Sauerkraut, Kimchi & Tropical Fruit - OH MY!!

 I taught a super fun class tonight at the Bosch Kitchen Center.  It was a hands-on class where everyone made their very own Kimchi with the Perfect Pickler.  Everyone learned how to make Kimchi , Sauerkraut, Fermented Tropical Fruit, Herbed Cashew Cheese, Paprika Cheese Ball, Almond Yogurt and Almond Milk.  Everyone also learned how to make Kimchi Fried Rice (Kimchi Bokumbap) YUMMY!! I will post pictures & recipes for all of these in the next couple of weeks.  Below are recipes for Sauerkraut, Kimchi & the Tropical Fruit Mix.  The Perfect Pickler is an amazing tool that makes fermenting vegetables and fruits fail proof.  To read more on the benefits of cultured/fermented vegetables, fruits and nuts, CLICK HERE.

Everyday Kimchi- Makes 2 quarts

Printable Recipe

3/4 pounds Napa cabbage (buy a pound, save a couple outer leaves) Cut into 1” pieces.

1/2 pound Daikon radish ( or mix of daikon and carrot) peeled, julienne slices or shredded)

3 large scallions, trimmed and cut into thin, slanted slices

Fresh garlic, 2 TBS minced

Fresh ginger, 2 TBS peeled and minced

Korean chile flakes, 1  to 3 TBS to taste. (You can adjust after fermenting)

Brine:

2 cups water to 1 rounded TBS. sea salt

Cut cabbage into 1” squares.  Add remaining  ingredients and pack into jar.  Leave 3” space at at top of jar.  Add whole cabbage leaves on top of Kimchi mixture.  Place brine overflow cup on top of mixture and carefully add brine until you just cover the top of the mixture by quarter inch or so.  You now have extra air space for expansion.  

Recipe by Bill Hettig (Creator of the Perfect Pickler)

Savory Sauerkraut – 1 qt.

Printable Recipe 

2 - 1/4  lbs cabbage (finely shredded)

Save several round pieces of cabbage cut from top as well as a 1” square chunk to place on top of kraut.
1 TBS (scant) fine sea salt

1 tsp caraway seeds

Cut round pieces out of top of cabbage to use on top of kraut mixture.  Shred cabbage and add salt.  Work cabbage with hands until you start creating a nice brine. Use a wooden kraut masher to break up cell walls of cabbage and help to form brine.  Mix cabbage with caraway seeds.  Pack tightly into qt. jar until several inches from top.  Place cabbage rounds on top of kraut mixture and then place 1” square cabbage chunk (cut from center of cabbage) on top of cabbage rounds.   Place brine cup on top of cabbage chunk and seal lid.
Recipe by Bill Hettig (Creator of the Perfect Pickler)

Rawfood101 - DVD Review & Recipe

If you are new to raw foods or confused about what steps to take,  Raw Food 101 is an awesome DVD to get you started. Tanya Alexseeva, Better Raw, lives in London and I absolutely love all that she is doing to help people live healthier lives.  Her 2 1/2 hour DVD is a complete beginners guide to raw food. The DVD is all in chapters so it is extremely easy to follow and go back and forth between the different subjects. I love being able to actually watch the recipes being created.  She starts off with the equipment she uses on a daily basis in her raw kitchen. She then goes on to green smoothies, nut milk and calcium, superfoods, the staples in her kitchen, sprouting, fermenting, dehydrating, sauces & flavors, five minute meals & desserts.  I received permission from Tanya to create one of her recipes from the DVD and I picked her delicious 'Curry in a Hurry' main dish meal. Oh my goodness this was so good with flavor plus!  My daughter dropped by and absolutely loved it too.  The cauliflower has all the properties to help build up your immune system and cleanse your body. It also has a lot of spices to help warm you up and satisfy. The recipe makes four large servings and is good for several days in the refrigerator. I highly recommend Tanya's DVD, even if you are not a beginner to raw foods.  Her recipes are excellent, nutritious and I just love her fun loving personality.  I know you will too.

