Watermelon Lime Slushy

We have really been on a smoothie kick lately.  What's not to like?  Some frozen fruit (no sugar added, please), a few scoops vanilla protein powder, maybe a splash of milk and voila!  A pretty good breakfast.  This slushy is a little different, though still amazing!  The lime and watermelon are a great combination, super refreshing.  And the frozen banana makes the drink really creamy.  Again, I'm not a banana person, but I'm discovering that only applies if I were to take a bite out of a banana (blech).  I rather like them blended up in smoothies or baked into muffins :)

PS: check this out!  Our nephew, Brayden, learning a few golf tips from old uncle Peetie.  He was only interested in gnawing on the end of the club, but you gotta start somewhere!!  :)

Watermelon Lime Slushy
Serves 2

3 cups watermelon, cubed and frozen
1 ripe banana, peeled and frozen
2 Tbsp sugar
Zest and juice from 2 limes
1/2 cup water

Blend all ingredients in a blender, adding more water as needed to keep fruit moving.  Add in a few shots of tequila or rum if you're feeling crazy :)

Greek Shrimp Quinoa

I'm finally done with my pediatric sub-internship, which was super fun, but the break is welcome!  I have the week off, then I'm headed to Madison for the month of September to do a pediatric pulmonology rotation and to scout the program :)  I'm not particularly fond of the idea of leaving Peter and Lady for a month, but I'm sure I'll have some fun.  Adventures to follow!

So this quinoa recipe was great...and I kind of made it up on the fly.  I love using quinoa, which (if you don't know by now) is a grain/rice-like thing that's super packed with protein and other great stuff for you.  This kept super well for lunch leftovers during the week!

Check out "Team Napping".  Gotta love shameless Sundays!

Greek Shrimp Quinoa

1 cup dry quinoa
Zest and juice from 3 limes
2 Tbsp olive oil
Salt and pepper
1 pint cherry tomatoes, halved
1 cucumber, peeled and seeded, chopped
1/4 cup black olives, chopped
1/4 cup cilantro, chopped
1 lb shrimp, chopped and sauteed.
Feta cheese for serving

Prepare 1 cup dry quinoa according to package directions.  Allow to cool.  In a large bowl combine lime zest and juice, olive oil, and salt and pepper.  Stir in quinoa and remaining ingredients (except feta), stir well.  Serve room temp or chilled.

Blueberry Muffins with Crumb Topping

Oh sweet freedom, I survived the week of boards!  Sometime during fourth year, we need to take both parts of Step 2 of the USMLE (medical licensing exam).  One part (CK) is like 360 multiple choice questions with super long patient vignettes, and the other part (CS) is a practical: 12 standardized patients.  We can take them anytime, and I decided to get them both over with straight away so I don't have to study adult problems anymore, at least not until I take Step 3 in about 2 years :)  (adios, CHF!)   I don't have to study any more this year, at all!  (well, except the constant studying we end up doing to try not to look ridiculous on our rotations...but that's different). Yay!  Thank you for listening, now for the muffins.

These muffins are a bit of a departure for me, but they are delicious!  I usually make oat bran/wheat germ/applesauce=healthy-ish muffins when I do, but these are more like an excuse to eat cake for breakfast :)  They are really good, and don't contain as much oil or butter as some I've seen, so they are legit.  Go ahead and indulge :)

Blueberry Muffins with Crumb Topping
Adapted from Our Best Bites

1 3/4 c all purpose flour
2 3/4 tsp baking powder
3/4 tsp salt
1/2 cup sugar
Zest from one orange
1 large egg
3/4 cup buttermilk (or 3/4 cup milk with 1 Tbsp white vinegar, let sit for 5 minutes)
1/4 cup canola oil
Juice from half the orange
1 tsp vanilla extract
1/4 tsp almond extract
1 cup fresh blueberries
1 Tbsp flour
1 Tbsp sugar

Crumb topping
1/4 cup sugar
2 1/2 Tbsp flour
1/2 tsp cinnamon
2 Tbsp butter, cubed

In a large bowl combine flour, baking powder, salt, sugar, and orange zest.  Make a well in the center.  In a separate bowl, combine egg, buttermilk, oil, orange juice, and extracts.  Pour into the center of the flour well, and mix until just combined.  In a bowl combine blueberries, 1 Tbsp each flour and sugar, and gently fold into batter.

Preheat oven to 400 degrees.  Spray muffin cups with nonstick spray, and using an ice cream scoop, dollop blueberry muffin batter into the pans.  Combine ingredients for the crumb topping in a small bowl (we have so many bowls out!) and smush with a fork until crumbly.  Divide evenly on top of batter, then bake for 18-20 minutes or until tops are golden.  Allow to cool.  Makes about 12 muffins.

Baked Zucchini Sticks

So, I have boards tomorrow.  And Thursday.  This week is icky.  Part 2 of the USMLE (MD licencing exams) consists of a long day of computerized multiple choice questions AND a full day of standardized patients, a practical portion.  Most of my (smarter) classmates split these up with months in between.  I decided it would be great to do them both in the same week.  I'm beginning to question my judgement.  Oh, and our three-year anniversary is on Wednesday.  I guess we'll have a lot to celebrate on Friday!

Wondering what those things in the picture are?  I ran across a version of this recipe on pinterest, and I knew I needed to try them!  We are all about sweet potato fries in this house, and I figured these would be a lower calorie yet yummy alternative!  Plus, zucchini are in season, and it's easy to find beautiful ones in your garden, the farmer's market, or even the grocery store.  They really are great...crispy on the outside, thanks to an eggwash and bread crumb crust, but tender on the inside.

