Setting an Example: Eating Well

At some point all physicians give advice to their patients about dietary changes to improve health.  Let’s be honest.  We don’t do so well ourselves.  The “classic” fare of residency (donuts or muffins for breakfast, pizza for lunch, and some fast food on the way home) doesn’t really give you much credibility when you are talking to patients.

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No medical student or resident is going to be able to eat perfectly, exercise regularly, and do all the other things that lead to a healthier lifestyle.  But every little change you make now will pay off.  You’ll feel better and have more energy.  You’ll be less likely to gain weight.  And – you’ll be able to talk to patients  – with specific examples – about what they can do to improve their own health.

In the crazy busy life of medical school and residency, it’s hard, if not impossible, to spend time and energy to shop, cook and eat really well.  It doesn’t get much better once you start your practice.  What is possible, no matter how busy you are,  is to realize that there are some simple things you can do to improve what you are doing now.

My top 10 tips for better eating in medical school and residency

1.  Eat fruits or vegetables with every meal or snack.  This may mean buying a bag of apples once a week and just eating apples twice a day (boring but effective).  Even better, follow the “USDA plate” recommendation – ½ fruit and vegetable, 1/4 protein 1/4 grain/complex carb on every plate of food you eat.

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2. Eat breakfast.  If you are up too early to really eat, make a smoothie the night before to put on the blender when you wake up and take it with you in the car.  My personal favorite:  ½ cup plain Greek yogurt, ½-1 cup of fruit, ¼ cup egg whites (pasteurized, in a carton), 1-2 Tblsp honey.

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3.  Eat more eggs (especially egg whites).  Eggs have gotten a bad rap, but they are very cheap and very easy to cook.  Cook hard boiled eggs on the weekend to eat for breakfast or snacks during the week.  Make omelets or huevos ranchero for dinner.  Go ahead and spend a little more to get cage-free eggs to do the right thing.

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4. Don’t skip meals.  Even on the worst call day you can keep a meal replacement bar or two in your pocket.

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5.  Pack the food you need for call days the night before so it’s ready to go in the morning.

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6.  Chop up a bunch of veggies on the weekend to throw in salads, soups or in wraps.

7.  Cook or buy one good meal on the weekend that will last for part of the week.   A good stew or soup?  Lasagna?  Look for good recipes on the web.  If you really don’t want to cook, find a healthy caterer or restaurant to buy it instead.

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8.  Take a good sandwich to work for one or more meals.  Peanut butter on whole wheat may be monotonous, but a) it doesn’t have to be refrigerated and b) it beats McDonald’s.

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9.  Free pizza isn’t really free.  It’s incredibly high calorie and the ingredients in the cheap kind aren’t good for you.  (Same for take out Chinese, donuts, muffins, etc)

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10.  Skip the liquid calories.  Cokes may give you an energy boost, but you are better off with real calories from a piece of fruit, a sandwich and some coffee or tea.  (but learn how to use caffeine effectively)

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Starting Internship (I know what you are worried about)

I sat at the table this week with our new interns and the outgoing chief residents. Listening to our new interns as they asked questions, I realized everyone starting their internship has the same fears, whether or not they express them:  Will I kill or hurt someone?  Will I look stupid?  What if they find out I’m not as smart as everyone else?  Will I get divorced/separated/alienated from my friends?  Will I gain weight?  How am I going to find time to take care of myself?

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What you are feeling is normal. Every doctor who ever started an internship felt exactly the same way.  The best way to manage your (healthy) fear is to have a strategy.   I’ve written in the past about how to succeed as an intern.  But if I were going to condense that advice into three easy rules (for every day except your day off)  it would be these:

1.    Read at least one section from a textbook in your field every day

2.    Learn something (in detail) from at least one patient every day

3.    Do something to take care of yourself every day

Read at least one section from a textbook in your field every day.

Your goal for the year should be to read a major textbook in your field cover to cover.  You don’t have to buy the physical book.  It’s fine if it’s on line or downloaded onto your iPad.

Once you have the book, make a list or spreadsheet of all the sections in all the chapters.  For most textbooks, it’s probably going to be a list somewhere between 150 and 200 topics.  When you look at the 48-50 weeks you will be working this year, it works out to basically a topic a day (with some days for review).

The real goal is not just to read these topics, but to really learn them.  So, when you read, don’t just skim.  Read to learn.  That means taking notes – and reviewing them.

Put a chart on the wall with the list and give yourself a gold star when you finish a topic if you have to, but find a way to make sure you cover all the topics (at a steady pace) during the year.

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Learn something (in detail) from at least one patient every day.

