Eating on the Run

“Downside, I skipped lunch and it is still in the work fridge. Upside, I don’t have to pack a lunch tomorrow!” – tweet from an intern on her first day

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It’s hard to eat well when you are crazy busy taking care of patients. Doctors really do know about nutrition, and we know we should set a good example. So why do we eat so poorly at work?  I can’t do better than the list of reasons from this post:

1.  The ”I don’t know when I’ll get to eat again” Phenomenon

2.  The “Graham Crackers and Peanut Butter” Phenomenon

3.  The “It’s free, therefore I must eat it” Phenomenon.

4.  The “I’m so tired I have to eat something to stay awake” Phenomenon

5.  The “I’m on call so I deserve a giant cookie” Phenomenon

Why it’s important to make conscious choices about what you eat at work 

1. You actually hurt your patients if you don’t eat well. 

Physicians that don’t eat at work have slower simple and complex reaction times. You don’t think as clearly or respond as quickly. Start thinking about your own nutrition as a part of good patient care.

 2. If you are like most people, not eating at work will result in gaining weight.  

Even if you don’t gain weight, you will likely have a detrimental change in your body composition. (i.e. you’ll get flabby)

3. Not eating at work will result in losing weight for some people. 

For some people stress leads to appetite loss.  These are the residents that aren’t hungry even though they are not eating enough. The message here is that your weight during residency is a decent barometer of your stress level and how well you are coping.  If you are losing or gaining, notice it early and adjust how you are eating, working out and coping with the stress of your job.

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There’s no question that the best option is to plan, prepare and bring your own food to work.  Even though it takes time to do this, you’ll save time in the hospital by knowing what you have and where it is.  (A good point made in the article “Strategies Resident-Physicians Use to Manage Sleep Loss and Fatigue” which you can download from http://med-ed-online.net/index.php/meo/article/download/4376/4558). Food choices in the hospital are limited, often poor,  and not always available. Make time on the weekends to plan for the upcoming week and shop for good food.  If you can, choose one healthy recipe to cook on your day off and make enough that you have plenty of meals in the refrigerator for when you get home.

General principles 

  • Eat at least every 6 hours.  It’s probably better if you eat smaller amounts every 3-4 hours.  Eat even if you are “not hungry” if it’s been 4-6 hours since your last meal.
  • Make sure you are getting plenty of protein.  Eating simple carbohydrates makes you less alert and creates bigger swings of insulin levels.
  • Don’t drink your calories.  (But do drink enough water)
  • The processed comfort foods that appear like magic in hospitals (doughnuts, pizza, etc) seem delicious when you eat them, but are terrible for you.
  • Plan, plan, plan.  It’s worth it.
  • Eat fruits and/or vegetables with every meal.
  • Bring good food from home.  If you don’t cook, buy good food to bring.
  • Make sure you have “pocket food” in your pocket at all times.  (Food that fits in your pocket and doesn’t need refrigeration.) You may not be able to stop for a real meal, but you’ll be able to eat something.

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Examples of  “pocket foods”

  • Kind bars.  Many meal replacement bars might as well be candy bars when you look at the ingredients.  Clif, Larabar, and Odwalla are all good choices.  Kind bars have no added sugar, a fair amount of protein and are made of only real food.
  • Peanut butter and jelly sandwich.  (Whole wheat bread, fruit spread, peanut butter without transfats)
  • Cabot 50% cheese or string cheese (higher protein, lower fat than most cheese)
  • Edamame (shelled is easier)
  • Homemade Trail mix – mix different nuts and dried fruits together and put in snack bags
  • Baked or steamed sweet potatoes with a little salt
  • Fruit

Fast Food for Call Nights

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.

These tacos are a great breakfast on the run, afternoon snack or 2am call food.  It takes ~15 minutes to make 10 of them on the weekend – which is enough to last for several weeks.

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 (broccoli, carrots etc with Monterrey 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!

Healthy, Fast, Easy (and delicious) Recipes: CookingLight.com

It’s not easy to eat well as a medical student, resident or busy physician.  Besides setting a good example, eating well is important to feel well when working hard. .. not to mention it really pays off in the long run.  You don’t have to spend hours in the kitchen to eat well at work but you do have to cook (some) and plan (always).

One of my favorite sites to find healthy, easy, delicious recipes is cookinglight.com.  They have sections like  Superfast Stir-Fries and Sautés and Quick and Healthy Recipes which are fantastic for busy clinicians.  If you aren’t a cook, they also have a section called Cooking 101 where you can learn basic techniques.  Before you say you “can’t cook” remember – If you can learn anatomy, you can learn to cook!

