Healthy, Low Calorie Cauliflower Breadsticks

Do you think whoever named the cauliflower plant knew that one day we would evolve into overweight, carbohydrate-overloaded, gluten-intolerant creatures, who, in searching for a suitable lo-carb substitute would find their holy grail in that crucifer whose name is homonymous with the ground product of the very thing we both crave and shun?

Think cauliFLOUR.

Then go grind up a head of cauliflower in the food processor (or be lazy like me and buy Trader Joes riced cauliflower), steam or microwave it for 10 minutes, strain out the liquid in a tea towel, pour into a large bowl and add two egg whites, 1/4 cup hemp or flax seeds, 1/2 low fat grated cheese (Trader Jose’s Lite Mexican Blend works perfectly) and a tbsp of minced fresh herbs (I used thyme, rosemary, basil and oregano). Spread out onto an 8 x12 inch rectangle on a parchment paper-lined baking sheet. Bake it in a 450 degree oven for 15-20 minutes, toss a little more cheese atop and bake 5-10 mins more and Voila! You’ve got a delicious, healthy, low calorie, if somewhat floppy breadstick. I cut mine using a pizza cutter while still warm, and got 32 cracker size pieces at 25 calories apiece. (If you want yours crisper, after cutting them, turn the oven off and put them right back in for 1-2 hours to crisp up as the oven cools down.)

I served these tonight to accompany Cream of Mushroom Soup. The flavors complemented each other well.

Maternal Use of Estrogen Hormonal Contraception Just Before Pregnancy – A Risk for Childhood Leukemia?

In a well done and very interesting study in Lancet Oncology, Danish researchers have identified an association between use of estrogen-containing oral contraceptives in the three months prior to pregnancy or during pregnancy and the risk of childhood leukemia in the offspring of that pregnancy.

The study’s conclusions are strengthened by the fact that the data come from three reliable nationwide Danish databases –  one registering births, one registering cancers and the other registering prescriptions –  and included over a million children born between 1996 and 2014, with a median of 9 years follow up from birth.

How high is the risk?

The hazard ratio for childhood leukemia was about 50%-70% higher among children born to women taking estrogen-containing contraceptives in the three months prior to or during pregnancy, compared to that in the offspring of women not using these contraceptives immediately before or during pregnancy. The risk was confined to non-lymphoid leukemias.

Because the overall risk of leukemias is low (most children do NOT develop leukemia), the actual risk translates to one extra case of leukemia for every 50,000 potentially exposed children, or in Denmark, about 4% of leukemia cases over the 9 years studied.

That’s not a large risk, but it is worth looking at.

Which hormonal contraceptives were implicated?

The risk for childhood leukemia was only found for use of estrogen-containing oral contraceptives in the 3 months just prior to pregnancy or during pregnancy. No association was found for non-oral preparations, but there were few cases of these.

No increase in risk was found for ever use of any hormonal contraceptive prior to the 3 months immediately preceding pregnancy.

No risk was found for use of non-estrogen containing hormonal contraception (think the mini-pill, levonorgestrel IUD and Depo-Provera) at any time, even immediately before or during pregnancy.

Is this really true?

Let’s be clear. Association is NOT causation. But it is a signal that warrants further study and a plausible explanation.

In this case there is a biologically plausible mechanism, in that estrogens can inhibit certain enzymes that protect DNA from cancer causing mutations. There are also other proposed mechanisms.

But there could be alternate explanations for the study’s results. For example, what if the mother carries and transmits to her child a genetic predisposition that not only increases the risk of leukemia, but also causes her to have heavy periods that necessitated her use of birth control pills? Or if by chance, in this study, more women with a genetic predisposition happened to take birth control pills? The researchers did not have genetic information on both mother and child, and that’s important.

Results of other studies exploring the birth control pill-leukemia link have been mixed.

So we need further studies.

But still, it begs the question – what should we do until we have the results of these further studies? After all that can take years, and women are getting pregnant now.

What should you do with this information?

What you should NOT do is let this study scare you away from using birth control pills to prevent pregnancy. Oral contraceptives continue to be among the safest, most effective ways to prevent pregnancy. Not to mention their benefits in treating irregular, painful or heavy menses, endometriosis, acne, hirsutism and in some women, PMS.

But until we have further data, I don’t see any harm in playing it safe – which means stopping estrogen-containing hormonal birth control and using either the mini-pill or a barrier method of birth control (such as condoms or diaphragm) in the 3 months prior to attempting pregnancy.  (Theres no reason to change to a long acting method such as Depo-Provera or the IUD for just 3 months.)

If you’re an inconsistent oral contraceptive user worried you may become pregnant due to missed pills, this may be another reason why you may want to change to a more effective method such as the IUD for long term use.

As they say, talk to your doctor.  

With my own patients, I tend to take an “If it’s not broken, don’t fix it” approach to birth control. Which means, if you are happy and healthy using estrogen-containing birth control, don’t let this be a reason to stop using it. But do have a plan for transitioning off when you want to become pregnant.

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References

  • Pombo-de-Oliveira MS. Maternal hormonal contraception and childhood leukaemi. Comment. Lancet Oncology 19:10. p1261-1262. Oct 1, 2018.
  • Hargreave M, Mørch LS, Andersen KK, Winther JF, Schmiegelow K, Kjaer SK.
    Maternal use of hormonal contraception and risk of childhood leukaemia: a nationwide, population-based cohort study.Lancet Oncology. 2018; (published online Sept 6. http://dx.doi.org/10.1016/S1470-2045(18)30479-0.)

Bread – Let it Sing

Listen closely.

That crackling sound you hear is the bread “singing”.

It’s why you should never cut into a piping hot loaf of bread fresh from the oven, tempting as that may be. Let it rest and sing for awhile as it finishes the process of baking all by itself.

