Browsing Tag

clean eating

Recipes

Ratatouillle

July 26, 2017
Ratatouille. Loving summer veg!

The farmer’s market is a beautiful place during high summer.  You can find all the ingredients to make one of my favorite summer dishes: ratatouille.  This is literally French home cooking at its best.  Fresh veg, fresh herbs, olive oil, a little heat, and most important of all… lot’s of patience!

If you don’t have all the ingredients, that’s okay.  The only essential ingredients are the eggplant, onions, garlic, and olive oil.

Ratatouille

1/4 pint of olive oil (and possibly more, be generous)

2 eggplants, diced

1 red pepper, sliced

1 green pepper, sliced

2 medium-sized zucchinis, sliced

1 large onion, finely sliced

4 cloves of garlic

3 tomatoes, peeled and diced

2 sprigs of fresh rosemary, minced

4 springs of lemon thyme, or more to your tasting, minced

Pinch of red chili flakes (not technically French but I like the taste)

Salt and pepper

Instructions

  1. Heat half the olive oil in a large cast iron pan.  Add the eggplant and sprinkle with salt.  Gently fry until tender and lightly caramelized.  The secret to an amazing ratatouille is time and generous amounts of olive oil.  Transfer the eggplant to a large bowl carefully leaving the drippings and left over olive oil in the pan.
  2. Add a little more olive oil and add both the red and green peppers.  Also add a pinch of red chili flakes.  Fry gently until the peppers are soft and lightly caramelized.  Transfer to the bowl containing the eggplant.
  3. Add a little more olive oil to the cast iron pan.  See the pattern?  This time gently fry the zucchini until soft and lightly gilded.  Transfer to the eggplant.
  4. Now gently fry the onions and garlic until lightly caramelized.  Transfer to the eggplant.
  5. Finally, fry the tomatoes until soft and collapsed.  This time transfer the eggplant, peppers, zucchini, onion, and garlic to the cast iron pan with the tomatoes.
  6. Add the minced thyme and rosemary, and season with salt and pepper.
  7. Gently cook, bubble, for about 5 minutes.
  8. Serve at room temperature.

Ratatouille is excellent served warm, room temperature, and even cold.  You can eat it straight or you can even use it to stuff a tart, as a topping for pasta, or to dress a pizza.  One of my favorite ways to eat it is at room temperature topped with a fried egg and served with a slice of sour dough bread.  It’s versatile and highly nutritious.

Enjoy!  Please leave your comments below.  How do you like your ratatouille?

Featured Overcoming Inflammation

What is the best diet for autoimmune diseases

June 21, 2017
What are some foods have anti-inflammatory properties?

In recent years there’s been a lot of talk about the autoimmune diet. But what exactly is an autoimmune diet and which foods have anti-inflammatory properties?  These are some of the most common questions my patients ask me in clinic.  Essentially, what foods help autoimmune diseases?  In certain cases, it’s pretty cut and dry.  If you have celiac disease, avoid gluten.  If you have ankylosing spondylitis, Crohn’s disease, or ulcerative colitis, try to follow the FODMAP diet.  There already exists evidence-based research that supports these interventions.

But what about other autoimmune diseases like rheumatoid arthritis, lupus, Sjogren’s syndrome?  What should you be eating if you have any of these?  Do they have their own autoimmune diet?  Should you avoid nightshades, dairy, gluten, eggs, etc.  In recent rears a myriad of “anti-inflammatory diets” have surfaced on the web.  For the most part, they are supported by little if any evidence-based research.  This is unsurprising.  Good quality research requires money.  Lot’s of money… pharma money.  It simply does not make any business sense for these companies to fund large and expensive studies that have no commercial potential.  Believe me, I am not defending big pharma, I’m simply stating reality.

What is epigenetics?

Even though we do not have great scientific evidence supporting a particular autoimmune diet or foods to prevent, cure, or lessen autoimmune diseases, it’s kind of obvious that some lifestyle practices lead to better health outcomes.  Take smoking.  People that smoke tend to get lung cancer and develop heart disease compared to those that don’t smoke.  But how does that work exactly?