It’s really easy, as an intern, to get caught up in the work and forget that you are fundamentally here to learn – not to provide service.  Make it a daily habit to learn in detail about one patient in your care.  It will overlap nicely with your goal to read a complete textbook.  When you admit a patient with pneumonia, read the section (and make notes) on pneumonia and then check it off your list.

One other important point (that none of us like to hear) – You will make mistakes. Be humble, be honest, and learn from your mistakes. The mistakes you make (and maybe more importantly your “near misses”) are absolutely your most valuable teacher.  When you do make a mistake, use it as the topic you will review for the day. You are going to be really upset but be easy on yourself.  Being upset is the mark of someone who cares, but don’t let it escalate beyond a healthy response. Talk to your mentors and senior residents.  They’ve been there.

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Do at least one thing to take care of yourself every day.

This may sound trivial, but it’s not. If you can, try to eat well, get some exercise and be social every day.  At a minimum, though, pick one specific thing you are going to do for yourself and then do it.

Eat well

Get Some Exercise

Be social

Cold Summer Treats

It’s summer and it’s hot.  I’m on call this weekend.  That combination made me think about cold comfort food I could take to work.

Chocolate (in any form) is always the answer… but I decided maybe I could find something a little more healthy (and a little less caloric) that could serve as the “treat” we all crave when we are working hard on call.  I’m thinking the team will like a little Salpicon mid afternoon tomorrow…

Salpicon – a sparkling fruit drink from Columbia

This soup looks delicious, but with the heavy cream probably isn’t in the “low calorie” list.  You can substitute milk or yogurt to cut calories (without too much sacrifice of taste).  But, then again, as an on-call treat this still beats McDonald’s!  This is just one example of cold soups – which are great for summer on-call days.

Cold avocado soup

Smoothies are great comfort food – but logistically not easy when you are on call.  If you love smoothies, you might want to invest in an inexpensive single-serve blender.  Take the fruit in a baggie, put some yogurt and ice cubes in… instant smoothie.  Alternatively, you can blend your smoothie at home and put it in a container in the refrigerator that you can shake up before drinking.

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Banana mango smoothie

May’s Healthy Habit: Eat Breakfast Every Day

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to eat breakfast everyday.

Granola with Yogurt & Berries from zestycook.com

Most residents and medical students start their day early.  At 5 am, no one wants to eat a big breakfast.  But, you really should eat something as you are heading out the door.  By 9 or 10 am, you’ll be hungry – and the muffins in the surgeon’s lounge (or breakfast at MacDonald’s) will be calling out your name.  You have to have a strategy to manage this rise and fall in insulin (and accompanying “starvation”).  If you don’t, you’ll end up eating nothing but fast food (and the box it comes in).

Physicians in practice and training should probably make a commitment to eat two breakfasts, not just one – an early breakfast to literally “break the fast” from the night before and a second breakfast in the mid morning.  (aka “Elevenses”)

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A good breakfast should give you a balance of protein and carbohydrate, with a little fat.   Here’s a list of suggestions for breakfast that provide the right mix of nutrients and are easy (fast) to prepare:

  • Cold cereal with milk
  • Yogurt with cereal and fruit
  • Oatmeal or other whole grains with milk +/- toppings
  • Leftovers from last night’s dinner
  • Frozen waffles or toast (whole grain is better) with peanut butter
  • Bagel or toast with cream cheese and salmon
  • Rice (or other grains) with eggs
  • Energy bars
  • Sandwiches
  • Egg mugs
  • Smoothies
  • Breakfast tacos (see below)
  • Scrambled eggs (plus whatever you want) in a tortilla
  • Healthy fast food
  • Homemade muffins or breakfast bars (make a batch on the weekend)
  • Hardboiled eggs and fruit

Healthy breakfast sandwich from foodnetwork.com

MLBs Breakfast Tacos

 

These breakfast tacos are my “go to” breakfast for hectic mornings.  I make them on the weekend in a big batch to freeze for the week

Buy 10-12 whole wheat tortillas, 1 can of fat free refried beans, 1 bag of reduced fat shredded Mexican cheese.   (if calories aren’t an issue for you, use regular refried beans and shredded cheese)

Spread all the tortillas out on the counter and divide everything up between them.

Add whatever else you want:

  • cooked chicken or turkey (grilled in the deli is best)
  • Sausage (regular or veggie)
  • Corn
  • Rice
  • Bell peppers or Roasted red peppers (from a jar)
  • Fresh or canned green chiles

Put the tacos in the freezer in individual freezer bag .  Put the individual bags in a big freezer bag if you want to further limit freezer burn.

2 minutes out of the freezer and into the microwave = breakfast.

