Eating alone—with garlic breath

So, sadly, my fiancé departed this afternoon to finish his job in Cleveland.  I’m in Texas alone.  Sad, but not that sad.  Alone time is awesome.  Considering I know about zero people in Dallas, besides the Patron promotional model who I met at the apartment pool, I’m hunkering down with my sweet self for some introspective, reflective, pampering “me” time.

People always tell me that they don’t cook because they don’t like cooking for one.  I love cooking for myself!  Considering I am the most important person in my life, I like getting the chance to whip up a quick dinner and curl up with the remote and watch whatever the hurk I want to watch (which would usually be PBS but considering we just got cable might just be the Keeping Up with the Kardashians marathon) or messily opening up the sewing machine.  I love that I can eat all of the food if I want to with nobody judging, that I can eat it out of the pot with a serving spoon, and that I can lick the countertops if I please. 

So tonight I’m making the perfect kind of meal for one.  It’s quick, easy, healthy and delicious and gives you really stinky garlic breath.  This way you can be in allium ecstasy and nobody will mind, expect maybe your cat if you have one.  The physiology of garlic breath is quite interesting.

Garlic breath comes from a combination the breakdown of garlic in the mouth and in the gut into sulfur containing compounds, ie stinky.  Many of the compounds can be rid of by brushing the teeth, but one major compound called allyl methyl disulfide (AMS) is absorbed by the gut, diffused into the blood and gives off the classic garlic breath smell.  It is thought that the liver metabolizes all other sulfur by-products of garlic breakdown with “first pass metabolism” but that AMS lingers on in the blood.  Ultimately, the AMS compounds stick around for a long time and are exhaled which is why teeth brushing doesn’t help garlic breath [1].

Breathe easy—your halitosis is acceptable.  Tonight I made my favorite Thai dish, which I ate every day when my fiancé and I were in Thailand a few years ago.  Yes, the recipe does say six cloves of garlic.  I also made a Thai inspired coleslaw/cabbage salad which cuts the salt and spice of the main course and gives a lovely, refreshing crunch.   A lot of the ingredients are purchased in an Asian specialty store such as holy basil and long beans, but I will give acceptable substitutions.  The only thing that is necessary is fish sauce.  Without fish sauce, it’s not Thai.  The recipe yields two servings, so you can pack up the other half for a delicious lunch, or you can torture your friend or lover with your stinky mouth.

Cooking for one (recipes actually serve 2)
Thai green bean basil

1 tbsp veggie oil
½ pound ground beef (or chicken or pork or tofu)
6 cloves garlic
1 large shallot
4 thai chilis (or more) seeded and chopped
1 ½ cups chopped long beans (or green beans)
2 ½ tbsp fish sauce
1 ½ tbsp soy sauce
Juice of one small lime
1 tbsp sugar
1 cup packed holy basil leaves (or regular basil)

To prep: using mortar and pestle or knife, pound garlic and shallots to a rough pulp.  In a bowl mix fish sauce, soy sauce, sugar and lime juice.  Make sure all ingredients are chopped and ready once you start because will cook very quickly.  Over high heat, heat wok or cast iron pan and add oil until smoking.  When smoking, add beef and garlic and shallots until beef is cooked and shallots are slightly translucent.  Add beans and chilies and cook until beans are slightly tender.  Add sauce, stir constantly, add basil until wilted.

Thai style cabbage salad

¼ head cabbage
¼ cup mint finely chopped
1 cup sugar snap peas
¼ cup baby carrots

Dressing:
Juice of 2 small limes. 
3 tbsp fish sauce.
1 tsp sugar
½ inch ginger root peeled and grated
¼ cup veggie oil
Splash sesame oil

Core cabbage and slice into thin pieces.  Thinly slice peas and carrots.  Add mint.  Add dressing.  Mix and refrigerate for at least 15 minutes to let flavors meld.

Serve dinner with rice. 

