Clean Eating

If you want 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 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, 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 advice on how to eat well (“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 LessSpring Roll SoupWheatberry and Edamame Salad

 

Salads

For medical students in basic sciences, a salad can be 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.

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

Recipes for Medical Students and Residents: Salsa for Beginners

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/

Farmer’s Markets

I just got back from my weekly (when I’m not on call) trip to the farmer’s market.    I’m going to try to convince you why buying food at a farmer’s market should be a regular habit for any medical student or resident (although I think it applies to everyone else, too).

What the heck is a farmer’s market?

In general, farmer’s markets are open air markets where local farmers bring their food to sell. They usually take place once a week (often on Saturdays).  If you want to know more about farmer’s markets, check out the website of Urban Harvest, which is responsible for the market I go to in Houston. 

How do I find out where they are?

The best way is to search the internet for your city.  Local harvest is a web site that covers most farmer’s markets, but there may be smaller (and possibly more convenient) markets in your city that aren’t listed here:   http://www.localharvest.org/farmers-markets/

If it doesn’t look like there is a farmer’s market near you, another option is to buy a share in a CSA (Community Supported Agriculture).  If you buy into a CSA you will pick up a fairly large quantity (usually a good sized box) of whatever is being grown at the time – usually once a week.   If you can find a group of friends to split this with, its a great option  http://www.localharvest.org/csa/

What should I do to look cool if I’ve never been to a farmer’s market before?

Bring your own bags. This isn’t an absolute requirement, but it’s much cooler than relying on the vendors.  They often have small paper or plastic bags, but it will be easier if you bring your own.  In the big picture, you should do this no matter where you shop (good environmental karma!).  Fortunately, the “give away” bags at medical meetings are perfect for this!   A lot of grocery stores sell reusable shopping bags or you can find them on the internet.

Bring cash. Some vendors may take credit cards but don’t count on it.

Does it cost more?

Yes (but not a lot more).  But don’t let that stop you!  Value isn’t always measured by money – even if you are poor student or resident.  It’s not going to be a lot more and it’s completely worth it. (see below)

If it costs more and it takes more time, why should I bother?

The food absolutely and unequivocally tastes better.  The first time I bought potatoes at a farmer’s market was a revelation for me.  I knew that tomatoes and peaches would be better, but I had no idea that a potato would be in the same category.  The produce you buy at a farmer’s market was in the ground (usually) less than 24 hours ago.  It is incredible how much better it tastes!

The food is probably better for you.  Most farmer’s markets sell organic or near organic food.  There’s good data that organic plants are higher in many nutrients and it’s intuitively obvious that avoiding pesticide residues on your food should be beneficial.

You’ll eat with the seasons. There are no data that this is better for you, but it really makes sense.  If nothing else, it will taste better and you’ll be helping the environment by not eating things that traveled thousands of miles to get to you.

You’ll get to know the people growing your food. This sounds trivial, but it’s really cool.  You can ask them about how they grow the food, and you’ll hear stories about what’s happening on their farms.  One of my favorite vendors, Blue Heron Farm, pictures brings pictures (usually baby goats) which she also shares on Twitter and Facebook. There is also something intangible (but cool) in knowing that someone (not just a big corporation) cares enough to grow your food.

The farmer’s market is a once a week “sanity break”. You are outside, surrounded by beautiful food and happy people.  At the market I usually go to, there is always some live music, too.  It’s a great experience and, combined with the fact that you are doing something healthy for yourself, it’s a once a week mood changer!

How to Eat Well On Call

It’s Saturday and I’m on call – and it’s going to be a busy day!  We have about 75 patients on the service, we already have 4 cases done and another 4 posted, and it’s still early (~4pm)   I have a fantastic resident with me today.  We just were chatting about what we are going to do for meals today.  He didn’t have breakfast and has only had a Coke and a “borrowed” bowel of Kix cereal from the recovery room so far.  I had whole wheat toast with some goat cheese before I left my house this morning, and I here’s what I have to eat today:

  • Strawberries
  • A handful of frozen cooked shrimp with cocktail sauce (they’ll thaw by the time I want to eat them)
  • Frozen peas (I put them in the microwave for a minute but, like the shrimp, frozen would be fine because they’ll thaw) + goat cheese, olive oil, vinegar, salt and pepper
  • Leftover whole wheat orzo, artichoke hearts, tuna and lemon pasta from last night
  • An apple
  • Lemon wedges for water

My resident’s Coke is probably more than I used to have as an intern… which is STUPID.   Eating well is important to feel well, perform well and do the right thing for your patients. There is one word that explains the difference between my resident (and what I used to do) and what I do now… planning.   “I’ll just get something from the restaurant across the street later…”, “There will probably be food leftover from the GI conference…” .. “I can always eat a bagel from the lounge..” … NOT.   When you finally have a minute to grab something to eat, you won’t usually have time to go look for the food.  It’s a lot easier if its’ there and ready to eat.

Here’s how to do this right:

1. Buy a good “lunch box” .

I like the hard plastic ones that fit in an outside, insulated carrying case.  It’s a lot easier to clean up if something spills than the usual “lunch box”.

You can use plastic (disposable) containers to carry your meals with you.  I’ve switched to glass containers because some of the data about heating the plastic containers in the microwave started sounding convincing.  It does mean you have to keep track of them and bring them home, but I suspect in the long run (if I don’t lose them) it will be cheaper than the plastic containers.   I particularly like the ones I bought because the seal is so tight that they don’t ever leak  (even for things like soup).

2. PLAN.

The night before call, figure out what you are going to take. Make it good stuff, too!  Call nights are not the “what I know I should eat” nights.  You need to have real food (i.e. not processed) but don’t skimp.  When you get to the “I really deserve those french fries” time of your call (which we all do) you will have really delicious and balanced food  in the refrigerator.

3. Pack your meals for the next day the night before (no matter how late it is or how tired you are).

It’s the only way you’ll actually do this.   None of us when we work this hard have the energy to put together meals for the day at 5am.  This takes a little effort but the payoff is real.  You will absolutely eat better, have more energy, maintain your weight and do a better job.  Don’t forget to throw some fruit in – and to make sure it’s washed so you can just pull it out of the refrigerator for a snack.