Breakfast taco from cleananddelicious.com

Other links to ideas for fast, healthy breakfasts

Why You Should Eat Breakfast from wellnessrounds.org

Healthy breakfast: Quick, flexible options to grab at home from mayoclinic.com

10 Quick, Healthy Breakfast Options from thedailygreen.com

10 Tasty, Easy and Healthy Breakfast Ideas from zenhabits.com

March’s Healthy Habit: Get Cooking

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

Last week I had a fairly common conversation with one of my residents.  She told me that with her schedule it’s almost impossible for either parent to cook for the family.  Secondly, she said when she does shop for food, she buys everything she thinks she might need… and half of it goes bad in the refrigerator.   They have resorted to picking up take-out as their solution to the problem.  There are at least two major problems with this strategy (and a lot of other minor problems): 1)  It costs a LOT more and 2) It is clearly not going to be as healthy.

I know this is a common scenario, hence why this month’s resolution is to cook at least 3 meals a week at home.  It’s doable!  Here’s how to get started:

Change your mindset about cooking.

Cooking is not hard and it doesn’t take as long as you think.  There are some basic skills you have to know, but you can start small and add new skills one at a time.  Make up your mind that you are going to acquire this important skill and practice!  Start with one simple act – sautéing an onion.  Here’s how to cut up an onion and how to sauté.  If you get this one simple skill down, you’ve learned the beginning of many, many recipes!

Make a plan

Decide ahead of time what you are going to cook and write it down. You can map out the whole week if you are a “gunner” – but,  at a minimum a) find 3 recipes for the week b) make a shopping list for the ingredients in those three recipes and c) go shopping.  If you plan ahead, you’ll have everything you need – but not a lot more (so no more growing interesting molds in the back of the refrigerator).  You’ll also be able to really eat well when you are on call (which is the hardest day to plan for).

Remember the pizza rule.

No one who is really busy has time to do fussy cooking.  You should look for recipes that take less than 30 minutes (the time it takes to order a pizza).  I’ve posted a lot of recipes that meet this requirement (use the tag marked “recipes” to the left of this web page).  Another strategy is to pick a cookbook, one issue of a magazine, or a website (some of my favorites are listed below) to choose the week’s recipes.  Another option is to subscribe to a site that will send you weekly menus (and will also automatically make your shopping list) – like Six O’Clock Scramble ($54.50/year) , Send Me Recipes ($65/year), Dinner Planner, ($60/year), or Make Dinner Easy (free).

Cook ahead for the week

It’s boring to eat the same thing over and over… but it beats buying fast food on the way home.  If you cook a big casserole or stew on the weekend, you’ll have it for meals on call, late at night or lunches.  If you really want to cook just once for the entire week, you can double the recipe or make two different dishes at the same time, and freeze portions for later in the week.

Supplement your main dish with lots of fruits and vegetables

If you don’t have a steamer basket, this is a cheap piece of kitchen equipment that is really worth having.  Almost any vegetable can be sautéed or steamed and it’s really easy to do.  Buy vegetables fresh, wash them, dry them and then store (clean) in the refrigerator (one less thing to do when you are tired). Refrigerator to plate will be less than 10 minutes for most veggies. (Here’s a table of cooking times for vegetables.)  Leftover steamed vegetables make a great “salad” by themselves (just add some olive oil, vinegar, salt and pepper) or as an addition to other salads.  You can also toss them into scrambled eggs or an omelet.  Having steamed potatoes in the refrigerator is particularly helpful – they are great in salads, with eggs, or just as a snack.  Frozen vegetables are more expensive, but are perfectly fine, too.

Make a list of  “emergency” meals (<5 minutes) for nights you are completely exhausted and really, really don’t want to cook. (And keep these items in your pantry and/or refrigerator.)

Here are some ideas to get you started:

1.    Scrambled eggs or egg whites (with leftover veggies and/or cheese if you have them) with toast.

2.    Angel hair pasta (takes 3-5 minutes) with bottled spaghetti sauce with a green salad

3.    Veggie (or regular) hamburgers (from the freezer) with a green salad

4.    Couscous with canned beans, canned tomatoes and any leftover (or frozen) vegetables you have

5.    Sandwiches

6.    Pancakes

Websites for “pizza rule” recipes

eatingwell.com

cookinglight.com

myrecipes.com

foodnetwork.com

My favorite magazines to cook from

Cooking Light

Bon Appetit

Clean Eating

Vegetarian Times

Cookbooks worth buying

How To Cook Everything

Joy of Cooking

The Silver Palate Cookbook

The Art of Simple Food

The Moosewood Cookbook

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Clementines

I’m beginning to think that Clementines are the perfect winter food item for busy people.  They are very portable, easy to peel and usually seedless, which makes them very easy to eat.  They are small, so they can fit in a white coat pocket.  Two or three make a great fruit portion so you can feel righteous in your good food choices.  They are really sweet, too, so eating them feels like a real treat. You can buy them by the pound in some stores, but more commonly they come in a box.