1. Suarez, F.; Springfield, J.; Furne, J.; Levitt, M. “Differentiation of mouth versus gut as site of origin of odoriferous breath gases after garlic ingestion.” American Journal of Physiology, v. 276 issue 2 Pt 1, 1999, p. G425-30.

Acclimating—With Cold Zucchini Basil Soup

Greetings from Texas!  After a round-a-bout road trip from Cleveland to Dallas via Chicago, Wisconsin and Minneapolis, a golf cart tour of Reedsburg, Wisconsin, enough cheese curds to kill any innocent lactose intolerant, and a road kill tally (of identifiable animals) of over 14 deer, 19 raccoons, 8 skunks, 5 jackrabbits, 6 turtles and 10 armadillos from central Wisconsin to Texas, we arrived in Dallas.

It is slowly sinking in that this will be my home for at least the next four years, and I’m alternating between feeling excitement and pure terror.  Mostly the terror isn’t for the place itself, although that comes in waves, but is more associated with the fact that in a few weeks I’m going to be a practicing physician after months of sitting on the couch.

I’ve heard it a thousand times, but Dallas is hot!  When we got here in the middle of the day, my little peanut of a car was roasting after an hour in the sun.  It’s only May.  My hands are so balloon-like swollen after walking around that I need a Lasix and if I had an unexpected trauma they would have to take a diamond saw to my ring. 

People say we’ll get used to the temperatures.  I have to think this is true, considering I somehow miraculously and unhappily got used to winters every year in Chicago, Vermont, and Cleveland.  Science shows as people acclimatize to hot weather, they begin to overheat less and sweat more efficiently without losing as much salt; this effect is thought to be enhanced by exercise [1,2].  Time to come out of hiding and go on a walk.

Well, I’m going to stay in hiding for just a few moments, because I’m thrilled to be back in the kitchen.  My new kitchen has seven outlets whereas my old kitchen had one.  I’ll be damned however if I turned on the oven unless necessary.  In keeping with my promise to myself to cook healthy food, I have done just that. It is amazing that after weeks of eating out how amazing a simply and freshly prepared meal at home can taste.

I based this cold zucchini basil soup on a zucchini salad that I love to make.  Before you say bleck, give me a chance.  The soup is bright, tangy and delicious.  If you marinate raw zucchini in lemon juice and salt, then not unlike ceviche, the lemon softens the zucchini and blunts the rawness as well as releases a lot of liquid which makes a great base for the soup.  I then added basil, raw garlic, olive oil and a touch of the lovely Mexican cream I love down here to make a lovely cold, pureed and very green soup.  Light, refreshing and easy.  Just like the next few weeks of my life…

Creamy Cold Zucchini Basil Soup

4 medium zucchini
2 large lemons
½ tbsp salt
½ cup packed basil leaves
2 green onions whites and greens
2 cloves garlic
2 tbsp olive oil
½ cup Mexican sour cream (or just take ½ cup sour cream and add 2 tbsp milk to thin)
Water (if needed to thin soup)

Grate zucchini.  Add lemon juice and salt to zucchini in large bowl and refrigerate until cold and zucchini has begun to release juice at least one hour.  Loosely chop garlic, basil leaves and green onion.  Reserve grated zucchini for garnish.  To blender add all ingredients and water if necessary.  Serve cold.

1. Chinevere, TD., et al. “Effect of heat acclimation on sweat minerals.” Medicine & Science in Sports & Exercise, v. 40 issue 5, 2008, p. 886-91.
2. Kampmann, B., et al. “Lowering of resting core temperature during acclimation is influenced by exercise stimulus.” European Journal of Applied Physiology, v. 104 issue 2, 2008, p. 321-7.

Farewell Cleveland

This week involved a lot of tape.  And cardboard.  My nutrition has been declining for the past few weeks as we cleaned out the fridge, had graduation parties, and generally didn’t notice what we were shoving in our faces.  I did manage to sneak a roast chicken into the oven a couple of weeks back, which honestly I wish I had taken a picture of because I roasted it with potatoes, rosemary, lemons, parsley and carrots and it was simply supreme.  Lemony potatoes are not something that sounds good, but they really are quite delicious.

