Bourdain calls out Deen

Paula Deen who crafted a remarkable, high profile career with her Southern style of cooking, delivered with Southern style charm, announced her diagnosis of  adult onset diabetes (type 2). Now the judgments are pouring in: her food and lifestyle led her to this diagnosis and the pundits are asking for her to “repent.”

As a physician let me be clear here:

Paula Deen’s diabetes is not a deserving fate for what she cooked, it is more a matter of genetics than anything else. For those who are unlucky enough to have the genetic code that predisposes them to diabetes, the odds are they will become its victim, as they get older.  Even the most “in shape” individual, who eats “right” who has the genetics for diabetes can no more avoid that than you can avoid a car accident  if someone misses a stop sign because they are texting.

Perhaps I am jaded – as someone who researches diets and performs weight loss surgery- I’m reminded that HL Mencken said that physicians are not suppose to offer repentance but absolution.  But a body never lies, and while we don’t know the “right” diet,  we do know that  certain foods can kill you.

While the news enjoys the pseudo-feud going on between Deen and one of my favorite writers-chef Anthony Bourdain, we in medicine hope that Paula Deen is using her celebrity to benefit millions who are diagnosed with diabetes. She is also cashing in a check from a sponsoring company;  isn’t that the American way?

The real quote from Bourdain is one anybody can respect, “Honestly, I have no ill will toward her personally. I respect anybody who’s had a trajectory like hers. But I don’t like the brand. If her shtick is food that’s going to rush you along your way to diabetes, then it’s not a brand I particularly like. I am the last person in the world to be advocating for any kind of healthy eating or lifestyle. The only distinction between us, actually, is that my show comes with a parental advisory and hers doesn’t.”

I won’t endorse Paula Deen’s cooking as “healthy” and most of it would cause blood sugar to rise higher than it should.  Food can kill you, but it cannot cure you. Hopefully Paula Deen will use her celebrity to advocate for diabetes education and awareness.  I also wouldn’t mind if she would come out with a few recipes that won’t raise the blood sugar as much as twinkie pie. And just to be fair– eating a little less of poison doesn’t mean it is being “moderate” it just means you are being less stupid. Besides- you can’t eat just one. So, Ms. Deen- lets see some new recipes.

Until then, I’ll be watching Bourdain eat camel cheeks in some far away place, wishing I was there with him.

]]> http://yourdoctorsorders.com/2012/01/paula-deens-diabetes-a-physicians-perspective/feed/ 2 http://yourdoctorsorders.com/2012/01/paleolithic-diet-old-genes-to-fit-in-jeans/ http://yourdoctorsorders.com/2012/01/paleolithic-diet-old-genes-to-fit-in-jeans/#comments Fri, 13 Jan 2012 02:49:23 +0000 thedoc http://yourdoctorsorders.com/?p=1614

The Paleolithic diet presumes that foods eaten during the stone-age (Paleolithic era from 2.5 million years ago to 10 thousand years ago) are optimal foods for humans. The Paleolithic (Paleo) diet includes grass fed beef and other lean meats, fish, shellfish, fruits, vegetables,  eggs, nuts, but no grains, no dairy, no salt, no refined fats (butter or margarine) and no sugar or high fructose corn syrup.

Fanatical Diet (Lifestyle types)
There are three things one should never discuss in polite company, religion, politics, and diet. Getting into an argument with proponents of diets is like a democrat trying to convince a republican that Obama is ok. Each side will quote their own studies, statistics, and population studies. But the key to scientific study of the various diets is not what we presume from correlation, but from what we learn when that diet is placed into patients – in this case, the laboratory values of those who have the diet.

Diet proponents become fanatical about their diet (lifestyle) to the point of religious fervor. Seeking to prove that their diet is backed by science, proponents use population studies with associations that are only suggestive and not proof of causation. These associations become propaganda as the associations are repeated over and over, morphing from a suggestion to “proof.”

The Flaws of population studies or Correlation does not equal causation
The foundation of many diets are based on the correlation of what a population eats and what diseases they suffer from. In the Paleo diet the assumption about what they ate and the diseases they suffered from is a spurious correlation at best, and far from causation.