In Tanya’s class (RawFood101) you will learn all the basics, such as:

◈Which equipment is necessary and which is just for fun

◈What superfoods are all about

◈ The difference between smoothies and juices

◈Why dairy is not the answer to calcium

◈Why fermenting is so important

◈What on earth a dehydrator is and what you can create in it

◈Secrets to staying raw in winter time

◈Guidelines on sprouting at home

◈Practical tips and tricks to creating easy meals and snacks in under five minutes

◈How desserts can very much be a part of your diet

◈Hear truly inspiring success stories

◈Recipes include green smoothies, nut milks, hummus, granola, crackers, sauerkraut, cheese, spaghetti bolognaise, curry, sushi, chocolate, ice cream and more!

Raw Curry in a Hurry

Printable Recipe

Serves 4

1/2 head of cauliflower (trimmed  & roughly chopped)

2 carrots (roughly chopped)

1 cup cashews (soaked until soft)

1/2 avocado

1/4 onion

1 clove garlic

1/2 inch ginger

1/2 cup flaked coconut

1/2 cup sun dried tomatoes 

2 Tbsp extra virgin olive oil

2 tomatoes

1 tsp cumin

1 tsp turmeric

1 tsp black pepper

1 tsp cinnamon

2 Tbsp + water

Garnish with cilantro.

Place cauliflower & carrots in food processor.  Process by pulsing until it looks about the size of rice and set aside.

Place remaining ingredients in blender and blend until smooth and creamy.  Add more water if needed until desired consistency.  

Place cauliflower/carrot mixture on plate and pour on sauce.  Garnish with cilantro and ENJOY!

You can follow Tanya on Facebook

The Ethics of Choosing Wisely and Practicing Efficiently

This month the American Board of Internal Medicine Foundation (ABIM) joined with nine medical specialty societies, each of which released a list of five tests, procedures or treatments whose use and clinical value were not supported by evidence, as determined by experts from the specialty.

This is a major step for the US health system. We've been phobic about engaging seriously with waste. In the 1990s we asked insurers to do the job, but physicians and patients pushed back against "managed care," and insurers backed off. Now we physicians ourselves are stepping forward. It's about time!

Among the 45 recommendations, the ones that are "absolute" should be relatively easy to discuss with patients, as in this example from cardiology:

Don’t obtain screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. In asymptomatic individuals at low risk for coronary heart disease (10-year risk <10%) screening for coronary heart disease with exercise electrocardiography does not improve patient outcomes.

There's no waffling here - this form of screening "does not improve patient outcomes." If I were a cardiologist I would say that asking Medicare, Medicaid, or a private insurer to pay for the screening would be unethical. If it is known not to improve outcomes there's no justification for using shared health care funds to pay for it. And I'd feel fully comfortable looking my patient in the eye and explaining why I would not order the test.

The same is true for this "absolute" recommendation:

Don’t obtain imaging studies in patients with non-specific low back pain.
In patients with back pain that cannot be attributed to a specific disease or spinal abnormality following a history and physical examination (e.g., non-specific low back pain), imaging with plain radiography, computed tomography (CT) scan, or magnetic resonance imaging (MRI) does not improve patient outcomes.

But some of the recommendations are "relative," not "absolute," as in these two examples:

Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology.
In the absence of cardiopulmonary symptoms, preoperative chest radiography rarely provides any meaningful changes in management or improved patient outcomes.

Don’t use cancer-directed therapy for solid tumor patients with the following characteristics: (a) low performance status (3 or 4), no benefit from prior evidence-based interventions, not (b) eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment.
Studies show that cancer directed treatments are likely to be ineffective for solid tumor patients who meet the above stated criteria...

Suppose a patient with a solid tumor that meets the specified criteria protested - "I understand that further chemotherapy is unlikely to be effective, but I want to try anything with the slightest chance of helping me. Your medical society is recommending rationing! That's not fair!"