Friends came over to collect the remains of what has proved to be an interesting four years of culinary creations: palm sugar, za’taar, brown rice, parmesan rinds, pine nuts, whole star anise and cumin, balsamic vinegar, ground rice powder, vermouth, and, well you get the picture.  The butcher blocks, 2 feet by 18 inches of wood upon which I cooked all of this food, sold on Craigslist in less than two hours.

I said my goodbyes to my vendor at the West Side Market and all my medical school friends as we quickly disperse all over the country.   So, this is my last installation from my Cleveland kitchen.  Which, besides the gas stove which we will be losing for a crappy electric one in Dallas, is not a bad thing.  My new kitchen is almost three times the size of my one here, and has a functional dishwasher and even a garbage disposal.  Ah, to finally get paid!

It will take me a bit to get the blog up and running again, but get ready folks.  I start residency orientation on June 22 so my life is about to get much more exciting.  Texas has awesome food too, so get ready for some spiced up versions of foods I like.  So, even if posting is infrequent, don’t forget about me please.  I like it when you visit.

So farewell Cleveland.  Even if the winters sucked and I complained a lot, it was a great place.  I made wonderful friends and fell in love with food. 

A Breakup Letter with Medical School

Dear Medical School,

Goodbye.  Even though I’ve learned so much from you, I think it’s best for us to part ways.  Really, it’s not you, it’s me.  I feel like you can’t give me what I need anymore.  What I need is to operate.  And prescribe really strong drugs.  I want to feel my feet soaking with amniotic fluid, and wake up before the sun comes up every day. 

While we were together, I admit it, I met somebody else.  He’s strong and kind, and he doesn’t cost $50,000 a year.  And he’s a person.  Not an abstract institution, an enormous hospital or a really ugly orange classroom without windows.  And he knows how to put glue in my hair and make it stick up like a Mohawk.

So that’s it, I’m running away with my MD and my fiancé (yes, we’re engaged, even though you tried to stop us many times).  We’re going to the wild frontier.  TO TEXAS!  Goodbye medical school.  You taught me a lot.  You made me a doctor, and a much more patient person.  You forced me to get along with people and go outside of my comfort zone.  You introduced me to another friend, the operating room.  So thank you. 

Yes, I know that I can’t forget you that easily.  I still have to pay your ugly alimony for the next thirty years in the form of monthly debt payments. 

I’m sure you’ll find another soul mate.  I’m sure there are plenty of young, naïve college grads eager to go out with you, to spend four impassioned years together.  So go, be free to conquer the hearts and minds of those still eager to “help people”.  Consider this a friendly departure.  I still care for you deeply.

Love,
Dr. OB Cookie

Contraceptive Confections—IUDs, you are so sweet

Disclaimer: These cookies do not prevent pregnancy.

In my last post I celebrated the birth of oral contraceptives.  Today I will salute another favorite form of birth control, the intrauterine device, or IUD.  IUDs have an interesting history of their own.  They have a very bad reputation among many of the lay population, but in fact, they are an extremely effective and safe form of birth control.  I would say that IUDs are a great form of contraception because they are very popular for OB/GYN docs [1].  If that doesn’t speak for itself!

The bad reputation of the IUD comes from a previous form of the IUD called the Dalkon Shield released in the 1970s.  The Dalkon shield caused a lot of controversy because it was blamed for causing an increased rate of pelvic inflammatory disease and infertility. A 1981 study showed that woman were 5 times more likely to have pelvic inflammatory disease from the Dalkon Shield than from other IUDs [2,3]. The Dalkon Shield is banned, but won’t be forgotten because it’s also a band.  Although, not a very good band.