Population studies are flawed, as often we find that we don’t know as much about the population as the data might suggest. Take the Pima Indians of the Southwest. In 1990 a paper came out stating that the Pima Indians had a low incidence of fatal coronary heart attacks in spite of having a high rate of diabetes. The Pima Indians were called among the most studied populations, with an NIH post in Phoenix, and lots of studies showing the highest rate of diabetes in the world. When the population was examined more carefully, the Pima Indians had plenty of heart disease.

Step back from the most studied group in the United States with great statistics and physicians trained in modern medicine and then imagine making conclusions about what Chinese eat, or Mediterranean’s, or French. Those assumptions are more flawed, as are the statements about what diseases they do or do not have. Now step back further trying to determine what people of the Stone Age ate, what diseases they had, and we leave the tenuous role of suggestion and enter the role of outright guessing. Even if we have reasonable data (and often we don’t – even for the best studied people in the United States) the correlation between what people eat as a cause for what diseases they have is a fundamental flaw. Correlation does not equal causation.

The Best Diet or Lifestyle is?
When it comes to the best diet plan for a person – we just don’t know enough to say that one is better than another. There isn’t enough evidence to state that the Paleolithic (also called Paleo) diet is better than the Ornish, Southbeach, Pritiken, or pick one, or better than how you currently live your life.

We cannot broadly say that any given diet will prevent heart disease, cancer, arthritis, or even obesity. When someone tells you a diet can prevent such, they have gone from the realm of science to the realm of bs.

The Paleo Diet Premise:
The Paleo diet premise is that we should avoid certain foods because our body is not evolved to process those foods, and if it does process them it will lead to the chronic diseases of modern man – heart disease, strokes, cancer. Cavemen didn’t have those diseases, so we should eat like cave men. Of course, we don’t know about what diseases that cavemen had – especially when it comes to organ and soft tissue diseases, we just have a few fossils that we examine and look for evidence of known diseases. Would coronary artery disease show up in a fossil – nope? Would cancer show up in the fossil – bone cancer would (kind of a rare cancer) or cancer that went to the bone might – but it would be hard to tell if the fossil evidence.

We do know, from many hunter-gathering societies, that they live a short life, and not long enough to develop the diseases we associate with aging. All a person has to do to pass on their genes is make it into puberty, and to be effective to nurture the young, into the 30′s, and to see grandchildren and help child raising – into the early 40′s. That is what a simple civilization needs. After that, in any primitive society, the elderly become a burden – perhaps to be placed on an ice flow. People who live into their 40′s and 50′s may die of cancer, heart disease, or obesity- but they will have passed on their genetic code.

The Evolution of Homo Sapiens:
When Homo Erectus came out of Africa, they encountered a world that was much more varied in food sources than Africa. The brain of the human (H. sapiens) evolved, becoming much larger, and utilizing far more energy than the brains of the Australopithecus – about 10 percent more. More than any other species, humans evolved a brain that required more calories- and our brain metabolism accounts for up to 25% of our energy needs. Bigger brains and its increased requirements mean a richer diet- and modern hunter gathering species derive about half of the energy from animal foods – in contrast with other primates that have far fewer animal foods. While our ancestors the Australopithecus dined on plant foods, and had large mouths to grind up fibrous plants – humans are built, with smaller faces and jaws, to dine on energy rich animal foods.

The reconstructed skull of Lucy, Australopithecus- large jar and muscles for eating plants

The Human skull is larger, larger brain- and jaws for more energy rich foods

Humans were successful, as the fossil record shows, because they were “flexible” eaters, using a wide variety of dietary strategies. If there were a lot of Elk, then we ate elk- berries, we picked berries. To state that our digestive system evolved only to eat some few items found in the Stone Age – has been disproven on the face of it. Our ancestors in Africa didn’t encounter Arctic char, whales, seals, salmon – and yet when they moved from that warm climate to the frozen north, they adapted quite well to a very high fat diet of primarily animal based diet that was clearly not available in Africa. The findings of starch grains from wild plants in grinding tools from sites in Italy, Russia, and the Czech Republic from the mid-upper Paleolithic era suggest that the production of flour was present 30,000 years ago.