What a great way to get anyone in your life to eat more veggies!  I pretty much went to town on these things, and I probably ate the equivalent of an entire zucchini.  I don't feel too bad about that, though :)

Baked Zucchini Sticks

2 large (but not baseball bat sized) zucchini
1 Tbsp salt
2 eggs, beaten
1 cup bread crumbs
1 Tbsp Italian seasoning (or freshly chopped herbs)
1/4 cup parmesan cheese
1/2 tsp garlic powder
1 tsp salt
1/2 tsp pepper
Marinara sauce, for serving

Cut the ends off the zucchini then cut them in half (across the equator, if you will).  Cut each half into thirds the long way, then turn 90 degrees and cut into thirds again (you should have made little sticks!)  Repeat with remaining zucchini.  Put sticks in a large colander in the sink, and sprinkle on 1 Tbsp salt. Toss and let sit for 1 hour to let some of their water come out.  When done, rinse thoroughly and dry well.

Preheat oven to 375.  Make your breading station by beating eggs in one dish, and combining remaining ingredients in another dish.  Grease 2 baking sheets and have them ready too.  With you left hand, roll a few sticks in the egg mixture, then toss in bread crumbs with your right hand (one hand will be for wet, one for dry-that way you won't end up with a bread crumb mitten).  Arrange on baking sheets, spacing them out so they won't steam.

Bake for 12 minutes, then turn each stick over, and continue baking for 10-12 minutes until golden and tender on the inside.  Serve with warm marinara sauce!

A Touch of the Sugars, the End

Finally!  We reach the end!  If you've stuck with me through the first two diabetes articles, here's the conclusion; treatment and prevention!  If you're interested, sandwiched in between some great recipes like Apple Pie Ice Cream and Greek Shrimp Salad, I have MORE articles, about how to become a doctor and how to save a life :)  Thanks for reading!!

Part Three

            Welcome back!  This is the final part of the “Stethoscopes to the Streets” article series about everything you (never) wanted to know about diabetes but were afraid to ask.  We still need to discuss how diabetes is treated and most importantly, how it is prevented! 

Finding patients with diabetes

            In article two, I outlined the diagnostic criteria with all the fancy numbers and tests, but how do doctors find the patients to test?  There is a group called the US Preventative Service Task Force who reviews a lot of the literature for all kinds of disorders and makes concrete recommendations for clinicians on who to test for disease.  They have really good guidelines that make good use of health care resources, but they didn’t really find great evidence that screening all adults for type 2 diabetes would be worth it.  They did recommend screening adults with blood pressures over 135/80, using a fasting blood glucose reading. 

            Also, most clinicians order a fasting glucose test on their patients with metabolic syndrome, or even just components of it, like those with high lipids or obese patients.  The interval that clinicians use varies, but every three years seems to be a common one.  Obviously, if a patient were to come to the office complaining of symptoms of diabetes like increased thirst and urination, fatigue, multiple infections, etc, a doctor should check their fasting blood sugar immediately.

Treatment and monitoring for complications

            As we talked about in the previous articles, the problem with diabetes is the long-term high blood sugar that the insulin from the pancreas is no longer able to get into muscle and fat cells.  That high blood sugar causes all kinds of problems to blood vessels and nerves, leading to those serious complications.  So, the obvious treatment goal would be to tightly control blood glucose, mainly in the range of 80-120 mg/dl.  Easier said than done, but we have some tips and medications that make that goal an attainable one.

            Lifestyle modifications: yeah, yeah, yeah, we all know what this means.  Diet changes and exercise, leading to that all-important weight loss.  A lot of people hear this recommendation from the doctor but don’t do much with it.  I totally get it, changing what you do on a daily basis is really hard, but like anything, consistency is key.  Once habits are changed, a new routine takes shape.  Let’s be a bit more specific though: “diet” usually means reduced carbohydrates (less processed foods), more fruits, vegetables, and lean proteins, and lower fat.  It gets tricky for diabetics though, as fruits can cause blood sugar to increase.  The diabetic diet can be hard to navigate alone, and I find patients do better when they work with a dietitian, who can take the time clinicians might not have, to explain the ins-and-outs of the proper way to eat and make a concrete plan.  Let’s face it; just saying “eat better” is really not clear enough.  A brief word on exercise: it’s fantastic for diabetes.  Exercising actually increases muscle and fat cell’s sensitivity to insulin (this means they are more receptive to the signal insulin is giving them to let blood glucose through those doors into the cell to be converted into energy).  Everyone should aim for at least 30 minutes of activity most days of the week, but again, your doctor should make individual recommendations based on whatever other conditions you might have.

            For most people, medications are necessary, at least in the beginning of treatment.  The effects of high blood glucose are concerning enough that most doctors don’t want to rely completely on a patient’s willpower to make lifestyle changes because we understand that these things take time, but your kidneys might not have that much time.  In Type 2 diabetes (at least before the severe end stage), the pancreas is still able to produce insulin, the body just isn’t responding to its signals.  So, we have medications that can help increase muscle and fat cells’ responsiveness to insulin (that’s pretty cool, right?).  We also have medications that make the pancreas secrete more insulin to help reduce blood glucose levels.  If these measures don’t work to control blood sugar, giving insulin injections might become necessary.  Remember, the important thing is to keep blood sugar down, and all these drugs can help do that. 

            We really can’t effectively control blood glucose levels if we don’t know what they are.  Therefore, it is super important (and often overlooked by patients) to monitor their blood sugar using a simple finger prick at home.  The frequency and timing may vary from person to person, but generally glucose should be checked in the morning before breakfast and a few hours after dinner.