In the US currently, there are two FDA approved IUDs--the Mirena and the Paragaurd.  The Mirena is impregnated with progesterone and is effective for five years, and the Paraguard, the more traditional device wound with copper wire, is effective for ten years.  The Mirena works by secreting progesterone into the uterine cavity and makes the uterus inhospitable to implantation as well as thickening cervical mucus (yeah I know, cervical mucus…kind of gross to some).  The copper in the Paraguard reacts with the uterine cavity to inhibit implantation.

The IUD is an highly effective form of contraception, more effective than birth control pills, with a pregnancy rate of <0.5% over 5 years [4].  The side effect profile is low; women are at a minimally increased risk of PID if they have an STD at the time of insertion [5,6].  Women can experience cramping, abnormal bleeding, and expulsion. The IUD does not affect fertility, and fertility returns once the device is removed [7]. 

Along with the birth control cake for my contraceptive confections series, I made IUD cookies.  What could be more delicious than a simple sugar cookie decorated to look like a plastic device inserted into the uterus?  Nothing really.  My fiancé ate them all.  I used my favorite childhood sugar cookie recipe straight from nothing else but the Betty Crocker Cookbook.  I fashioned up some simple royal icing and with my two surgeon gal pals, we delicately iced the ladylike cookies.  So thanks girls and I’m so proud of you!

IUD Cookies
Sugar Cookies from The Betty Crocker Cookbook
Makes about 50 IUD cookies

T shaped cookie cutter (purchased at Sur La Table and the only thing in the ENTIRE store that costs $1)

Cookie dough
1 ½ cups powdered sugar
1 cup (2 sticks) butter softened
1 tsp vanilla
½ tsp almond extract
1 large egg
2 ½ cups all purpose flour
1 tsp baking soda
1 tsp cream of tartar

Royal icing
4 cups powdered sugar
6 tbsp heavy cream or 4 egg whites

Beat powdered sugar, butter, vanilla, almond extract and egg in large bowl.  Stir in remaining ingredients, cover and refrigerate for at least 2 hours.  Heat oven to 375.  Roll dough to ¼ inch thick on floured surface, cut into T shape.  Bake 7-8 minute or until edges are light brown. 

Combine icing ingredients until smooth.  Color some and leave some icing white.  Pipe shape with pastry tube.

If you are interested in an IUD, please discuss with your doctor.  I might be a doctor soon, but I’m not yours.  There are other risks and side effects not discussed above. 

1. 2003 ACOG News Release. Gallup Survey of Women
OB/GYNs. Available at: http://www.acog.org/from_home/
publications/press_releases/nr12-09-03.cfm. Retrieved February
2. http://www.cdc.gov/mmwr/preview/mmwrhtml/00000072.htm
3 Burkman RT. Association between intrauterine device and pelvic inflammatory disease. Obstet Gynecol 1981;57(3):269-76.
4. Thonneau, PF.; Almont, T. “Contraceptive efficacy of intrauterine devices.” American Journal of Obstetrics & Gynecology, v. 198 issue 3, 2008, p. 248-53.
5. Mohllajee, AP.; Curtis, KM.; Peterson, HB. “Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.” Contraception, v. 73 issue 2, 2006, p. 145-53.
6. Shelton, JD. “Risk of clinical pelvic inflammatory disease attributable to an intrauterine device.” The Lancet, v. 357 issue 9254, 2001, p. 443.
7.  Hubacher, D., et al. “Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.” New England journal of medicine, v. 345 issue 8, 2001, p. 561-7.

Contraceptive Confections—Happy Birthday Birth Control! I Made You a Cake

Disclaimer: This cake contains no contraceptive properties and does not prevent pregnancy

Ladies and gentlemen, let’s all give a big happy birthday to a very special someone today, THE PILL!  Today marks the birth control pill’s fiftieth birthday.  You’ve probably seen a lot of press coverage of this anniversary in important publications such as The New York Times and Time Magazine.  Well, I’d like to give oral contraceptives my own little commendation.

