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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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I’m on Pathology elective. This means that I get to see interesting “gross” specimens and I spend a lot of time sitting at a multi-headed microscope looking at slides with attending physicians, residents, and fellow med students. It also means that I have a bit of a breather.  I do have to give a presentation later this week (I’ve opted to talk briefly about pathology of the appendix because I am oh so fond of it!), but there is no exam at the end of the elective and the final grade is pass/fail. When I’m not in the hospital, I’m using this two week period to go to the gym, catch up on clinic visits, and refresh my social life. So far I’m doing well on all fronts!

If you haven’t caught on by now, I’m a bit of a nerd. Therefore it should come as no surprise that I’m a fan of things such as ‘The Rap Guide to Evolution’.

Curious?

I was first introduced to Baba Brinkman’s work two years ago on the now (sadly) defunct Evolvify forum. Last year I saw that he was performing the Rap Guide to Evolution in NYC and couldn’t resist the train ride in to see the show.  When I heard he was back with a new show this winter I made plans to catch his new production: Ingenious Nature:

Everyone’s looking for love, or sex, occasionally even both. Evolutionary psychology claims to explain why, and how this state of affairs came about. But can it help us find the right one? A young man decides to take the “science of mating” seriously in his quest for a happy ending. Will the theory work in practice? It turns out, ovulation studies can make for awkward first date conversation.

I should admit that my first foray into internet shenanigans (by which I mean getting somewhat involved in the paleosphere) came not because of diet, but because I wanted to talk about evolutionary psychology on the previously mentioned Evolvify forum. There I found bright minds that not only embraced an evolutionary appropriate approach to diet, but who also liked thinking about why humans act the way we do- especially when it comes to sex and behavior (no neck down Darwinists there).  Curious for more? Read this as an example. (Or I highly recommend the book The Mating Mind.)

So anyway- Ingenious Nature!

After a delicious dinner at Takashi, a Yakiniku restaurant with a mind-expanding menu  (Thanks Melissa McEwan for the recommendation!), my friend and I headed over to Soho Playhouse to catch the show.  I’ve been a fan of Baba Brinkman since the first time I saw one of his videos (maybe it was his “[Darwin-] Very gradual change we can believe in” T-shirt), and this show certainly didn’t disappoint. It was interactive, witty, smart, and entertaining, and that was before he even started rapping.

It appears Baba is a generous man, as you can listen to all his tracks in one place online for free (though donations are of course appreciated).  I highly recommend you go take a listen to his work. The tracks are fun, and the information is backed up by scientific principles and peer-reviewed research. Heck, he even has some of the heavy hitters in the field weighing in on his tracks (at the end of the show there was a message from Steven Pinker, though that track doesn’t appear to be available online*).  Here’s a personal favorite: She’s Ovulating (and yes, lap dancers do make more money while ovulating and men find the scent of fertile women more alluring).

The show is a complete package, with an amusing story line interwoven with raps and sketches that bring scientific theories and data to life. If you have a sense of humor and are interest in the mating game (~99% of humans I suspect!), I expect you will enjoy this show.  If you’re someone with a long-standing interest in evolutionary psychology, you’ll recognize that Brinkman is very knowledgeable on the subject. Even the most well-read evolutionary psychologist will get something out of this show- even if it’s just some laughs and a refreshing new way to look at the data.

Speaking of data… The show is interactive. At times you can use your phone to text responses that are compiled into graphs as the show goes on- it’s kind of fun, though I didn’t always have time to get my answer in before the next question came up. It would be interesting to know if he gets any reliable trends with some of his questions!

Brinkman is accompanied by Jamie (Mr. Simmonds) on the turntables. I’ll admit that I’m ignorant about DJing and remixing, but whatever they’re doing is working. The final package is fantastic.  If you’re in the New York area and can get in to see his show, I highly recommend it. Actually, I’ve heard enough first-date horror stories in the last few days to think I should be giving away tickets as Christmas presents!

OK, if you haven’t already listened to “She’s Ovulating”, do it now!

I love this. You can read the story here. Profits from sales go to NCSE.

I love this. You can read the story here. Profits from sales go to NCSE.