Contrary to what Paleo proponents state: people made flour 30,000 years ago

How to eat like a caveman
There are some things about the Paleo diet that people avoid:

Excess sugars including fructose
Excess Omega 6 oils – including soy
Processed wheat, grains, and gluten
Dairy

What is the scientific evidence for this? It’s the simple premise that modern man has lifestyle illness from altering food, taking in too many calories, and if we would return to our ancestors roots (pun intended) we would avoid these highly processed foods and not suffer from the holy trinity of diabetes, obesity, heart disease, and maybe even cancer. There is not a single shred of evidence to support the premise of this diet.

An entire dietary regimen has been formed with plenty of books and websites to guide you through this. It has become so popular that the question becomes not the flawed premise for the diet, but rather how the diet would compare to other diets. If you want to eat like a caveman, then shop on the outside of your grocery store.  Everything on the inside of your grocery store is generally processed foods, and everything on the periphery of the grocery store is generally not processed.  On the periphery you will find the vegetables, fruits, meat counter, fish counter – although you might get in trouble with dairy, and before you check out they might have a cookie or two – or there might be a bakery (a big no no among the non-Geico types). But lets be clear- whatever the caveman could get that they could eat- they would eat, and if a caveman were to be around today- wait, we have them – well, they eat Poptarts.

In one real scientific study patients with known heart disease who were randomized to either the Mediterranean-like diet (based on whole grains, low fat dairy products, fish, fruit, and vegetables) or the Paleolithic diet (no grains or dairy but plenty of lean meat, fish, fruits, vegetables, root vegetables, eggs, and nuts) and those who undertook the Paleolithic diet were satisfied with less food. There was also a decrease in leptin in the Paleolithic group by 31% and by 18% in the Mediterranean group.

There have been other studies that show that people who go with this diet have improved laboratory values – less triglycerides, lower blood pressure, some weight loss, that the diet has a better glycemic index (the food doesn’t increase blood glucose levels as much). This diet compared to a standard diabetic diet did better. Those studies are short term, with small numbers of individuals, and hints of laboratory values.

So before one assumes I am putting this diet plan into the trash bit along with Ornish- there is clearly some data here that shows good nutritional sense in the food.

While highly processed carbohydrates transiently increases blood glucose levels more than whole grains – it does not mean that bread is bad for a person. At least we don’t know enough about this to state that today. Clearly, people who eat a lot of flour based products can get fat quickly, and getting off the bread and bakery products will help reduce weight, decrease hemoglobin A1C levels, decrease triglycerides, and overall be healthy.  Some people need to be told to never eat them again – as some alcoholics must never drink again- and some people are able to moderate them so they do minimal damage to the body.

Only a few studies have examined the effects of the Paleolithic diet on laboratory values that we associate as increased risk for disease – but again, those were laboratory values, not a long-term follow up for disease.

The premise for the Paleo diet may be flawed, but here are the parts of the Paleo diet that most would agree with:

(a) Highly processed grains – white flour, rolled oats- do cause a rapid increase in blood glucose levels and the body responds to that by increasing triglycerides and ultimately fat.
(b) Fish – as long as it is not contaminated with mercury, is a protein source that is high in Omega 3 fatty acids, which have been shown to be beneficial. If you have some great fish three or four meals a week it works out well.
(c) Vegetables and fruits are the basis for most diets- thus a vegetarian could participate in a Paleo diet easily. Too many people do not eat enough fruits or vegetables or look to them as snacks.
(d) The trend away from cattle feedlots and desire to have grass fed rather than grain fed beef. Grain fed beef is fatter and more prone to being infected with Salmonella or E.Coli than grass fed beef.  There is a wider variety of taste with grass fed beef, and most who find grass fed beef end up preferring its flavor. Grass fed beef is best cooked with Sous Vide cooking.
(e) If you eat more calories than you burn you will gain weight. But it is more than just calories – it is also the types of calories. Eating high glycemic index foods mean you will spike glucose pushing it into cells, where it will be quickly transformed and stored as fat. Low glycemic index foods will be slowly burned  - thus, calorie for calorie with the Paleo diet plan you will tend to burn the fuel from the food as opposed to store it.
(f) If you eat a majority of your food with highly processed grains instead of whole grains you will have a faster rise in blood sugar. Some attribute this rise to increased obesity and an increased load on the pancreas.