Birth control pills are certainly not perfect.  They are not 100% effective at preventing pregnancy and they require excellent compliance.  They put women at increased risk of blood clots, especially those who are older or who smoke.  They can cause high blood pressure.  They do not prevent sexually transmitted diseases or HIV. 

However, oral contraceptives are an incredible drug and we should celebrate them.  Not only have they revolutionized a woman’s ability to control her reproductive fate, but they also have peripheral benefits.  They are effective at resolving painful or heavy periods, they can help resolve acne, and they reduce a woman’s risk for ovarian cancer.  A recently released cohort study from the UK following 40,000 women over 40 years found that women who had ever taken the pill had lower mortality than those who had never taken the pill, controlling for age, smoking status, and socioeconomic status. [1]

When birth control pills were introduced on May 9, 1960, there was only one pill, called Enovid. Enovid contained very high levels of progestins which caused multiple undue side effects.  The dose was lowered fairly quickly as a lower amount of hormone was shown to be equally effective at suppressing ovulation.  Now there are over 30 different formulations of pills approved by the FDA, as well as shots, vaginal rings, patches and hormone laced intra-uterine devices which are all derivatives of the original birth control pills. 

It is impossible to dispute that the pill has had a tremendous impact on our society.  Analysis by political economists suggests that the Pill allowed women to pursue higher education and prolonged the average age of marriage [2].  Regardless of each woman’s individual contraceptive choices and intimate practices, I do think that we as women can at least indirectly thank birth control for our ability to realize our personal and professional dreams, whatever they might be, in this crazy, uncontrollable world. 

So, happy birthday The Pill.  I made you a birthday cake.  It was another baking disaster day, but the beauty about making cake with frosting is that frosting covers all scars.  I had to make the cake twice because I broke one half of it, and then when I re-baked it I took it out while it was still gooey so part of the cake is undercooked.  The white chocolate ganache, which I still can’t figure out for the life of me how to whip up right, got kind of grainy and then I put part of it on a hot cake so it melted everywhere.  But, the cake itself which I layered with kiwis and strawberries with a white chocolate filling, is delicious and I can only thank James Peterson’s Baking for his beautiful vanilla butter cake.  I made a simple buttercream frosting to coat the outside and cover the disaster, and I think it turned out beautifully.

Birth Control Cake (they're all sugar pills)

Vanilla Butter Cake from James Peterson’s Baking
2 9” by 1” round cake pans
Butter an flour for the cake pans
2 ½ cups cake flour (all purpose will work fine)
1 ½ cups sugar
½ tsp salt
1 tbsp plus 1 tsp baking powder
2 eggs
3 egg yolks
1 ½ cups milk
2 tsp vanilla
¾ cup plus 2 tbsp softened butter, sliced

Preheat oven to 350.  Butter and flour cake pans.  In a mixing bowl, whisk together flour, sugar, salt and baking powder.  Add 1 cup milk and butter.
In a second bowl, whisk together eggs, egg yolks, ½ cup of the milk, and vanilla.
In bowl with flour, mix with wooden spoon or mixer for about 2 minutes, until well combined.  Add ¼ egg mixture, work until smooth, then work in half of remaining egg mixture.  Add last of egg mixture.  Transfer to cake pans and bake until toothpick inserted in center comes out clean, about 25 minutes.  Remove from oven, let cool in cake pans for 5 minutes and then invert onto cake rack.

For white chocolate Ganache
From James Patterson’s Baking
8 oz white chocolate chopped
1 cup heavy cream

Place the chocolate in a heatproof bowl.  Bring cream to simmer and pour it over chocolate.  Let mixture sit for about 10 minutes.  To whip, put the bowl in a bowl of ice water to cool it and beat until fluffy and stiff, like beaten egg whites.

For buttercream frosting
From Betty Crocker Cookbook
2/3 cup butter softened
3 cups powdered sugar
1 tsp vanilla
1 tbsp milk

With mixer, beat butter and sugar until a paste, add vanilla and milk slowly and whip until desired consistency. 