Here’s what Jim Lahey has to say about singing, in his book My Bread, which is where I get my bread recipes and technique –

Just after you take a loaf out of the oven, something strange often happens: it begins to make wierd noises, a rapid-fire crackling sound, one pop after another. This “singing” as some bakers call it, is especially loud and obvious in the professional bakery, where dozens of loaves may be pulled out of an oven at the same time and placed together in a basket. They become kind of a snapping chorus. The singing lasts for several minutes – the temperature of the room will determine how long – as the bread cools.

This singing is evidence of the last phase of cooking, which takes place out of the oven- and is why you should always given a loaf time to cool before slicing it. The exterior of the loaf is very dry at the moment it’s removed, but the interior is still wet. During cooling, the two elements of the bread start to even out somewhat, although the crust will remain brittle and the crumb soft. The crust is shrinking and cracking. Steam escapes through the cracks, which is the racket you hear, as it forces its way through, while the crumb solidifies. At this moment, the bread seems alive.

I know its a romantic idea, but it’s how you get to feel when you fall in love with a simple, but beautifully baked rustic loaf.

So wait till the song is over before you cut into that loaf of bread. It’s well worth the wait.

The Best Easy Dinner You’ll Ever Make

Okay. Maybe I’m being hyperbolic about this meal because I’m back on my food delivery diet (I still have a few more pounds to go..) and so all I could do was have a small taste after watching Mr TBTAM cook it. But I really don’t think I’m overstating it.

Skillet Chicken With White Beans and Caramelized Lemon. One of the easiest amazing dinners you can make.

What makes it special is what Alison Roman at the New York Times calls “the liquid gold in your skillet“, that secret ingredient Jewish grandmothers have been sneaking into their children’s vegetables for centuries – chicken fat.

I admit to keeping a jar of the stuff in my freezer, but this is the first recipe I’ve seen that uses every drop of chicken fat right in the skillet in which it was formed.

Its a one pan dinner, less than 30 minutes from start to finish. Add a side of rice or potatoes if you want, or some crusty bread, but you really don’t need it.

You’re probably thinking you could pour a little of the chicken fat off to keep the calorie count a bit lower. Well don’t. Its perfect just as it is.

The Recipe is here. You’re welcome.

Title X – Free Speech Under Fire. Again.

It’s deja vu all over again, as the current administration, borrowing a never-implemented move from the Reagan administration, attempts to gag physicians who provide reproductive care to women.

New proposed regs would forbid Title X funded providers from freely providing information about abortion to their patients, limiting such conversation to the provision of a list of names to women who have already decided to have an abortion.

Given that close to 50% of pregnancies in the United States are unplanned and that a significant proportion of women with unplanned pregnancy are unsure what they will do at the time of diagnosis or presentation to their doctor, the ruling is effectively a gag rule for any encounter around unplanned pregnancy. Or a planned pregnancy that goes wrong. Or that occurs in a woman with medical issues placing her health in danger during pregnancy. Or anytime when a pregnant woman is unsure what she wants to do regarding her pregnancy.

There’s more to the ruling that just the gag, much of it targeting Planned Parenthood, which provides reproductive health services to 41% of Title X clients.

By imposing extensive physical and financial separation requirements, the proposed rule effectively excludes from Title X any safety-net health center that provides abortion using non-federal funds. Specifically, Title X-funded entities would have to maintain separate accounting records, physical spaces (such as waiting and exam rooms, entrances, and exits), workstations, phone numbers, email addresses, staff, patient health records, educational programs, and signs.

The Ruling also lowers the bar and redefines family planning to allow Title X Funds to flow to programs that don’t actually offer medically approved contraception, but instead focus only on fertility awareness (rhythm), adoption or abstinence.

If you, as I do, oppose the proposed Title X changes, then I urge you to submit a formal comment and make your voice heard.

You’ll be joining the AMA, AAP, ACOG and ACP and almost 600 bipartisan elected officials in opposing this attempt to limit the free flow of healthcare information to women seeking to make choices among legal medical options. If you’re not great with words, head over to PRH Website for some more freely given text.

Here’s the comment I submitted today. Feel free to share, copy and paste.

Dear Secretary Azar, Senior Advisor Huber, and Deputy Assistant Secretary Foley:

I am writing you at this time to express my strong opposition to the proposed changes to Title X funding rules, which would limit Title X-funded providers in dispensing information or referrals for abortion services.

The proposed rule effectively gags both health care providers and their patients, limiting free speech within the patient-provider relationship.

Many, many women at the time of pregnancy diagnosis are unsure of their plans for that pregnancy, and wish to discuss their options with their provider. Limiting abortion discussion and referrals to women who have already decided to have an abortion is tantamount to malpractice, as women who are unsure of their options are not provided by their clinician with the critical health information they need to make a choice between the legal options available to them.

As a practicing physician I vehemently oppose this attempt to dictate medical care. Abortion is a legal medical procedure, safer than carrying pregnancy to term when performed by qualified providers, and information about it must be freely available to women, who need unbiased, factually correct, evidence-based information to make the choices that are safest and best for themselves and their families.

The proposed regulations unfairly and unconscionably impacts low income women, who frequently have no other options for reproductive health care other than that provided by Title X providers. The proposed rule changes create a two tiered system of reproductive education and care – one for women of means, who are given the information and counseling they need to make decisions about their reproductive health, and the other for poor women, from whom information about legal, safe reproductive options is deliberately withheld. If the legislation has its intended impact, women will lose trusted providers such as Planned Parenthood, which currently provides care to 41% of Title X patients.

Finally, the government cannot, though its funding mechanisms, require physicians to deliberately withhold information about completely legal health care options from our patients.  This violates our free speech, promotes unethical behavior and violates the patient-physician relationship.

I urge you to withdraw the proposed changes

Thank you for allowing me to comment.

Sincerely,

Margaret Polaneczky, MD

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More reading

Blackened Shrimp with Citrus and Roasted Fennel

It’s been quite a long hiatus from blogging, and I for one am glad it’s over.