Everyone is born with genes.  Some of these genes are active and some remain dormant.  Your genotype is the entire makeup of your genes.  Your phenotype is the result of how your genetic material is expressed.  For example, you may have the genes for blue eyes and brown eyes.  If the genetic material for brown eyes is dominant, you’ll have brown eyes.

This is where it gets really interesting.  Over the course of your lifetime, some of your genes are turned on and off.  This is influenced by factors like aging, the environment, and lifestyle.  Epigenetics is the study of how genes are turned on and off based on external influences.

Epigenetic changes can be good but can also cause harm.  We think that some of these changes can result in autoimmune diseases.  It’s important to remember that epigenetics is in its infancy.  Researchers still are not 100% sure how this happens, let alone, how to specifically manipulate the environment to cause favorable epigenetic change.

Autoimmune diet: what foods should I eat?

This simple answer to this question is, “I don’t know”.  One day, when researchers crack the epigenetic code, I may be able to answer this questions more accurately.  I may be able to tell you, if you follow the rheumatoid arthritis autoimmune diet, this should help control your inflammation.  Unfortunately, I am unable to say that yet.

But like I was saying at the beginning of this post, some people who adhere to certain lifestyle practices tend to be healthier.  Given we don’t really have actionable epigenetic data to guide lifestyle choices, the goal when it comes to nutrition and lifestyle is to adopt habits that have a tendency to result in overall general health to live happier, healthier, and longer.

The Blue Zones®

The Blue Zones® are 5 regions in the world where people statistically people tend to live to 100 years AND who tend to reach this age in health.  The project spawned from the National Geographic Society.  The goal was to find “hot spots of longevity” around the world.  The researchers identified 5 zones and circled them in blue ink.  These regions are as follows:

  • Ikaria, Greece
  • Okinawa, Japan
  • Ogliastra region, Sardinia
  • Loma Linda, California
  • Nicoya Peninsula, Costa Rica

One would think that there are no similarities between people living in Japan versus people in Greece.  What the researchers identified was a core list of lifestyle practices and environmental factors that shared between all the different regions.

The Power 9®

Move Naturally

People that live to 100 years don’t necessarily run marathons or go the gym.  They are always on the go and they move naturally.  For example, they tend a garden, they walk to the market, they use stairs instead of the elevator.

Purpose

People that live in the Blue Zones live with purpose.  They wake up every morning, and they know “why I wake up in the morning”.  Having a clear purpose in life can add an extra 7 years of life expectancy.

Down Shift

We all know that stress can cause inflammation.  I often see people in my clinic who’s rheumatoid arthritis was in perfect control until something really bad happened, like a divorce, job loss, or a death in the family.  Chronic stress leads to chronic inflammation.  People in the Blue Zones develop daily habits to help reduce stress.

80% Rule

The Japanese have a saying “Hara hachi bu”.  This is a mantra that Okinawans say before every meal, reminding them to stop eating when they feel about 80% full.  There is a delay between feeling full and actually being full.  When you feel 80% full, you are actually full.  So if you stop eating when you feel full, you are overeating.  People living in the Blue Zones tend to eat their largest meal at breakfast and their smallest meal at dinner.

Plant Slant

Although not all regions of the Blue Zones eat meat, their diets all mainly consists of fresh veg and beans.  Lot’s of beans: fava, soy, lentils, etc.  They eat meat very sparingly and servings are small, “about the size of a deck of cards”.

Wine @ 5

Thank goodness for this one!  People in the Blue Zones, expect for Adventists, drink alcohol moderately and regularly.  Typically, they drink 1-2 glasses of wine per day with friends and family at the end of the work day.  They found that people who drink regularly and moderately tend to live longer than those who don’t.

Belong

Almost all people who live until 100 tend to belong to some sort of faith-based community.  They found that attending a service 4 times a month can add up to 4 – 14 years of life expectancy.

Loved Ones First

People living in Blue Zones tend to live close to their families.  It’s common to have children, parents, and grandparents living under the same roof.  They also tend to commit to a life partner.