For cake assembly
1 kiwi thinly sliced
5 strawberries, thinly sliced
2 packs Giant Smarties for pills

Put first layer of cake down, cover with layer of ganache and fruit.  Add other layer of cake, if ganache remains put on top.  Coat with frosting and arrange smarties to look like pills.

Update: A special thanks to Dr. Charles of the blog The Examining Room of Dr. Charles.  He hosted Grand Rounds this week, a carnival of medical blog posts, and the birth control cake post was the editors choice.

1. Hannaford, PC., et al. “Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study.” BMJ: British Medical Journal, v. 340, 2010, p. c927
2. Claudia Goldin and Lawrence F. Katz. The Power of the Pill: Oral Contraceptives and Women's Career and Marriage Decisions.  The Journal of Political Economy, Vol. 110, No. 4 (Aug., 2002), pp. 730-770.

Essay on Food and Think

Hi everybody,

A quick note.  Just in case you didn't see it, yesterday I had a guest essay posted by the lovely Amanda Bensen, an editor of Smithsonian Magazine and food science blogger at the blog Food and Think.  She prompted readers to write about manners, and I wrote about my lack of manners and clumsy nature, even though my mother tried very hard for me to behave.  Check it out here: From Table Manners to Bedside Manner.

Have a wonderful day,
Elizabeth

Huevos a la Mexicana

Silence.  Well, it’s really the absence of silence.  The manmade noises, the churn of humanity are reduced to a hum.  We are left with sounds previously unnoticed.  The swish of the waves on the beach, the rustling of palms, and the creatures that activate at dusk are all that ring in our ears.

This week I unplugged from it all and spent a week in the Pacific region of Mexico with my best friend from high school.  We didn’t rough it, but we did play to local style by taking buses everywhere instead of taxis and planes and eating lots of delicious street food.  We flew to Puerto Vallarta for a night and then immediately departed to Guadalajara and then a small town on the beach near San Blas.

I unplugged from it all.  I checked my email twice and called my fiancé for five minutes.  The current Mexican telenovela buzzed in the background while I ate my pozole, but that was it for TV.  It was incredibly refreshing and mind clearing.

My friend found this magnificent bed and breakfast (although no breakfast for us) right on the beach.  I’ve been on a fair amount of beach vacations and stayed on the beach plenty of times.  But what I didn’t comprehend was that not only were we on the beach, but that we were on the beach alone.

Miles of smooth sand stretched out and the clear water extended shallowly out for hundreds of yards.  Other visitors, Mexican locals, frolicked a quarter of a mile away.  Vendors drove by in ATVs and pickups right on the sand selling ice cream and banana bread.  Otherwise, silence.

For breakfast, we adventured to the building adjacent to ours.  We pick up the menu and I start to ask questions in Spanish about the different food.  The cook for the small restaurant, an older lady named Maria Camanera astutely asked me if I like to cook.  I asked her how she knew. “Is it because soy gordita (I’m chubby?)” She chuckled.  “No" she says, "because you talk about food with passion.  Most people aren’t like that.”

I ask her to teach my how to make a simple Mexican breakfast “huevos a la Mexicana”.  She cuts up Serrano, onion, and tomato, which she proudly states are colors of the Mexican flag.  The gas to the grill glows in the underlit kitchen as she stirs her eggs and beans and presses freshly made corn tortillas right in front of us.  I contemplated staying forever, with the waves and the sand and the sun.  Silence can be very seductive.

Huevos a la Mexicana

½ onion finely diced
½ Serrano seeded and finely diced
1 ripe plum tomato finely diced
4 eggs
2 tbsp vegetable oil
Chile sauce
Refried beans
Corn Tortillas
Avocado slices
Mexican cook and beach

Over high heat, heat oil until smoking and cook vegetables until onions start to soften.  Salt to taste.  Add eggs and stir until cooked.  Serve with love.