Overall- this is not a bad diet program. Nothing in it would appear to cause nutrient deficiencies and there is some preliminary evidence that this diet keeps a person more satisfied with less food. It is a low-carbohydrate diet, and those diets, in comparison to other diets, tend to produce faster and longer weigh loss.

Here are a few scientific references- I’m sure we will add more as time goes on

Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes. RG Nelson, ML Sievers, WC Knowler, BA Swinburn, DJ Pettitt, MF Saad, IM Liebow, BV Howard, and PH Bennett
Circulation. 1990;81:987-995

Food for Thought: Dietary change was a driving force in human evolution. Wm R Leonard. Scientific American. December 2002: 107-114.

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in inviduals with ischemic heart disease. Jonsson, et. Al. Nutrition & Metabolism 2010, 7:85

Thirty thousand-year-old evidence of plant food processing. A Revedin, et al Proc. Nat. Acad. Sci, November 2010: 107:18815-18819

It is the New Year- the celebrations have finished, the high calorie foods are now tossed or consumed- and you want to start fresh and clean and ready to tackle the year.

So what about some “cleansing” to “flush the toxins” out of the body?

Thankfully, your body has already done that for you, and there is no outside cleanse  that will do more for you, than what your body has done.

There are thousands of people who will offer you various forms of “cleansing” from simple fasting, to colonics, to drinking olive oil and lemon juice. None of which have any merit to them- none of which will help your body – and some of which might even have some downsides.

Of course people who advocate “cleansing” will point to all the bad things you took in: the alcohol, the high sugar cookies, the fatty meats, and state that their product will clean the rest of those out of your system so you can start the New Year fresh and healthy. They are just full of what they want to rid you of.

By now your liver has processed the alcohol and it is gone. The food has passed out of you- and if there were any “toxins” left- well, none of the therapies that you can find in your health food store will do more than what your body has already done.

So, you want to help your body? Try this instead: focus on eating healthy this year.  Don’t bother trying to drink Acai berries (see a previous post) – they don’t taste that great and are not as “anti-oxidant” as blueberries (cheaper and tastier).

So relax – eat healthy – minimize the processed foods, and think of whole grains, fruits, vegetables – and if someone offers you a coffee colonic? It isn’t worth it.

Drank too much? Your body has processed it.  Will a “liver cleans” make it better – nope.  What about those “gallstones” that come out– well, they are not gallstones. As a surgeon, I can tell you that if you had gallstones that size you would be yellow– and then a liver cleans isn’t what you need. Those are simply little balls of feces that have been brought together by the lime or lemon juice and olive oil (really- it is just that). You want your liver to be healthy – don’t abuse it. Moderate your alcohol intake, and get rid of excess pounds, and avoid too many cakes and cookies and that is the best you can do to keep your liver healthy.

And colon cleansing- they show these photos of all this stuff built up. Well, having operated on hundreds of colons, I can promise you, things don’t build up in there. The only thing you will have when you get your enema is a lighter wallet and no benefit to your health. Colon cleansing is a myth, and in fact it can be a dangerous one.  But many famous people believed this would be the secret to long life- including Kellogg, of the cereal fame- who died of a heart attack – with a very clean colon. John Kellogg used water and yogurt “from above and below” to restore the bacteria of the colon (apparently he like pro-biotics). Bottom line (couldn’t resist) – colonics are worthless.