            Remember all those complications of diabetes we talked about?  Most doctors want to start treating and preventing those right away too.  This means in addition to any blood glucose-regulating medications a patient might need, there’s a good chance they will be started on a blood pressure medication, even if their blood pressure isn’t high in order to protect those kidneys.  Also, since diabetics have a heart attack and stroke risk equivalent to those who have already had one of those, their cholesterol levels need to be even more tightly controlled than before their diagnosis of diabetes, often needing a medication like Lipitor (a statin) to help.  Aspirin will likely be prescribed as well to stop platelets from sticking together and forming clots.  Lets count up the meds:  a few to control blood sugar, blood pressure medication, and lipid medication plus aspirin.  Whew.  Aside from more medications, regular doctors appointments (every few months) are needed to monitor for foot sores, blood pressure, and eye changes.  Blood will need to be drawn more often so that lab tests can be done.  Patients will need to visit an eye doctor yearly to monitor for those changes to the retina that might cost them their vision. 

            Most of my patients tell me they “don’t like to take medications.”  Who does?  It’s a lot to remember, especially if some need to be taken at different times or multiple times during the day.  Also no drug is free of side effects!  Newly diagnosed diabetics may go from taking no meds at all to suddenly needing to juggle five or more.  The good news, though, is that if patients really get serious about changing those lifestyle factors we talked about, it’s possible to get their blood sugar under control and maybe, just maybe, “cure” their diabetes altogether.  Of course, this requires constant and continued vigilance and a pretty significant weight loss if the patient is obese, but it is possible.  We can then shave down or completely eliminate some or all of those medications.  How cool is that!

Prevention

            Don’t you think the best way to deal with a problem is to never have the problem in the first place?  There are many things you can do to prevent the development of metabolic syndrome or diabetes, and most of them are “lifestyle” related.  Like most diseases, there is a strong genetic component to diabetes, but everyone has control over how much they move and what they put in their mouth.  Prevention strategies include the common sense things we all know about:

·      Exercising at least 30 minutes daily, even more if you can

·      If you are overweight, lose weight.

o   Even a 5-7% weight loss can decrease the risk of developing Type 2 diabetes by as much as 50%!

·      Limiting refined carbohydrates

o   These include products made with white flours, added sugar, sweets, and other starches.

o   As you might suspect, I love to bake, and yes, most of my favorite recipes are included in the “naughty” category.  But like most things in life, moderation is the key.  You can bake and enjoy an occasional treat, just share what you make, and try to treat yourself on special occasions only.

·      Watch fat and cholesterol intake

·      Eat more whole grains, fruits and vegetables

o   A high fiber diet (found in these types of foods) helps regulate blood sugar by preventing frequent spikes and dips in blood glucose that make you hungry.

·      Don’t smoke

o   There are just a million reasons not to smoke.  Prevention of diabetes is another one.

·      Limit alcohol intake

o   Alcoholic drinks are full of carbohydrates (alcohol itself is a carb, and all the juice and soda mixed in don’t help either). 

All these suggestions are not new ideas, and I do realize they aren’t easy to implement either.  I’m a creature of habit, and if I have a behavior I want to change, I know it will take at least 2 weeks of consistent change before it will start to become a new “habit” for me.  In other words, don’t start a healthy eating and exercise program all at once, and don’t quit after two days of it either.  Small changes tend to stick, and they are better than no changes at all! 

Wrap-Up

            Well there you have it.  We took a pretty big journey into the world of diabetes in a short amount of time!  Hopefully now you understand a bit more about how insulin and glucose work in your body, what diabetes actually is, how it affects it’s sufferers, and some ways to treat and prevent it’s occurrence.  Now go out there and take one small step for yourself in the right direction of healthy!

Lattice Topped Cherry Pie

Who doesn't love pie?  Peter has been asking me to make a fruit pie for some time now, and since I've been home "studying" full time this month, I thought now would be a good time!  Cherry pie is just all-American, don't you think?

My brother-in-law, his wife and their baby (our nephew Brayden!) just moved back to the area, and I took this pie over there to share with them.  Who doesn't need comfort food when moving!  It was a big hit, even with Mr. Brayden himself, who thought the cherries were pretty great :)

Ok so a word on pie crust...it seems kinda daunting, and by no means am I an expert.  I do have a pretty good recipe (from my friend Betsy!), but I think for today I'll leave you to using either a store bought unbaked pie crust or your own trusted recipe.  I think pastry crusts deserve their own post, and this recipe is long enough already!  The trick to a flaky crust, though, is keeping everything cold, cold cold!

Lattice Topped Cherry Pie

Unbaked pie crust for a 2 crust pie (either store bought or your own recipe)
2 bags frozen cherries (about 16 ounces total), or about 4 cups fresh cherries (pitted!)
3 Tbsp cornstarch
3/4 cup granulated sugar, plus more for sprinkling on crust
1/4 tsp almond extract
1/2 tsp vanilla extract
1 egg (for eggwash)

Place thawed cherries in a medium saucepan and heat over medium until the cherries lose a lot of juice (a few minutes).  In a small bowl combine cornstarch and sugar, then mix into the hot cherries.  Continue cooking cherry mixture until it's thick and bubbly.  Remove from heat and transfer to a glass bowl.  Stir in almond and vanilla extracts.  Allow to cool completely.

