I just got back from vacation and had the pleasure of attending a session where Shawn Brisby, the demo chef for Canyon Ranch in Tucson, gave us a great piece of advice …
“Have you ever gotten raspberries home and within a day they are mush with white stuff on them?”
He had my attention.
“The problem is that home chefs don’t keep their refrigerator cold enough. They should be set at 40 degrees.”
So I’ve been experimenting and … it works! (not that I doubted you, Shawn :-).
Step 1. Decide what you are going to eat for the week.
This planning is essential. It takes me 20-30 (very enjoyable) minutes to find recipes in a magazine (Clean Eating and Cooking Light are my favorites), one of my cookbooks or on line. Here’s what we’re cooking this week:
And, for breakfast for the week…
Step 2. Make a shopping list and go shopping.
Step 3:. Prep all the food for the week
This is what makes it work in terms of efficiency. For the rest of the week, when you get home, everything will be washed, cut up and ready to throw in the pan. I timed myself and it took 1 hr 22 minutes to turn the pile of veggies you see above into this:
An hour and a half is nothing compared to the time it takes when you get home late and really don’t want to do it. Turn on some music, chop while you are watching some football.. it is a great return on investment to insure you eat well!
Other helpful hints
- Get some fun containers. These are the ones I bought, but any food quality containers will work.
- Wash the other produce, cut everything up for all the recipes, spin dry them and put them in your 40 degree refrigerator. (If you don’t own one, get a lettuce spinner.)
- Wash the fruit and dry it before you put it in the refrigerator.
One other tip…. Make stock! I throw all the vegetable bits (peels, seeds, etc) into a pot with water and make vegetable stock while I’m working. In addition to using this stock for any soup we decide to make, we use it instead of water for rice or pasta to increase the flavor.
This morning I was lecturing to the first year medical, PA and DNP students. At the end of my embryology lecture I included some advice on how to eat well as a busy student. I talked to them about how to set a good example for their future patients, how to increase vegetables in their diet by making Mirepoix every weekend, shopping at the farmer’s market, and how to plan for the week. I also talked about why it’s important to eat breakfast. I told them about one of my favorite fast breakfasts, but forgot the second one!
MLB BREAKFAST TACOS
Here are the ingredients:
This is SO easy and really delicious. Put ~1/3 cup rolled oats in a bowl and add twice as much (~2/3 cup) liquid. (You may need more of both depending on your caloric needs)
My favorite liquid is kefir (liquid yogurt), but it can be milk, almond milk, soy milk, etc. Leave it in the refrigerator overnight. Eat it in the morning. That’s it!
You can add any variety of fruit, nut or nut butter the evening before or in the morning. My current favorite is blueberries and slivered almonds added in the morning.
It’s hard for those that haven’t been there to understand how medical school, residency and/or long hours in the hospital changes what and how we eat. There isn’t time to sit down to eat, there aren’t good choices and often, the only thing to eat is the “free” food at conferences. But…. Free food isn’t free. There’s a reason it’s cheap (poor ingredients) and that it “tastes good” (lots of fat, sugar and salt)… but it makes us feel terrible after we eat it. (Beware the middle of the night french fries!) More importantly, we aren’t providing the nutrients we need to take care of other people and ourselves. So, what’s the answer?
Spend the money and the time to invest in your health! Grabbing donuts or bagels in the surgeons’ lounge in the morning, pizza at noon-day conference and a hamburger at MacDonald’s in the middle of the night is terrible. (You know it’s true).
So what’s the alternative? Here’s a five-step, easy plan that will let you eat better, feel better and avoid gaining weight in medical school and residency. This is predicated on cooking your own food but you can use this plan if you don’t cook by buying prepackaged foods. But really…. If you can learn how to take out a gallbladder or care for ill patients in the ICU don’t you think you can learn how to sauté a few vegetables???
