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This sh*t is bananas…

Whenever I type the word “bananas”, I hear a certain Gwen Stefani song in my head… This post is going to be painful to type!

 

I just wanted to put up a quick post on one of Americans’ favorite fruits. According to the USDA, bananas are the most consumed fruit in the United States, accounting for 25% of fresh fruit consumption.  Bananas are rich in potassium, magnesium, and manganese, and while some who embrace a low-carb lifestyle may find fault with them, they are without doubt a whole, real, food.  While our modern domesticated varieties are very different from wild bananas (and no, the shape of the banana is NOT proof of creationism!), bananas can be part of a healthy diet for most people. Bananas are a staple of many traditional diets, and their leaves are also used for cooking in many cultures.

 

A wild banana, courtesy of Wikimedia commons. I wonder how they taste?

A wild banana, courtesy of Wikimedia commons. I wonder how they taste?

 

In America, the word banana is synonymous with the Cavendish banana, but this is certainly not the only variety and many argue it is not the best. “Best” is, of course, subjective.  Choosing a “best” banana is like choosing a best apple*. Seasonality and freshness matter, as does personal preference.

 

Variety makes life interesting. Genetic variation is necessary for evolution. Food variation makes out diet more interesting (and broadens our nutrient intake while minimizing exposure to potential toxins).  Over the past year or so, I’ve made it my goal to try as many varieties of banana as I can find- so far I’m doing pretty well.

 

Cavendish bananas (a triploid variant of Musa acuminata) can be found just about anywhere. Grocery stores, cafeterias, and many gas stations have these ubiquitous yellow fruit on offer year round.

 

At my local grocery store I can usually find other Musa varieties.  Next to a small selection of yucca, aloe, and other somewhat “exotic” offerings I can almost always find plantains (a hybrid between Musa acuminata and Musa balbisiana).  They usually have green plantains, sometimes yellow, and occasionally brown.  The color varies with ripeness. Green plantains are the least ripe and are not sweet, while yellow- or even better, dark brown- plantains are sweet.  Plantains are best eaten cooked. (Personally I love to fry them up in coconut oil. The greens are great with a squeeze of lime, some chile, and salt, while the sweeter fruits are good plain or with a shake of cinnamon or cocoa.)

 

Occasionally my local supermarket has Niño bananas ( a diploid variant of Musa acuminata known by a number of other names), and I can almost always find these at the Asian supermarket I like to visit. I find that these small bananas have a similar taste, though slightly different texture, than Cavendish bananas.

 

At my favorite Asian supermarket I’ve also found Burro bananas, which (at least to me) seem like a hybrid between plantains and Cavendish.  It can be eaten cooked or raw.  To me they have a slightly tart, almost lemony, flavor when eaten fresh.  They have a distinct shape- shorter than Cavendish and very angular.

 

This weekend, I found yet another type of banana to add to my list. I was visiting a friend on Long Island and took a trip through an ethnic supermarket that caters to the local Hispanic population.  Like so many ethnic supermarkets, this store had a fabulous produce section- with a great variety of fruits & vegetables, all really fresh and reasonably priced. The meat department was also extensive, with lots of interesting cuts, including goat! (A friend and I were recently bemoaning the fact that you can rarely find goat in the US- I’ve only ever had it when my family bought whole animals from a local farmer).

 

At the store on Long Island I finally came across Red bananas (another triploid variant of Musa acuminata). As the name suggests, this variety is a dark red, almost purple. Otherwise, it looks like a slightly smaller Cavendish.  I picked up a couple but I haven’t tried them yet as I don’t think they’re quite ripe.

 

The variety of different bananas I picked up.

The variety of different bananas I picked up. From left to right: Niños, Reds, Cavendish, and plantains.

 

I only have to find one more type of banana to knock off every variety on this list, and I will continue to keep my eyes open for other, unusual varieties. Some of my family members have tried Manzano bananas while visiting Hawaii, and as the name promises, they do taste a bit like apples (Manzano is spanish for apple).

 

Actually, it looks like Hawaii has many interesting types of bananas, and I’m in desperate need of some sunshine and relaxation… looks like it’s time to go look at plane tickets to Hawaii!!

 

I wish… I start an EMS elective tomorrow. I’m looking forward to working with first responders as we pick up and transport patients to our University Hospital. From all reports, this is an exciting elective!

 

*When it comes to apples, GoldRush are, without a doubt, my favorite, but the “best” apple on any given day depends on what is fresh, what is in season, and what you’re in the mood for!

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New Year in Dubai- part 1

As I let on in a recent post, I spent Christmas and the start of the New Year visiting my brother in Dubai and touring around the United Arab Emirates (UAE). This isn’t a travel blog, but while I was touring around the emirates and learning some of the history of the region I made some observations that I think are worth sharing- especially since I got a great tour of a part of the world that many will never visit. Apologies if this reads like a blog version of a vacation slideshow!

 
Dubai is an otherworldly place.  Obviously built to be “the city of the future”, the skyline is chock-o-block with architectural masterpieces, though many have been stalled or vacant since the financial collapse of 2009. Put in any other city, many Dubai buildings would be iconic, but standing next to the world’s tallest building, the world’s only 7-star hotel (self proclaimed), and other masterpieces, otherwise stunning buildings start to look commonplace.

 

The tallest building in the world. It's almost twice the height of the Empire State Building.

The tallest building in the world. It’s almost twice the height of the Empire State Building.

 

Burj Al Arab by night: Taken from Palm Jumeira- an entirely man made island in the shape of a palm tree (http://en.wikipedia.org/wiki/Palm_Islands). The Burj Al Arab is actually built on its own man-made island in the Gulf. *

Burj Al Arab by night: Taken from Palm Jumeira- an entirely man made island in the shape of a palm tree. The Burj Al Arab is actually built on its own man-made island in the Gulf. *

 

 

Old Town: While parts of the city look “authentic” (or what you might expect to see in a Middle Eastern city), the oldest building in Dubai is probably from the 60s or 70s. This complex, known as “Old Town”, was finished in 2007.

Old Town: While parts of the city look “authentic” (or what you might expect to see in a Middle Eastern city), the oldest building in Dubai is probably from the 60s or 70s. This complex, known as “Old Town”, was finished in 2007.

 

 

Other towers: My brother was able to give me fairly detailed background on many buildings around Dubai, many of which have been stalled or vacant since his arrival in the city 3 years ago. Their vacancy does not hinder their stunning architecture.

Other towers: My brother was able to give me fairly detailed background on many buildings around Dubai, many of which have been stalled or vacant since his arrival in the city 3 years ago. Their vacancy does not hinder their stunning architecture.

 

On the surface, there seems to be little “traditional living” or “ancestral health” wisdom to glean from Dubai.  It is a very modern city with immigrants, corporations, and businesses from around the world.  Within a block of my brother’s home you can get Kentucky Fried Chicken, Nando’s (a chicken restaurant originally from South Africa), and Al Tazaj (a chain BBQ chicken restaurant from Saudi Arabia) and that’s just to name the chicken restaurants (Popeye’s chicken is also popular, but there isn’t one within a block of my brother)! You also see The Cheesecake Factory, Texas Roadhouse, PF Chang’s and just about any American or international chain you could name (though I don’t think I saw a Chipotle).

 

I’m confident that if humans develop an extraterrestrial community, this will be the first chain available in outer space.

I’m confident that if humans develop an extraterrestrial community, this will be the first chain available in outer space.*

 

Of course, Dubai only recently became a modern global city. Dubai changed rapidly from a small pearling center and regional trading port to a cosmopolitan global hub fuelled largely by the discovery of oil in the region.  Dubai also developed laws and practices that encouraged rapid expansion of business and real-estate on a global scale . Older Emirati have truly seen it all, from the days of very basic living to modern global excess.  As someone who is deeply interested in ancestral health, I asked around and read about the traditional ways of living in this part of the county. While no one today lives an “ancestral” lifestyle, the memory of traditional days is not yet forgotten.

