Wellness Rounds

I was recently introduced to The Blue Jean Gourmet by a resident on our rotation.  The site’s byline is “Unfussy food from a fun-loving kitchen”.  I thought it would be a great addition to the “pizza rule” list.  For those that aren’t familiar with my “pizza rule”, it refers to any recipe that can be made in less time than it takes to order a pizza.

Cooking for yourself as a medical student, resident or practicing physician is key to eating well.  Let’s be honest, there aren’t good choices in most hospitals and clinics.  If you want to feel well you have to eat well… and that means making the effort to cook for yourself!

Green Bean Lentil Salad

Tomato Bread Pudding

Grilled Halloumi

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

Spring Roll Soup

Wheatberry and Edamame Salad

In keeping with the “pizza rule” (everything we cook needs to take less time than it takes to order a pizza) and the hot weather…. Here’s some new recipes from a site I just discovered www.danispies.com.

Some of you don’t cook or, put more positively, are learning how to cook.   Dani Spies not only has fabulous, healthy and easy recipes but has also posted “Cooking 101” videos like this one called Egg 101.  These are a great resource if you are trying to learn the basics.

Here’s three recipes that meet the “pizza rule” and will make great dinners or on call lunches.

Chunky Greek Salad Topped with Sardines

Clean and Simple Asparagus Pasta

So, so Simple Shrimp Tacos

I’m addicted to watching the Tour de France.  It’s an amazing athletic event, and the images (at least on HD) are simple astonishing.

There was a really great “side story” on tonight’s Tour broadcast about Dr. Allen Lim, a PhD sports physiologist.  The segment was specifically about his rice cakes – a real food equivalent of a commercial energy bar used by the Radio Shack riders.   http://dailyburn.com/recipes/dr_allen_lim_rice_cakes.

I haven’t made these yet, but I’m pretty certain they are going to be really good and – more importantly – a great call/energy food for busy students and residents.  He has some other recipes that would probably be good on call energy food, too

Here’s a video on how to make these rice cakes.   http://www.cycle-ops.com/videos.html?id=50

Photo from http://bikefleet.blogspot.com/2009/03/allen-lims-rice-cakes.html

I was really inspired by a recent post by veggielady4life (a medical student, photographer and foodie!) on taking salads for lunch.  For medical students in basic sciences, this is a great “energy” lunch that lets you stay alert in class.  For students on rotations and residents, a fresh salad is a great lunch and an even better middle of the night meal when you are on call.

The concept couldn’t be easier – put lettuce, spinach, or the greens of your choice in a big container.  Top with protein, cheese, veggies, nuts and/or fruit.  If you don’t care what it looks like, it’s also really easy to dump it all in a big zip-lock bag.  When it’s time to eat, pour the salad dressing in the bag with the salad, shake, and then serve yourself from the bag.

Protein:  Beans from a can, beans you make yourself with a crockpot or pressure cooker (which saves money and avoid excess salt and additives), canned tuna, cooked chicken from the deli, prepackaged meats (look at the labels to make sure you aren’t getting a lot of additives you don’t want), shrimp, etc.

Cheese:  Shredded cheddar, Monterey jack or Mexican cheese (reduced fat or regular), feta, goat cheese, thin slices of parmesan

Veggies:  Any leftover in your refrigerator!  Another good idea for this is to buy what you need for a mirepoix when you do your once a week shopping.  A mirepoix is the basis of  French cooking and is one part onions, one part carrots, and one part celery.  The Cajun trinity is similar but substitutes green bell pepper for the carrots.  If you buy the ingredients for a mirepox (or trinity) and chop it up on the weekend, you can use handfuls in salads, omelets, soups, etc all week.  (You can add other things, too, like mushrooms, red bell pepper, etc – anything that can be eaten raw).  If its a really busy week and you don’t have time to chop up vegetables, you can used canned green beans, corn, beets… whatever vegetables you like.

Nuts and/or fruits: Adding some dried fruits and nuts, sunflower seeds, etc, will add some extra nutrition.  Fresh fruits like blueberries, strawberries, sliced peaches are delicious in salads.  Canned fruits, especially mandarin oranges, are good, too.