Nothing special made me stop blogging, just the overwhelming business of life and work. It’s a good life, but one that for the past year or two has lost the balance between work and private life that I seem to have achieved when I was blogging more frequently.

At any rate, things in general have settled down a bit and I find myself actually having free time again to write. And so the blog is back!

What’s new, you ask?

Well, I am about 30 pounds thinner, that’s one big thing.  Nothing magic or amazing, just a food delivery diet that let someone else do the work for me. I still have at least another 40 pounds to go, but decided to see if I could take myself there without the crutch of a delivery diet. And so, I’m on a mission to find a stable of light and healthy but delicious meals that I can begin to incorporate into our life and my diet. It’s only week two of this new on-my-own diet and I am pleased to tell you I have found one amazing dinner that I know I’ll be making over and over again.

Try it, and I predict you will be too.

Blackened Shrimp with Citrus and Roasted Fennel

This recipe is a modification from a recipe found in Cooking Light, a magazine I highly recommend for anyone, not just dieters, who is looking for great recipes. The recipe written here is with my modifications, mostly made to accommodate my larder, which did not at the time include fresh herbs or more than one shallot. I also made my own rice/grain mix. (The original recipe called for a box mix.).

Next time I will add an additional fennel bulb – found myself wanting more! You could also add a few more shrimp when serving 4, as this only gives about 7 per person. Farro would make a nice alternative to rice.

Ingredients

  • 2 oranges
  • 2 medium fennel bulbs with stalks (about 7 oz. each)
  • 2 tbsp olive oil
  • 1/2 tsp sea salt
  • 1 large shallot, quartered
  • 6 cloves garlic, peeled
  • 1/2 large sweet onion, peeled and cut into quarters

For Shrimp:

  • 2 teaspoons paprika
  • 1 teaspoon chopped fresh thyme (or 1/2 tsp dried thyme)
  • 1/2 teaspoon garlic powder
  • 1/4 teaspoon dried oregano
  • 1/4 teaspoon red pepper flakes
  • 2 tbsp olive oil
  • 1 pound large shrimp, peeled and deveined, tails on

For Rice-Grain mix

  • 1/2 cup basmati rice
  • 1 tsp olive oil
  • 1/4 tsp salt
  • 1 cup water
  • 1/2 cup quinoa (I used a red/white quinoa blend)
  • 1/4 tsp salt
  • 1 cup water
  • Reserved orange rind

Instructions

Preheat oven to 425 degrees Fahrenheit

Grate one orange to equal 1 teaspoon rind; reserve for use in the rice/quinoa mix. Cut oranges crosswise into 1/3-inch-thick rounds. Remove stalks from fennel; chop fronds to equal 2 tablespoons and reserve for garnish. (Save the stalks for future use in a salad, broth, meat braise or fish dish.) Cut fennel bulbs into 1/2-inch-thick wedges. Combine orange slices, 2 tablespoons oil, 1/2 teaspoon salt, shallots, garlic, onion and fennel wedges on a rimmed baking sheet, spreading them out in a single layer to cook. Bake at 425°F for 25 minutes or until fennel is tender and lightly charred.

While veggies are cooking, make the rice/quinoa mix.

Cook the rice: Rinse rice well under cold running water; drain. Boil 3/4 cup water in a pyrex measuring cup in the microwave. Heat 1/2 tbsp oil in a small pot till shimmering. Add rice and salt, stirring well while sauteing over medium high heat for about 2 minutes, till slightly toasted. Add the boiling water, cover and simmer over a low heat until done.

Cook the quinoa: Rinse quinoa well under cold running water. Add to saucepan with water and salt. Bring to a boil. Reduce heat and simmer, uncovered, for 15 minutes or until done.

While rice and quinoa are cooking, combine 1/2 teaspoon salt, paprika, thyme, garlic powder, oregano, red pepper in a small bowl. Toss with shrimp, being sure it is evenly coated with the spice mixture. Hold in the fridge if veggies and rice mix are not yet done. (You’ll be cooking up the shrimp at the last minute before serving.)

Toss cooked rice and cooked Quinoa in serving bowl with the reserved orange rind. Cover to keep warm while shrimp cooks.

Heat 2 tablespoons oil in a large skillet over medium-high heat. Add shrimp; cook 3 minutes, tossing frequently, or until done. Arrange fennel orange mix on serving platter. Top with shrimp and garnish with fennel fronds.

Serves 4. Shrimp/fennel/orange mix has 141 cals per serving. Adding 1/2 cup cooked rice/quinoa brings it to 428 cals per serving.

TBTAM’s Top Ten Podcasts of 2017

You know you’re a radio junkie when you find yourself scribbling not just prescriptions, but lists of podcasts for your patients to listen to on their long plane flights or drives to Florida or wherever else they are heading for the winter months. I figured if I wrote them all down, I could save myself the scribbling and just share a link to the list.

And so here, in no particular order, are the podcasts I found myself recommending over and over again this past year.


S-Town

Part mystery, part bizarre tale, part crazy sad but also totally wonderful and addicting. I fell in love with this guy John B McLemore, quirks and all.  Not to mention this is one gorgeous website.

And some great theme music.


Here’s the Thing with Alec Baldwin 

A veritable who’s who of modern media and culture sit down for one-on-one’s with Alec. He’s not the worlds best interviewer, and sometimes I wish he’d shut up and stop trying to impress us, but the truth is I love him. He’s not afraid to seek common ground with his guests, who range from Judd Apatow to Kristin Wiig to Patti Smith to Jerry Seinfeld.


Fresh Air

Terri Gross is a true national treasure, and her interviews just get better and better with time.

She makes me so proud of my hometown, Philadelphia. And WHYY, still my fave radio station ever.


More Perfect

Thanks to my daughter for introducing us to this podcast about the Supreme Court, that branch of government no one but Nina Totenberg seems to understand. Until now. Learn about the cases that define the court and the nation. The Imperfect Plaintiffs and Object Anyway, from season 1, are must-listens for every American.