 

The easiest place to start, of course, is food.  Until relatively recently, the diet of the Middle East was limited to foods that could be locally produced or transported great distances without refrigeration. While traders would bring spices and rice, which was a staple of the diet, perishable food was limited to what is locally available- which isn’t much. On the shore, seafood was a staple. I was told by a local Emirati (a good friend of my brother) that a generation ago, the main meal of the day would be rice and fish. Fish, readily available from the sea, was relatively cheap, while meat was expensive. Today this has reversed and meat (usually lamb, but sometimes goat and increasingly beef) is cheaper and more commonly eaten while fish is now more expensive and less common.

 

One of the highlights of my trip to the United Arab Emirates (I spent time in Abu Dhabi, Fujairah, and Sharjah in addition to my time in Dubai) was an evening walking tour around Sharjah led by my brother’s friend Khalid. Khalid is a native Emirati, with a deep knowledge of the area as well as the history and culture of the region. He kindly took us on a tour of some of the markets of Sharjah, and graciously answered my endless questions about the food, history, culture, and religion (and occasional lack thereof) in the area.

 

The first stop on our tour of Sharjah was the local fish market, where merchants sell fresh catch from dawn until late in the evening (they get two deliveries of fish per day).  Here we saw the wide variety of fish that are caught, sold, and eaten in the area.

 

The fish market in Sharjah**

The fish market in Sharjah**

 

I recognized a number of fish and marine life on offer. There were shark, rays, and tuna, as well as small reef fish (such as angel fish, parrot fish, and grunts) that I’m familiar with as a SCUBA diver.  In Dubai, I saw Tiger Prawns (shrimp) larger than I’ve ever seen: almost a foot long. It appears that this species is on the seafood “red list” as, I’m sure, are other species I spied in the market. An interesting aspect of the fish market was a large station at the end of the market where men would prepare your purchase (fish, squid, or shrimp). It cost 1 Dirham (about $0.27 US) to have a fish cleaned, 2 Dirham to have a kilo of squid cleaned, or 3 Dirham to have a kilo of shrimp cleaned (the most expensive item on the list). As someone that peels her own shrimp, I recognize that ~$0.35/lb is a cheap price for cleaning shrimp!

 

Traditionally, fish was also dried and used for trading, fertilizer, and animal food.  Dried fish would make its way to the oases in the desert (anything fresh from the coast would spoil before it could reach any inland populations) where it could be sold or traded for products of the oases. The #1 product of the oases has traditionally been dates.

 

The cultivation of date palms (Phoenix dactylifera) has been the most important form of agriculture in the area now known as the UAE.  Date palms not only provide their owners with high calorie fruit, but also supply leaves that can be used to make fans and baskets, branches that can be used to make walls and roofs, bark fibers that are suitable for making rope and for stuffing pillows and saddles, and dead trunks that can be used as beams. Date fruits can be eaten fresh, dried, crushed for juice, or boiled and packed in bags made of palm leaves. Fruits stored in this way could be kept for a long time and were used as staple foods for men and animals on long journeys across the desert [1].

 

 

Palms of many uses. You can see in this open kitchen in a historical abode that palms trunks were sometimes used as beams and fronds were used as roofing or for walls.

Palms of many uses. You can see in this open kitchen in a historical abode that palm trunks can be used as beams and fronds used as roofing or walls.

 

This was a small building on the same homestead. Dates were placed on the ridged floor and a large trunk was used to crush them, with the juice running off into the depression where it could be collected.

This was in a small building on the same homestead. Dates were placed on the ridged floor and a large trunk was used to crush them, with the juice running off into the depression where it could be collected.

 

Today most dates are eaten whole- usually dried, but sometimes fresh when in season.  There are MANY types of dates, a number of which I sampled. I’d be lying if I said I weren’t a date enthusiast (though it is a fondness I’ve only developed in the last couple years). Varieties have different characteristics, though they are all incredibly sweet (one shop keeper tried to tell me that a certain variety was lower in sugar and therefore “good for diabetics”. I think not…).

 

Date Poster: This is an incomplete list, but it gives you an idea of the variety available. I expect it is like the many types of apples that were once available in the US. While you can still get a wide variety today from growers and specialty markets, a few types have started to dominate the market. (In the US, I’ve only seen two types for sale in stores Medjool and Deglet Nour. To me, the Deglet Nour is the Red Delcious of the date world- not worth bothering with- but maybe I’m picky.).

Date Poster: This is an incomplete list, but it gives you an idea of the variety available.

 

Many types of dates are available from different shops and stands in the UAE, but I definitely didn’t see many of the varieties that are shown above.  I did see some unique dates, but there were a few varieties that I saw over and over again. I imagine that the diversity of dates is much like the diversity of apples available in the US. While you can get a good selection from growers and specialty markets, a few types make up the majority of the market. (As far as dates go, in the US I’ve only seen two types for sale in stores: Medjool and Deglet Nour. To me, the Deglet Nour is the Red Delcious of the date world- not worth bothering with- but maybe I’m picky.).

 

Date alley: Perhaps my favorite part of our Sharjah tour. With the exception of the stand directly on the right that sells coconuts, all of these stands sell dates.

Perhaps my favorite part of our Sharjah tour. With the exception of the stand directly on the right that sells coconuts, all of these stands sell dates.

 

One of the many date stands. Merchants were keen to tell you the price and source of dates.

One of the many date stands. Merchants were keen to tell you the price and source of dates.

 

The price of dates varied widely. At the street markets, I saw dates from 8-16 Dirham/kg (~ $1-$2/lb), in Waitrose (a nice supermarket) they were 22-35 Dirham/kg (~$3-$4/lb), and at fancy date stores at the Dubai Mall they were 165-240 Dirham/kg ($20-$40/lb)! I tasted dates from all sources and will say that the cheapest and the most expensive were the best- the ones from Waitrose were a disappointment. Lining them all up and having a blind taste test would be fun- I’ll put that on my list for next time!

 

The third and final local food that played a role in traditional diets is camel products- usually camel milk. If you haven’t seen it already, check out my recent post.

 

Camel milk of many colors: rose, cardamon, and saffron flavored alongside plain.

Camel milk of many colors: rose, cardamon, and saffron flavored alongside plain.

 
Though there has never been enough wildlife to support a population of hunter-gatherers in this part of the Middle East, there is (or was) some game that has historically been hunted.  Such sources could not be relied upon, but provided much appreciated variety and sustenance when found. Traditionally, falconry was used for hunting.  Falconry remains a deeply loved sport in the Emirates, one that is seen as part of Emirati heritage and supported by the Sheikhs.

 

Falconry remains a popular sport in the emirates.

Falconry remains a popular sport in the emirates.

 

Coffee also holds a special cultural significance in the UAE. Arabic coffee, usually spiced with Cardamom, is offered to guests as a sign of hospitality. The hotel where my brother lives (a common choice of housing) has dates and Arabic coffee on offer to guests at all times in the lobby. The coffee (at least to my taste) is rather weak, though the spice is pleasant.

 

While I’m interested in traditional diets, I’m also interested in what people are eating now.  Maybe I’m a weird tourist (or maybe I’m just easily amused), but when I’m traveling I always love to take a trip through a local supermarket to see what people are eating. The Waitrose at the Dubai Mall did not let me down…

 

First to the meat department:

 

Grass fed beef from NZ and Grain fed beef from Australia. I really like that you can buy the two side by side. I wish I’d found two comparable cuts so I could compare the prices…

Grass fed beef from NZ and Grain fed beef from Australia. I really like that you can buy the two side by side. I wish I’d found two comparable cuts so I could compare the prices…

 

Pork Department: Islam is the national religion in the UAE, and laws are based around Sharia law. Muslims may not drink alcohol or eat pork (amongst other things). That being said, non-Muslims may buy pork at supermarkets and alcohol is served at hotels (though not in Sharjah).

Pork Department: Islam is the national religion in the UAE, and laws are based around Sharia law. Muslims may not drink alcohol or eat pork (amongst other things). That being said, non-Muslims may buy pork at supermarkets and alcohol is served at hotels (though not in Sharjah).

 

 

 Interesting finds in the pork department: The pork department isn’t just a meat counter- you can also find processed foods that include pork products. The Corn Bread has Pork Fat in it, but I couldn’t find an offending ingredient in the Pop-tarts (though I do find Pop-tarts offensive!). The bacon flavored crackers are obviously taboo!