Right Tribe

People in the Blue Zones keep strong social networks.  Not only are these social strong, but they also foster healthy behaviors.  Women in Okinawa create “moais” early on in life.  These are groups of 5 friends that are completely committed to each other for life.


The true beauty in the Blue Zones Project® is that you don’t need to live in a Blue Zone to reap the benefits.  By living the Power 9® you can set yourself up to live with vitality to a ripe old age.

Conclusion

Medications certainly have made a huge difference in the prognosis of many autoimmune diseases like rheumatoid arthritis and lupus but it’s not enough.  By integrating healthy habits we can potentially turn on an and off genes that contribute to ongoing autoimmunity and inflammation.  Although we still don’t know exactly what the perfect autoimmune diet is, by adopting healthy habits set forth by the Power 9®, you can increase your odds to live a long, happy and healthy life.

RheumDoctor Learning Center

RheumDoctor Learning Center: What is the microbiome?

May 17, 2017
How the microbiome affects the immune system

The microbiome refers to the combined genetic material of a group of microorganisms found in a certain body part such as the gut, respiratory tract, skin, or genitourinary system.

Symbiosis refers to a relationship between organisms that are beneficial for one another.

Dysbiosis refers to an imbalance of different microorganisms.  It is the opposite of a state of symbiosis.

How the microbiome and autoimmune diseases relate?

There appears to be an association between autoimmune dieaseses and dysbiosis, such as inflammatory bowel disease, spondyloarthritis, psoriasis, and rheumatoid arthritis.  It is still unclear whether autoimmune diseases cause dysbiosis or whether dysbiosis causes autoimmune diseases, let alone how we can use this information to treat and prevent autoimmune diseases.

Ultimately we need more research.  We live in interesting times!  Please leave your comments below!


References

National Human Genome Research Institute

Recipes

Potage Saint Germain (Fresh Pea Soup)

March 29, 2017

Nothing says Spring like fresh peas!  This soup is as old-school as it gets.  History attributes its invention to the court of Louis the XIV’s.  Before moving his court to Versailles, the king held court at the château of St. Germain.  When court was finally moved to Versailles, the king’s gardener planted among other edibles, the sweet pea.  The original recipe consisted of fresh peas, lettuce, white leeks, and a mirepoix.  The perfect spring fare.  Simple, fresh, classic.

A classic is a classic not because it conforms to certain structural rules, or fits certain definitions.  It is a classic because of a certain eternal irrepressible freshness. – Edith Wharton

 

Potage Saint Germain (Fresh Pea Soup)

1                    Leek, green removed, finely minced

1 tbsp           Butter

1                    Potato, cubed

4 cups          Chicken broth

1/2                Boston lettuce, minced

1/4 cup        Fresh mint, minced

4 cups           Fresh sweet peas

Salt and pepper, to taste

1/2 cup         Cream 15% optional

  1. In a heavy saucepan, soften the leeks in the butter.  Add the broth and potato and bring to a boil.  Simmer for about 20 minutes or until the potato is tender.
  2. Add the peas, lettuce, and mint and bring to  boil.  Simmer for about 2 minutes.  In a blender, purée the soup until smooth. You can also use a hand mixer.  Personally, I prefer my soup with A LOT of crunch.  If you like your soup silky smooth, use the blender and strain.
  3. For a richer fare, add cream.  For a lighter fare, skip this step.
  4. Season with salt and pepper.
  5. When servicing, garnish with croutons if desired.

Enjoy!

Serves 4

Recipes

Pistou Soup

February 15, 2017

Last Thursday, I came back from work with 8 inches of snow on my driveway.  Waiting for me, taunting me.  Fortunately this year was the year I decided to ditch the shovel and invest in a snow blower.  About an hour later, I finally finished clearing the driveway.  As I was sitting in the living room, trying to nurse my hands from a Raynaud’s flare, I thought about what to make for dinner.  I wanted something warm, I didn’t want to work too much, and I wanted to be reminded of summer.  Basil!  Fresh sweet basil.  Pistou soup was the answer.