The Axe Files

David Axelrod, former Obama campaign strategist and White House Advisor, interviews key figures in the political world. Broadcast from the University of Chicago, where Axelrod heads the Institute of politics.

Naturally, a highlight was his interview/discussion with Barack Obama (12/16/16), but if you’re a political junkie, you won’t stop there. Great listening, this.


The New Yorker Radio Hour

Somehow I never find time to read the New Yorker, but I do listen to the podcast. The episode on how Oxycontin was sold to the masses is a tour de force, and David Remick’s conversation with Hillary Clinton is one of her best post-memoir interviews she’s given.

 


Freakonomics Radio

Stephen Dubner hosts this wonderfully creative and interesting podcast, exploring ” the riddles of everyday life and the weird wrinkles of human nature”. A three-part series “Bad Medicine: explores the underbelly of medicine and the drug industry. The July 5 episode tying the fracking boom to local population explosions and the decline of marriage is fascinating. And “When Helping Hurts” will change forever the way you think about what “doing good” can really mean.


This American Life

Of course.

 

 

 


Missing Richard Simmons

One day Richard Simmons, fitness guru, weight loss coach and darling of the aerobics set, just up and disappeared from public and private life. Dan Tuberski wants to know why. If you think it’s none of his or your business, don’t listen. Or rather, try not to listen.

 


Number Ten 

Actually, I only have 9 top podcasts of 2017.

I’m still searching for number 10, which I hope to listen to on drives back and forth to Philly over the holidays.

Contenders are :

  • 36 Questions (a three part podcast musical);
  • Dirty John (True crime mystery, supposed to be riveting); and
  • Sincerely, X (Anonymous Ted type talks about things no one really talks about- including one doc’s medical error that lead to a diagnosis of burnout).

Let me know in the comments which you think I should listen to first.

And if I’ve left your favorite podcast off the list, tell us what it is and why it’s your favorite.

Happy listening, everyone!

Acupressure App – Does it really alleviate menstrual cramps?

The media is abuzz over a study reporting that use of a cell phone app to train women in self-acupressure is effective as pain medication for treating menstrual cramps.

The Android app is called AKUD and is written in German, so unless du sprichst Deutch, it won’t do you much good. But let’s ignore that for now. Here’s the study intervention:

The study intervention

Participants received a menstrual tracking App that included instructions on acupressure for cramp relief. They also got one-on-one instruction on the location of specific acupressure points and use of acupressure using drawings and video. The App reminded them to apply acupressure starting five days before the anticipated menstruation. Control participants received a version of the app that did not include acupressure info and got usual care.

Both groups reported a reduction in menstrual pain, but participants who used the acupressure-containing app had a greater reduction in menstrual cramps compared to those who did not get the app to use, and use of birth control pills to control cramps was higher in the non-app group. Note that menstrual pain was not eliminated by use of the app,

So does acupressure help menstrual cramps?

I don’t know. Why? Because the study did not include an appropriate control.

The right control would have been to give controls a sham app that taught them ‘acupressure’, but used the wrong acupressure points.  This would have controlled for what may be a significant placebo effect of the use of the acupressure app.

A Cochrane review of acupuncture and acupressure for menstrual cramps concluded that there is insufficient evidence to recommend the practice. I would say this new study does not change that conclusion.

Could it hurt? 

Probably not. Although a few users of the acupressure app reported bruising and pain at the acupressure sites, only one user stopped the app due to these symptoms.

Bottom Line

For milder menstrual cramps, a lay down with a hot water bottle or a nice tub soak may be all that’s needed. Or ask a friend or loved one to massage your lower back. And don’t be afraid to exercise during your period if the cramps are not debilitating.

NSAIDs such as ibuprofen, naproxen and mefaminic acid are first-line medications for treatment of more bothersome menstrual cramps. Midol (combo tylenol, caffeine and an antihistamine) may work for milder cases.

Your doctor can prescribe stronger doses of NSAIDs or a cox-2 inhibitor such as Celecoxib if needed. And if you also need birth control, birth control pills and the hormonal IUD are good treatment choices.

Save your phone space for a good podcast

In my opinion, your phone app space would be better spent downloading a good podcast. In fact, I think my next blog post will be some podcast recommendations. Stay tuned…

It’s not gonna’ kill you to take hormone replacement

It’s not going to kill you to take hormone replacement therapy.

That’s the take home message from the latest analysis of the Women’s Health Initiative, the largest and longest randomized trial of hormone replacement therapy (HRT) in menopausal women.

After almost 18 years of follow up in the WHI, there was no increase in overall mortality, including death rates from cancer, in women taking HRT for up to 5.6 years (estrogen plus progestin) or 7.2 years (estrogen alone). There was a non-significant reduction in mortality among those who started HRT between ages 50 and 59, the group most likely to be prescribed hormone therapy for menopausal symptoms.

I’ve blogged before about the results and limitations of the WHI, which found, on balance, that the health risks of HRT (breast cancer, blood clots, stroke) about equaled its health benefits (protection against colon cancer and osteoporosis). The study (and the US Preventive Services Task Force) concluded that there was no reason for women to take HRT for preventive health reasons.

The biggest criticism of the WHI was that 70% of its participants were 10 or more years post-menopausal. The study did not include women most likely to benefit from taking HRT – those with hot flashes, night sweats, insomnia and other menopausal symptoms – or enough women in the 50-59 year age group. These women start HRT at menopause, not a decade or more after it’s over. In this younger group, more recent research suggests there may be a reduction in heart disease risk not captured by the WHI. Or not. It’s an ongoing debate among health experts not likely to be decided very soon.

In the meantime, millions of women enter menopause every year, some of them with significant symptoms that impact the quality of their life (and sleep), who must decide whether or not to use HRT to treat their symptoms.

For these women, this newest update from the WHI is reassuring.