Interesting finds in the pork department: The pork department isn’t just a meat counter- you can also find processed foods that include pork products. The Corn Bread has Pork Fat in it, but I couldn’t find an offending ingredient in the Pop-tarts (though I do find Pop-tarts offensive!). The bacon flavored crackers are obviously taboo!

 

I didn’t travel halfway around the world just to visit supermarkets. In addition to spending quality time with my brother and his family, I also got to see A LOT of sites in the surrounding emirates, but as this post is already getting rather long, maybe I’ll save that for next time!

 

Credit where credit due. I took most pics, but the ones marked by a * were taken by a friend Amber, and ** were taken by Khalid. 

1.            Heard-Bey, F., From Trucial States to United Arab Emirates. 2011, London: Motivate Publishing.

 

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An Offal Weekend

As I’ve written before, I’m a fan of eating odd bits. If you’re going to eat meat, and you want to be ethical about it, I think you should make the effort to try and eat all the parts of an animal (or use them in some manner).

 

I realize this concept is not for everyone. I am one of those people who used to cringe at the thought of eating non-traditional (at least in the current western world) pieces of meat.  The disconnect between animals and the plate has become so great that for some, the concept that meat comes from animals is so distant that they won’t eat meat with bones in it. People- meat comes from animals, animals have bones. But I digress…

 

My family raises cows, so I’m well aware of the importance of “hanging weight”- the weight of an animal’s carcass after it has been killed and eviscerated. If you buy an animal by the whole, half, or any other fraction, it’s likely that the cost is calculated based off of this number. This weight, however, does not include lots of other tasty (and incredibly nutritious) bits that an animal has to offer.

 

When I buy an animal from a farmer for butchering (or when I send my own animals to slaughter) I make sure I put in a request for lots of odd bits: I want the animal to be fully utilized, I want to get all the tasty bits, I want to get all the nutritious parts, and heck- I want to get my moneys worth!  As a result, I sometimes end with a substantial stash of offal in my freezer (especially beef offal, as not everyone who buys beef from us wants the odd bits, though that is changing as we sell more meat to paleo and foodie eaters).

 

When I came home to my parents this weekend, I thought I’d have a go at eating some of odd bits…  My photography is definitely not up to par with many food blogs, but hopefully I do these tasty bits justice (though it takes a better artist/photographer than me to make a raw beef tongue look anything other than kinda weird).

 

It all started on Friday night, when I decided it was time to experiment with some of the pork skin that I requested from the Berkshire pig I purchased this fall from a local farmer.  I found this page and gave their method a try. The result was tasty, though perhaps a danger to my teeth!

 

Cracklings

Cracklings!

 

This set in motion a bit of a personal challenge to see how much offal I could put to good use this weekend. Next on the block was a beautiful smoked jowl from the same Berkshire pig as above. Jowl is a really fatty piece of the animal that makes BEAUTIFUL (albeit very fatty) bacon. It can also be cured in other styles such as the Italian Guanciale (which reminds me, I have a piece of jowl from another pig in my freezer that a friend cured into Guanciale at home (<– Worth checking out, if only for the pic of a curing pork jowl hanging from the ceiling).  If you don’t request that the butcher save the jowl, I expect it ends up being ground into sausage- a shame for such a delicacy to end in anonymity.

 

Jowl1

A whole smoked pork jowl

 

I initially tried to slice this by hand, but quickly realized this was a job for my little deli-slicer.

 

Jowl_Cut

Jowl bacon, fresh cut

 

As its winter, I’ve been using quite a bit of stock out of my freezer for soups and stews. It seemed like this weekend was a good time replenish my stores by making some collagen rich pork stock from pork trotters and neck bones.

 

Trotters

Trotters and neck bone, to be made into stock.

 

I shared this pic on my personal facebook page and the general consensus there was “gross”.  Although trotters don’t have the same panache as a standing rib roast, they do have a certain je ne sais quoi (and I wouldn’t call them gross).

 

A number of years ago my parents were visiting Paris. At a restaurant, they were offered a menu in French and English. My father’s grammar school French led him to believe that an item on the menu was “foot of pork”, but the English menu said “leg of pork”. When he inquired, the waiter assured him that it was leg of pork (I think you see where this if going…). When a trotter was brought to the table, my father was less than amused.  It is worth noting that my parents are from England, bringing up theories of potential remnants of French-anglo animosity!

 

As I write this, the trotters have been simmering for almost 24hrs and have made three lovely batches of stock. I have some omnivorous scrap-disposal units that are looking forward to the remnants!

 

I used some of the stock to make a hearty soup for lunch today, which I paired with a luxurious beef marrowbone.

 

Marrowbone- I describe it to skeptics as being similar to a savory crème brulee.

Marrowbone- I describe it to skeptics as being similar to a savory crème brulee.

 

I’m one of the few med students on my current rotation who consistently brings lunch. In preparation for this week, and in keeping with the offal theme, I decided to cook up a cow tongue.  After it has simmered for a number of hours I’ll shred it and sauté it with an onion and some spices, eventually portioning it out with some mashed sweet potato.

 

Tongue

Yes- it’s a tongue.

The final offal of the day is a meaty shinbone that I will stew up with a beef kidney, making the old British standby Steak and Kidney (minus the pudding). Kidneys were one of the last odd bits to make their way into my diet. As a child I would hear of this traditional British meal and cringe- funny how things can change (and how long it can take to get over childhood aversions!).

 

For those of us used to human anatomy, beef kidneys sure look WEIRD! (It’s important to trim a kidney well, you don’t want to be eating the calyx!)

For those of us used to human anatomy, beef kidneys sure look WEIRD! (It’s important to trim a kidney well, you don’t want to be eating the calyx!)

 

I realize offal isn’t for everyone, but I hope this might inspire someone to give offal a chance. There are other great things to do with odd bits (imagine a post on offal that doesn’t talk about liver!), and with the help of the internet you can get all kinds of tips and recipes (or you can buy a book).  Even if offal isn’t for you, I hope you can recognize that nose-to-tail eating is a responsible decision when thinking about the ethics of eating meat (even if you do find it a little gross).

 

(Here’s guessing that a number of my friends won’t be looking for dinner invites anytime soon!)

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Happy New Year!

2012 was a whirlwind year for me. I defended my PhD at the beginning of 2012 and am now almost finished with all the required clerkships of third-year medical school. Phew!

I spent my winter holiday visiting my brother in Dubai, exploring many sites of the United Arab Emirates (UAE). I got to see a lot during my stay, and I’ve been writing a post on some of the interesting things I saw there.  As I was writing about the traditional dietary staples of the Middle East, I took a foray through a lot of literature that is available on camel milk.  It’s interesting stuff, and I found myself heading off on a tangent that I thought I should post as a stand-alone article.

So here we go…

Ship of the desert
Camels were (and still are, but for different reasons) an important part of life in the Middle East. The Arabian camel (the dromedary Camelus dromedarius) is a one-humped beast, and should not be confused with the 2-humped Bactrian camel (Camelus bactrianus) of central Asia.  Dromedaries were the only mode of transportation in the desert before motorized vehicles (walking any substantial distance on foot is out of the question and horses need too much water), and they also were an important form of wealth and source of food. Camel meat was a rare delicacy, while camel milk was a staple of the Bedouin diet. Camel hair was also used to make household necessities and camel dung was often used as fuel (a nice argument against the calories in calories out argument- if biological creatures were bomb calorimeters there wouldn’t be anything worth burning coming out the other end…).

Camel meat was not a staple of the Bedouin diet.  In fact, most nomadic people are reluctant to kill their subsistence animals for meat. Female camels were used for dairy and some males were kept for breeding purposes, but extra young male camels would be slaughtered and eaten for special occasions.

Though definitely not a traditional dish- this seems to be the #1 way to eat camel meat today

Though definitely not a traditional dish, this seems to be the most popular way to eat camel meat today

Camels are uniquely able to provide sustenance for humans in an environment that is generally rather inhospitable. Camels are able to not only survive, but thrive, on the limited and harsh forages that are available in the desert. She-camels can produce enough milk to nurse their offspring and provide liters of milk per day for their owner.

Camel in its native environment. These beasts thrive on the course and sparse forage of the desert.

Camel in its native environment. These beasts thrive on the coarse and sparse forage of the desert.