When ready to bake the pie, preheat oven to 375.  Roll out half the pie dough, roll up the round onto the rolling pin, then transfer to 9" pie dish.  Prick the bottom with a fork to prevent the crust from bubbling, then pour the cherries over the top.  Roll out the other half of the pie dough, and with a pizza cutter, cut out even strips of pie dough.  Arrange about 5 strips going one direction across the top of the pie.  Fold back every other strip, then place another strip going the other direction.  Put back the strips you folded back, and now fold up the other strips and repeat to create the lattice top.  Crimp the edge of the crust with a fork or your finger.

In a small bowl beat an egg, and with a pastry brush, brush the eggwash onto the pie crust (this will make it nice and golden).  Sprinkle the top of the whole pie with sugar (for some sparkle).  Place pie plate on baking sheet (incase there is cherry spillage!) and line the edge of the crust with foil to prevent burning.  Bake for 20 minutes, then remove foil and continue baking for 25-30 minutes more or until crust is golden.  Allow to cool completely before serving.

A Touch of the Sugars, Part 2

Remember my first article on diabetes I posted?  I promised more, and here is part 2!  I know it's long, but it's a pretty quick and dirty tutorial on a super complex topic!

Diabetes: the definition

I can’t tell you all about a disease without defining it first, and now is a good time to do that.  In medicine we are nothing without our objective criteria, classifications, and rating scales, so here’s the scoop for diagnosing diabetes:

·      Fasting blood glucose greater than 126 mg/dl

o   Normal would be under 110 mg/dl

·      Two hour glucose tolerance test greater than 200 mg/dl

o   This is a test where the doctor gives you a standard amount of glucose to take, makes you wait two hours, and sees if your pancreas can get it together to secrete enough insulin to cause much of that glucose to “disappear” from the blood into cells.

·      Non-fasting (random, anytime of the day) blood glucose reading of over 200 mg/dl in the presence of symptoms of diabetes.

o   Symptoms of diabetes include increased thirst (polydipsia), increased urination (polyuria), fatigue, and possibly weight loss.

o   In Type 2 diabetes, symptoms usually come on more slowly than in Type 1, and a patient may present with some of the complications like changes in vision, more infections, or nerve problems.

·      Hemoglobin A1c over 6.5%

o   This is my favorite lab test of all time: Hemoglobin A1C (HbA1c) is a variant of hemoglobin (a protein found in red blood cells that carries oxygen) that looks different than normal hemoglobin because it has been “glycosylated.”  Basically, all the extra glucose  in the blood stream is sticky and attaches to hemoglobin molecules.

o   The thing about this test is that it’s a predictor of the average blood sugar over the past 3 months.  That’s the average life span of a red blood cell, and once they get stuck with the sugary goo, it doesn’t come off.  So basically this means that doctors know when diabetics say they are controlling their blood sugar, but really are not.

Let’s say someone fits this criteria and is diagnosed a diabetic.  Great, now what?  There are several treatment options that we’ll get to, but first, I think we need to take a look at what diabetes does to the whole body.  Hopefully I’ll make complying with those treatment options seem like a really good idea.

The “side effects” of diabetes

            When I say that diabetes takes a big toll on the entire body, I really mean the entire body.  There are literally so many complications that I would bore the pants right off you if I outlined them all.  So let’s just talk big picture:  high blood sugar that is uncontrolled will damage your big blood vessels and your small blood vessels (fancy terms: macrovascular and microvascular complications).

           

Big blood vessel complications: 

Diabetics undergo accelerated atherosclerosis (you know, fat plugging up big important vessels, like the ones carrying oxygen to your heart muscle, ie the coronary vessels).  As a matter of fact, diabetics are considered to be as high risk for heart attacks and strokes as someone who has already had a heart attack or stoke.  We’re not super sure why atherosclerosis happens faster in diabetics, but it might have something to do with the excess glucose attaching to the walls of vessels, making platelets more likely to stick there and form a big clot.  The most common cause of death of a diabetic patient is coronary artery disease (heart disease=big risk for heart attacks).  Other major heart and stroke risk factors are high blood pressure, high lipids (LDL, triglycerides, etc), smoking, and obesity.  Unfortunately, most diabetics meet criteria for at least one of these other risk factors too (remember the metabolic syndrome?).  Decreasing some of these other risk factors decreases the risk of heart attack and stroke in diabetics, but that risk is still much higher than someone without the disease. 

In addition to the big blood vessels of the heart and brain being affected, the blood vessels that serve the legs and arms are affected by diabetes and are prone to earlier “clogging” by atherosclerosis, called peripheral vascular disease.  This can cause all kinds of problems, including pain during activity because the muscles can’t get enough blood and increased risk of sores that don’t heal, leading to ulcers and infection.  As a matter of fact, patients with nonhealing ulcers sometimes need amputation of the affected limbs to spare the rest of the body from spreading infection.  Diabetics account for almost 70% of all the non-traumatic amputations performed in this country!! 

Small blood vessel complications

            Long term uncontrolled blood sugar does a lot of damage to the very small blood vessels that provide nutrients to important “end organs”, like the eyes, kidneys, and even nerves.  We’ll talk about each of these individually.