The breast cancer mortality data from the WHI are complicated, and based on a small number of cases in the study population. Let’s just say there was no statistical increase in deaths from breast cancer among users of estrogen and progestin. Since the breast cancers occuring in HRT users are not inherently less aggressive, its more likely the lack of increased breast cancer mortality is because most breast cancers are not lethal, while those that might become lethal are effectively treated. Paradoxically, there was a significant decrease in breast cancer mortality among users of estrogen alone, perhaps related to the fact that estrogen, when taken after a long hiatus, actually inhibits breast cancer growth. (I told you, it’s complicated. You can read more about this here.)

Will this new information matter to women deciding about using HRT?

The use of HRT has plummeted in the years since the WHI results were published in 2002.

In my practice, the reason for the decline is clear – women don’t want to increase their chances of getting breast cancer, however small that increased risk may be.

I tell my patients this : “If you take HRT for 20 years, your risk of breast cancer will be about 1% higher. Use it for 2-3 years for menopausal symptoms, and that increased risk is less than a quarter of a percent”.

After considering this, the majority of women thank me for the information, and decline to use estrogen. Their symptoms are just not bad enough to entertain even that small a breast cancer risk. (I’m happy to prescribe HRT or non-hormonal therapies for those who opt to use them.)

This new study won’t change that conversation much, but I will now add that taking HRT for a few years around menopause to alleviate its symptoms will not increase mortality. I’ll also tell them that the data on breast cancer mortality, while complicated, seem to suggest no overall impact. That’s most likely because the overwhelming majority of breast cancers are not lethal, either due to their inherent behavior or our improved treatments.

I’m curious to see if this changes the choices they make.

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More Reading on Menopause and HRT 

Tomato Jam

My sisters and I are planning on putting up a some tomato jam next weekend. Before we invest a whole afternoon (and 22 pounds of tomatoes) to it, I figured I should try out the recipe at least once.

I had the loveliest afternoon doing it. A gorgeous, sunny day, with the breeze coming in through the kitchen window, a batch of bread rising on the counter, NPR playing in the background, and me shuttling back and forth between the kitchen and the den, where I’m working on a little writing project that I’ll hopefully tell you about one of these days soon. It was one sweet day.

As sweet as this jam – sweet and savory, with just the right bite to make it the perfect accompaniment to cheese, or as we ate it that evening, broiled lamp chops. Be careful with this stuff – it’s addicting.

TOMATO JAM

Another winner from Mark Bittman. He makes his as a small batch refrigerator jam, which will keep in the fridge. But the recipe is ok for canning as well. Makes about a pint of jam. 

Ingredients

  • 1 ½ pounds good ripe Roma tomatoes, cored and coarsely chopped
  • 1 cup sugar
  • 2 tablespoons freshly squeezed lime juice
  • 1 tablespoon minced ginger (I used crystallized ginger)
  • 1 teaspoon ground cumin
  • ¼ teaspoon ground cinnamon
  • Small pinch ground cloves
  • 1 teaspoon salt
  • Red pepper flakes to taste

Preparation

Combine all ingredients in a heavy medium saucepan. Bring to a boil over medium heat, stirring often. Reduce heat and simmer, stirring occasionally, until mixture has consistency of jam, about 1 hour 15 minutes. (No need for it to be too thick – it will gel as it cools.) Taste and adjust seasoning.

Towards the end of your cooking time, sterilize your jars. Sterilize the lids in a smaller pan.

To refrigerate – Pour into sterile jar, cap, cool and refrigerate until ready to use; this will keep up to 6 months.

To can – Ladle the jam into sterile jars. Wipe the rims, apply mason jar rings and lids and screw to finger tight. Process the jars in a boiling water bath, covered by 1-2 inches of water, for 20 minutes. Remove from bath, cool and then further tighten lids. Label and store for up to 2 years.

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More on Tomato Jam

Einkorn No Knead Artisan Bread (and a primer on ancient wheat)

All wheat is not the same.

What we now call wheat is actually the product of hybridization and cross breeding of wheat species to increase crop yields, ease harvesting, decrease costs and scale up production. As a result, where there were once just 5 or so species of wheat, there are now literally thousands, which genetically, may be virtually unrecognizable to ancient grains from which they are descended.

Allow me to introduce these so-called ancient grains to you now:

  1. Einkorn Wheat (14 chromosomes / Diploid): The first known wheat ever cultivated by humans (circa 3300 BC in Europe) is Einkorn Wheat, which has just 14 chromosomes (diploid) and has a hull. Einkorn has great flavor, and has higher lipid, protein, vit E, lutein and carotenoids that modern bread wheat, and may be better tolerated by those with gluten sensitivities. (But not Celiacs, who should avoid all wheat, ancient or otherwise).
  2. Emmer and Duram Wheat (28 chromosomes / Tetrapoloid): About 10,000 years ago, Emmer Wheat appeared in the Middle East, as a product of natural cross breeding of Einkorn with wild goat grass (Aegelops speltoides). Emmer is a hulled wheat, has a lower glycemic index and is higher in protein and anti-oxidents than typical bread wheat. Some varieties may be lower in minerals than bread flour. Durum wheat is a domesticated form of emmer used for pasta and is a naked wheat (no hull).
  3. Ancient Bread Wheat and Spelt (42 Chromosomes / Hexaploid): Sometime before biblical times, it is thought that Emmer bred naturally with a durum wheat grass called Aegrolops squarosa to yield Triticium aestivum, a higher yield and better baking species that we call “bread wheat”. It is a naked wheat (no hull). Spelt is another hexaploid species that probably formed a little later than bread wheat, and has a hull.  Spelt has similar gluten, and is higher in protein, lipids, and unsaturated fatty acids and minerals when compared to bread flour. It is lower in fiber than bread wheat, and I am told that it does not make as good a bread.

The hexaploid bread flour species are genetically pliable, having 42 chromosomes with thousands of genes available for natural selection and breeding by man. Still, by the mid 18th century, only 5 species of bread flour were being grown in Europe, and until the mid-20th century, most bread flour was pretty similar.