It looks like you can get tickets half price here. Also- if you’re interested in the mating game, cruise around some of the older posts on Evolvify or check out this awesome old blog with conclusions drawn from online dating profiles. There are also LOTS of good books, papers, and blogs exploring evolutionary psychology, a fascinating field.

* UPDATE! You can hear the messages from the Peer-Reviewed panel here.

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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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(I wrote this a few weeks back as I was just starting the first portion of my internal medicine clerkship. I was obviously rather energized at the time, though my thoughts now remain generally the same. More science-y posts to come, I promise, but for now it’s hard to find time to put together such posts!)

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Our current medical system does not fit our current medical condition.

Our health-care system was built on the premise of people being relatively healthy until they became significantly sick.  By those standards, our medical system has been hugely successful. Antibiotics routinely save people who would die without medical intervention. Trauma surgeons routinely put people back together who would have died 100, or even 10 years ago (and put them back together better and faster with improving technology).  Today, conditions that used to be major killers- meningitis, endocarditis, pneumonia- are usually (though not always) successfully treated.  The pediatrics floor of my University’s hospital is frequently almost empty- most serious diseases of childhood are now prevented.

Yet people see our medical system as a failure.

And it is.

Our medical system fails to prevent the preventable.  Rates of diabetes, cardiovascular disease, and “diseases of civilization” are increasing exponentially.  The expense of our medical system is unaffordable. As much as we are able to treat the sick, we often fail the ill.

Different doctors have different views towards medicine. Some are rather paternalistic; some are loud proponents of patient autonomy. For the most part, however, all hospital-based doctors know they can’t keep their patients in the hospital until they are healthy. They treat them, and when they are ready to go home (or to a rehab center or nursing home), they are discharged. The problem is- you can treat an infection or a crisis, but you can’t treat a lifestyle.

When a patient comes in with Acute Coronary Syndrome (ACS- a term that refers to a spectrum of cardiac conditions from unstable angina to a severe myocardial infarction) and four risk factors (let’s say diabetes, hypertension, dyslipidemia and a history of smoking), what is the job of the hospital team?  They CANNOT fix all the underlying factors. Their job is to stabilize the patient, make a diagnosis, and treat their current condition.

Who is “to blame” for this situation?  Is it the patient that lived a lifestyle full of cardiovascular risk factors? Is it the fault of the patient’s family that never taught the patient, as a child, how to cook and care for themselves? Is it the fault of the community for not providing safe playgrounds for the patient when they grew up, leading to a sedentary lifestyle? Is it the fault of the education system, which might have fed this patient disastrous food while preaching the benefits of the food pyramid (if they taught anything nutrition-related at all)?  Is it a lack of physician availability, which leads to ‘dead zones’ where no primary-care physicians can be found, even if you have insurance or can pay for care?  Is it the failure of the patient who took at face value all the ill-guided “health-care” advice they were given (or perhaps, is it their fault for blatantly pursuing a lifestyle that no one would suggest is healthy)?

Our system was built around the premise of people being healthy until they got sick. We currently live in a world where most people are chronically ill.

It’s a fun thought-experiment to imagine what we could do with modern medical tools and technology with the patient base of 100 (or 10000?) years ago.  What would the hospitals look like in a world where patients ate real food, moved, lived, and interacted like humans, but with all the marvels of the modern world?  It’s a pretty dream to dream- especially if you are a physician (or future physician).  Helping people return to health is rewarding. Patching people up to die another day is exhausting, and frequently demoralizing.

Some say the system is broken.  I wouldn’t necessarily disagree, though I’d be apt to argue that we have some pretty amazing skills and tools, but we’re working in a broken world.  No one person can fix this. No one profession can fix this.  What are you doing to make things better?

Imagine there’s no diseases of civilization
It’s easy if you try
No collapsed arches below us
Above us only Vitamin-D producing sky
Imagine all the people living for today

Imagine there’s no diabetes
It isn’t hard to do
Nothing to chronically treat or amputate for
And no exogenous insulin too
Imagine all the people living life in peace

You, you may say
I’m a dreamer, but I’m not the only one
I hope some day you’ll join us
And the world will be as one

 

(Humblest apologies to all John Lennon fans… I couldn’t help myself)

There will always be disease. There will always be trauma. The question is: how do we handle these things, minimizing illness and maximizing the enjoyment of life?

