To Corn Beef--Part 2

 

As I said, before, YEEHAW! Folks (excuse me, y’all), get ready. I’m moving to Dallas, Texas. Life is full of surprises, and this move is one of them. But as I come to understand the reality of the situation and the craziness and uncertainty of the match, I am getting very excited. I matched to the biggest OB/GYN residency program in the country, University of Texas, Southwestern. With lots of residents come lots of babies and lots of sick mommies. In fact, at Parkland hospital where we do almost all of our work, there are an average of 16,000 babies delivered a year! 16,000! Most large hospitals average around 3000 to 4000.

When I was looking for a residency, I wanted to go somewhere warm (I am a winter hater TO THE CORE), and I desperately wanted to work somewhere where I could take care of underserved Spanish-speaking women (ay si, senora!). As my mother told me yesterday, “This is where you were meant to be. You went to medical school to work with those that are often overlooked. You are going to be the doctor that you always dreamed about becoming.”

I don’t know if they eat corned beef in Texas, but I do know that they worship the un-cured cow meat there. I hope that my carnivorous habits, love of sausage making and new interest in meat curing will make me lots of friends. Look forward to lots of barbeque tips! I think barbeque ties in perfectly well with what I was originally going to talk about today, which was the question, “is sodium nitrite toxic”?

Sodium nitrite is rapidly converted to nitrous oxide when added to curing solutions. Nitrous oxide reacts with amino acids present in meat to form potentially cancer causing agents called nitrosamines; the formation of these compounds is accelerated by the heating of meat, particularly in high temperature situations like grilling [1]. It was discovered that adding vitamin C derivatives to nitrite-cured foods reduced the nitrosamine concentration. Now foods are required by the FDA to have anti-oxidants added to them. In a recent excellent review by the Journal of Food science, authors discuss toxicity of nitrated foods, and how addition of citrus compounds to these foods could potentially reduce nitrosamine concentrations [2].

My solution to neutralizing the nitrated corned beef, in the form of a rich corned beef hash, was to make a bright and tangy, vitamin C rich citrus salad. The citrus salad is a variety of pink to orange fruits dissected and bathed in simple syrup infused with ginger and rosemary. The rosemary adds an herbal earthiness while the ginger adds the slightest pungent kick. The corned beef hash contains not only potatoes, onions and meat, but also sweet potatoes and red and green peppers. It was the perfect treat for my perfect friends, who I am so proud of for all of their amazing residency matches. I love you ladies, and I can’t wait for us to become the best doctors in America!

Corned beef hash
2 cups corned beef, cubed
2-3 medium potatoes
1 medium sweet potato
½ green bell pepper diced
½ red bell pepper diced
1 medium onion diced
1 tsp salt
1 cup cooking liquid from corned beef
½ tsp ground marjoram
1 tsp butter
1 tsp vegetable oil

In a 400 degree oven, bake potatoes for 45 minutes or until easily pierced with knife. Peel and dice. Keep oven on. In large pan, heat oil on medium heat, add onion, salt and peppers, cook until soft about 15 minutes. Add potatoes to pan, cook until potatoes are soft, about 10 minutes. Add corned beef and cooking liquid. Heat through, about 5 minutes. Add mixture to casserole dish, bake at 400 degrees for about 15 minutes or until brown and bubbly on top. Serve with eggs, cooked to order.

Citrus salad (serves 3, I made a batch about 3 times the size)
1 ruby red grapefruit
3 clementines
1 navel orange
1 blood orange
¼ cup water
¼ cup sugar
½ sprig rosemary
1 inch ginger root grated
1 tbsp honey
Zest of orange
 

Section citrus. To cut up grapefruit, peel with knife, including the pith. Cut the sections vertically between the fibrous stuff. Cut clementines, oranges and blood oranges. To make syrup, boil water, sugar, honey, rosemary, zest and ginger. Reduce to a simmer for 5 minutes. Strain on top of fruit, refrigerate overnight.

1. Lijinsky, W. “N-Nitroso compounds in the diet.” Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis, v. 443 issue 1-2, 1999, p. 129-38.
2. Viuda-Martos, M., et al. “Citrus co-products as technological strategy to reduce residual nitrite content in meat products.” Journal of Food Science, v. 74 issue 8, 2009, p. R93-R100.

The grapefruit--one way to battle winter

As the snow keeps drifting down, the wind keeps a blowing, and the gray skies ever make me desire a personal psychiatric consult, the citrus aisle of the grocery store is a welcomed reminder that there are palm trees and sanity in blessed parts of the United States of America.  As you can tell from repeated posts and reminders, I’m not really a fan of winter.  I particularly disdain the bleak species where the snow turns black and there’s no topographic variation to permit skiing or mountainous exploration.***

I have employed a variety coping mechanisms for the seasonal blahs.  Tactics have included the evasive, fleeing the northern hemisphere in December for summery South America for six months; the illuminating, having my fiancé design and build me a “happy lamp” as a sun substitute; and the caloric, particularly baking.