The oncologist won't have an easy time responding. The patient is right - the medical society has made a rationing recommendation. In my view, this is a long overdo step forward out of the lala land of make believe infinite resources. But in our political culture, the word "rationing" is avoided as assiduously as the "f" word. Our reflex is to deny that rationing is occurring, not to discuss the rationale for why and how it is being done.

And with regard to the recommendation against a routine chest X-ray, it's only a matter of time until the evening news features a patient whose X-ray picked up an undiagnosed cancer, leading to cancellation of the scheduled surgery and removal of the cancer. The patient will tell us "the X-ray saved my life - are we going to let a rationing decision kill people just to save money?"

I hope the ABIM and the specialty societies are brave enough not to run for cover when the inevitable backlash occurs. They've taken a courageous step on behalf of the health of patients who could be harmed by interventions that wise clinical practice should avoid. And they've pushed us towards open engagement with the question of when interventions that "rarely" produce any benefit should be paid for our of shared insurance funds. We should thank the ABIM and the specialty societies for their contribution to healthier patients and a healthier society!

(Information about the ABIM's "Choosing Wisely" program can be found here.)

Making Doctors more Ethical

The Association of American Medical Colleges (AAMC) has redesigned its Medical College Admission Test (MCAT) for the first time since 1991. For premeds, the MCAT is like the pearly gates - they have to pass through it to get to the promised land of medical school. It's more than 50 years since I took the MCAT, but as I wrote this paragraph I felt my pulse going up. Our innards don't forget major stressors from the past!

Starting in 2015, the MCAT will add a section on psychology and sociology and another on critical analysis, to the sections on the hard sciences and mathematics. The AAMC wants to send the message to premeds and colleges that medicine requires more than mastery of scientific knowledge. And they're right - taking good care of patients requires understanding the patient's psychology and social context, application of critical analysis to diagnosis and treatment planning, and the interpersonal skills for developing trusting relationships.

The MCAT section on psychology and sociology will be organized around five basic truths about human nature and society that the designers of the test call "foundational concepts":

• Biological, psychological, and socio-cultural factors influence the ways that individuals perceive, think about, and react to the world.
• Biological, psychological, and socio-cultural factors influence behavior and behavior change
• Psychological, socio-cultural, and biological factors influence the way we think about ourselves and others.
• Cultural and social differences influence well-being.
Social stratification and access to resources influence well-being.

The draft version of the new MCAT probes these basic truths with challenging questions. Some of them were tough to answer. I didn't get a perfect score.

At a welcoming event for first year Harvard Medical students in 1960, a distinguished scientist on the faculty asked me what I'd majored in at college. I told him - a combined major in philosophy and psychology. He responded - "philosophy and psychology - what are you doing in medical school?" 

The AAMC doesn't want that kind of "greeting" to happen in the future.

The AAMC is entirely right to extend the scope of what the MCAT examines. The new standards, however, are just a drop in the bucket for changing the culture of medicine. Doing well in psychology and sociology courses won't be hard for smart undergraduates. Course work matters,  but character can be refractory to book learning.

In a freshman philosophy course in college, the instructor asked "how many of you can refute Plato's argument for XYZ?" None of us raised our hand. "So am I right that you have all decided to change your lives in accord with XYZ?" Again, none of us raised our hand.

His point - the dissociation between what was on the page and what was in our hearts, was clear. In a similar vein, in the anatomy lab during my first year of medical school the instructor came to my table and asked our group about the course and branches of the femoral nerve (the major nerve going to the leg). Studious book learners that we were, we looked at the ceiling and tried to recall what we'd read in the anatomy text. The instructor suggested - "wouldn't it be better to look at the dissection you've just done?"