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An addendum…

A friend and classmate made a good point over on my facebook page. I’ll paraphrase.

Our hospital’s pediatrics ward is empty because we’re not a peds specialty hospital and all the intense cases get shipped to a hospital with more pediatric specialists or to a children’s hospital.

It’s a good point, but if anything I think it strengthens my argument. We no longer have the bread-and-butter pediatric diseases of yore. Our pediatricians aren’t managing polio, treating a bunch of meningitis, or rehydrating children with rotavirus. On the other hand- the children’s specialty hospitals are now treating things that were previously unseen because children died. Children with rare and complex disorders now survive and are treated at specialty hospitals, while the run-of-the-mill pediatric illnesses fall into distant memory (though Pertussis is making a nasty comeback).

When it comes to pediatrics, we’re making great headway in keeping children healthy (though the rates at which our children are getting “adult” diseases such as Type II Diabetes are terrifying). What we do see, at least at our hospital, is a failure of good pre-natal care, leading to complex and problematic pediatric conditions… Again- it’s the lifestyle stuff that we struggle with!

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…thoughts on hiking, med school, and life…

The last couple of weeks have been a bit of a whirlwind.  First there was the Ancestral Health Symposium (more on that later- if I ever get my thoughts together), then there was the flurry of activity that marked the end of my Family Medicine Clerkship (topped off with a nice 2.5 hour exam), and before the dust settled I was off to the airport to make the most of every hour of the one-week vacation that my school grants third year medical students at the end of the Family Medicine Clerkship.  I spent that week touring Colorado with my long-time best friend.

I expect that everyone has heard the phrase “It’s the journey, not the destination”.  A quick internet search suggests that this gem comes from Ralph Waldo Emerson (1803-1882), though this is unsubstantiated by any reference… Sourced or not, it seems to be a sentiment that most people can get behind.  My recent mental meanderings- while hiking, while musing about med school, and while thinking about life- have me wondering otherwise.

I enjoy hiking.  As the demands of my degrees have changed I’ve had to take a step back from my equestrian endeavors and embrace other activities that can be picked up and put down a little more easily.  I’ve had a pretty good season for hiking thus far- hitting up a number of beautiful locations.  Some, like my recent trek up Matterhorn Peak in Colorado, were out and back trips, while others, like Falls Trail at Rickets Glenn in Pennsylvania, were scenic loops.  When it comes to hikes, these two adventures were very different.  Climbing the Matterhorn was, in all honesty, a grueling trudge through rather stark scenery to “bag” a 13er (a peak over 13,000 feet- Matterhorn is 13,590).  The Falls Trail at Rickets Glenn, on the other hand, is a non-stop feast for the eyes of waterfalls and lush greenery that takes you back where you started, with no single “goal” for the trip.  In the context of this post, one could easily argue that the former was all about the destination while the later was about the journey.

I said that the trek to the top of Matterhorn was a grueling trudge.  I’ll admit that I was rather ignorant of what I was getting myself into when I boldly posited that “We should climb Matterhorn.” Honestly, I made this statement based on the general location (in the San Juans near where we wanted to camp) and the name (named after the Swiss peak- which has a much higher death toll!).  I didn’t quite realize when we set out the magnitude of the mountain we were climbing, nor the type of country we would be traversing.  Unlike the lush countryside I am used to exploring back east, much of the hike up to the summit was above the tree line, in alpine tundra.  While the trip to the top was interspersed with pauses in which I appreciated the absolutely awe-inspiring views, it was a hike that in all honesty was rather dull.  The top, however, was anything but dull. Visually, the uninterrupted views of the Rocky Mountains extending for miles were breathtaking. Personally, the satisfaction of successfully climbing (I’m mildly averse to the term “bagging”) a large named mountain was immense (and I did it in Vibram Five Fingers- an additional triumph).  Was the journey worth these end satisfactions? Yes! But in this circumstance- the destination certainly trumped the journey.