            The eyes: Oh, the poor eyes.  High blood glucose causes problems in two main ways. Firstly (and probably the first to be noticed by the patient), fluctuations in glucose levels can cause the cornea of the eye to become distorted in shape as glucose gets trapped and water follows behind (swelling!).  This results in rapid changes in vision prescription needs, as light travels differently through the different thicknesses of the cornea.  Patients will often report to their eye doctor several times within a year, complaining that their eyeglass prescription isn’t working again!  The second way that diabetes does damage to the eyes is through “diabetic retinopathy,” a fancy medical term for the changes that take place to the retina, which is the nerve layer of the back of the eye that responds to light and transmit the information to the brain.  When the small blood vessels that serve the eye become damaged, they can bleed onto the retina, causing small hemorrhages, or even be cut off completely, creating areas of ischemia (decreased blood flow).  As a result of the decrease in blood flow, the eye tries to make more blood vessels to keep the nerve cells of the retina alive in a process called “neovascularization”.  These new vessels aren’t as good as the original ones that were all clotted up with sugar though.  In fact, they are weaker and can cause retinal detachment, which is an emergency that can end in blindness!

             The kidneys:  Full disclosure: the kidneys are my least favorite organs, mostly because they are the true workhorses of the body and are incredibly complicated (and thus, very hard to understand as a medical student).  You would not believe all the important bodily processes your kidneys take care of, and unfortunately, they are very prone to damage in the diabetic state.  Due to the high glucose load that comes screaming through the kidneys every minute of every day, the microscopic structure of the kidneys themselves change and eventually they start spilling protein into urine, something they are never, ever supposed to do.  This leads to swelling of the legs or even the whole body, but more than that, it indicates that since the structure of the little kidney cells are all changed, the whole kidneys themselves are headed toward failure.  It’s a very serious thing when kidneys fail, making patients undergo dialysis for several hours a week just to keep up with the blood-cleaning process the kidneys should be performing.  After needing regular dialysis, life expectancy decreases significantly.  It’s very, very bad to make the kidneys sick.

            The nerves: Diabetic neuropathy is a common complication, affecting as many as 70% of diabetics.  Nerves of all kinds can be damaged by diabetes, again through a variety of mechanisms, but the idea is the same as for the other organs we’ve talked about; high blood glucose levels damages blood vessels that keep those nerves alive and can damage the nerves themselves.  There are tons of ways diabetic neuropathy can present, and a patient may have a combination of these symptoms.  If the peripheral nerves (ones in your arms and legs) are affected, there could be a sensation of burning, or “pins and needles”, or even a loss of sensation completely, making it very hard for patients to tell when they have a sore on their feet (the starting point for those non-healing ulcers that can lead to amputations we’ve talked about).  The nerves that serve the internal organs and blood vessels can be affected to, and this is called “autonomic neuropathy.”  These symptoms are particularly bothersome and can include any of the following: indigestion, nausea, vomiting, diarrhea, constipation, difficulty urinating, and even dizziness or fainting on standing.  Men also experience a high incidence of impotence due to damage to the nerves that control erection.  Do I have your attention now?

End of part two

            So now we know how diabetes is diagnosed and the long-term effects it has on organs like the brain, heart, blood vessels, eyes, kidneys and nerves.  Next time we’ll talk about how doctors decide who gets tested and start talking about treatment options.  Most importantly, we’ll figure out how a person can fend off diabetes completely because to me, prevention is the best medicine!

Southwest Chicken Chopped Salad

I eat salads like all the time.  I think I've mentioned this before but I usually have a pretty big appetite, and I've found that I can get a lot more bang for my caloric buck if most of it is vegetables.  Besides, the health benefits of eating veggies are endless (high water content, lots of fiber, antioxidants, low calorie, blah blah blah).  There are really an endless combination of salads, and this is one of our new favorites.

The dressing is "homemade", requiring some Greek yogurt (you could use sour cream here too I bet) and some dry ranch dressing mix and taco seasoning to create a zesty ranch-ish flavor.  The cilantro mixed in the salad adds really great flavor, and the beans add nice protein in addition to the grilled chicken breast (you could add more beans and take out the chicken for a Meatless Monday recipe!)

I served these with quesadillas (and wine, of course)

Southwest Chicken Chopped Salad
Makes 4 large salads

1 lb baked or grilled chicken breast, sliced
1 red pepper, diced
4 green onions, chopped
1 can black beans, drained and rinsed
1 cup corn
1/2 pint grape tomatoes, halved
1/4 cup fresh chopped cilantro
1 head iceberg lettuce, cored and chopped
1 avocado, diced
Tortilla chips

Dressing
1 cup greek yogurt
1 Tbsp ranch dressing mix
1 Tbsp taco seasoning
Salt and pepper to taste
Splash of milk to thin it out, if desired

Combine ingredients for dressing; set aside.  In a large bowl, combine all ingredients except chicken and tortilla chips.  Toss with enough dressing to coat (start light, you can add more as needed).  Divide onto serving plates, top with chicken and tortilla chips.

**To make 2 servings, only chop up half the head of iceberg lettuce.  Combine pepper, green onions, black beans, corn, tomatoes, and cilantro in a large bowl.  Add half of this mixture to the lettuce and toss with about half the dressing. You can refrigerate the corn/bean mixture and make another salad at a later time :)

Homemade Vanilla Bean Ice Cream

Ice cream is one of my favorite things.  Of all time.  So for our first anniversary, Peter and I purchased an ice cream making attachment for my Kitchenaid mixer (I believe he got some new golf clubs for his end of the deal :)  I've made several batches (can't be making it every week now...lets keep it real), and I'm getting the hang of it!  There are a few rules I've figured out:

1. Forget about making "light" or "low fat" ice cream.  Just buy the Edy's Slow Churned stuff for regular consumption, but if you're going to make ice cream, make ice cream.  It will be icy, not smooth if you use anything less than whole milk.

2. It's a three day process:  you need to remember to put the churning bowl in the freezer at least 2 days ahead of time.  Then you need to make the base the day before so it has 24 hours in the refrigerator to chill.  Then you actually churn the ice cream (which only takes 20 minutes), and it's good to let it "ripen" in the freezer for a few hours before serving.