- Make a plan
- Make a shopping list
- Shop once for the week and (when you can) prep ahead
- Use your day(s) off to cook things that might take a bit more time and freeze some for other days
- Keep a few “instant” healthy meals in your pantry
Make a plan
Map out your week’s meals and snacks using the “pizza rule” (nothing you cook should take longer to cook than it takes to order a pizza). Pay special attention to call days. It’s important to have really delicious food which can be grabbed in a minute when you are on call. I use Evernote to make my list for the week so I can share it with my family:
If you like to cook, you probably already know where to find recipes you’ll like. If you don’t cook regularly, I post recipes on @drmlb with #CallFood that meet the “pizza rule” and would be delicious on call. Here are few other sites I use regularly: Eating Well, Cooking LIght, My Recipes, Food Network, Kayln’s Kitchen, Skinny Taste. If you use Evernote to organize your list, it gives you one other advantage – you can download their add-on and clip recipes from the internet directly to Evernote. Each “note” (i.e. recipe) in Evernote can then be shared with whoever you cook with (i.e. whoever gets home first can start dinner!). It also lets you search all your notes so you can easily find your recipes in the future.
Make a shopping list
I use Grocery IQ for my shopping list. This app lets you organize your grocery list by the aisles in your favorite stores to make shopping faster. It also allows you to share the list with your significant other which means that whoever is able to get to the store first has the updated shopping list! I don’t really use the “coupon” feature or the barcode scanner, but if you choose to use these functions, please use the FoodEducate app with it to make sure your choices are healthy!
Shop once and (when you can) prep ahead
Planning lets you spend less time in the grocery store and absolutely means less food wasted. When you get home from the store think about the meals you are going to cook later in the week. If your carrot soup on Tuesday calls for sliced carrots, diced fennel and chopped onions, chop them when you get back from the store on Sunday and put your “mise en place” in baggies or containers in the refrigerator. Cooking is not that time consuming…. but prepping is!
One other good trick is to make “mirepoix” on the weekend for the week. Diced onions, carrots, celery, bell peppers, etc can be prepped and put in a bag. It can be an instant stir-fry on nights when you need something fast. You can also put a handful in soups, omelettes, or wraps to get extra vegetables in your day. Mix it with leftover rice or other grains to make an instant salad (you can add tuna, if you want, too).
Use your day(s) off to cook things that might take a bit more time and freeze some for other days.
You need good “comfort food” when you are working hard, but it can be both comforting and healthy. For example, this recipe for spaghetti squash lasagna. The preparation for this recipe isn’t that hard (you can steam the spaghetti squash in the microwave instead of roasting it in the oven, for example) but it’s a little too long for nights when you get home late and are really tired.
Learning to use a pressure cooker (my favorite) or a slow cooker like a crock pot is a great way to cook up a batch of something when you are home and doing other things without spending a large amount of time in the kitchen
No matter what you make or how you make it, make enough to freeze individual portions and then store them so they will stay fresh. Don’t forget to mark the containers with a Sharpie and eat them within 3-4 months!
Keep a few “instant” healthy meals in your pantry
Despite my best efforts to plan, there are weeks when I’ve miscalculated amounts, don’t have enough time or just don’t want to eat what I had planned. When that happens, it’s great to have a go-to “instant” meal, which usually comes out of the freezer and pantry. Here are some to get your list started!
Moroccan Lentil Stew – (particulary good with harissa and served over couscous)
The senior class ends their formal education at Baylor with a capstone course called “APEX”. In addition to reviewing critical medical information, communication skills and other important aspects of becoming an intern, there are also wonderful lectures from faculty on “how to be an intern”.
One of the APEX speakers this year was Dr. Sally Raty, who stressed how important it was to take time to care for yourself.. but that you had to look for efficient ways to do it! She promised to share recipes that are easy and take very little time to cook. I’ll share the rest of the recipes on future posts… but here is the first one (which she adapted from this recipe).
These bars have a ton of ingredients, but they are easy to find, and this bar is way better for you than those processed, chemical blobs you’re spending $2+ on. I keep all of the dry ingredients for these bars in a basket in my pantry. I just pull the basket out and make the bars. The crumbs are amazing on vanilla ice cream….not that I would ever do that, but I’ve heard it is good.
3 cups raw oats (nothing fancy. Quaker 3 minute (not instant) oats are fine)
1/2 cup whole sesame seeds, or shelled sunflower seeds
1/2 cup shredded coconut (unsweetened is best, but sweetened is easier to find)
1 teaspoon ground cinnamon
1 teaspoon salt
1/4 cup brown sugar
1 cup vanilla Greek yogurt
1/4 cup + 2 tablespoons pure maple syrup or honey
1 cup peanut or almond butter
1 teaspoon vanilla extract
1/4 cup coconut oil, liquefied if solid (or just use canola oil)
1/2 cup chopped chocolate chips (> or = 70% cacao is best)
1/2 cup chopped nuts (almonds, walnuts or pecans)
1/2 cup chopped dates, raisins, figs or other dried fruit–optional (I don’t typically add these)
1 cup vanilla or chocolate whey protein powder– Garden of Life Raw Protein is a good one and is available at Whole Foods Market
½ cup egg whites (or add a 3rd egg)
Heat oven to 350F. Spray an 11 X 7 inch glass baking dish with nonstick stuff. Throw everything in a big bowl. Mix well with your hands. Place in the baking dish, press into the pan to eliminate bubbles and try to get it level. Cook for about 20-25 minutes. Let cool completely to room temp. Refrigerate for a few hours before cutting into bars. Cut into about 48 bars. Refrigerate the cut bars.