View from Matterhorn

View from Matterhorn: A place to think…

Med school is also a journey.  Much like the climb up Matterhorn, parts of it are grueling and significant portions are unpleasant.  There are, however, moments of awe and wonder.

There are people that grew up knowing they wanted to be a doctor; I was not one of them.  In fact, I actively told people I would not be a doctor when I was asked the dreaded “What do you want to be when you grow up?” question.  Even as I completed college my inclination was always towards research and not clinical practice, and I committed to an MD/PhD program with the thoughts of using the clinical knowledge (and the professional clout of the MD) to pursue medical research.  Much like climbing Matterhorn- I really didn’t know what I was getting myself into when I signed on to attend med school.  The MD/PhD degree was a destination, something to be obtained without much thought to the journey.

Now that I am in med school, and I recognize the magnitude of the effort required to reach this goal, I wonder- if I knew what I was getting myself into when I embarked, would I have started?  While it is surely not the case for everyone, I entered med school with my mind on the destination, with almost complete ignorance of the journey that entailed.  It has been, and continues to be, one hell of a journey.  There are many aspects of this adventure: the people I have met (classmates, friends, professors, and patients), the events I have experienced, the emotions I have witnessed, the intimate details of their lives that patients have shared… These have made for an incredible experience, and are things I would never have experienced without the end destination of a degree in medicine.

Playing at Rickets Glenn

Playing at Rickets Glenn: Sometimes it’s about the journey, and sometimes the journey is more fun when you go off trail!

Destinations change.  Sometimes they are unreachable, sometimes they are not what you expect, and sometimes they are just a point on the way to a yet further destination.  They do, however, inspire journeys.  Journeys vary based on destination, and while life is not a destination, one might argue (and indeed I do) that the journey of life gets more interesting when you choose a destination.

Choose a destination. It can be big or it can be small, but it should be something you choose. The journey of life seems much more interesting when you are chasing your own goal than when you are treading the path of someone else’s expectations. And don’t worry too much… you can always change your destination if a better one comes into view.

En route to Diamond Lake (Colorado): What you find on the way to your destination, and what you do with it, is all part of the fun.

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Road Trip!

I have more to write about lipids and liver (consider yourselves warned!), but I likely won’t have a post out on that subject for a little while.

During the last month I have been enjoying my Family Medicine Clerkship. I am very fortunate to be working with an excellent and enthusiastic physician, with whom I have had fantastic patient interactions both in the office and on house calls (Yes, house calls- who knew physicians still did those?!). Not only is this physician an enthusiastic practitioner and teacher, but she is also very supportive of my (not so main-stream) academic interests. This was evident in the office, where she was keen to push me towards patients whose medical conditions I was particularly interested in and where she encouraged me to talk about nutrition with many of the patients (Yes- evolutionarily appropriate nutrition- not some American Diabetic Association or “My Plate” nonsense”).  This physician was also keen that I pursue my academic interests outside of the clinic, so she has worked with me and my schedule so that I can attend the 2nd annual Ancestral Health Symposium in Boston at the end of this week.

This time last year I was in the throes of writing my thesis, and I was forced to watch the inaugural Ancestral Health Symposium from the sidelines (you can watch the videos from last years symposium here). I’m very excited to participate in person this year!  (If you’re unable to attend but want to be kept up to date, you can follow the twitter feed @Ancestry2012)

While I am looking forward to a number of the lectures on offer this year, I am equally excited about catching up with other people interested in Ancestral Health.  I’ve been fortunate to cultivate a number of friendships within this community over the last couple years, though because of distance I’ve only met a couple people in person.  While I’ve come to know some quite well through the powers of e-mail, Skype, and Twitter, there’s nothing quite like some face time with friends who share (arguably very nerdy) interests.

Anyway- this is a drawn out way of saying “Hey- I’m headed to Boston for AHS 2012. If you’ll be there and want to say ‘Hi’, please do!”.

Pic- for identification purposes!

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Season’s Greetings!

The hours of my surgery clerkship have my internal clock a little out of whack, but don’t worry, I’m not 7 months out of step.  Actually, I’m all-abuzz about the arrival of spring, and all the great things that this season brings! (I’m also all-abuzz because I have a full weekend off for the first time in 3 weeks… Hazzah!).