Coconut Curried Pork, Snow Pea, and Mango Stir-Fry

Healthy, homemade steak house pizza

Chickpea Bajane

Healthy Recipes: My Life Runs on Food

I’m always looking for new sources of healthy recipes for medical students, residents and busy docs. My Life Runs On Food is self-described asa sweet, savory, buttery, green and healthy food blog” and is written by Sanura Weathers.  As she describes it

“My Life Runs on Food is a blog demonstrating how to plan a well-balanced meal back into our lives. It’ll offer tips on how to “brown bag” yesterday’s dinner for lunch. The blog will suggest which seasonal produce to use in recipes. It will encourage buying food from local retailers, such as farmer’s markets. Read how to adapt life events into a weekly menu, and how to quickly update a menu in the middle of the week because of a sudden change of plans.”

 

 

Tomato Chili Pizza

 

Asian Inspired Peanut Butter Roasted Chicken

 

Couscous with Roasted Cauliflower and Shrimp

 

 

 

 

Fast, Easy Recipes: Canyon Ranch

I’m always looking for sources of recipes that meet my “pizza rule” for cooking.  (Things that take less time to make than it takes to order a pizza).

Stressful work requires good fuel.  Taking time to cook something healthy, satisfying and delicious provides that fuel  – but it also sends a clear message that you are taking care of yourself.  Canyon Ranch  has been teaching people this message for years.  They have a wonderful website with really delicious, easy and healthy recipes.

Recipe for Salmon with Mango Blueberry Salsa

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Recipe for vegetable soup

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Recipe Chicken Apple Quesadilla

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You are going to have to trust me on this one and try it.  This is the most delicious cauliflower you will ever eat

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Recipe for Mashed cauliflower

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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Zucchini

It’s summer and there are too many zucchinis (and yellow squash, tomatoes and other fabulous summer vegetables). Even in seasons other than summer, zucchini is always around and makes for really good eating!

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Cooking zucchini takes 5 minutes – just sauté them with a little olive oil, salt and pepper and whatever herb you like (tarragon, thyme, basil).  You can add in a little garlic if you’d like or (like the photo and recipe below) some almonds.  Leftovers are great in salads or omelets, so cook more than you need for one meal.

Zucchini with almonds from Smitten Kitchen

One of my all time favorite summer foods is ratatouille, a great food that takes advantage of the bounty of the summer harvest.  It’s easy to make and incredibly delicious.  I suggest you make a big batch – It gets better with time  (at least a few days).  When you get tired of eating it plain you can put it over pasta, eat it cold (particularly good with cottage cheese), or mix it with a grain for a hot meal or salad.

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Ratatouille recipe

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Turkey stuffed zucchini from Skinnytaste.com

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Tomato Zucchini Tart

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Zucchini cups (and 20 more zucchini recipes from Kalyn’s Kitchen)

Fast, Easy Recipes: Kalyn’s Kitchen

I’m always looking for good websites for recipes that are healthy, simple and easy to make.  In other words, the kind of food that makes it easy to avoid eating fast food when you are on call.   Kalyn’s Kitchen is a fabulous website for delicious, healthy, and often low calorie recipes that meet the “pizza rule” for medical students and residents (i.e. recipes that take less time to prepare than it takes to order a pizza). She also really goes out of her way to teach each step in the recipe, so if you are new in the kitchen, this is a fabulous website for you!

 

Tuna Salad Lettuce Wraps with Capers and Tomatoes

Not-so-Dumb Salad with Cucumbers, Tomatoes, Onions, Avocado, and Balsamic Vinegar

Mediterranean Tostadas with Hummus, Feta, and Kalamata Olives

Crockpot Double Lentil, Sausage, Brown Rice, and Spinach Soup

The Best of Wellness Rounds 2011

HAPPY NEW YEAR TO EVERYONE!

Advice for interns

Why I hardly ever drink diet drinks

How to choose your specialty

What to do on your day off

Studying basic sciences – strategies for success

Studying clinical medicine

Getting (and staying) motivated to exercise

How to succeed on clinical rotations

Gifts for medical students and residents

Why I’m spending more time on Twitter

How not to have sore feet after a day in the hospital

Fast, Easy Recipes: Simplyrecipes.com

I’m always looking for new websites that have easy, delicious and healthy recipes that meet the “pizza rule” for medical students and residents (i.e. recipes that take less time to prepare than it takes to order a pizza).

My latest find is simplyrecipes.com.  It’s a great site run by Elise Bauer.  These are mostly recipes she and her family have created.  There is a section on “budget recipes” and another one on “Quick Recipes” both of which are great for students and residents.  She also has a lot of instructions about cooking if you are new to the kitchen.

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Baked Shrimp with Tomatillos

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Sesame and Cilantro Vermicelli Salad

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Chicken Breasts with Mushroom Sage Sauce