What premeds learn in social science courses is important, but what they learn from personal relationships, their jobs, teams, and volunteer activities has a deeper influence. I love leading a section of the first year Harvard Medical "Professionalism and Medical Ethics" course, but I think of it as trying to impart a framework that - with good luck and good mentoring - the students will be able to apply in their future clinical work. Albert Schweitzer taught that "Example is not the main thing in influencing others. It is the only thing." The example of what the AAMC is saying in its redesign of the MCAT is probably as important as what future students will learn in Psychology and Sociology 101!

Winner of The Perfect Pickler

We have our Perfect Pickler winner and it is Jenn.  CONGRATULATIONS Jenn !!! She was chosen through a computerized random drawing this evening.


I want to thank all of you for leaving comments.  I enjoyed reading them and I know everyone else did too. I will be having many more drawings for books, kitchen gadgets & food items, so I hope you will all enter them as they come up.


Please watch for my next post "Rawfood101".  I will be reviewing this DVD by Tanya Alekseeva and sharing some recipes and pictures.  I know you are going to love this!

Jenn, please send me your address so I can send the Perfect Pickler out to you - thank you.

Probiotic Vegetables with the Perfect Pickler & Giveaway

My new found love is the Perfect Pickler and I am so excited to give one away and share this amazing product!  See bottom of page for details and how to make my yummy probiotic carrots. There is also a video to watch that will show you how super easy they are to make.

I will be teaching two classes this month using the Perfect Pickler. These are hands-on classes where class members will be taking home their own Perfect Pickler filled with vegetables. I will be discussing all the health benefits.  We will be sampling a lot of different pickles with yummy Artisan Bread Panini Sandwiches.  The Artisan bread is fermented overnight and then baked in a 500 degree hearth oven called the La Cloche. Class 1 will be the probiotic carrots and class 2 will be Kimchi. We will also be learning to make Non-Dairy Almond Yogurt in Class 2.  I hope you can join us on April 11 & 25, 2012.

You fill the Perfect Pickler with just water, sea salt, vegetables and seasonings and watch the transformation take place.  "You can not purchase the nutrients found in fresh, cultured brine pickles for any amount of money, nor find more dynamic supplements.  Yet, these ingredients are inexpensive and lie within common vegetables and sea salt. We're not going back, we're coming around to the wisdom of our Elders:  make brine pickles a regular part of our daily diet." ~ Bill Hettig, creator of the Perfect Pickler.

Here's their bounty:

Vitamins:  Brine pickling creates additional vitamins as well as boosting them into highly absorbable
forms.

Minerals: Minerals from both sea salt and within plants become ionized (charged), becoming more absorbable.

Enzymes:  Dense concentrations are created and combine with vegetable-based enzymes to power up
digestion.  Enzymes pre-digest foods during the meal.

Microcultures:  Multiply by the billions.  These beneficial bacteria replenish our own resident cultures. As a probiotic they act to limit pathogenic bacteria as our very first line of immune defense.  Fresh brine pickles are both a tasty and healthy treat. 

Nowhere on this planet can you find better nutritional value than in making your own fresh brine pickles, like those made in the Perfect Pickler.  Our entire digestive tract -- from mouth to colon --benefits from ingesting daily amounts of fresh vegetable probiotics.  Each bite contains millions of friendly bacteria, the very same that reside in a healthy digestive tract.  Fresh pickles (probiotic vegetables) maintain and build upon our own colony of friendly bacteria.  

Recently, science has found these cultures to be our primary immune function; some say as much as 70 percent.Maintaining a healthy gut culture is the number one way to stay well and vital!!

Fresh pickles are a dynamic aid for hard-to-digest foods so common in this age of highly processed food.  Ancient cultures learned to combine pickles, relishes, salsas, chutneys and other ferments with their staple foods.  When you eat a little pickle with your meal these mighty organisms immediately start the digesting process in the mouth and all the way through to the colon.