Clementines are hesperidiums (a subset of citrus fruit).  They are a small type of mandarin orange.   (the same as you get in the cans).  They are more perishable than oranges, so keep them in the refrigerator crisper drawer.

“The origin of clementines is shrouded in mystery. Some attribute their discovery to father Clement, a monk in Algeria, who tending his mandarin garden in the orphanage of Misserghim, found a natural mutation. He nurtured the fruit tree and subsequently called it “clementino”. Others, like Japanese botanist Tanaka, believe that clementines must have originated in Asia and found their way through human migration to the Mediterranean. Whatever their origin, the fact is that clementines found their natural climate and soil in Spain, where they developed their particular aroma, sweetness and taste. Commercial production of clementines began in Spain in 1925. Today there are 161,000 acres dedicated to the cultivation of clementines.” (From producepete.com)

Clementines are a great addition green salads, grain salads, chopped vegetable salad, jicama salad … really any kind of salad.

clementine-salad

Here are some other recipes, some easy (within the “pizza rule” and others that take a little more effort – good for cooking on a day off.

Chicken Paillards with Clementine Salsa – Paillard just means a flattened out chicken breast – you can use this salsa on plain chicken breasts or fish if you prefer.  You can use clementine gremolata (another kind of salsa) on chicken or fish, too.

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Caramelized Bay Scallops with Clementines and Cauliflower

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Clementine-Chipotle Roasted Chicken Served with Yellow Rice and Avocados

Clementine Cake

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January’s Healthy Habit: Fruits and Vegetables

I had already decided that I would propose a “resolution” every month this year for myself and anyone who follows this blog when I came across Cooking Light’s 12 healthy habits.  Cooking Light is one of my favorite magazines, so I’m going to take their idea and run with it!

It just makes sense to spend 30 days working on a single habit to change, rather than creating a long list of resolutions without an endpoint. If this idea works for you, take these habits (one at a time) and work on them for a month.

Here is January’s healthy habit:

Add at least 3 servings of vegetables and fruit to your daily diet

Here’s some suggestions for how to accomplish this goal.  These are some of my ideas and other ideas compiled from suggestions on thedietchannel.com, nutrition.about.com, cancer.org, and health.harvard.edu

  • Take fresh fruit or veggies with you to work to eat as a morning and afternoon snack.  The best fruit for your pocket are apples, clementines carrot and celery sticks, cherry tomatoes (in a Ziplock bag), and grapes (in a Ziplock bag).
  • Cut-up celery, carrots, bell pepper, cucumber, etc and keep them front and center in your refrigerator for snacking.   If you don’t like them plain, dip them in hummus or ranch dressing.  They’ll be fresher if you do this yourself, but if you need to, buy them already cut up in the grocery store.
  • Add fruit like berries, a banana or a cut up peach to your cereal in the morning.
  • When you shop, buy the ingredients to make a mirepoix, chop them up and store them in the refrigerator.  A classic mirepoix is carrots, celery and onion.  The Cajun “trinity” is a variation – celery, onion and bell pepper.  Pick anything that can be cooked (mushrooms, bell peppers,  are a good addition), and chop them up when you get home.  Grab a handful for stir-fries, salads, omelettes or soup.
  • Steaming vegetables is really easy and very fast.  If you don’t have fresh vegetables (or don’t want to take the time to steam them), make sure you keep steam and serve frozen vegetables in your freezer as an easy way to add vegetables to your meals at home.
  • Keep frozen fruit in your freezer to throw in a blender with yogurt or milk to make smoothies.
  • Dried fruit is a good occasional substitute for fresh fruit, but beware – it’s very caloric!
  • If you are making a sandwich to take to work, pile on veggies – spinach, shredded carrots, cucumbers etc.  Use avocado instead of mayonnaise.
  • Fruit or vegetable juice is not a great substitute, but will do in a pinch.  Most fruit juices are high in calories.  It’s always better to eat the fruit if you can so you get the fiber and other nutrients, but if there are no other options, juice is better than nothing!
  • Applesauce and canned fruit (in water) can be bought in single serving portions, or you can share larger portions!
  • If you are buying food for lunch in a cafeteria or fast food restaurant, look for vegetable soup or a salad bar than lets you pile on the veggies.
  • Sweet potatoes can be microwaved in 10-12 minutes and make a great meal when paired with a salad or some frozen veggies.
  • Choose desserts that are fruit based – and have as much fruit as possible.  Chocolate dipped strawberries or a berry cobbler are better than cheesecake!