Camels’ milk is interesting stuff. Unlike the milk of cows, goats, and sheep, it cannot be easily made into cheese.  It doesn’t coagulate with bovine rennet, however recombinant camel rennet is incredibly efficient at coagulating cow milk and can also coagulate camel milk (there is a difference in the camel kappa-casein that makes it more resistant to cleavage) [1, 2].  With the right enzyme the job can be done, and there is at least one company that makes a camel cheese (nicknamed Camelbert!).

Camel milk isn’t much good for making yoghurt either, being much more resistant to lactic acid fermentation than cow milk. The result of camel milk lactic fermentation is very runny, with little microbial growth [3]. Gariss, a traditional Sudanese fermented camel’s milk product, is made with a mixed culture including Lactobacillus, Streptococcus, and yeast [4]. Here’s how it was traditionally made:

fermentation is carried out in two leather bags of tanned goat skin embedded in green or wet grass carried on the bag of camels and subjected to continuous shaking by the jerky walk inherent to camels. Whenever part of the product is withdrawn for consumption, a portion of fresh camel’s milk is added to make up volume and this continues for months [4].

According to one paper I spotted, food scientists can thicken fermented camel milk with gelatin or alginate (a thickener made from seaweed) in order to make a yoghurt-like product that consumers might find acceptable, but I didn’t spot any on the shelves in the stores of Dubai [5].

It seems to me that when it comes to camel milk it might be best to just keep it simple. Plain old milk.

CamelMilk

But camel milk may not be such simple stuff.  There is growing research that explores the use of camel milk for medicinal purposes.

I haven’t gone into the research in depth, but there are a number of small studies looking at the benefits of camel milk for people with diabetes (type 1 and type 2), with rather remarkable results. The addition of 500mL of camel milk on top of usual care for patients with type 1 diabetes resulted in significant improvements in a number of parameters in comparison to people who just received standard care. The camel milk group had a decrease in mean blood glucose levels and hemoglobin A1c.  The study was small, but 3 of the 12 participants in the camel milk group were able to completely stop using insulin (an almost unheard of occurrence for those with type 1 DM).  While the mean amount of insulin used in the control group remained constant, the amount used in the camel milk group dropped rapidly [4].

Abdelgadir et al [4]

Abdelgadir et al [4]

It hasn’t been determined how camel milk affects those with diabetes, but there are a number of hypotheses. Some sources think that insulin from camel milk is uniquely able to escape digestion when ingested or that camel milk contains a unique insulin-like small peptide that is bioavailable when consumed [6]. This is unlikely to be the whole story, however, as camel milk is able to increase endogenous insulin secretion in type 1 diabetics (individuals in standard of care + camel milk groups have higher levels of C-peptide, showing an increase in insulin production) [7].

Some readers may know that I have a fondness for fatty liver disease, so I was particularly interested to learn that, in a rat study, camel milk reversed alcohol-induced liver injury. This was seen histologically, where there was minimal fatty accumulation in the livers of alcohol-treated animals supplemented with camel milk in comparison to those just treated with alcohol alone, and serologically, where animals that were treated with ethanol alone had significantly increased liver enzymes in comparison to controls and those fed alcohol and camels milk [8]. I would postulate that it might have something to do with the high levels of carnitine found in camel milk [9], but that’s a story for another day.

Nutritionally, camel milk is unique. As I just mentioned, it has a more free carnitine as a percentage of total carnitine than other species and higher total carnitine than cow or human milk (though lower than sheep and goat milk) [9]. Camel milk has three-times the vitamin C of cow milk, but a similar amount of vitamin E and considerably less vitamin A and riboflavin [10]. Camel milk is low in short chain fatty acids in comparison to other milks and it has primarily long chain fatty acids, a significant portion of which is linoleic acid [11].  I tend to avoid this omega-6 FA, but I suspect that as part of a traditional diet the amount found in camel milk does not cause a problem.
Camels can carry a number of zoonotic organisms, including Coxiella burnetii (which causes Q fever) and Brucella sp. (which causes brucellosis), which can be transmitted through the milk. In fact, there was a recent brucellosis outbreak in Israel caused by raw camel milk [12].  If you’re drinking milk from an untested camel, it’s probably best to have it pasteurized. All the milk that’s available in Dubai supermarkets is pasteurized and homogenized. There are a variety of brands, and you can get milk in an array of flavors!

I spied plain, chocolate, strawberry, saffron, rose, cardamom, and date flavor! In this pic there's saffron, chocolate, strawberry, date, and plain.

I spied plain, chocolate, strawberry, saffron, rose, cardamom, and date flavor! In this pic there’s saffron, chocolate, strawberry, date, and plain.

Of course I had to try some… I opted for plain milk, and found it slightly sour in comparison to cow’s milk, with a watery mouthfeel. It’s been at least a decade since I drank skim milk, but as I remember the mouthfeel is similar.

Sculptors of human evolution

Camels have played central roles in the lives of desert dwelling people for millennia. They are the “ship of the desert” and their milk has nourished and sustained generations.  Their milk has also shaped the human genome…

The predominance of lactase persistence in populations is a well-known and well-studied example of human evolution. In populations that had access to animal milk, a mutation that allowed for the production of lactase past the age of weaning gave humans access to a rich food source. This was a huge advantage to those that had such a mutation.  Those that could easily consume milk were able to have more children, and the mutation spread throughout the population.  The advantage of having persistent lactase expression is so advantageous it has occurred independently in multiple populations over time.  While some mutations are linked back to the domestication of the cow, there are novel mutations found in Middle Eastern populations that are linked to the domestication of, and subsequent milk consumption from, Arabian camels [13].

The advantage of camel domestication is still present today.  A paper from 1996 looked at child health in three populations of Rendille pastoralists in Northern Kenya. Two of the groups had abandoned their nomadic roots to become settled, while one group remained nomadic.  In wet years (good years) there was a similar number of malnourished children in the three groups; however in a drought year, the children of the nomadic group faired significantly better.  The differences in malnutrition were attributed to food- specifically camels milk.  In drought years, the children in the nomadic group consumed three times as much milk as those from the sedentary group, where the children got more starches and sugar.  Other studies have found that nomadic groups generally do poorly during drought years (because of decreased production of milk from their herd), but because the Rendille maintain a large number of camels, they faired better during hard times [14].

So there you have it… I went diving into pubmed looking for a few fun facts to incorporate into a blog post on my trip to Dubai and found myself swept up in a mess of Dromedary data… I hope you found it as interesting as I did!

Camel

1.            Kappeler, S.R., H.J. van den Brink, H. Rahbek-Nielsen, Z. Farah, Z. Puhan, E.B. Hansen, and E. Johansen, Characterization of recombinant camel chymosin reveals superior properties for the coagulation of bovine and camel milk. Biochem Biophys Res Commun, 2006. 342(2): p. 647-54.

2.            Sorensen, J., D.S. Palmer, K.B. Qvist, and B. Schiott, Initial stage of cheese production: a molecular modeling study of bovine and camel chymosin complexed with peptides from the chymosin-sensitive region of kappa-casein. J Agric Food Chem, 2011. 59(10): p. 5636-47.

3.            Attia, H., N. Kherouatou, and A. Dhouib, Dromedary milk lactic acid fermentation: microbiological and rheological characteristics. J Ind Microbiol Biotechnol, 2001. 26(5): p. 263-70.

4.            Abdelgadir, W., D.S. Nielsen, S. Hamad, and M. Jakobsen, A traditional Sudanese fermented camel’s milk product, Gariss, as a habitat of Streptococcus infantarius subsp. infantarius. Int J Food Microbiol, 2008. 127(3): p. 215-9.

5.            Hashim, I.B., A.H. Khalil, and H. Habib, Quality and acceptability of a set-type yogurt made from camel milk. J Dairy Sci, 2009. 92(3): p. 857-62.

6.            Malik, A., A. Al-Senaidy, E. Skrzypczak-Jankun, and J. Jankun, A study of the anti-diabetic agents of camel milk. Int J Mol Med, 2012. 30(3): p. 585-92.

7.            Mohamad, R.H., Z.K. Zekry, H.A. Al-Mehdar, O. Salama, S.E. El-Shaieb, A.A. El-Basmy, M.G. Al-said, and S.M. Sharawy, Camel milk as an adjuvant therapy for the treatment of type 1 diabetes: verification of a traditional ethnomedical practice. J Med Food, 2009. 12(2): p. 461-5.