3. Despite all these rules, it's super fun to make ice cream, and it's SOOOO good.

Milk and egg/sugar mixtures, before tempering and combining

Obviously the possibilities with this base alone are endless, but you can do a chocolate base, caramel, coffee, fruit, anything!  Lots of options online.  So go buy yourself an ice cream maker and get churnin!

Homemade Vanilla Bean Ice Cream
3 1/3 cups whole milk
1 cup half and half
2 vanilla beans, split lengthwise and seeds scraped
1 Tbsp vanilla extract
1 cup sugar
3 egg yolks

Combine milk and half and half in a saucepan.  Add vanilla beans and extract.  Bring to a boil.  Remove from heat and discard vanilla beans.

While milk is heating, combine sugar and egg yolks, whisking until pale yellow and fluffy.  When milk is warm, add a few ladle-fulls to the egg mixture, whisking to prevent it from curdling.  Add the tempered egg mixture into the milk mixture and heat over medium for about 5 minutes until mixture coats the back of a spoon.

Pour into a bowl and allow to cool slightly.  Cover surface with plastic wrap and chill in refrigerator at least overnight.  Freeze in ice cream maker.  You can add any mix-ins during the last 2 minutes of churning.

A Touch of the Sugars, Part 1

Have any questions about diabetes but are too afraid to ask?  Well, today's your lucky day.  Here is the first part of three in a series I wrote about diabetes.  I did my best not to make it boring and dry :)

“A Touch of the Sugars: Why America Needs to Care About Type II Diabetes”

Amy Falk, MS4

Part One

Diabetes: it’s a disease we hear a lot about and maybe know a lot of people who have it.  But have you ever thought about what it really means to be diabetic?  Or how it happens?  Or what someone can do to prevent it or even make it go away? 

Before coming to medical school, of course I knew diabetes was a big problem in this country.  You can’t turn on the TV or flip through a magazine without seeing an advertisement or story about diabetes.  What was really shocking to me, though, was that many diabetic patients I cared for this year as a third year medical student didn’t understand that a “touch of the sugars” would ultimately have devastating consequences for their health.

One day in clinic, I was taking a medical history on a gentleman who came in for some viral syndrome.  I asked him about his past medical history, and he tells me, “I’m pretty healthy.  I just have a touch of the sugars, I guess.”  This takes me by surprise; a touch of the sugars?  What does that mean?  I quickly figured out that he is trying to tell me he has diabetes, and with further questioning, he divulges that no, he doesn’t take any medication, no he doesn’t see a doctor, and no, he doesn’t check his blood sugar.  He feels fine, so he doesn’t think it’s important.  We checked his blood sugar and it was super high, somewhere in the 300s (a normal, random blood sugar reading is between 70-140), and his hemoglobin A1c, a fancy, sneaky measurement that indicates the average blood glucose over the past three months, is through the roof, indicating that indeed he hasn’t been taking care of his condition.  Don’t worry about the numbers and tests, I’ll tell you all about them in a bit, but the point is that this man, like so many Americans, has a serious condition that will have adverse effects on his ENTIRE body, but isn’t taking proper measures to prevent the adverse events.  I truly feel that almost everyone will take better care of themselves if they understand why they are doing it.  My mission regarding diabetes in this “Stethoscopes to the Streets” series is to educate you about how blood sugar, insulin, and diabetes works, and how this horrible illness can be prevented or even cured!  What great news!  But first a disclaimer:  I’ll be discussing Type 2 diabetes, the “preventable and (maybe) curable” kind.  Type 1 diabetes is an entirely different entity (but with similar consequences) that we’ll save for another day.  Now lets get to work.

How your body works: sugar and insulin

            Before we can talk about how diabetes causes so many medical problems, we need to review what happens to the food you eat.  No, we’re not going to take a swim in the deep end of biochemistry here (I’ve done that already), we’ll just kind of float on the surface.  Let’s say you just ate lunch.  Your GI tract (stomach, intestines and all those great parts) will digest what you have eaten, thus allowing your body to use it.  Carbohydrates like fruits, crackers, and cookies will be broken down to single molecules of sugar, called glucose.  Glucose is small and can be absorbed into your bloodstream where it will float around and attach to cells that need it.  Glucose is useless just floating in the blood, though (all it is there is just bloody syrup, yuck).  It needs to get inside cells for energy to be produced.  So, glucose is taken up by every cell in your body, but muscle and fat cells (about 2/3 of your whole body mass) need using special transporters that are sort of like doors that can open to the inside of the cells, letting glucose in.  Simple enough, but here’s the trick; in muscle and fat cells, glucose can only get through those “doors” and into those cells if insulin unlocks those doors.  Insulin is a small protein molecule made by the pancreas (an ugly but important organ in the middle of your belly) that convinces those muscle and fat cells to let the glucose floating around in the bloodstream in, allowing energy to be produced.  Insulin has other functions too, mainly anabolic or “building up,” increasing the synthesis of more muscle and fat.  Insulin makes your liver store up energy in the form of glycogen (available for a rainy day when those cookies are out of reach). Insulin also tells various cells in your body to please stop using up those energy stores like glycogen, protein and fat (how counterproductive would that be, if insulin is working to store energy away?).  So, you eat, carbohydrates get broken down and glucose gets absorbed.  Glucose gets into cells because insulin unlocks the doors, thus insulin helps your body to build up and maintain energy stores. 

Metabolic syndrome and insulin resistance: Things are getting out of control!