Salad dressing. Don’t put the dressing on the salad until you are ready to eat.  (The French say it “cooks” the salad… but the result in any language is soggy salad.) My favorite dressing is a homemade vinaigrette.  Start with vinegar (red wine, white wine, sherry or balsalmic), a clove of diced (not crushed) garlic, a healthy teaspoon of good Dijon style mustard, salt and pepper.  Stir these all together until the salt is dissolved and the mustard is blended with the vinegar.  Add olive oil while you are stirring (or shake it up at the end.)  The classic ratio is 1 part vinegar to 2 parts oil, but you can add less oil to taste.  I usually squeeze a little lemon juice in, too.  There are many different French vinaigrettes, so experiment!

The easiest thing by far is bottled salad dressings.  Be careful about calories (if you are watching your weight).  If you take salads to work regularly, you may want to leave the bottle there (unless the food snatchers raid your refrigerator on a regular basis).

http://allrecipes.com/Recipes/Salad/Green-Salads/Top.aspx

http://hubpages.com/hub/Favorite-Salad-Toppings-Lessons-From-Restaurant-Salad-Bars

http://www.fitsugar.com/Nutritional-Information-Salad-Toppings-7598444

Making a healthy sandwich for lunch is a great way to insure that you don’t eat the leftover pizza from last night’s call team.  A really good sandwich which balances protein and carbs is also a great way to get through a long call night.  Keeping your energy up when you are up all night on call is difficult but there are tricks to maintain energy for call. The most important way to have good energy on call is to eat good quality food every 3-4 hours. Sandwiches are great for call because they are so easy to make, easy to store and easy to put in a pocket to eat on the go.

Pick good ingredients whenever you can.  It’s worth paying a little more to have food that is just food (and not a lot of fillers, corn syrup, transfats, etc).  Make sure you get high quality bread – 100% whole wheat is best, but if you really don’t like whole wheat, at least try to get as much whole grain in the bread as you can. Whenever possible, add veggies to add nutritional value.

Peanut butter sandwiches have the advantage of not needing refrigeration.  You can keep them in your white coat pocket if you want to (an advantage on a busy day).  You can stay traditional (i.e. peanut butter and jelly), or up the nutritional content by adding banana (or other fruit) or with unusual combinations http://www.epicurean.com/articles/beyond-jelly-reinventing-the-peanut-butter-sandwich.html

Egg salad sandwiches are great in the middle of the night when you are on call.  101cookbooks.com egg salad recipe is a pretty classic recipe which is really wonderful.  If you want to up the protein and decrease the fat try the  Eat Clean Diet egg salad recipe. There are other sites that give you other options for traditional egg salad recipes or  healthy egg salad recipes

Tuna or chicken salad sandwiches can be made with classic recipes, or less traditional ingredients that up the nutritional content such as spicy tuna salad, or other unique tuna salad recipes.

Lean meat (chicken, ham, pork, beef) makes a great, high protein sandwich.  Add cheese, tomatoes, spinach, shredded carrots or other veggies to increase the nutritional value.  If you are watching your weight use low-fat cheese and avoid mayonnaise.  If you use hummus or avocado instead of mayonnaise or other spreads you’ll also make the sandwich more nutritious.

Here are a few other sites to help you be creative with your sandwich ideas:

Beyond Peanut Butter and Jelly: Healthy Sandwich Choices for Everyone

Healthy Sandwich Recipes & Tips

Love Your Lunch: 10 Healthy Sandwich Recipes

Healthy Sandwich Ideas

Good Nutrition is in the Bag: Healthy Sandwich Alternatives

I made a great dinner last night that took about 5 minutes to cook – absolutely within the “pizza rule” for medical students and residents (i.e. a recipe should take less time to cook than it takes to order a pizza).  It’s the kind of recipe I wish I’d had when I was a student/resident, so I thought I’d share it.  I know that many of you are not from Texas (or another state with a tradition that includes salsas), so here’s the basic concept.