But beginning in the latter part of the 20th century, aggressive modern breeding practices began that created literally thousands of different varieties of hexaploid bread and durum wheat. Much of the breeding was done to improve crop yields and battle environmental scourges such as drought and pests. Some have made wheat easier to process, but dependent on man-made assistance from pesticides and irrigation. Still other breeding may have been done to improve the nutritional content of wheat. But virtually none of the new wheat varieties was ever tested in humans before introduction into the food supply.

While we know how these species perform on the farm and in the wild, what we don’t necessarily know is how they may affect the humans who ingest them. The question now being asked by many is this – In selecting for things like crop yield, harvest ease and bakeability, have we created wheat species with genetic and nutritional profiles that are unfriendly to our bodies? We are not just talking gluten sensitivity here. We are talking glycemic index, fat and protein content, vitamin and mineral profile. Not to mention the effects of the additives food manufacturers add to baked goods to improve shelf life, taste and other qualities that will increase their appeal to consumers.  Many of us are asking if the symptoms we experience such as bloating, weight gain, skin rashes, headaches, allergies, joint pains – in the absence of identifiable disease – may in fact be the result of sensitivities to the proteins found in modern wheat.

Not everyone is waiting for answers. Instead, they are turning back to the ancient grains nature created before modern man got his mitts into Triticum’s genetic pool. American farmers are belatedly joining their Eupropean counterparts in growing Einkorn, Emmer and Spelt, as the demand from consumers for these grains begins to rise. Some of us are enjoying using Farro – the wheat berries of Einkorn, Spelt and Emmer – in salads and side dishes. Others are using the flours of these wheat species to make their own breads and pastas. The anecdotal evidence seems mixed on whether or not there are really any health benefits to using ancient wheats. We know they cannot be used by those with true gluten allergy.

My interest in the ancient grains comes from reading Wheat Belly, cardiologist William Davis’s program for eliminating wheat from the diet to lose weight. I’m still reading it, and have not tried his program – if I do, I’ll let you know. In the meantime, like many, I see no reason not to try these ancient grains. Farro for sure has already won me over.

This recipe is my attempt at seeing what kind of no-knead bread I can coax from Einkorn flour.

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EINKORN NO KNEAD ARTISAN BREAD

Readers of this blog know well my enthusiasm for Jim Lahey’s No knead bread making techniques, made famous by Mark Bittman of the NY Times. (If you don’t, stop right now and go to my previous posts about this technique, and learn it first before trying this recipe.) For this Einkorn bread loaf, I used a recipe from Jovial Foods, makers and distributor of Einkorn Flour.

It was an interesting experience. Einkorn flour has an almost baby powder-like silkiness and consistency, and is clearly a more moist and fatty flour than standard issue modern bread flour. One needs to use 5 cups of flour to get a similar size loaf to Lahey’s, and this flour ain’t cheap. The dough is much stickier and harder to work with, so make sure your board is well floured and use a dough scraper rather than your hands when forming the bread round.

The Jovial bakers do not use Lahey’s cloth technique (probably because the dough is so wet), or let the dough rise a second time before baking. I did both, and next time will avoid since it really was a mess, and the Jovial chefs state it is not necessary.

The results?

First and foremost, there is no such thing as a not delicious home made bread, and this was no exception. The bread is flavorful, moist and dense with a hard crust, and it is just lovely toasted.

But I have to say that it disappoints when compared to the incredible results I get with Lahey’s technique using regular flour. The crumb structure is more cake than bread-like, and I miss the big air pockets and incredible crunch that regular bread flour gives.

I’m going to give it one more try, avoiding the second rise and cutting back a bit on water (which I admit I upped a bit to get the dough to look more like Lahey’s.) The recipe below is exactly as I will make it next.

EINKORN NO KNEAD ARTISAN BREAD

Ingredients

  • 5 cups (600 g) of Jovial Einkorn Flour
  • ¼ teaspoon (1 g) dry active yeast
  • 1 teaspoon (6 g) sea salt
  • 1¾ cups (410 g) of warm water

Instructions

  1. Whisk flour, salt and yeast together in a large mixing bowl (Do not use a glass bowl, as the dough will darken if exposed to light).
  2. Add water and combine using a wooden spoon or spatula (dough will be wet).
  3. When the flour is incorporated, push down sides of dough and flatten the top.
  4. Cover the bowl with a large plate and let rise for 12-14 hours.
  5. In the last half hour of the rise, preheat a covered ceramic or cast iron Ditch Oven in the oven to 500°F.
  6. Turn out the dough on a heavily floured work surface. Using a dough scraper, fold the dough ala’ Lahey (See video here), nudging and tucking the dough into around shape.
  7. Plop the dough right into the pot, cover, lower the heat to 450 degrees fahrenheit and bake for 40 minutes. Uncover and bake another 15 minutes to darken the crust.
  8. Lift the loaf out of the dish and place on a cooling rack.
  9. Let cool for at least one hour before slicing.
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More Einkorn Links

Whole Wheat No-Knead Bread

Summers in the mountains means bread.

I rarely make bread at home in New York City. Not that I couldn’t. After all, this bread is easy enough to make, and despite it’s long rise time, requires very little of my attention.

But thinking about making bread does require, for me at least, a relaxed, open mind. And the inward assurance that in 18 hours I will still be available to move the bread on to it’s second rise, and then to it’s baking. Coordinating that with my schedule in the city makes the bread making feel like a chore and not the joy it is when I undertake it here at the cottage. Here, the day and the next lay ahead of me, open and lazy. The only things on my must do list today are a morning lake trail walk and if its warm enough, a swim. Maybe a bike ride into town to the farm stand market to hunt for inspiration for dinner.