8.            Darwish, H.A., N.R. Abd Raboh, and A. Mahdy, Camel’s milk alleviates alcohol-induced liver injury in rats. Food Chem Toxicol, 2012. 50(5): p. 1377-83.

9.            Alhomida, A.S., Total, free, short-chain and long-chain acyl carnitine levels in Arabian camel milk (Camelus dromedarius). Ann Nutr Metab, 1996. 40(4): p. 221-6.

10.            Farah, Z., R. Rettenmaier, and D. Atkins, Vitamin content of camel milk. Int J Vitam Nutr Res, 1992. 62(1): p. 30-3.

11.            Gorban, A.M. and O.M. Izzeldin, Fatty acids and lipids of camel milk and colostrum. Int J Food Sci Nutr, 2001. 52(3): p. 283-7.

12.            Shimol, S.B., L. Dukhan, I. Belmaker, S. Bardenstein, D. Sibirsky, C. Barrett, and D. Greenberg, Human brucellosis outbreak acquired through camel milk ingestion in southern Israel. Isr Med Assoc J, 2012. 14(8): p. 475-8.

13.            Enattah, N.S., T.G. Jensen, M. Nielsen, R. Lewinski, M. Kuokkanen, H. Rasinpera, H. El-Shanti, J.K. Seo, M. Alifrangis, I.F. Khalil, A. Natah, A. Ali, S. Natah, D. Comas, S.Q. Mehdi, L. Groop, E.M. Vestergaard, F. Imtiaz, M.S. Rashed, B. Meyer, J. Troelsen, and L. Peltonen, Independent introduction of two lactase-persistence alleles into human populations reflects different history of adaptation to milk culture. Am J Hum Genet, 2008. 82(1): p. 57-72.

14.            Nathan, M.A., E.M. Fratkin, and E.A. Roth, Sedentism and child health among Rendille pastoralists of northern Kenya. Soc Sci Med, 1996. 43(4): p. 503-15.

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As an evolutionarily minded medical student, you can sometimes feel a bit alone in the crowd of conventionally minded medical practitioners and students.  I’ll admit that I’ve been repeatedly impressed with the interest that many of my fellow med students (as well as residents and even some attendings) show the ancestral/evolutionary ideas that I sometimes talk about, but most generally find an evolutionary approach to health and wellness interesting, rather than integral, in the consideration of health, wellness, and disease. 

 

I am not, however, alone.  There are a number of MDs and DOs who are interested in bridging the gap between ancestral health and western medicine.  There is a budding new organization of Physicians and Ancestral Health (with a winter meeting in February that I hope to attend), and there are other medical students who share a passion for thinking about modern medicine in the context of ancestral health. One such medical student is Angela Arbach, a student at Cornell Medical School currently doing research during a year long sabbatical between her third and fourth years of medical school, who I had the pleasure of meeting at the Ancestral Health Symposium in Boston in August.  There we had a long chat about our shared interest in evolutionary and ancestral medicine, as well as our specific areas of focus (she is passionate about women’s health and infectious disease).  I didn’t know it at the time, but Angela would soon be winging her way to Africa, where she would be involved in an international nutrition research project. When we recently caught up over e-mail I asked if she’d be interested in sharing her experience on my blog.  Her travels and observations are something that so few get to experience but so many could benefit from pondering. 

 

With out further ado: an ancestrally minded med student abroad.

Fresh from the Ancestral Health Symposium (AHS), after several days home in NYC and then a national boards exam in Philly, I was on a 4-hour bus trip to upstate New York to finalize plans for a research project in international nutrition.  A month later, I was on a plane to Northern Uganda: a nation in the global south, devastatingly resource poor, with an uncomfortably recent history of conflict.  [Check out the doc Uganda Rising, on youtube, for more history and a quick but imperative summary of colonialism in Africa].  It’s also a beautiful place.  From polychromatic garb to the giant layered sky underscored by the surrounding savannah, there is no shortage of images to appreciate.  The Acholi people, the dominant ethnic group of Northern Uganda, are still close to their traditional roots despite colonization and the recent influx of modern technologies.  When the English arrived, they left their development plans out of the north, making it easier to forcibly enlist Acholi men in the security forces.  And then, after independence (50 years, last month!), the north remained isolated and underdeveloped due to the LRA insurgency.  The Nile River, separating Acholiland from the rest of the country, only aids in this political and cultural divide.  For these reasons, an AHS-primed brain finds many cultural practices as fodder for rumination, along with prompts for contemplating our role in a global context.  Below, I will describe some of my earliest observations in this complicated milieu.

First, of course, the food.  It starts with starchy staples, mostly sweet potatoes, millet, rice, maize, sorghum, cassava, squash, and plantains.  These starches are used to scoop up, usually by hand, some combination of beans, peas, sesame seed paste, and, if you’re not incredibly food insecure, goat, fish, chicken, beef, or offal. The modicum of nonstarchy vegetables is nearly always cooked: the beans and meat stews are boiled with small pieces of tomato, green pepper, and onion, and a common side dish is boiled leafy greens.  I recently read an account of a Ugandan grandmother’s reaction to Western salads, laughing and asking how people can be healthy eating these raw foods since humans are not goats or cows.  The author explained how cooking all vegetables is a protective tradition, as soil and water is often contaminated by waste, but I wonder if there is more to it.  Fruit is eaten raw, however, and the most common fruits I see are bananas, oranges, jackfruit, mangos, avocado, passion fruit, and watermelons.  In terms of ferments, I’ve only heard of bongo (fermented milk) and the various alcoholic homebrews, usually from banana, maize, sorghum, or millet.

Example meals:  a plate of sweet potato and posho (stiff maize porridge) with a bowl of beans in a sesame paste sauce; kwan kal (stiff millet porridge) with boiled greens, tahini mixed in the green water; rice with a bowl of smoked goat meat stew.

fresh fish, sesame pasted greens, stiff millet porridge, sweet potatoes

One of my favorite meals, also an Acholi staple, is sesame paste mixed with mashed, cooked pigeon peas (dek ngoo) drizzled with dark shea nut oil (moo yaa).  Eat this by dipping in pieces of sweet potato or kwan kal.  These are typical lunches and dinners.

dek gnoo and moo yaa, with stiff maize porridge rice on the right

Breakfast is varied.  Some skip it, especially if they live in poverty and work all day (sure, call it a “feeding window, or just malnutrition).  Milk tea and milk instant coffee are very popular, with a milk-to-water ratio of 1:1 loaded up with table sugar.  The milk here is delicious– largely local and grassfed, it tastes so rich and sweet (a Ugandan colleague’s wife, who lived in the US for a year, told me “American milk doesn’t taste like milk”).  Millet porridge is served in some schools for breakfast.  A popular drink for children is milk, fermented or fresh, mixed with some kind of grain (I’ve heard millet or corn).  More common outside of the north, but still present here, is katogo:  stewed plantain or banana with offal or groundnuts.  Groundnuts are very similar to peanuts, and people buy them roasted for breakfast or snacking.  Groundnut stew (similar to a mild peanut sauce) is common elsewhere, but sesame paste stews are more common here.  Overall, the food variety is less than other places I’ve traveled, and the dishes are quite plain with little spice or herb additions– low food reward, perhaps.

That all sounds wonderful, but I left out a big part of the common diet:  wheat, vegetable oils, and soft drinks.  All new additions to the food tradition, sometimes supplanting old foods.  Indian influence means chapati and samosas are common street foods, cooked in vegetable oils, of course.  Loaves of bread are becoming a staple, as well, and some people eat it with a schmear of sesame seed butter for breakfast.  I was happy to discover how common eggs are, but if I eat out, they are always fried brown in veg oil.  So it goes.  Within the ubiquity of food insufficiency in a context of very limited healthcare, I fear the implications of substituting already meager dietary items with these industrial foods.