Looks like they should be asking if you want unleaded or not

This year resolve to take lots of walks – moderate your drinking – and plan the New Year to be a year of health – because if you have your health- you have everything. Eat healthy- we just don’t know what that means – honestly we don’t. We know a bit about it – mostly don’t eat too much. Stop being a member of the clean plate club, and instead – leave a quarter of what you would eat on your plate. You will see the pounds disappear and you won’t be so hungry.

In addition to academic publications, her writing has appeared in USA Today, the A Cup of Comfort series, KevinMD.com, EmpowHer.com, Exceptional Parent, Parents Press, Sacramento Parent, and the Marin Independent Journal.

The post originally appeared on her blog, and she’s kind enough to share it here…

I lost 45 lbs this year and I did it by following evidence based medicine.

The #1 thing that I did was commit to weight loss journaling….writing every morsel down that goes into my mouth (helping me stick to my 1,500 calorie a day allotment that I needed to eat to lose weight at a safe rate). Studies tell us that people who journal every day lose twice as much weight as people who don’t.

One of the most important points about journaling is a defense against what we dieters call “bad” days. We shouldn’t be pejorative like that, but many people who are overweight have a black and white view of food intake (I did anyway). What I mean by that is, if the day is shot (e.g. I broke the bank by eating 4 slices of pizza or a piece of apple pie), well, in for a penny in for a pound and it dissolves into a belly-up-to-the-trough kind of day.

But journaling, I have found, can help even when you hit a rough patch….let me rephrase, especially when you hit a rough patch. It’s like a rip cord for your back up parachute. Because stopping to write things down helps you realize that

A) The situation may not be as dire as what you have worked out in your head

and

B) Honesty about what you eat is essential. Because if you are over weight (like I was) you probably lied to yourself about it, “I’m not that fat,” or “I’ve tried journaling/everything and it doesn’t work.”  These are the lies that keep us from losing the weight and trust me, you haven’t really tried journaling until you have honestly weighed and measured every scrap that goes into you mouth, written it down, and stuck to your daily calorie allotment.

Which brings me back to the holidays. Last week was a challenge for me. I only stuck to my maintenance calories (2,000/day) 2 of the 7 days. But I journaled. Every day. Even when it wasn’t pretty. Looking back, I realize it wasn’t the horror that I had concocted in my out of control imagination. And when I really wanted that desert on Friday, I looked at my journal and didn’t. And while it didn’t stop me from eating the 3rd piece of pizza on Saturday it did stop me from eating the 4th (and stopping my descent into pizza madness is no mean feat).

It worked for me and it will work for you. It is as much about being honest and accountable to yourself as it is about the calories. And the only thing you have to lose is the weight.

You can follow Dr. Jennifer on Twitter, too.

Heart artery plaque- low fat diet doesn't prevent this

Never has it been more clear that publishing a paper in a respected journal can lead to a career. Even if the science has changed it. It has been 15 years since Dean Ornish published his data showing a 3 percent reduction in the plaques seen by coronary angiograms on a select group of patients who followed his diet and “lifestyle” plan.  To be exact: they found 1.75% improvement after one year and 3.1% improvement after five years.  Where the control group increased by 2.3% in one year and 11.8% at five years. This was a group of 28 patients who followed his diet to the letter.

In 15 years no one has reproduced that data. No one. In medicine we see a lot of data come through, when it is not reproduced, or unable to be reproduced by others we look at it with a very jaundiced eye. Or to be blunt – we don’t believe it. Yet, his data, with all the issues it has- is still touted by a few in the popular press as “proof” that the “low fat” works. We have levels of evidence in medicine, and while Ornish attempted to get to the highest level of evidence, by having a control group – he fell short with several major statistical issues: (a) his study does not contain enough people to be anywhere nearly significant (b) one cannot rely on angiographic photographs which are interpreted in many different manners (c) one cannot control outside factors, exercise, BMI, smoking cessation.

In contrast, we now have an entire group of lipid medications. A recent study in New England Journal of Medicine showed how that Crestor had produced a regression of plaque in 63% of the individuals.