1.  Buy tortillas (I like corn the best, but flour or whole wheat flour tortillas are fine).

2.  Choose a protein.  I prefer fish or shrimp (because they are so fast) but any meat will work.  An even easier alternative  is to buy a roasted chicken (or cooked beef or pork).   You can also use beans or tofu if you are vegetarian.

3.  Make a fresh salsa (see below)

When it’s time to eat:  Cook or heat up the meat (or alternate protein), heat up the tortillas (1 minute in the microwave).  Put the meat (or alternate protein) into the tortillas and top with the salsa. These soft tacos can make a compete meal, but serve a side of vegetables if you want … it’s a great dinner (and lunch the next day at work).

Salsas are best when you make them yourself.  You can buy good salsa in a jar but it’s never as good (or as healthy) as the ones you make.  Leftover fresh salsa can be used as a dip for tortilla chips – as is (diced) or blended.

The salsa I made last night was easy:  1 mango, 1 green tomato, red onion, cilantro, a jalapeno pepper – all diced fine and then mixed with lime juice and seasoned with salt and pepper.   All traditional fresh salsas are a variation on this same theme – tomato with or without fruit, cilantro, onion and peppers to taste.  On of the best examples is “Pico de gallo” (shown below), which is one of the most classic salsas – red tomato, onion, cilantro and jalepeno with lime juice and salt.  http://en.wikipedia.org/wiki/Pico_de_gallo

You can be creative!  Mix and match from this list or check out some of the recipe links  below

• Vegetables:  tomato, tomatillo,bell peppers, corn, cucumber
• Fruit:  melon, watermelon, peach, pear, mango, nectarine, avocado
• Onion:  white onion, yellow onion, green onions, garlic
• Chiles:  jalepeno, serrano, chipotle
• Spices:  oregano, parsley, cilantro

Links to salsa recipes:

http://allrecipes.com/Recipes/Appetizers-and-Snacks/Dips-and-Spreads/Salsa/Top.aspx

http://www.salsa-recipes.com/index.html

http://www.fresh-salsa-recipe.com/

I’m going to periodically add some recipes to the blog that meet my “pizza rule” i.e. if it takes longer to cook than it does to order a pizza it’s not going to work… http://wellnessrounds.org/cooking-for-yourself-in-medical-school-and-residency/

WHOLE WHEAT SHELLS WITH ASPARAGUS, PEAS, FETA AND MINT

This is a great vegetarian dish and would make enough for a lot of call nights!.  The recipe calls for garlic oil (which I’ve never heard of).  I’d skip it or, if you really want to add a little garlic taste, mash up a couple of cloves in some olive oil (like 2 tblsp) before you start and let it sit while everything else is cooking.  You can drizzle the olive oil over the pasta at the end.

http://www.vegetariantimes.com/recipes/10964?utm_source=Vegetarian&utm_medium=newsletter&utm_campaign=vege174

GRILLED FISH WITH FRESH PEA SAUCE AND PEA AND TOMATO RELISH

Here’s the original url for this recipe which is delicious (but a little fussy and violates the pizza rule)

http://www.foodista.com/recipe/4V8PPYZF/grilled-fish-with-fresh-pea-sauce-and-pea-and-tomato-relish

Here’s the resident friendly version:

GRILLED FISH WITH FRESH PEA SAUCE AND PEA AND TOMATO RELISH  (PIZZA RULE VERSION)

2 servings

• 2 filets of the freshest white fish in the store (Tilapia, snapper, etc)
• 2 tablespoons olive oil  (cut to 1 tablespoon or use Pam to save calories)
• 1 package frozen peas
• 1 cup chicken stock  (buy the 4 packs of one cup each)
• 1 shallot (if you can’t find one, use part of the red onion)
• 2 cloves of garlic (don’t cheat on fresh garlic)
• Salt and pepper

• 2  Italian Roma tomatoes
• ½  minced red onions
• 1/4 cup chopped black olives  (buy in bulk at Whole Foods – use Nicoise or herbed olives of Provence – can buy small jar, too)
• 2 tablespoons chiffonade of basil  (chiffonade = finely sliced.  Don’t cheat on the fresh basil, either)
• 3 tablespoons extra-virgin olive oil  (cut to one table spoon if you are watching calories)
• 2 Yukon gold potatoes cut into 6ths or 8ths