I don’t think there’s a place I’ve been where spring doesn’t bring a certain sense of joy and optimism- there’s something about the change in temperature, the awakening of plants, and the enthusiasm of spring mating games (human and otherwise) that makes this a very special time of year. While I haven’t been able to enjoy as much of the spring weather, spring sun, and spring scenery as I would like (not to mention the spring mating games), I am enjoying taking advantage of one of the benefits of spring- the food!

To me, the start of spring is signified by the start of the asparagus season.  While I’ve had limited success growing it myself (probably a combined issue of a poor planting location and an inability to let the first couple years of spears grow unmolested (you shouldn’t pick the spears for the first few years so the crowns can grow to be big and strong… I suppose patience (at least for asparagus) is not one of my redeeming characteristics)), there is a farm ½ a mile down the road that produces it by the bucket load.  As soon as the roadside stand comes out, you can be guaranteed to find asparagus in my fridge.  This asparagus is fresh, with no need to *snap* the bottoms off and with excellent texture and flavor. For a month or so, asparagus is a staple of my diet, and there are days when I’ll have it at every meal of the day (honestly- asparagus, poached eggs, and Hollandaise sauce- it works for breakfast, lunch, or dinner!).  Outside of this brief season, I’ll never buy asparagus (you’re just setting yourself up for disappointment), and if I happen to be served asparagus at other times of the year I’m puzzled by the physical resemblance but gustatory dissimilarity between the tender and tasty spring spears I’m accustomed to and the tasteless stringy curiosities I’ve been served mid-winter.

My mention of poached eggs, asparagus, and Hollandaise sauce was no accident. Not only is this one of my favorite meals, but it’s also (at least to me) an excellent seasonal meal. While my hens produce eggs year-round, they outdo themselves in the spring. Production is up, and as they feast on new grass and fresh bugs, the quality (and flavor!) of their yolks increases. Similarly, butter from cows grazing on spring grass is brilliantly yellow with a decadent taste. Combined (with a squeeze of a not-so-local lemon) these ingredients come together to form a culinary delight that complements asparagus and poached eggs perfectly (as well as a number of other delicious things).

In my book, asparagus is the ultimate ‘spring-tiding’, yet there are other signs of spring (along with the orange yolks of my chickens’ eggs) that I look forward to every year. Spring brings the first fresh greens (arugula being my favorite), and fresh fruit-like-substance to the table. Rhubarb, a stem that is transformed by stewing and sweetening into a dessert, is another tiding of spring. My father reasons (and he might well be right), that the only reason anyone ever ate rhubarb is that it is one of the earliest spring products. If this curious, tart, stem came to maturity during the summer, between waves of berries and stone fruit, it seems unlikely that it would be paid much attention, but as one of the earliest edibles of the year, it finds it’s way to our table.

There are a number of great books that explore the difficulties and pleasures of seasonal and local eating. I read “The Dirty Life” last year, and recently enjoyed “Animal, Vegetable, Miracle”.  “The Dirty Life” documents the life of a young couple that work a farm that provides a complete pantry (from maple syrup and flour to vegetables and meat) CSA style, while “Animal, Vegetable, Mineral” follows the year long adventure of a family that aims to ‘eat local’ for a year. The task in both books is daunting and the process is time consuming (and at times limiting) yet the benefits, and the connection such a commitment brings to the environment and your food are vast.  I highly recommend both books, especially to those that enjoy reading about the trials and tribulations of farming and eating local. (By no means are either book “Paleo”, as both authors embrace grains, yet the tenets of ‘eat local, eat seasonal’ are ones that I think all should embrace.)

I am not a puritan. I enjoy non-local, non-seasonal fruits and vegetables, and some of my dietary staples are things that never have been and never will be local or seasonal to my environment (Oh, to live in a place where avocados, cacao, coffee or coconuts are local or seasonal!). Yet every winter I await the coming of spring and the bounties that the ensuing seasons will bring. The pungent reminder of asparagus recently consumed harkens the arrival of a bounty of crops that the following months will bring!

Seasonal bounty: Spring greens, Spring eggs, rhubarb, asparagus, and (teensy) radishes

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