Modern staples: vegetable oils, toilet paper, and soda

Walking around, I see people in positions that could be in Gokhale’s book.  The women work hard– constantly bent over to cook, wash dishes, do laundry, and clean floors (brooms are 2-3 feet long and made from reeds, mops are rags that you move with your arms).  They stay bent at the waist with perfectly straight backs, motivating me to keep stretching the hammies…

Women at work

 Some of these chores are done squatting, too.  Otherwise, the women can be seen transporting heavy objects on their heads, from 5 gallon jugs of water to sacks of grain.  This is all done with a baby wrapped to their backs.

I could be wrong, but perhaps these practices are the reason I see less postural kyphosis in the elderly ladies.  Also, I should mention that gyms are nearly nonexistent, and the only time I see running is when people get caught in the rain, are playing football (soccer), or are white people doing aid work or research (that’s me! But my research involves too much time at a desk).  Strenuous jobs are the norm, and most people don’t have cars.  Walking and bicycling are the rule.  Most of the footwear I see are thin sandals (minimalist), and it’s common to see barefooted people walking around, especially outside the towns (poverty).

About 100 years old, but I’m told these are still made in some villages

The lack of street lamps, along with daily power outages, and the fact that the vast majority of homes don’t have access to electricity, means that people generally experience natural darkness as the sun sets.  I’ve been heading to bed much earlier, especially since I cannot sleep past 5 or 6 am due to the roosters.  If I go to bed early enough, I often wake up in the middle of the night for an hour or so before a “second sleep”.  One of my colleagues (a Ugandan) does this, too, but I cannot generalize beyond us.  He and his family sometimes take a little siesta after lunch, too, which I can certainly get behind.  I can also check off items from the recent MDA post on hormesis.  I already mentioned the exercise and calorie restriction, and sunlight exposure is a given in a country on the equator.  Also, without modern conveniences such as electricity and hot water heaters, all showers are cold showers!

Another topic I want to touch on is Acholiland’s continued tribal culture.  Traditional dance and music is at the heart of this.  I frequently hear drums in the distance as I walk, and I’ve seen groups of students in universities meet up for dances in the grass.  For more on the healing power of traditional music and dance, track down the 2007 film War Dance, an incredibly beautiful but heartbreaking story about school children in Northern Uganda.  I have yet to read my book on the history of the Acholi tribes, so the majority of my info is from conversations with Ugandan friends, one of whom is the designated leader of his clan.  The presence of tribal culture is strong, the sense of belonging is crucial, and excommunication from your clan is considered a punishment worse than death.  Clan leaders are still called upon to resolve disputes or offer advice.  [See the Al Jazeera documentary, Bitter Root, for how these traditional practices lead to reconciliation, rather than retribution, for former abducted-children-turned-rebel-soldiers, taking the justice system from the hands of the government to the realm of tradition].  Distant relatives are sometimes described using nuclear family nouns– the son of your grandpa’s cousin’s kid is your brother– and everyone feels a sense of responsibility and goodwill towards other members of their clan.  This sounds like ubuntu, the topic of Frank Forencich’s talk (Africa reference?) at AHS, which I missed because I had to run back to New York that day.  I should mention that everyone here was thrilled when Obama won, and they often cite that sense of brotherhood they get from him, along with his more skillful way of taking care of the poor.

That’s my account so far, but remember that some of this information came from people who may want to tell the foreigner something interesting, rather than common, and then that data is filtered through my biased brain.  And of course, I can’t talk about these things without sprinkling in some political, economic, and social issues facing the Acholi.  An ancestral health picture is nice, but it’s not complete.  Acholi tradition has been undermined by forced migration into internally displaced peoples camps for over a decade, ending merely a few years ago, preventing the practice of many cultural rituals.  They were without land, independence, and other means to continue traditional livelihoods.  On a few occasions, I’ve been able to informally talk with Acholi elders.  They never fail to remind me how the IDP camps destroyed their peoples’ culture and morals, as well as fostering drug abuse, rape, and disease.  And yes, the foodways and hormesis sound great, but people are starving here.  Naturally active livelihoods are awesome, but not when they are the result of extreme gender inequality where women have no choice.  It’s sweet and heartwarming that man-on-man handholding is so common– brotherhood, right?  But it’s scary that the same affection towards your wife is risqué, or that you could be killed or imprisoned if you engage in love outside the bounds of heteronormativity.  Blame it on the proximate lack of education, former colonialism, or widespread Christianity, but it’s happening.  And let’s not start on the infectious diseases, government corruption, illiteracy rates, motor vehicle accidents, and lack of good healthcare.

So what can we learn from these people, a group so geographically close to the Hadza, Batwa, and Karamojong, close to some of the earliest human remains in the archaeological record?  The answer seems largely irrelevant.  We have a lot of the answers we need about diet and lifestyle.  Perhaps this is a case where we should ask:  what can we give of ourselves?  The ancestral health community has gained a lot from the study of indigenous groups, so what can we do in return?  How will we enable empowerment and protect culture?  American health trends have a global effect, so how can we be the example of doing this in a positive way?  Why was the apropos panel on Reclaiming Latino Health so under-attended, compared to the lamentable, stale debate on… potatoes?  Were we fighting with the Pima to protect their water?  Has anyone heard of the Decolonizing Diet Project?  And for the egocentric: more preservation of cultural heritage means more research opportunities to figure out the perfect post-workout meal…  I mentioned missing Forencichs’ talk, but when I read how greatly he inspired people, I looked him up and found this relevant post.  Adele Hite, a speaker at the symposium, gave a list of ways to become more involved than just frequently-commenting-on-blogs.  Her examples largely involve the USA, but I don’t see why our scope cannot transcend self-created national borders.  This already happens in research and blogging, so why not in action?  Involvement in other cultures demands care and scrutiny (you want to avoid dead aid), but I think this community is smart and thoughtful enough to create a significantly net-positive effect.  We’re crafty people, and we’ve already accomplished so much.  Some organizations are doing exciting, ancestral-health-minded things, like this medical clinic in Burundi.  They started a native foods garden, along with the administration of agriculture education programs, to combat widespread food insecurity that took place after the civil war and genocide– a nice solution to what many food aid programs stick a bandaid on by creating relationships of dependency using their culturally inappropriate bags of wheat and jugs of vegetable oil.

I’m merely a student, so I cannot provide all the answers, but I hope the bulk of my career will work on these issues.  I think this community is also up for the challenge, as evidenced by the last symposium.  The blogging about micro/macronutrients is dying down, and our focus is getting bigger:  public policy, remarkable research projects, interventions, activism, creation of med student electives, and the introduction of evolutionary health into workplaces and grand rounds.  I’m not saying that global issues and cultural preservation need to supplant the other amazing endeavors born from the synergy in the ancestral community, but I look forward to more attention to these topics.  They are not tangential, but fundamental, to progress for us all.

Angela is a medical student at Cornell in NYC. If you’d like to read more of her observations (with less focus on ancestral health) you can check out her travel blog, I highly recommend it!  

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Sandy has come and gone (at least in my part of the country- last I heard she was still making her presence felt somewhere in the middle of the country), but for me (and many fellow New Jerseyans) power has gone and not yet come back.  I weathered the storm in my apartment near school, and stayed there for the following day. When word came that my school would be closed for the entire week (the associated hospitals have remained open throughout), I decided to pack up my freezer and head back to my parents’ place (also without power) where there was storm damage that needed to be handled.

All things considered, my family and I were very fortunate with this storm. We are not on the coast and as such were spared the coastal flooding that has damaged so much of our Jersey Shore. We faired much worse with Irene last year, where flooding led to serious damage at our house and at our farm.  While Irene brought us water, Sandy brought us wind.  The majority of the damage after this storm (at least in our area) is due to downed trees or direct wind.

Of course, with downed trees come downed power wires.  As I write this, we approach 100 hours without power*.  At my apartment, while I lacked power, I had water (and while it lasted, the bit of hot water that remained in the tank). My parents’ old farmhouse is on a well, and as such lacks running water when the power goes out.  Luckily there is a stream that can be accessed for water to flush the toilets and we stockpile water in tanks for occasions such as this. We have lots of firewood stashed (and a good old wood-burning stove), so while the temperatures continue to drop we are able to keep ourselves warm the old fashioned way.  The biggest concern with extended power cuts (for us at least) is the risk of our 2 big freezers defrosting. With hundreds of pounds of beef, lamb, pork, and fish (not to mention veggies and berries), an extended outage gets a bit concerning.  Fortunately we have very generous neighbors who have a generator, and after a couple days without power they bring their generator over so we can plug in and recharge our freezers for a bit (as I write this, we’re on round 2 of recharging- so far so good).