Start with the base of the sauce

• Saute the shallot (or onion) in the olive oil
• Add the garlic until you smell it (more and it will burn = bitter)
• Pour in the chicken stock
• Bring to a boil
• Add the potatoes – drop the heat to a simmer and cook until just fork tender (~8-10 min)
• Pour in the frozen peas – cook for 3 minutes
• Take the potatoes out and save

Take out a third of the peas with a slotted spoon and put in a bowl to use later

• Put everything else (minus the peas and potatoes you took out) into a blender until smooth.  (If you don’t own a blender, this is a critical tool for residents so go out and get one!  Smoothies are a key food item for medical students and residents and blenders are cheap!)

Make the relish

• Cut up the tomatoes, olives, basil, red onion
• Add to the peas you saved from above
• Add the olive oil

“Grill” the fish

• Use a grill pan or non-stick sauté pan (another important piece of resident equipment)
• Put olive oil in the pan (Pam if you are watching calories)
• Cook 3-4 minutes per side

Assemble the dish

• Pour the sauce into a bowl
• Put the fish on top
• Arrange the pieces of potato around the edges
• Put the relish on the fish

A variation (if you like Mexican flavors)

• Use tomatoes, corn, cilantro, jalepeno and onion for the relish
• Use frozen corn instead of peas

MLB’S EASY MEXICAN SOUP

8 servings

• 1 tsp olive oil
• 1 onion, diced
• 1 red bell pepper, diced
• 4 carrots, diced
• 4 stalks celery, diced
• 8 cups (two containers) chicken broth
• 1 roasted chicken (bought already cooked), skin removed and meat broken up into small pieces
• 10 oz frozen corn
• 1 can pinto beans
• chopped cilantro
• 2 avocados
• pico de gallo (buy at the store)*

Saute vegetables in olive oil until they are soft

Add chicken broth, bring to a boil

Lower heat to simmer and cook 10-15 min (until vegetables are mostly cooked)

Add chicken, corn and pinto beans

Cook another 5 minutes on simmer

Garnish bowls with chopped avocado (1/4^th per serving), cilantro and pico de gallo

Optional:  Add cooked rice and/or shredded cheese

* to make pico de gallo (if you can’t find it ready made)  combine 3 diced tomatoes, 1 diced onion, chopped cilantro, one diced (fine) jalapeno, salt and lime juice.  This is a great dip for chips or to put on grilled fish or chicken, too.

If you are not up to eating a big breakfast when you wake up, that’s ok.  Particularly in residency you may be getting up too early to be hungry.  As you are brushing your teeth make yourself drink a big glass of water.  Even if you are not hungry at all eat a little something  like a piece of fruit or a cereal bar.  (Set them out on the counter the night before to grab and eat in the car if you have to.)  There will be days that you may not get anything else to eat until the middle of the day, so don’t forego all nutrition in the morning.  Take a  ”real” breakfast to work with you and eat it when you can between 8 and 10.   

 

Easy breakfasts for doc’s on the go

 An energy bar (e.g. PowerBar)

Frozen breakfast taco (see recipe below!)

Last night’s dinner (such as rice and meat, rice and an egg, noodles)

A smoothie (you can put the ingredients in the blender the night before, then just put it on the blender in the morning)

Peanut butter and jelly sandwich

Frozen pierogies heated up in a microwave

Instant oatmeal (add nuts and dried fruit if you want)

Cereal and milk (add fruit to make sure you get fruits into your diet)

 

MLBs Breakfast Tacos

Buy 10-12 whole wheat tortillas, 1 can of refried beans, 1 bag of reduced fat shredded Mexican cheese.   Spread all the tortillas out on the counter and divide everything up between them. 

Add whatever else you want: 

8oz of cooked chicken or turkey (grilled in the deli is best)

Sausage (veggie soy sausage is good and tastes fine in the tacos)

Corn

Rice

Roasted red peppers (in a jar)

Chiles

 Put the tacos in the freezer in individual freezer bags (Ziplock,etc) .  (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.