Additional Benefits of Eating Brine Pickles (Probiotic Vegetables)

• Micro-cultures produce a complex of B vitamins and vitamin K. They preserve Vitamin C found in the veggies.
• Pickles kick-start digestion through salivation and enzyme production in the mouth. 
• Certain brine bacteria act as anticancer factors by preventing the formation of chemicals which are carcinogenic.
• Probiotic-rich pickles are beneficial while taking antibiotics.
• Micro-cultures develop healthy digestive tracts and immune function in the young.
• They make low-cost probiotics for daily consumption.
• They speed up bowel function by improving peristaltic action and reduce transit time of digested food.
• They play a role in protecting against the negative effects of radiation and toxic pollutants.
• Evidence is strong that an overgrowth of E. coli in the bowel may provoke a diabetic condition.  Resident microflora keep E. coli in check.
• They help control genito-urinary tract infections.
• They are an ideal treatment for diarrhea including rotavirus, Clostridium difficile and "traveler's diarrhea" especially pediatric diarrhea - one of the greatest killers of children throughout the world.

I am giving away a Perfect Pickler through a random drawing next Wednesday 4/11/12.  Please leave a comment below and you will be entered into the drawing.  The Perfect Pickler Kit includes: Fermentation Lock, Special Wide Mouth Lid, Brine Overflow Cup, Gasket & O-Ring Set, Instruction Recipe Booklet & Celtic Sea Salt.  Good luck-I know you will love the Perfect Pickler!

 Probiotic Carrots with the Perfect Pickler
Makes 1 Qt.

About 5 medium  Carrots (I sliced them with the salad shooter and they were absolutely perfect)
2 cups brine (made with water and 1 Tbsp. Celtic Sea Salt)
1 tsp. red pepper flakes
1 large minced garlic
1 inch piece ginger (peeled & grated)


Slice carrots and put into 1 qt. mason wide mouth canning jar until you reach about 2 inches from top of jar.  In bowl mix 2 cups purified water and 1 Tbsp. Celtic Sea Salt.  Let salt dissolve and then add remaining ingredients.  Pour brine mixture into jar until you reach about 1/4 inch from the top of jar.  Add brine overflow cup so it floats in brine.  Place lid on by first twisting on jar counter clockwise until in clicks into place and then turning clockwise to seal. Add fermentation lock.  Be sure to add water to the fill mark on the fermentation lock.  Place jar in a bowl and place on counter for 4 days.  Be sure to mark the date you made the carrots so you will remember when to open them.  After 4 days take off lid and fermentation lock and replace with canning jar lid.  Place in refrigerator where flavor will continue to develop. Carrots will keep for months (if they aren't eaten before then). 

Euthanasia and suicide

On March 29 Charles Snelling killed Adrienne, his wife of 61 years (the mode of her death has not been publicly revealed) and then shot himself. Both were 81.

Charles and Adrienne had an exceptionally loving marriage. He was a successful entrepreneur and inventor who ultimately went into public service. She cared for their five children and then became a fine arts photographer.

Six years ago Adrienne developed Alzheimer's disease. Charles cared for her at home, with 14 hours of help per day. When he travelled for his work he often took Adrienne with him. Charles spoke of their lives together as a love story.

On November 22, 2009, Adrienne wrote to her children:

As you know I have Alzheimer’s. It is not a nice disease. So far I have held up pretty well. Dad and I are still having a pretty good life. There is no doubt where my sickness will end up for me.

All of our lives, Dad and I have talked over our end of life beliefs. We are both in agreement that neither one of us wants to live after all reasonable hope for a good life is over. . . . We have had such a great life together and with all of you.

Several hundred readers commented on the New York Times obituary, creating a kind of Rorschach test of our attitudes about euthanasia, suicide, and the right to control the manner of our own death.

Some condemned Charles:

When people choose to take another person's life, regardless of circumstances, it is a deliberate execution. I say that as a hospice volunteer, a daughter of a fully demented mother with Alzheimer's, and a medically fragile 90-year old father. Life counts until the end.

