I Forgot To Tell You About My New Favorite Breakfast!

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!

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MLB BREAKFAST TACOS

Here are the ingredients:

FullSizeRenderThis batch had beans, cheese, a red bell pepper, a jalapeño and some cilantro, but you can add anything!  Spread out the tortillas and divide up the ingredients between the tortillas.

IMG_3511-1024x1016Roll them up, put them in the freezer. Two minutes in the microwave and they are ready to eat!

 

OVERNIGHT OATS

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.

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Eating Well at Work

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).

 

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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???

 

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  1. Make a plan
  2. Make a shopping list
  3. Shop once for the week and (when you can) prep ahead
  4. Use your day(s) off to cook things that might take a bit more time and freeze some for other days
  5. Keep a few “instant” healthy meals in your pantry

 

keep calm count to five

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:

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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.

 

grocery IQ

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!

There are other apps for shopping which come recommended by others which, to be fair, I thought I should share: Any List, Pantry Manager, Paprika

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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!

mirepoix

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).

 

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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!

 

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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)

Quick meals from frozen ravioli

Shrimp fried rice

 

food be your medicine

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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