Most medical students and residents eat poorly.  It’s not really a surprise – the days are packed with work from sun-up to sun-down.  There are no planned meals because there can’t be.  Food is a quick bite when it is available.  It’s feast or famine.  On the far end of the scale, the stereotypical diet of a resident is no breakfast (but usually coffee), a doughnut and coffee grabbed on the run once you get to work, some mid-day meal of fast food, and pizza on call.  Food, particularly fast food, becomes solace.  In the stressful world of residency, this kind of “comfort food” becomes a “reward” for the hard work and tribulations. It’s not rocket science.  This kind of diet doesn’t give you the energy you need to function at your peak.  It is also a diet that is very likely to lead to weight gain.  In your 20s, your body can cope with this suboptimal fuel, but it’s not ideal.  However, what “works” in your 20s won’t work as you get older and could even be responsible for a heart attack, diabetes, or other medical problems in your 40s and 50s.  On a more philosophical level, you would never advise this kind of diet to one of your patients.  None of us want to be hypocrites.

The answer is to cook for yourself.  Not everyone likes to cook, and not every one knows how.   I’m going to make a case that you should learn.  Trust me – if you can learn to take out an appendix, or diagnose a pneumonia, you can learn to cook.   I’m going to assume that you are single for the sake of this description.  But, if you have a significant other, it’s even more important to cook at home.  He or she can participate in helping with the meal preparation, and, by doing this together and for each other, there is added benefit for your relationship.  Having dinner at home with a significant other will become an “anchor” to your day that will become very important to you.  As hard as it is to work around a busy schedule, if you can eat together, and have a real conversation, you will both benefit greatly.

Cooking is a wonderful therapy for the stress of medical school and residency.  If you’ve never learned how to cook, this is a hard time to learn complicated techniques, but it’s not hard to learn simple techniques.  There are several advantages of cooking for yourself that outweigh (on most days) the hassle of spending the time.  The act of cooking for yourself can be a time of “decompressing” from work.  Arranging vegetables, cutting them, smelling the odor of the food appeals to all your senses and is a moment in the day that you can intentionally slow down.  It’s very important that the recipes you choose are simple and quickly prepared.  No one wants to come home to a 2 hour task in the kitchen after a hard day.  Cooking for yourself has other benefits as well.  First, it is tangible evidence that you are taking care of yourself.  This is not a trivial point.  There are days during your training when it seems no one is taking care of you.  Having concrete evidence that you are caring for yourself is an antidote to that feeling.  Secondly, you will eat better.  By cooking from fresh ingredients, you will decrease the amount of pre-packaged and fast food.  Even without medical school, you know that this will result in better nutrition.  Thirdly, you will eat cheaper.  Other than the “free” pizza (ethically debatable, but financially clear), processed food is usually more expensive.  And lastly, you can share.  It isn’t any more work to make 4 or 6 portions of a dish than it is to make 2, and it usually isn’t that much more expensive, either.  If you can convince one of your colleagues that this is a good idea, you can cook for each other on alternate days.   Likewise, you can cook larger amounts and, using freezer ready containers, freeze portions for yourself for the future.  Doesn’t homemade pasta with a side of fresh vegetables really sound better than the greasy middle of the night food that is available in most hospitals?   It’s true that you can’t cook just anything with the kind of schedule you will have in medical school and your residency.  But, there are few key rules that will make it possible for you to do this, enjoy it, and eat well.

Rule 1:  Don’t cook anything that takes more than 30 minutes to prepare.

Let’s be realistic – you are not going to walk into your home at 8 o’clock at night, hungry, and spend an hour preparing something.  But – there are very nutritious dinners that take less than 10 minutes, so getting home late is no excuse.

Rule 2:  Plan ahead.

The first step in preparing dinner for most busy people is to open the refrigerator door and ask “What can I eat tonight?:  If you are anything like I was in residency, the refrigerator had some cheese, some vegetables (often way past their prime), and maybe some leftovers.  Not very appetizing.  There is an easy way to prevent this from happening.  On whatever day you have off and have time to shop, spend 30 minutes making a menu.  Start by making a table for the week with what is happening.