A less proud moment of winters past may have involved an entire chocolate layer cake topped with toasted walnuts and about a pound of homemade buttery caramel that I ate—alone.  (At least I completed an Olympic distance triathlon that summer.)  Now I moderate a bit better, but I still love to bake during the winter.  Benefits of winter baking include, admittedly, the cold weather allowing the oven to steam the windows Titanic style, and of course, the citrus.  Not only are the lemons and oranges beautiful, but the grapefruits are brilliant in baked goods.

The grapefruit, the beloved seemingly benign diet food of America also has a more mischievous side.  Grapefruit juice can be a bad player when taken with a variety of medications.  This discovery, like many scientific discoveries was hobbled upon coincidentally.

 In the 1980s in attempts to study the interaction between ethanol and a popular blood pressure medication, scientists decided on a Saturday night to make a felodipine Cosmopolitan with grapefruit juice to help the booze go down a bit better [1].  When they ran the experiment, they found that patients who took the drug with the cocktail had significantly lower blood pressures than those who had no alcohol.  Somebody astutely suggested it was the juice, not the liquor that caused such drastic changes in the drug metabolism.

Since this time, the grapefruit juice/medication interaction has been further explored.  [2,3].  Many medications are metabolized through an enzymatic pathway.  It appears that grapefruit juice reduces the prevalence of the enzyme CYP3A4 part of the cytochrome P450 in both the gut and the liver.  This allows for more medicine to be absorbed in the intestine and allows for medicines to linger in greater concentrations.  This can exacerbate toxic effects of  multiple drugs. 

A list of common medications that interact with grapefruit are listed here.  If you are concerned, please talk to your doctor.  If you are not taking any of these medications, feel free to participate in the construction and destruction of a luscious grapefruit lemon bar.  The benefit of the grapefruit is a complex sweetness with a less harsh tartness that I find many lemon bars have.  The crust is a modified shortbread recipe, so it is crisp, crumbly and light, with a bit of sour cream to echo the acidity in the filling.  The filling is more of a curd than a sturdy baked custard, so these treats are best eaten with a fork after refrigerated overnight.  The curd would also work great on toast or as a filling for cakes or cookies so feel free to separate the elements and work with what pleases you.

Grapefruit lemon bars

Shortbread Crust
Adopted from Joy of Cooking
¾ cup unsalted butter (1 ½ sticks) softened
2 tbsp sour cream
¼ cup confectioner’s sugar (powdered sugar)
2 tbsp granulated sugar
¼ tsp salt
1 ½ cups all purpose flour

Preheat oven to 300 degrees.  In large bowl beat all ingredients minus flour.  Stir in flour.  Light knead until blended.  In 8x8 baking pan with fingers press dough into bottom and up around the edges about ¾”.  Bake for about 35 minutes or until lightly browned and darker at the edges.  While baking, make the curd filling.  Allow to cool slightly for about 5 minutes and add the curd.  Refrigerate for 4-5 hours or until cool and set.  Sprinkle with powdered sugar and enjoy!

Grapefruit Curd
Adopted from James Peterson’s Baking

Juice and zest from one ruby red grapefruit (about 1 cup juice)
Juice and zest from one lemon
4 eggs
¾ cup granulated sugar
1/2 cup plus 2 tbsp unsalted butter cut into tablespoon pieces

Set a saucepan of water over medium heat and bring to a simmer.  In a heatproof bowl that will fit over pan, whisk together eggs and sugar for about 2 minutes until pale.  Then whisk zests and juice.  Set the bowl over the saucepan.  Stir constantly with a whisk for about 8 minutes or until the mixture starts to thicken.  Add the sliced butter, one piece at a time and stir constantly.  Cook for about 2 minutes longed.  Remove from heat.

***On a side note completely unrelated to the core of this essay, I have just undergone the most unbelievable ritual to prove that winter is evil.  Coincidentally, my car and my fiancé’s car break simultaneously.  Our lovely repair shop lends us a loaner.  After spending an hour driving through blustery conditions to drop him off and then drive to the hospital, I roll down the window to take a parking ticket. The window falls into the door with impressive speed and doesn’t come out.  I then proceed to drive through downtown with no window while it snows into the car.

1. Bailey D et al.  Ethanol enhances the hemodynamic effects of felodipine.  Clin Invest Med 1989: 12: 357-362.
2. Dahan A et al.  Food Drug interaction: grapefruit juice augments drug bioavailability—mechanism, extent and relevance.  2004.  European journal of Clinical Nutrition.  58, 1-9.
3.  Bailey D et al.  Grapefruit Juice-Drug Interactions.  1998.  British Journal of Clinical Pharmacology.  46: 101-110.