            Now that we know how the body is supposed to respond to insulin, let’s look at what happens when it doesn’t respond.  Have you ever heard of the metabolic syndrome, or Syndrome X?  You probably have, since by some accounts about 25% of Americans meet the criteria of the disorder.  I’ve always thought of metabolic syndrome as the culmination of too many unhealthy food choices and not enough exercise which causes a person to inch towards full-blown diabetes and heart disease.  Here are the criteria for metabolic syndrome:

• ·      Increased waist circumference

o   More than 40 inches for a man, 35 inches for a woman

• ·      High triglycerides: over 150 mg/dl
• ·      Low HDL (the good) cholesterol

o   Men less than 40 mg/dl, women less than 50mg/dl

• ·      High blood pressure:  over 130/85 or needing to be on a blood pressure medication
• ·      High fasting blood sugar: over 100 mg/dl

People who fit this profile tend to have “insulin resistance:” their pancreas is “kicking out” plenty of insulin to get all that extra sugar they are eating into their cells, but the cells just aren’t listening!  Like a good organ, the pancreas tries to secrete MORE insulin to make the cells listen and take up the glucose that is floating in the bloodstream, but because of a variety of factors, the cells become more resistant to insulin, and eventually the pancreas isn’t able to keep up.  Hello diabetes. 

Remember how I told you that insulin is responsible for getting glucose into cells and making sure that the liver, muscle, and fat cells are building up energy stores, not breaking them down?  Well, since those cells stopped listening to insulin, the body is in a relative state of starvation, despite the ridiculously elevated blood glucose level.  Think about being super hungry, trapped in a room with a window, and just on the other side of that window is a wonderful meal…but you can’t get at it no matter what you do.  That’s what the cells of a person with Type 2 (insulin-resistant) diabetes feel like.  Furthermore, high blood glucose ultimately leads to kidney, eye and nerve damage, but we’ll deal with that in part two.

End of part one

            Tune in next time for the continuation of the “Touch of the Sugars” article, where we will (finally) define what diabetes is, what it does to the body, how it is treated once diagnosed, and what people can do to prevent or reverse the disease. 

Homemade Yogurt

So I'm back in Chicago and have the whole month of July "off":  I'm doing a senior independent study elective (I'm sure I'll torture you with more of my articles) while studying for Step 2 of the USMLE boards that I take July 24 and 26.  As you can imagine, I'm experiencing a quantity of free time I haven't in quite some time (by "free time", I mean time procrastinating when I could be studying...but at least I'm home!!)  This is turning into kitchen experimentation time.  Yes.

You have to heat the milk to 180 degrees to denature the proteins
It's science...I'm not quite sure why either.

Homemade yogurt...don't get weirded out.  I've seen a lot of blogs doing this, and I've been dying to try it.  It is super easy (just kind of a lot of steps) and surprisingly really good.  Our little household happens to have a pretty costly yogurt habit, and this appears to be a very economical solution (a half gallon of yogurt will make over 48oz of yogurt...try to buy that quantity of Greek yogurt for about $2.50).

After a night in the oven with just the light on (and covered
with a plate, wrapped in towels), this is what you get!!  Yogurt!

From what I've read online, homemade yogurt will keep for at least 7-10 days, and you can use your yogurt to make more yogurt (after a few times, it might get "weak", so just start over with using 2 tsp plain yogurt from the store, which has more bacteria).  

Strain off as much whey as you'd like.  I like mine super thick,
so I strained a bunch :)

Homemade Yogurt

8 cups skim milk
2 tsp plain yogurt (with live, active cultures, read the label)
1 Tbsp vanilla extract
Sweetener, as desired (or stir in preserves!)
**Cooking thermometer

In a large pot, heat milk over medium high heat until temperature reaches 180 degrees.  Remove from heat and allow to cool to 115-120 degrees, then pour into a very large mixing bowl.  Stir in 2 tsp store bought yogurt into the milk, cover the mixing bowl with a plate, then wrap the bowl in a few kitchen towels to insulate.

Preheat oven to any temperature for one minute, then shut off oven.  Turn on oven light and place wrapped bowl in oven overnight for about 8-12 hours, or until the milk looks like yogurt! (may look a bit runny).

After incubating, strain yogurt in a colander lined with thick paper towels or cheesecloth set over a large bowl to catch the whey.  Strain in the refrigerator (pouring off the whey as needed) until yogurt reaches your desired consistency (I strained a lot and ended up with Greek yogurt!!)

Transfer to a storage container and whisk in vanilla extract and sweetener if you want (I added 4 splenda packets and a few tsp of sugar, which was perfect for me).  Will keep in the refrigerator for a week or so!

Stethoscopes to the Streets: The First Minute of Life

Are you up for a little physiology today?  If so, read on!  Today I submitted my first article for my "independent project" elective and thought I'd share it with you.  Enjoy!! 

Have you ever gone to visit a newborn baby in the hospital?  Most of us have, but have you ever thought about the amazing changes that took place in that little body in a very short time?  I mean, the last time you “saw” that baby it was a functional parasite that breathed water and really just chilled out on the proverbial “couch” of mom’s uterus.  Now, the kid is well on his or her way to becoming an independent, walking, talking taxpayer.  Seriously, how did that happen?

            As part of my “Stethoscopes to the Streets” article series, let’s look at how a baby in the uterus (called a fetus) is different than a baby on the outside world, and the way that change takes place.  A word of warning: we are entering into the “deep weeds” of physiology and neonatology, but don’t worry, we’ll go together and I’ll be your tour guide and translator.  Ready?