I put this bread up to rise last night at 10, just after we arrived. This morning we read, then I put the bread out for its second rise around 1. We stocked the beach locker with clean towels and then went to town for lunch and to check out the local shops for the first time this season, stopping to hear some bluegrass on the porch and chat with friends outside the Common Ground. After that, I came home and baked the bread while Mr TBTAM cleaned the gutters and mowed the grass and I read some more. By 5 pm the bread was done. It’s in the bread box now, awaiting tomorrow’s breakfast and lunch.  The salmon is marinating, we’re drinking wine and getting ready to start a fire. (Obviously it was too cold to swim today…) Tonight will either be a scrabble or a card game, and something made with the peaches I found at the farm market for dessert.

As I’m thinking about it now, bread making gives a kind of structure to an otherwise completely unstructured existence here on the mountain. It doesn’t depend on the weather (though it may vary a bit depending on temperature and humidity), and needs no one but me to make it happen. If we have company, as we will for much of the rest of the summer, I can adjust the timing accordingly, or make the shorter rise version. But every weekend will have it’s loaf at some point.

The bread making is a touch point for me, a way of grounding myself and transitioning from the hectic overdriven life in the city to the lazy days in the country. It gives me a sense of having accomplished something without demanding that I actually do very much at all.

And it tastes amazing.

NO-KNEAD WHOLE WHEAT BREAD

This recipe is from Mark Bittman, inspired by Jim Lahey’s now legendary No-Knead bread making technique. Before making this bread, watch this video of Mark and Jim making this bread together, and this video of Jim teaching Mark for the first time how to do it. Even better, read Jim’s book, which was what I read today while my bread was rising. And read my previous blog post on my experience making this amazing bread.

This was my first try at making a whole wheat no-knead bread. The results were fantastic – a light, tasty, moist and chewy interior with a crunchy crust. Not as hard and thick and crunchy as Lahey’s white bread crust, but this may have been because I mistakingly baked the bread at 450 degrees instead of the recommended 500 degrees Fahrenheit. (Lahey seems to go back and forth between these two temps a lot – find which is best for your oven and stick to that). 

I went to whole wheat flour looking for something healthier. To that end, my next foray will be to the land of the heritage wheats.  I ordered some Einkorn flour today, and will see what kind of no-knead bread I can coax out of it next weekend.

Stay tuned.

INGREDIENTS

  • 2 2/3 cups bread flour
  • 1 1/3 cups whole wheat flour
  • 2 tsp salt
  • 1/2 tsp yeast (Active dry or instant)
  • 2 cups water.

INSTRUCTIONS

Whisk dry ingredients together in a large bowl. Pour in water and mix well with a wooden spoon. Cover with plastic wrap or a towel, and let rise for 12-18 hours at room temp till well-risen, with a bubble foamy top and the beginnings of darkening color.

Scrape out onto a well floured surface, and with floured hands fold over ala’ Lahey. Place seam sides down on a clean non-terry towel generously dusted with wheat bran or corn meal. Fold the towel over top the bread and let rise another 4 hours, till doubled in bulk.

During the last half hour of the rise, preheat a 4-5 quart cast iron or ceramic french oven on a pull out shelf in a 500 degree Fahrenheit oven.

Open the oven door, pull out the shelf and take off the pot lid. (If your shelf does not pull out, take the entire pot out and place on top of the stove or on a heat proof counter to accomplish the next steps, but work quickly.) Gently place the bread-filled cloth onto an outstretched palm and walk over to the pot. Remove the lid and lay the bread, seam side up, into the pot. (Watch the videos for this technique.) Shake the pot a bit if you need to settle the dough into place. Place the lid back on and bake for 30 minutes. Remove the lid and bake another 15-30 minutes to develop the dark, almost burnt crust. Remove pot from the oven and remove bread from the pot. Let the bread “sing” as it cools for another 15-30 minutes before even considering cutting into it.

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More TBTAM Bread Making 

Spinach Stuffed Mushrooms

stufffed mushrooms

Tired of serving the same old cheese plate and cracker appetizer? Looking for something just as satisfying and crowd pleasing but without the calories or carbs?

Look no further than these delicious, easy to make, healthy spinach stuffed mushrooms.

Eat them with a knife and fork, cut into quarters and you have four incredible mouthfuls. Serve with a bowl of spicy olives – there’s nothing that tastes better than a bite of each in your mouth at the same time.

These mushrooms are so satiating that I’ve served them as a main dish. Add a side salad following a small bowl of soup and you’ve got a light but highly satisfying supper.

Spinach Stuffed Mushrooms

Look for large mushrooms with nice long stems, since you’ll be chopping those stems to make the stuffing. Adjust the amount of bread crumbs and cheese to your liking. Try not to eat any leftover stuffing – you’ll want to use it in an omelet tomorrow morning.

Ingredients

  • 12 extra-large white or crimini mushrooms
  • 1 tbsp olive oil
  • 1 tbsp butter
  • 1 large shallot or 1/2 medium onion, finely chopped
  • 1 clove garlic
  • 1 tsp minced fresh thyme leaves
  • 6 oz bag washed organic baby spinach leaves, chopped coarsely
  • 1/4 cup bread crumbs
  • salt and pepper to taste
  • a pinch of crushed red pepper (optional)
  • 1/4 cup finely shredded Romano or Parmesan cheese, plus another tbsp or so for sprinkling atop (latter optional)
  • 2 tbsp chopped parsley

Instructions

Preheat oven to 325 degrees centigrade. Find a small sheet pan or baking dish large enough to hold the mushrooms in a single layer and lightly brush or spray the base with olive oil.

Clean mushrooms. Remove mushroom stems and chop them finely. Arrange the mushroom caps in the baking dish, being sure they are not too snug.

In a large saute pan, heat olive oil and butter. Saute shallot till soft, the add the mushrooms, garlic and thyme and saute till mushrooms are soft, about 5 minutes or so. Add spinach leaves and cook till wilted – about 3-5 minutes. Turn off heat. Add breadcrumbs and season. Toss in the cheese and parsley. Stuff the mushrooms with the stuffing, being sure to press it in well with your finger to use all available space. Sprinkle a little cheese atop if you want (optional).