At times such as this there are a number of things for which I’m very grateful .

1-    Health. If you aren’t physically well and physically able this manner of glorified camping could turn into hell.

2-    A gas stove. Seriously. The power may go out, but at least I can still cook. What do people with electric stoves do?

3-    Firewood. And after this storm we’ll be set with firewood for many more years to come

4-    Friends with generators (who not only recharge out freezers, but also offer warm showers… saints!)

5- Merino clothing. Cozy and  stink free… need I say more?

With a limited water supply and a desire to keep dirty dishes to a minimum, I keep my cooking simple. Dinners have been big one-pot numbers (I cooked up a good beef shin bone 2 nights ago and I have lamb shanks on the go at the moment), and breakfasts have been soft-boiled eggs.

“Eggs and soldiers” (soft-boiled eggs served with slivers of toast for dipping) was a regular breakfast when I was a child.  While I haven’t had toast in years, soft-boiled eggs remain a regular part of my diet.  They’re quick, they’re easy, they require no preparation or clean up, and despite this I’m not sure I’ve ever met another American that eats them (my parents are English).  Soft-boiled eggs seem to be quite popular in Europe.  Not only are they part of English culinary history (Go to work on an egg), but I’ve seen them at a number of breakfast buffets while traveling in Germany.

I have no intention of writing a food blog. There are much more capable chefs (with much fancier cameras) who cook and write about delicious and nutritious healthful food (here’s a good example), but I’ll take this opportunity to introduce this tasty treat to my readers (and if I’m completely wrong and Americans are eating soft-boiled eggs like mad, please let me know!).

If you can boil water, you can boil an egg. The difficulty with making soft-boil eggs is getting the timing right.  I’ve sometimes heard soft-boiled eggs referred to as “4-minute” eggs, as 4 minutes is about as long as it takes to cook.  Some variables interfere, such as altitude, size of the egg and freshness of the egg (there’s nothing worse than overcooking a beautiful fresh egg still warm from the chicken!), but 4 minutes is a good estimate.

I’ll admit I almost never time my eggs. I invested in one of these gadgets a few years ago, and can’t recommend them highly enough. If you’re lazy like me and sometimes cook tons of eggs at a time, this little device can tell you when they’ll all be done better than any timer.  Worth every penny (I get no kickbacks, I assure you)!

Once your egg is cooked you can stick it in cold water to stop it from cooking too much or just eat it right away. Soft-boiled eggs are best enjoyed warm and are most easily eaten using an eggcup.  Here’s my favorite:

This was the eggcup my Nan would give me as a child when I visited her in England. I reminisced about it and she kindly gave it to me!

The next step is cracking the egg. This too, is easily done!

Once whacked, you can get to work and open up the egg. If all went according to plan, you’ll have a perfect soft yolk!

Mmmm…. Brains

I like mine with a bit of salt (and sometimes some pepper).

I’d like to thank my hens for eating such a nutritious diet and for having such lovely yolks!

It seems as though Brits are pretty keen on soft-boiled eggs (or at least they have been in the past). Maybe it’s because soft-boiled eggs are delicious, or maybe it’s because eggcups are kind of fun. There are lots of options, from cute little pants sets to fine silver.

An antique silver eggcup set- also from my Nan (I can’t believe anyone ever used these!)

Soft-boiled eggs are not only quick to cook with minimal cleanup (usually just a spoon) but they’re also excellent emergency food.  They’re very nutritious, and they can be cooked in water that wouldn’t otherwise be potable (love that shell!). I remember my good friend Jamie Scott  making that point when he wrote about his experience with the earthquakes of Christchurch.

In college I toured Iceland, including a visit to the geysers. I remember hearing that you could cook a soft-boiled egg in the sulfurous hot springs if you were so inclined (talk about Waste not, want not!), and I tracked down a video of some guys doing just that.  The kitchen method might be easier- no hot spring required!

(As the pictures might suggest, I am going a but stir-crazy, though I have to admit that life without power is not without its charms. I’ve read a big book of EKG interpretation cover-to-cover, dismembered a fallen old maple, fixed a chicken house, and taken the dog for a number of walks over the last few days. I’m also rather enjoying the darkness-imposed early bedtimes (now that it no longer sounds like the wind will rip the roof off from over me!)  More science to come- I do plan to get back to liver and lipids shortly!)

 

*This post is up courtesy of the photons and electrons of a local coffee spot… Thanks Riverside Coffee!

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As my last post started to explore, different types of dietary fats have different effects on the progression of alcoholic liver disease. This post will further explore the protective effects of saturated fats in the liver.

 

For many, the phrase “heart healthy whole grains” rolls off the tongue just as easily as “artery clogging saturated fats”. Yet where is the evidence for these claims? In the past few decades saturated fats have been demonized, without significant evidence to suggest that natural saturated fats cause disease (outside of a few well touted epidemiological studies). Indeed, most of the hypothesis-driven science behind the demonization of saturated fats is flawed by the conflation of saturated fats with artificial trans fats (a la partially hydrogenated soybean oil).

 

In the face of a lack of any significant scientific evidence that clearly shows that unadulterated-saturated fats play a significant role in heart disease (and without a reasonable mechanism suggesting why they might), I think the fear-mongering “artery clogging” accusations against saturated fats should be dropped. On the contrary, there is significant evidence that saturated fats are actually a health promoting dietary agent- all be it in another (though incredibly important) organ.

 

Again (from my last post), here is a quick primer on lipids (skip it if you’re already a pro). For the purpose of this post, there are two important ways to classify fatty acids. The first is length. Here I will discuss both medium chain fatty acids (MCFA), which are 6-12 carbons long, and long chain fatty acids (LCFA), which are greater than 12 carbons in length (usually 14-22; most have 18). Secondly, fatty acids can have varying amounts of saturation (how many hydrogens are bound to the carbons). A fatty acid that has the maximal number of hydrogens is a saturated fatty acid (SAFA), while one lacking two of this full complement, has a single double bond and is called  monounsaturated (MUFA) while one lacking more (four, six, eight etc.) has more double bonds (two, three, four, etc.) and is called a polyunsaturated fatty acid (PUFA).

 

Next time you eat a good fatty (preferably grass-fed) steak, or relish something cooked in coconut or palm oil, I hope you will feel good about the benefits you are giving your liver, rather than some ill-placed guilt about what others say you are doing to your arteries. From now on, I hope you think of saturated fats as “liver saving (and also intestine preserving) lipids”. Here’s why:

 

In 1985, a multi-national study showed that increased SAFA consumption was inversely correlated with the development of liver cirrhosis, while PUFA consumption was positively correlated with cirrhosis [1].  You might think it is a bit rich that I blasted the epidemiological SAFA-heart disease connection and then embrace the SAFA-liver love connection, but the proof is in the pudding- or in this case the experiments that first recreated this phenomenon in the lab, and then offered evidence for a mechanism (or in this case many mechanisms) for the benefits of SAFA.

 

The first significant piece of support for SAFA consumption came in 1989, when it was shown in a rat model that animals fed an alcohol-containing diet with 25% of the calories from tallow (beef fat, which by their analysis is 78.9% SAFA, 20% MUFA, and 1% PUFA) developed none of the features of alcoholic liver disease, while those fed an alcohol-containing diet with 25% of the calories from corn oil (which by their analysis is 19.6% SAFA, 23.6% MUFA, and 56.9% PUFA) developed severe fatty liver disease [2].

 

More recent studies have somewhat complicated the picture by feeding a saturated fatty-acid diet that combines beef tallow with MCT (medium chain triglycerides- the triglyceride version of MCFAs). This creates a diet that is more highly saturated than a diet reliant on pure-tallow, but it complicates the picture as MCFA are significantly different from LCFA in how they are absorbed and metabolized. MCFA also lead to different cellular responses (such as altered gene transcription and protein translation). Nonetheless, these diets are useful for those further exploring the role of dietary SAFA in health and disease.

 

These more recent studies continue to show the protective effects of SAFA, as well as offer evidence for the mechanisms by which SAFA are protective.