Clean Eating

If one of your New Year’s resolutions is to lose weight, or just to eat “better” you might want to consider looking into the concept of “clean eating”.

Although eating clean works to lose weight, it’s not really a “diet” in the usual sense of the word. Clean eating is a lifestyle and way of eating that is medically very sound.  It’s getting rid of the junk food, eating often enough to maintain your energy and  “shopping the periphery” of the grocery store.  (Think about it – the food being sold on the periphery of the grocery store is mostly non-processed.)

Everyone has had the (horrible) experience during a call day of not eating anything all day, having a big meal in the evening  (often McDonald’s or an equivalent) and then being brain-dead from lethargy for 2-3 hours. In addition to helping you control your weight (and preventing weight gain during medical school and residency),  “eating clean” will prevent the on-call lethargy you get from eating junk food and can give you sustained energy during long work days.

In a nutshell, here are the “rules” for eating clean (Revised from lists published on ehow.com , eatingcleanworks.com and cleaneatingonline.com)

How to Eat Clean

1. Eat 5-6 small meals a day: breakfast, lunch, dinner and 2-3 snacks – and don’t skip meals! This means taking a cooler with you to work and/or having choices like meal replacement bars in your pocket. It’s important to eat every 3-4 hours to keep your insulin levels (and energy levels) from waxing and waning too much. It’s really important to never skip breakfast!

2. Eat a serving of complex carbohydrates at every meal (about the size of your fist). Grains should be unprocessed as much as possible (more fiber = more satiety) like brown rice or quinoa .

3. Minimize or (preferably) completely eliminate processed food, soft drinks and alcohol.

4. Eat fruits and/or vegetables at every meal.

5. Eat a serving (about the size of your palm) of lean meat, chicken or fish at (almost) every meal. Vegetarian options are fine, too (beans, tofu, etc).

6. Read labels. Try to avoid foods with white flour, sugar and sugar substitutes, saturated fats and trans-fats.

7. Take good snacks (like premeasured servings of nuts) with you to work so you don’t get tempted by vending machines and breakroom junk food.

8. Don’t beat yourself up if you cheat – in fact, you’ll probably need to have a cheat day (on purpose) every once in a while. But recognize it’s a cheat day and not a permanent change from your new way of eating.

9. Keep things interesting by checking out recipes and cooking for yourself. You can subscribe to Clean Eating Magazine or at least pick up an issue to check it out.  The Diet Rebels Cookbook: Eating Clean and Green, Clean Food: A Seasonal Guide to Eating Close to the Source with More Than 200 Recipes for a Healthy and Sustainable You and Tosca Reno’s Eat Clean Cookbook: Delicious Recipes That Will Burn Fat and Re-Shape Your Body! are cookbooks with good recipes for clean eating. Here’s some websites with recipes, too: cleaneatingonline, cleaneatingclub, eatcleandiet, cleaneatingmag

Farmer’s Markets

I just got back from the farmer’s market and decided to add to my previous thoughts about buying your food locally.

Houston is a little bizarre when it comes to produce.  Our growing season has a real lull in the summer when it gets so hot.  As the weather cools in October, the plants perk up again and we start seeing great produce reappear.

I’ve become convinced that food bought from local farmers usually has less contaminants, more nutrients and just tastes better.  It’s also clear that you are doing a good deed for the environment if you buy food that doesn’t have to be shipped to you.  But there is another intangible benefit of shopping at the farmer’s market for people who spend their days in intense work – it’s a social event that is very grounding (no pun intended).  It’s outside, it’s beautiful and – at least in Houston – there is good music, good coffee and a crowd of smiling people.

Take care of yourself by buying food that’s good for you.  If you are trying to follow Michael Pollan’s advise on how to eat well (i.e. “Eat food. Not too much. Mostly plants.” ) you can’t do better than buying your food at the farmer’s market.

Recipes for Medical Students and Residents

I love when I find new websites that provide great “pizza rule” recipes (recipes that take less time to prepare than it takes to order a pizza).  I just discovered Keep Your Diet Real, a site run by Corrine E. Fischer, MS, RD, LDN.  She’s not only a dietician, but she’s a professional food photographer, so the site is beautiful.  Her recipes are healthy, straight-forward and are great for the busy life of docs, medical students and residents.

Ten Healthy Breakfasts in Ten Minutes or Less

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Spring Roll Soup

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Wheatberry and Edamame Salad