            Ok first, the big difference between a baby in the uterus and a baby outside is its circulation…the way the blood flows around the body.  We’ll take a small step back and talk about how your circulation works:  your heart has a right and left side separated by a wall.  Blood comes from your body (low oxygen) to the right side of your heart, which pumps it to the lungs.  In the lungs, your red blood cells dump off carbon dioxide (a waste product from burning sugar for energy) and pick up more oxygen to take back to all the cells of your body to use in metabolic processes.  Then, the blood travels from your lungs to the left side of your heart, where it gets forcefully pushed back out the periphery (ie, your arms, brain, kidneys, the whole thing) to drop oxygen off and pick up carbon dioxide.  Great review.  Now the fetus…

            Think about it…mom is taking care of everything for the fetus while it is growing in her uterus.  Thanks to an organ called the placenta (not found in the non-pregnant state, it’s made from a combined effort of the fetus and mom’s uterus to act as an interface for the fetus to get mom’s blood), the baby receives all the glucose, oxygen, and love it could possibly want from mom’s blood.  Mom then graciously takes away baby’s carbon dioxide and waste products and takes care of them with her own organs.  Like I said, that fetus is just hanging out, stealing glucose and growing.  Because the fetus doesn’t need to breathe to get oxygen, its lungs don’t need to be open for business.  This is one way fetal circulation is markedly different from normal human circulation; blood comes up to the right side of the heart like normal but skips right through to the left side of the heart thanks to a window called the foramen ovale.  Foramen means “hole”, and ovale means oval…creative, right?  It really looks like an oval hole.  If some blood doesn’t go through the window and ends up on the path to the lungs, there is another bridge (the ductus arteriosus) that would move blood from the artery traveling to the lungs to the artery going to the whole body, thus giving another way to bypass the lungs.  So to recap, the fetus doesn’t let very much blood get to the lungs because of this hole that allows blood to skip from the right side to the left.  Whew, I told you this was in the weeds.  Any questions so far?

            Blood travel in a fetus is different in other respects too.  Remember how I told you mom takes care of all of baby’s needs through the placenta?  Well, the placenta is hooked up to the baby through the umbilical cord, which enters baby through its belly button.  The umbilical vein carries oxygenated, sugar-filled blood from mom up to the baby’s heart, mostly bypassing the liver thanks to another special vessel that goes away after birth, heading up to the heart (remember, this is oxygenated blood, opposite of how it works in your body when blood is going up to the heart, which would have low oxygen).  Once the oxygenated blood gets to the right side of the heart, it crosses over to the left side of the heart via the holes we talked about and gets pumped out to baby’s body.  When the baby takes what it needs, it ships the old, used up blood back to mom via the umbilical arteries, back to the placenta, and subsequently back to mom’s body to take care of the waste and reoxygenate it with her lungs. 

            Did you hang in there?   Because it’s about to get exciting.  We’re going to fast-forward though all the gory, gushy OB stuff (I’m much more interested in the baby end than the mom end of that story) and get to the part where the baby is delivered.  Now what?  That kid just went from an environment of a balmy 98.6 degrees to the cold room temperature.  This significant drop in temperature triggers the baby’s brain to demand the lungs to take a huge breath; the first breath that baby will ever take!  I won’t bore you with the details, but because of the rapid lung expansion and oxygenated air entry, the blood vessels in the lungs go from being shut off to being open for business.  In other words, the lungs are available to take blood from the right side of the heart (like in you and me) and oxygenate it!  This is amazing; a fetus’s lungs only gets 4% of the blood that comes back to the right side of the heart.  As soon as baby is born and takes a big breath, the lungs gets ALL of the blood that comes back to the right side of the heart. 

So what happens to that big hole that lets blood go from the right to left heart?  It seals shut, almost within minutes.  So now, the right and left sides of the heart are sealed off, which is how we like it.  Remember that other connection between right and left circulations called the ductus arteriosus?  Because of the big change in the blood highway, now with all lanes open going to the lungs, this isn’t needed anymore either and closes off pretty quickly (within a few days, at most). 

            What about that pesky placenta and umbilical cord?  Well, as you probably know, most nervous-nelly dads get to “cut the cord”, after the doctor puts on two clamps; one for baby and one for mom so no one looses too much blood.  The clamping of the umbilical cord serves to further change fetal circulation (I mean, now the kid is REALLY on his own to pump blood around, breathe to oxygenate, etc), and all those special vessels I told you about that keep blood away from the fetal liver and lungs start to close off because now blood needs to go to those places.  Interestingly, the remnants of these structures can be found in the adult body; they are just strands of tissue now, not big vessels carrying lots of blood. 

            Being a future pediatrician, I’ll quickly mention that if the baby can’t quite get it together right away and doesn’t breathe, we have lots of tricks to help them out; anything from vigorous rubbing (just incase the 30 degree temperature differential wasn’t enough to scare them straight) to oxygen supplementation to even intubation if their lungs aren’t mature yet.  It sounds scary, I know, but there is SO much that needs to happen that it’s not uncommon for a baby to struggle a bit.  In fact, about 10% of babies born will need some “support” in the first few minutes, while 1% will need full resuscitative efforts.  Pediatricians are great at this, so try not to flip out if you’re ever in the delivery room.

            So there you have it; the wonderful story of when a baby arrives in the world and takes his or her first breath.  The changes don’t stop there, but I’m hoping now you have a better understanding of how cool and complicated that one moment is in a life.  Thanks for reading this (super complicated, sorry!) edition of “Stethoscopes to the Streets!”