawberry shortcake. 

This cake contains all of the elements of what I love about strawberries.  My mom always used to serve fresh berries with sour cream and brown sugar.  Instead, I make a pound-Bundt hybrid cake with brown sugar, lemon zest, sour cream and buttermilk to serve in small slices heaped with fresh berries.  If you want to go all out, you could add ice cream, sour cream with sugar or fresh whipped cream.

Sour cream/brown sugar pound/Bundt cake
Adapted from Martha Stewart’s Baking Handbook

¾ cup butter unsalted (softened)
1 cup dark brown sugar packed
1 ¼ cup granulated sugar
½ cup sour cream
1 tsp vanilla
Zest of lemon
3 cups all purpose flour
½ tsp salt
2 tsp baking powder
5 eggs
¾ cup buttermilk

1 pint strawberries, sliced
¼ cup sugar (optional)

Preheat the oven to 325.  Butter (or Pam) a Bundt pan or 2 8 ½ by 4 ½ inch loaves.  In a medium bowl, combine flour, baking powder, and salt; set aside. With an electric mixer, cream butter and sugar until light and fluffy, about 3 minutes.  Add sour cream, vanilla and zest and mix for another 2 minutes.  Add each egg individually and stir until just mixed.  Add buttermilk and flour mixture and stir until combine.  Add mixture to pan and bake until toothpick comes out clean, about 1hour 15 minutes. 

Allow to cool, invert pan, slice, top with strawberries, and enjoy!

1. Henning, SM., et al. “Strawberry consumption is associated with increased antioxidant capacity in serum.” Journal of Medicinal Food*, v. 13 issue 1, 2010, p. 116-22.
2. Joseph, JA., et al. “Reversals of age-related declines in neuronal signal transduction, cognitive, and motor behavioral deficits with blueberry, spinach, or strawberry dietary supplementation.” Journal of Neuroscience, v. 19 issue 18, 1999, p. 8114-21.
3.  Djordjevic RJ, et al.  “Effects of Perceived and Imagined Odors on Tasted Detection.” Chemical Senses.  v 29 Issue 3. 2004 p199-208
4.  Dematte MS et al.  “Olfactory Discrimination: When Vision Matters?” Chemical Senses. V34 issue 2, 2009, p 103-109

The Green Stuff

Oof, I’ve been thinking a lot about the green stuff lately.  A couple of weeks ago, we had our financial aid exit counseling sponsored by multiple corporate groups (including the army) for managing student loans and massive debt.  My medical school class of 140 students borrowed over $16 million for four years of private medical education. 

In 2007, seemingly unbeknownst to me and my friends, although I do remember a bit of buzz from the more politically attuned legion of students, George W passed legislation enacted in 2009 that federal loans cannot be deferred through residency anymore.  Residency does pay a modest but decent salary, but certainly not any glamorous wages, particularly for the amount of hours worked.  The terms of repayment are fair and based on a resident’s income, but interest rates are not that low and debt multiplies fast. 

Looking at the match list from my class, I am convinced that high debt steers medical students towards more lucrative specialties.  The data, however, is not convincing as I would have thought.  A 2005 study published in Academic Medicine showed that indebtedness slightly decreased senior medical students’ likelihood to pursue primary care; the correlation was even greater if the student had more than $150,000 in loans [1].  However, a 2006 study of 2022 senior medical students showed that there was no correlation between debt amount and specialty choice [2].  Even so, it is very hard to explain the primary care shortage without looking at the sky-rocketing cost of medical school. 

If debt only slightly affects career choice, it has also been shown to affect physicians’ lives long after graduating.  A 2009 study in the Annals of Surgery of 550 academic surgeons reported that many surgeons felt that their academic debt affected their academic productivity, career choices and quality of life [3]. 

I certainly am not worried about living on a budget and spending within my means, but growing up is hard!  Responsibilities beyond my professional obligations are accumulating rapidly.  I can barely do laundry.  And I certainly can’t keep my room clean.  Now I have to keep track of my cash and make sure I don’t forget to pay the loan man.  Yeah, I know I sound like a big baby crying about things that every adult confronts.  WAAAH!

Fortunately, spring is here and the attainable green stuff is popping up all over.  No, money still doesn’t grow on trees, but broccoli grows on stalks and you get to eat it.  This broccoli dish that I threw together last week is bright, light and easy and is a great accompaniment to pasta, chicken or really anything else.  Raisins seem like a strange thing in vegetables, but they add the slightest bit of sweetness and mellow out with the salty, acidic accompaniment of the broccoli.  Plus, they were sitting on the counter and I need to get rid of them.  Isn’t that the biggest motivator for eating anything?

The green stuff (broccoli with raisins and pine nuts)

1 bunch of broccoli, rinsed, trimmed into crowns with ~1 inch of stalk
½ tbsp butter
½ tbsp olive oil
1/2 tsp salt
2 tbsp raisins
2 tbsp vermouth, sherry, white wine or water
2 tbsp pine nuts, walnuts, sliced almonds (any nuts really, optional)
Juice of 1/2 lemon

Rinse broccoli and cut into florets.  Over medium high heat in sauté pan, melt butter and oil.  Add florets and raisins, cook until slightly brighter green, about 3 minutes.  Add vermouth, cover another 2 minutes.  Add pinenuts, sauté for another minute, dress with lemon and serve. 

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