Lets be clear- the medication data is using far more sensitive instruments to measure plaque. Intra-vascular ultrasound where they thread a tiny ultrasound probe into the artery and  measure the plaque precisely.   In the Ornish data, he used photos of angiograms ( show two cardiologist the same angiograms and you will get two different interpretations of it – angiograms are not precise). The medications show specific reductions in plaque- not everyones – unlike Ornish. It is rare that anything does 100 per cent to everyone.

When looking at angiograms- like Ornish did- the interpretation of them is so variable, that no scientific publication today would accept that data, or its interpretation. The small amount of plaque reduction is too small to be anything but observer bias.

Two views of the same image- angiogram interpretation is flawed

Still, from one old paper- Dean Ornish has made a career, being the anti-Atkins, and riding the anti-cholesterol, low-fat band wagon with the same religious fervor as Keyes did thirty years ago (see my earlier post about that).

The difficulty is this: science has caught up with us, and we know a lot more about how plaque forms and doesn’t form. We know that dietary cholesterol is far less important that what the liver makes. We know that the dietary component may be far more related to the triglycerides – and they are raised far more by the grains and pastas that Ornish loves.

Still, Ornish is the lead health-blogger for Huffington Post, has influenced Bill Clinton (see the previous post) and is favorably mentioned by Dr. Oz. He still argues against those who advocate any “low carbohydrate” solution, based on his “empiric” data.

Personality, the willingness to believe in  your hypothesis no matter what science says, and the desire by the public to see “natural” leads to a great career in politics, and entertainment. For most scientists, Ornish’s paper isn’t a breakthrough, but borders on confabulation.

There is always another “fad” diet out there- and the HCG diet hopefully died when the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued letters to companies warning them that selling “homeopathic” HCG weight-loss drugs was not FDA approved and that there was no evidence of the claims, thus violating FTC rules.

HCG is a hormone that is produced by the human placenta during pregnancy. Clinically HCG is used as a fertility treatment, and can lead to increase in progesterone and testosterone, which have consequences of their own including deep vein thrombosis (a clot in the veins of the lower extremity) leading to pulmonary embolism and even death. This is not a benign hormone, and should only be used under the strict supervision of a physician – who knows what they are doing, not a naturopath or homeopath, or chiropractor. HCG is also elevated in some cancers, and we follow HCG levels to determine how effective our cancer therapies work with some tumors. This is also the hormone most use to determine if a person is pregnant.

This fad diet started in the 1950’s when Albert Simeons, a physician working in India, noted that pregnant women on a low-calorie diet lost fat rather than muscle and the fetus was protected. He hypothesized that the HCG reprogrammed the brain to lose fat rather than muscle, thus protecting the body against loss of muscle. Simeons went on to become an entrepreneur founding weight loss clinics, manufacturing centers, and having widespread use of his product. There was no evidence for HCG working and the diet died in 1976 after an article in JAMA showing that there was no difference between patients who received HCG and those who received a placebo. In 1976 the FTC ordered the Simeon Weight Foundation and HCG Weight Clinic Foundation to stop claiming the HCG was safe and effective, and the FTC has required labeling and advertising of HCG to state:

Albert Simeons- went from working in India to making a fortune in weight loss

HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets

HCG was reborn in 2007 with the book, “The Weight Loss Cure They Don’t Want You to Know About,” by Kevin Trudeau (if you watch infomercials you have seen him – the infomercial guy). Shortly after the FTC charged Trudeau with violating a court order and misrepresenting the contents of the book on his infomercials. He was ordered to pay 37 million dollars for violating their order.

This silly book resurected a bad diet

Still, that started a new industry with companies manufacturing products that could be sold out of major drugs stores, injections given in drive-by diet centers, and lots of people touting this as the cure to obesity. The manufacturers decided if they would slap the “homeopathic” label on it, they could get by with selling this over-the-counter and make even more money off consumers. The FDA stopped this nonsense- not only because this is a potentially dangerous hormone, often given without strict medical supervision, but because the very low calorie diet that goes with it should be done under the supervision of a physician also.