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after rounds
Thur
Fri					On call
Sat

Once you have an outline of your week, fill in the blanks with the meals.  Now, most of us can handle “hamburgers” or “Raisin Bran” as a menu item… but it’s more fun, and healthier to branch out a bit.  So, if you are not used to looking for new things to cook, how do you find recipes?  Cookbooks can be fun, particularly if you are looking for a particular ethnic food or a style (e.g. low-fat) of cooking.  If you like cookbooks, and bookstores, find the used book store nearest you and go to town!  There are also web sites for recipes.  Many of them also have “cooking lessons” on line.  Most cooking shows have a web based recipe site as well.   So, say you start by searching the web and find this recipe. (for this particular recipe, I’m assuming you have no concerns about calories)  It looks easy, and like it would taste good.   So you print it out.

NEW ORLEANS PASTA

ESSENCE OF EMERIL (FOODTV)   SHOW #EE123 – http://www.recipesource.com/main-dishes/pasta/11/rec1100.html

1 tablespoon olive oil

16 ounces chicken breast half, cut into strips (about 1/2 cup)

1/4 cup chopped chorizo sausage

2 tablespoons chopped green onions, plus extra for garnish

1/2 tablespoon chopped garlic

Tabasco and Worcestershire sauce

3/4 cup heavy cream

1/4 cup grated Parmesan cheese

1/4 pound shrimp, peeled and deveined

1/2 pound penne pasta, cooked al dente and tossed in oil to coat

Creole spice, salt and pepper

In a large saute pan heat oil, add chicken and sausage and cook 5 minutes, stirring often. Add green onions, garlic, 2 dashes each Tabasco and Worcestershire sauce or to taste, and cook for 1 minute. Add cream, cheese, shrimp and pasta. Cook, tossing, to heat through. Adjust seasoning to taste with Creole spice, salt and pepper. Serve garnished with green onions.

Yield: 2 servings

Now what?  First, cut and paste the ingredient list to a shopping list.  If you are compulsive, you can organize it into meat, dairy, produce, etc (it makes shopping easier, but it’s not essential).  You’ll need to add a vegetable or salad to balance this out nutritionally. (I picked broccoli as an example) If you can afford the calories, add a desert. (Ice cream in this case)  Then decide what night in your schedule this will work best.  This recipe will take about 12 minutes total so it would be great for a night you are getting home late.  You can either share the other portion with your significant other or you can take it with you the next day as lunch.  You can double the recipe and have it more than one night.   For example:

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after roundsThaw shrimp for tomorrow
Thur				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoliIce Cream	Freeze one portion for later
Fri				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli	On call
Sat		NEW NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli

Shopping list:

2 lbs chicken breast (16 oz x 2)

1/2 cup chopped chorizo sausage

1/2 pound shrimp, peeled and deveined

heavy cream   (need 1 1/5  cup)

Parmesan cheese  (need 1/2 cup grated)

Olive oil

Creole spice

green onions

garlic

broccoli (4 portions to steam)

One pound penne pasta

Ice cream

Rule 3:  Cook (or prep) today today to eat tomorrow

As soon as you get home from the grocery store:

• Freeze any meat that is for later in the week (and make a note to yourself to put in into the refrigerator to thaw a day or two before you are going to use it.)
• Wash the vegetables, dry them and put them away
• Wash lettuce for salads and dry completely (a spin dryer is the best).  Store in a zip lock plastic bag with a paper towel in the bag (which absorbs any residual water).  Make sure you squeeze out all the air you can before closing the bag.

Take advantage of days off to cook things that may take a little more time or effort.  While  you are watch the football game on Sunday, you can cook chili in a crock pot for Wednesday.  If you know that your vegetable stir fry on Tuesday is going to be after a long day, go ahead and chop all the vegetables and meat a day or two before when you have the time and have them stored in the refrigerator.   When Tuesday rolls around (and you are exhausted from work), you’ll have all the ingredients chopped and ready to throw in the pan.