 

Before we explore the mechanisms, here is a bit more evidence that SAFAs are ‘liver saving’.

 

 

A 2004 paper by Ronis et al confirmed that increased SAFA content in the diet decreased the pathology of fatty liver disease in rats, including decreased steatosis (fat accumulation), decreased inflammation, and decreased necrosis.  Increasing dietary SAFA also protected against increased serum ALT (alanine transaminase), an enzymatic marker of liver damage that is seen with alcohol consumption [3].  These findings were confirmed in a 2012 paper studying alcohol-fed mice. Furthermore, these researchers showed that SAFA consumption protected against an alcohol-induced increase in liver triglycerides [4].  Impressively, dietary SAFA (this time as MCT or palm-oil) can even reverse inflammatory and fibrotic changes in rat livers in the face of continued alcohol consumption [5].

 

But how does this all happen?

 

Before I can explain how SAFA protect against alcoholic liver disease, it is important to understand the pathogenesis of ALD. Alas, as I briefly discussed in my last post, there are a number of mechanisms by which disease occurs, and the relative importance of each mechanism varies based on factors such as the style of consumption (binge or chronic) and confounding dietary and environmental factors (and in animals models, the mechanism of dosing). SAFA is protective against a number of mechanisms of disease progression- I’ll expound on those that are currently known.

 

In my opinion, the most interesting (and perhaps most important) aspect of this story starts outside the liver, in the intestines.

 

In a perfect (healthy) world, the cells of the intestine are held together by a number of proteins that together make sure that what’s inside the intestines stays in the lumen of the intestine, with nutrients and minerals making their way into the blood by passing through the cells instead of around them. Unfortunately, this is not a perfect world, and many factors have been shown to cause a dysfunction of the proteins gluing the cells together, leading to the infamous “leaky gut”. (I feel it is only fair to admit that when I first heard about “leaky gut” my response was “hah- yeah right”. Needless to say, mountains of peer-reviewed evidence have made me believe this is a very real phenomenon).

 

Intestinal permeability can be assessed in a number of ways.  One way is to administer a pair of molecular probes (there are a number of types, but usually a monosaccharide and a disaccharide), one which is normally absorbed across the intestinal lining and one that is not. In a healthy gut, you would only see the urinary excretion of the absorbable probe, while in a leaky gut you would see both [6]. Alternatively, you can look in the blood for compounds such as lipopolysaccharide (LPS-a product of the bacteria that live in the intestine) in the blood. (Personally, I would love to see some test for intestinal permeation become a diagnostic test available to clinicians.)

 

Increased levels of LPS have been found in patients with different stages of alcoholic disease, and are also seen in animal models of alcoholic liver disease.  Increased levels of this compound have been associated with an increased inflammatory reaction that leads to disease progression.  Experimental models that combine alcohol consumption and PUFA show a marked increase in plasma LPS, while diets high in SAFA do not.

 

 

But why? (Warning- things get increasingly “sciencey” at this point. For those less interested in the nitty-gritty, please skip forward to my conclusions)

 

Cells from the small intestine of mice maintained on a diet high in SAFA, in comparison to those maintained on a diet high in PUFA, have significantly higher levels of mRNA coding for a number of the proteins that are important for intestinal integrity such as Tight Junction Protein ZO-1, Intestine Claudin 1, and Intestine Occludin.  Furthermore, alcohol consumption further decreases the mRNA levels of most of these genes in animals fed a high-PUFA containing diet, while alcohol has no effect on levels in SAFA-fed animals.  Changes in mRNA level do not necessarily mean changes in protein levels, however the same study showed an increase in intestinal permeability in mice fed PUFA and ethanol in comparison to control when measured by an ex-vivo fluorescent assay. This shows that PUFA alone can disturb the expression of proteins that maintain gut integrity, and that alcohol further diminishes integrity. In combination with a SAFA diet, however, alcohol does not affect intestinal permeability [4].

 

Improved gut integrity is no doubt a key aspect of the protective effects of SAFA. Increased gut integrity leads to decreased inflammatory compounds in the blood, which in turn means there will be decreased inflammatory interactions in the liver.  Indeed, in comparison to animals fed alcohol and PUFA, animals fed alcohol with a SAFA diet had significantly lower levels of the inflammatory cytokine TNF-a and the marker of macrophage infiltration MCP-1 [4].  Decreased inflammation, both systemically and in the liver, is undoubtedly a key element of the protective effects of dietary SAFA.

 

This post is already becoming dangerously long, so without going into too much detail, it is worth mentioning that there are other mechanisms by which SAFA appear to protect against alcoholic liver disease. Increased SAFA appear to increase liver membrane resistance to oxidative stress, and also reduces fatty acid synthesis while increasing fatty acid oxidation [3]. Also, a diet high in SAFA is associated with reduced lipid peroxidation, which in turn decreases a number of elements of inflammatory cascades [5]. Finally- and this is something I will expand on in a future post- MCFAs (which are also SAFA) have a number of unique protective elements.

 

I realize that this post has gotten rather lengthy and has brought up a number of complex mechanisms likely well beyond the level of interest of most of my readers…

 

If all else fails- please consider this:

 

The “evidence” that saturated fats are detrimental to cardiac health is largely based on epidemiological and experimental studies that combined saturated fats with truly-problematic artificial trans-fats. Despite the permeation of the phrase “artery clogging saturated fats”, I have yet to see the evidence nor be convinced of a proposed mechanism by which saturated fats could lead to decreased coronary health.

 

ON THE CONTRARY…

 

There is significant evidence, founded in epidemiological observations, confirmed in the lab, and explored in great detail that shows that saturated fats are protective for the liver. While I have focused here on the protective effects when SAFA are combined with alcohol, they offer protection to the liver under other circumstances, such as when combined with the particularly liver-toxic pain-killer Acetaminophen [7].

 

Next time you eat a steak, chow down on coconut oil, or perhaps most importantly turn up your nose at all things associated with “vegetable oils” (cottonseed? soybean? Those are “vegetables”?), know that your liver appreciates your efforts!

 

 

1.            Nanji, A.A. and S.W. French, Dietary factors and alcoholic cirrhosis. Alcohol Clin Exp Res, 1986. 10(3): p. 271-3.

2.            Nanji, A.A., C.L. Mendenhall, and S.W. French, Beef fat prevents alcoholic liver disease in the rat. Alcohol Clin Exp Res, 1989. 13(1): p. 15-9.

3.            Ronis, M.J., S. Korourian, M. Zipperman, R. Hakkak, and T.M. Badger, Dietary saturated fat reduces alcoholic hepatotoxicity in rats by altering fatty acid metabolism and membrane composition. J Nutr, 2004. 134(4): p. 904-12.

4.            Kirpich, I.A., W. Feng, Y. Wang, Y. Liu, D.F. Barker, S.S. Barve, and C.J. McClain, The type of dietary fat modulates intestinal tight junction integrity, gut permeability, and hepatic toll-like receptor expression in a mouse model of alcoholic liver disease. Alcohol Clin Exp Res, 2012. 36(5): p. 835-46.

5.            Nanji, A.A., K. Jokelainen, G.L. Tipoe, A. Rahemtulla, and A.J. Dannenberg, Dietary saturated fatty acids reverse inflammatory and fibrotic changes in rat liver despite continued ethanol administration. J Pharmacol Exp Ther, 2001. 299(2): p. 638-44.

6.            DeMeo, M.T., E.A. Mutlu, A. Keshavarzian, and M.C. Tobin, Intestinal permeation and gastrointestinal disease. J Clin Gastroenterol, 2002. 34(4): p. 385-96.

7.            Hwang, J., Y.H. Chang, J.H. Park, S.Y. Kim, H. Chung, E. Shim, and H.J. Hwang, Dietary saturated and monounsaturated fats protect against acute acetaminophen hepatotoxicity by altering fatty acid composition of liver microsomal membrane in rats. Lipids Health Dis, 2011. 10: p. 184.

What is “Fatty Liver”? Well here’s a slide from my research showing a slice of liver from a control-fed rat on the left and an alcohol-fed rat on the right. Arrows mark macrovesicular lipid accumulations (other models can show much more impressive lipid accumulations).

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