Bake for 30-40 minutes, till the mushrooms are well-cooked and the stuffing browned and crusty. (If pressed for time, turn up the heat to 375 degrees fahrenheit and cook for 15 minutes, but watch our that the mushrooms don’t shrivel.)  Serve warm.

Can be made ahead and reheated just before serving.

Ottolenghi’s Roasted Chicken with Clementines and Arak

Chicken w/ Clementines & Arak

One of these days, I’m going to visit Israel, if only to taste in situ the foods that inspire Ottolenghi, whose Jerusalem cookbook has become one of the most used cooking tomes in our household. The hummus recipe alone is worth purchasing his book.

This recipe combines orange and anise flavors with a delightful roasted chicken. Don’t let the use of Arak, a licorice flavored liquor – worry you. The anise flavor is subtle, despite the use of both fennel and fennel seeds – and perfectly balanced by the clementines.

We served it with brown basmati rice and carrots, and I used the leftovers the next day to make a warm Flageolet salad.

OTTOLENGHI’S ROASTED CHICKEN with CLEMENTINES & ARAK

Note – Ottolenghi’s US version of the recipe seems to have made an erroneous conversion of celsius to fahrenheit, and says to cook at 475 degrees. Cook instead at 425, or you’ll find yourself with little juice to serve it with.

Ingredients

Marinade

  • 6 1/2 tbsp/100ml arak, ouzo or Pernod
  • 4 tbsp olive oil
  • 3 tbsp freshly squeezed orange juice
  • 3 tbsp lemon juice
  • 2 tbsp grain mustard
  • 3 tbsp light brown sugar
  • 2 1/2 tsp salt
  • 1 1/2 tsp pepper

Chicken and veggies

  • 2 medium fennel bulbs (500g in total)
  • 1 large organic or free range chicken, about 1.3kg, divided into 8 pieces, or the same weight in chicken thighs with the skin and on the bone
  • 4 clementines, unpeeled (400g in total), sliced horizontally into 0.5cm slices
  • 1 tbsp thyme leaves
  • 2½ tsp fennel seeds, slightly crushed
  • salt and black pepper
  • chopped flat-leaf parsley, to garnish

Preparation

Make the marinade – Whisk together the arak, oil, orange juice, lemon juice, mustard, brown sugar and salt in a bowl large enough to hold the chicken.

Trim fennel and cut in half lengthwise, then cut each half into 4 wedges.

Add fennel, chicken, clementine slices, thyme and crushed fennel seeds to the marinade. . Turn several times to coat, then if tie allows, marinade in fridge for a few hours to overnight.

Preheat oven to 425 degrees. Transfer all ingredients, including marinade, to a roasting pan large enough to hold the ingredients in a single layer (12×14 1/2 inches); chicken should be skin side up. Roast until chicken is browned and cooked through, 35-45 minutes. Remove from the oven.

With tongs, Remove chicken, fennel and clementines to a serving plate; cover and keep warm. Pour cooking liquid into a small saucepan and over medium-high heat, bring to a boil, then simmer until sauce is reduced and you are left with about 1/3 cup. Pour heated sauce over chicken. Garnish with parsley and serve.

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Other Ottolenghi recipes from TBTAM

Flageolet with Fennel and Feta

Flageolet beans w fennel and Feta

I send Mr TBTAM to the market for French Le Pay lentils yesterday, and he returned instead with French flageolet.

It’s partly my fault. After all, he did call me from the store to be sure he had the right brand. My mistake was assuming he knew what a lentil was, and instead focusing on making sure that what he was buying was actually imported from France. He said the word flageolet, and even spelled it out for me. I had no idea what flageolet meant, but it sure sounded French to me, and thinking it was a lentil brand name, I approved the purchase.

Only when he got them home did I discover that flageolet are not a lentil brand, but a type of bean. And not just any bean, but a small, buttery bush bean plucked from the pod while still young and delicate. Sort of the veal of the bean family, but without the force feeding or animal cruelty.

Flageolet beans

Flageolet have been called the “caviar of beans”. I’m not sure I’d go that far – a bean is after all just a bean. And truth be told, I still love the stronger flavor of a good lima bean more than any other legume. But flageolet are a really nice alternative to white beans, and the small size is just lovely.

How I cooked and served my flageolet

I eschewed the overnight soak, instead following Epicurious’s recommended method of bringing the beans and water to a quick boil, then letting them soak for just an hour. Then I added salt and a bay leaf, brought the beans to a boil again and simmered for one and a half hours, till a blow on a spoonful of beans loosened the skin and I knew they were done and ready to be drained. (I saved the bean water to be used as a chicken stock alternative).

While the beans were cooking, I sauteed a diced onion with diced carrots and celery and 4 cloves minced garlic in a few tbsp of olive oil. I had a large piece of chicken, some braised fennel and a few cooked clementine slices leftover from last nights dinner – Ottolenghi’s Chicken with arak and clementines.  I chopped that up and added it to the sauteed veggies, along with the now cooked and drained beans, and finished it all off with some low fat feta, lots of parsley and a drizzle of olive oil. A side of cucumber salad was the perfect accompaniment.

Perhaps a better approach

Ina Garten has a baked preparation for flageolet that I may try sometime soon. She uses the very same ingredients I used, but sautees her veggies in bacon (oh yeah…), adds rosemary and cooks her beans in the oven using beef stock instead of water and with the veggies and herbs, advising that the mild flavor of the flageolet requires them to be cooked with their accompaniments. She also advises not to add salt till the end of the cooking time, as it toughens the beans – which may explain why I did not find the flageolet to be the buttery consistency I’ve read so much about.

A fortuitous mistake

I’m so glad Mr TBTAM got it wrong at the market yesterday. Flageolet are a wonderful bean, a great alternative to white beans, and are now a staple in my pantry.

How do you serve your flageolet?

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Some flageolet serving ideas from around the web