The reason we won’t see the HCG end is because physicians can still prescribe injections of HCG – even though this is not a diet that will work. There are still unfortunates who think getting an injection of this hormone will work- and as PT Barnum once said “there is a fool born every minute.”

The HCG proponents are filled with confirmation bias.  They lose weight, so they assume it is the HCG that suppresses appetite – although there is no evidence it does.  They then will cite articles in non-peer reviewed journal  such as Dr. David Bryman, an osteopath from Scottsdale, who published a non-randomized study with a higher protein low calorie diet- showing the HCG had more weight loss (The Bariatrician – 2010 Vol 25, page 11) . The problems with this study are several: first there is no randomization, second there is no control, third there is no blinding, and fourth there is a clear bias.  To put this in perspective- this study has less validity to it than a noted expert opining.  This study does not rise to acceptable levels of Evidence based medicine. Sadly, the HCG proponents, including health care professionals, do not understand the value of the evidence based medicine that clearly demonstrated no efficacy of HCG in any study in a peer reviewed journal.

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm

The action of chorionic gonadotrophin in the obese. Simeons ATW. Lancet 2:946-947, 1954.

Chorionic gonadotropin in weight control. A double-blind crossover study. Young, Fuchs, and Woltjen. JAMA. 1976 Nov 29;236(22):2495-7.

I thought I had steak down- as a person who loves to grill food, owner of The Big Green Egg — I thought I knew how to make a steak. Then I started to cook Sous Vide.  Simply put- these are the best steaks I have ever had. They are so good, that my wife hates it when we have to meet friends at a steak restaurant, because these make it so much better.

Here is the rub:

Equal parts of Kosher salt, paprika, brown sugar, and ground pepper.

Season a steak with salt.
Rub in the rub– generously.
Put in a water bath at 146 degrees for 45 minutes. You can go longer if you like- and sometimes I find an hour works well too. The advantage of Sous Vide cooking is that you will not overcook — the water is only 146 degrees. So if you have friends over and not ready to serve- let it sit.

Nothing like great grill marks on a steak

Once you are ready- have a grill pan on high – so you can sear the outside of the steak. My favorite grill pan has marks on it. You can also do a quick grill on your outdoor grill if you like.

Serve the steak. Simple – easy- and notice the steak. Inside of it it is all medium rare- not just the center. This means that steak is juicy!

Don’t have a Sous Vide machine? Treat yourself and start changing the way you cook.

Mom prefers Sous Vide to the traditional roasted turkey

Thanksgiving is my favorite holiday- for so many reasons. But the turkey can be a pain — a pain to make properly, and then a pain because you have so much of it that one tires of turkey leftovers after a day or so.  The answer- making Turkey Sous Vide.

Sous Vide is a method of cooking that we have advocated for a while.  Don’t have a Sous Vide machine? Treat yourself and start changing the way you cook. It allows low temperature cooking, so that the meats are not overly dry. The most common reason people go to an emergency room on Thanksgiving is they get a piece of dry turkey caught in their throat. With Sous Vide, the turkey won’t be dry (of course, if you swallow too large a piece it can still get stuck).

The previous posts have talked about Sous Vide but there are a number of places that sell the equipment for the home cook to do Sous Vide cooking easily.  Most people need to get a water oven and a machine that does vacuum sealing of the food.  You can use the link above to purchase the Sous Vide machine, or you can find them at places like  Sur Le Table and William-Sonoma.  Mine was purchased from William-Sonoma and I have demonstrated its use at their stores.

Turkey

The first key is to butcher the turkey into its parts.  This makes the bird manageable.  As  you can see from the video, I love to do that myself, but if you have a good butcher they will do that for you. You can also purchase the pieces individually from the butcher if you like.  Some purchase just breast, some thighs.  It is cheaper to purchase the entire bird, though, and have the butcher break down the bird, including splitting the breasts.

This allows the turkey parts to be cooked at temperatures and times individually for them. It also allows you to cook the entire turkey Sous Vide and those parts you won’t use can be frozen for up to six months (avoiding those many recipes for turkey soups, turkey casseroles, and turkey curry).