It’s 2am on call. All of a sudden you are starving, not to mention craving comfort food. The only thing available is MacDonald’s or (on rare occasions) the leftover pizza from the noon conference. It’s a problem. Eating that kind of food at 2am will almost certainly result in food coma, not to mention that you really know it’s not healithy or what you would recommend for your patients.
Here’s the answer.
Start by chopping up the veggies you want to put in the tacos. My “go to” is one red bell pepper and a poblano pepper. Corn and rice work well, too. You can change the taste by using different cheese and different veggies (brocolli, carrots etc with Monterey Jack, for example).
Buy the cheese you want already shredded. Lowfat Mexican is my usual choice, but any cheese is fine. I’ll often cut up a block of 50% Cabot cheddar cheese which is a great tasting low calorie cheese.
Put 10 whole wheat tortillas on the counter and divide one can of refried beans between them. Use nonfat if you are watching calories. Black beans, pinto beans, spicy or not – your choice!
Divide up your veggies and cheese onto the 10 tacos.
Roll them up and put them in snack size plastic bags.
Put the little bags in a gallon freezer bag (important to prevent the bad taste of freezer burn) and put them in the freezer. They last for weeks.
Two minutes in the microwave directly from the freezer gives you a great breakfast, snack, or middle of the night comfort food!
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.
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.
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.
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.
4. Don’t skip meals. Even on the worst call day you can keep a meal replacement bar or two in your pocket.
5. Pack the food you need for call days the night before so it’s ready to go in the morning.
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.
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.
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)
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)
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?
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.
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.
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 a good breakfast
- Pack the food you need for call
- Cook for yourself
- Eat fruits and/or vegetables with every meal
- Make a salad to take for lunch
- Use caffeine wisely
- Make a healthy sandwich for lunch
Get Some Exercise
- Go for a run
- Find a new, fun way to exercise
- Do a little exercise even if you are on call
- Try a spin class
- Find a way to fit exercise into your busy schedule
- Take the stairs
- Ride your bike to work
Twitter has become a wonderful way for me to send out a variety of ideas and links that I think are helpful (and/or interesting). Here are this week’s highlights! If you are new to Twitter RT means Retweet (just “forwarding” it as is) and MT means Modified Tweet (“forwarding” it with a comment).
- Damned if you do, damned if you don’t – the ethical dilemma of #resident duty hrs bit.ly/r3KO1C #meded @drmlb
- “This is definitely a 15 minute video every medical student should see.” The art of the physical exam bit.ly/nnmaTN @drmlb
- The value of narrative in both medical non-fiction and fiction RT @hastingscenter Hastings Center bit.ly/rnx8Zs
- Baked oatmeal. Make it on the weekend, have it for breakfast all week – great idea for #medstudents #residents bit.ly/n6k3Z1 @drmlb
- Comments one makes to colleagues: as important as the interview. Professionalism = doing the right thing when no one’s watching. RT @MedPedsDoctor
- #Surgeon study finds limits on training hours may impede medical performance fxn.ws/p66MoS RT @MedEdAMA
- Beginner’s mind in medicine. How to keep what we do exciting! MT@KevinMD bit.ly/qle7SJ
- One flight of stairs = 16 calories burned. One day on call = ?10 flights ?20 ?30)..it adds up! @drmlb
- “…small things often adds up to produce a far greater impact than any of us realize.” Surgery through different eyes bit.ly/q5XUkh @drmlb
- “..those of us who spend our emotions at work are not the kind to view our work as “just a job.” MT@Kevin MD bit.ly/pRAbmm @drmlb
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!
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.
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”)
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
- Egg mugs
- 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
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)
- 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.
Other links to ideas for fast, healthy breakfasts