Some focused on quality of life with Alzheimer's:

For those of you who'd rather be institutionalized than peacefully put out of your misery (given a complete loss of your personhood)--all I can say is that you've either not spent much time in institutions or you have a masochistic streak a mile wide.

For me, the quality of my life is far more meaningful than the quantity of it….

Some saw the murder/suicide as the right way for a loving life to end:

In my mind, this husband was brave, loving and strong. He gave his wife a beautiful gift by allowing her death with some dignity left; a death alongside the love of her life and a death that spared her the worst parts of the Alzheimer's "spiral".

And some withheld judgment:

This is one of those things that I don't think you can understand unless you're in it.

I agree with this last comment. The actual facts about the Snellings' health and ethical beliefs don't matter to those who believe (a) it's a sin against God to hasten death or (b) that individuals have complete liberty to choose their own path. For them there's an irrefutable "right" answer. They "know" whether the way Mr. and Mrs. Snelling's lives ended was right or wrong.

For others, facts matter. Adrienne Snelling's letter to her children certainly sounds as if she contemplated the possibility of suicide and euthanasia. If this was her consistent view, those who call her death an "execution" are doing an injustice to her husband, who was carrying out her wishes.

 But even if you're prepared to see what Charles did as an act of love, not an execution, did he do the right thing? In a New York Times op ed this morning, David Brooks says "no":

Either Snelling was so overcome that he lost control of his faculties, or he made a lamentable mistake. ..who is to say how Snelling would have felt four months from now? The fact is, we are all terrible at imagining how we will feel in the future. We exaggerate how much the future will be like the present. We underestimate the power of temperament to gradually pull us up from the lowest lows. And if our capacities for imagining the future are bad in normal times, they are horrible in moments of stress and suffering.


Given these weaknesses, it seems wrong to make a decision that will foreclose future thinking. It seems wrong to imagine that you have mastery over everything you will feel and believe. It’s better to respect the future, to remain humbly open to your own unfolding.

Brooks is making an important point. In my clinical practice I often spoke with people about the "logic" of their suicidal thinking, and I often argued that the ostensible "logic" was faulty. That's what Brooks is doing in his imagined posthumous conversation with Snelling. This would have been the right conversation for a family member, close friend, or primary care physician to have over time. But even if Mr. Snelling initially said, in effect, "you might be right," at a later time he may well have said "I've waited long enough, and the future you're imagining seems further and further away."

Two years before their deaths the Snellings sent a holiday card with a photograph of them walking together holding hands, with their backs to the camera. A friend interpreted the card as saying they were "going home." That's how I like to think about the end of their lives.

(In December, 2011, Charles Snelling wrote a remarkable essay about his life and Adrienne's condition. You can see it here.)

 

 

New Alternative to Open-Heart Surgery for Severe Aortic Stenosis

Transcatheter aortic valve replacement (TAVR) is a promising new procedure for patients with severe aortic stenosis, a disease of the aortic valve. The aortic valve is one of four heart valves and acts as the gateway that allows blood to exit the heart and travel to the aorta and rest of the body.

As people get older, the incidence of aortic stenosis significantly increases. Older patients also commonly suffer from other conditions in addition to aortic stenosis, putting them at higher risk for complications during or after heart valve surgery, the standard treatment for valve replacement.

Until recently, patients with severe aortic stenosis who were deemed too high risk for open-heart surgery did not have many other treatment options, but that’s all changing with TAVR. As a less invasive treatment approach, TAVR involves replacing the damaged valve with a newly designed balloon-expandable valve.

The valve is placed via a catheter that is inserted through a small incision in the leg. For patients with damaged valves who were previously ineligible for valve replacement, this means new hope.

Penn Heart and Vascular was the first program in the region and one of only 23 in the nation to perform TAVR. With more than 300 procedures performed to date, Penn’s highly specialized heart team has more experience performing TAVR than anywhere else in the region.

Learn more about Penn's Heart Valve Disease Program