To Brine or not Brine

Many talk about placing the turkey into a brine in order to help the turkey stay moist through cooking.  The brine has little to do with a turkey being moist. A brine is a solution of salty water, and some place other herbs and sugar in it- that draws water out of the turkey, especially the skin. It does not make the turkey more moist when cooking it.  Over cooking turkey in an oven is easy- over cooking turkey Sous Vide is impossible.

I find brines and marinades to be messy.  But having a turkey broken down into its parts makes it easier to handle.

Instead consider seasoning the turkey with Kosher Salt for a day. Less messy than making up a brine.  Salting the turkey helps the skin become crisp.

Seasoning the turkey:

A simple salt and pepper seasoning works well on the turkey. You won’t need olive oil on it, and we will take care of that great herb flavor with our cachet of herbs.  Salt and pepper the skin.  There are a number of poultry rubs available- and you may prefer those.

Herbs:

With Sous Vide the best way to permeate the turkey with sage, rosemary, thyme, and even basil if you like- is to roll these up in a plastic wrap. Cut off both ends and drop this into the bag.  If you put the herbs in directly there will be bits of turkey that will have intense flavor, and other bits that have none.

Duck Fat or Butter:

Placing either duck fat or butter in the bag will bathe the turkey during the time it is in the water oven. Some prefer one over the other- some even use a bit of olive oil. Butter is easy because it is solid at room temperature and melts nicely in the water oven.  Duck Fat, if kept in the refrigerator is solid at cool temperatures also.  Olive oil isn’t solid at room temperature and may be pulled out by the vacuum sealer, unless you are careful.

Water Oven Time:

Once sealed, they can be placed into the water bath kept at 150 degrees F.  Breast is done in 2.5 hours, thighs about 2 hours. They can stay in for longer- so if the guests are not quite ready, you can relax knowing that the turkey will not over cook.

Simple Sear:

When you are ready, have a hot grill to sear the turkey skin and provide that crispness to it. Whether you use a grill, grill pan, or hot oil – it is only two minutes a side.

Pre-Left overs:

If you find that you will have more turkey than you need- leave the turkey in the vacuum sealed bag. Put it into an ice bath immediately to stop the cooking and cool it down. Then freeze it. The turkey will be ok for up to six months.  Three months after last Thanksgiving we placed turkey breast back into the Sous Vide for 30 minutes to “re-warm” it (an oven, microwave, or stove will dry it out) – and had the most delicious, most amazing turkey breast — far better for sandwiches than anything you could purchase.
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Want to smell that stuffing– simple- make your favorite stuffing and bake it– the house will smell like thanksgiving and no choking on dry turkey!

Rack of Lamb is one of the easiest proteins to make- it is healthy and the flavor is great.

First start with a great Rack:

There is debate among people who like their lamb from New Zealand and those who prefer American. My good friend @DolceDebbie doesn’t like American lamb, while Chef Thomas Keller has all of the lamb for his restaurants raised in the United States. Those are complicated arguments- know that both have great lamb.

Ingredients:

1/2 cup of Dijon mustard

1/2 cup of Italian bread crumbs

1 Tablespoon of Fresh Rosemary or two teaspoons of dry Rosemary (get the fresh- it stores a long time)

1 teaspoon of minced garlic

The juice from one lemon

Preheat the oven to 450 degrees

Mix all the ingredients in a bowl and spread the thick paste over the loin (meaty) side of the lamb

Put the lamb bone side down  into a casserole dish or any oven safe dish, or a roaster (two sides to a rack – the meaty side should be up) -

If the oven isn’t ready- it is ok to let this to sit for a bit

Put the dish the center of the oven

Cook for 25 minutes. Then turn the oven off.  Leave in the oven  for another 20 minutes and take out.

Once it is out of the oven leave it on the counter to “rest” for ten minutes

Cut and serve

If the lamb is too rare for your liking – heat up a skillet to medium heat and sear them the lamb for 1 minute per side.