Pistou soup or “soupe Pistou”, is a traditional French soup from the region of Provence.  It’s loaded with vegetables, it’s very versatile, and it’s delicious.  It’s bit like minestrone but French and much less heavy on the tomatoes.  Just before serving, the soup is infused with a sort of pesto called a “pommade”.  This infuses the soup with a burst of fresh basil.

Enjoy!

2 tomatoes, cubed

2 zucchini, cubed

2 carrots, cubed

1 onion, chopped

2 garlic cloves, crushed, a finely sliced

2 handfuls of fresh white beans

2 handfuls green beans

2 handfuls of dried macaroni

Pommade

1 cup packed fresh basil

1 egg yolk

olive oil

Parmesan

Salt and pepper

  1. Cut all the vegetables into cubes.
  2. In a large enameled cast iron dutch oven, heat the olive oil, onion, tomatoes, and garlic over medium heat until soft.
  3. Add the carrots, zucchini, and the beans.
  4. Cover with water.  The water should be about 2 cm above the vegetables.  Salt as desired.  Remember, more salt is on the way so don’t add to much.
  5. Bring to a boil and cover.  Bring to a simmer.  Cook for about 45 minutes.  Add the pasta about 15 minutes before the end.
  6. In the meantime, prepare the pesto.  Also called “la pommade”.  It isn’t really a pesto in the strict sense.  In a food processor, grind the basil with the egg yolk.  If you really want to do it old-school, use a mortar.
  7. Add some grated Parmesan cheese, salt, and pepper.  No need to be precise.
  8. Then add the olive oil and emulsify.  Continue adding olive oil until you get a thick-ish paste.  It should not be too runny.
  9. Go back to your soup and remove it from the heat.  Season with salt and pepper.
  10. Ladle into a bowl, then add 2 tablespoons of “pommade”.  If you want more, knock yourself out!
  11. Serve with Parmesan cheese and sourdough bread.

Serves 6 – 8

Note:

If you want a little bit more protein in your soup, add a lamb shank or any other type of meat.  I personally like to add a pork neck bone.  Simply add the meat at step #3 and remove the bone before serving.  You can also return the meat in bite-sized pieces.

Gluten-free?  Skip the pasta.

Diseases and Conditions Overcoming Inflammation

Simple and easy ways to hydrate your skin

January 23, 2017

This past Christmas, I received probably one of the most bizarre gifts I have ever received.  A full adult-sized onesie! Let me tell you, it hasn’t really brought out the most flattering bit of my anatomy.  Last year I had lamented that my house was kind of cold in the winter and mentioned that babies had it made with their one-piece pajamas.  That being said, I decided to use my family’s superhuman memory to my advantage.  This year it was all about my dry skin and how wonderful it would be to have a paraffin wax machine.

I have to admit it though, that onesie does keep me nice and toasty at night!

While waiting for the paraffin wax machine that hopefully will be making its apparition Christmas 2017, hint-hint, I thought I’d do a little research about the topic of dry skin: anatomy, immunology, and basically how to keep it as moist as possible without that oily feeling.  People who suffer from autoimmune diseases tend to suffer from dry skin.  This really isn’t surprising.  This skin is the largest organ in the human body.  Because of its large surface area, it needs a large complex immune system.  Autoimmune diseases = inflammation and inflammation involving the skin = dryness, irritation, and itchiness.

Anatomy and immunology

The medical term for dry skin is xerosis and the term dermatitis signifies inflammation of the skin.  The skin is made up of the epidermis which is the most superficial layer followed by the dermis and then the subcutis.  These layers are made up of blood vessels, hair follicles, as well as glands.  One of the main functions of the skin is to protect your body from the outside world.  That being said, the skin contains many immune cells such as Langerhans cells, neutrophils, eosinophils, and lymphocytes.  When skin is irritated by bacteria, viruses, chemicals, the immune system kicks in to fight off the foreign invader.  With autoimmune diseases, it’s the immune system that starts to attack the skin itself.  In either case, when the immune system is activated it causes inflammation which = irritation + dryness.

There are many autoimmune diseases that affect the skin.  Some of these include scleroderma, Sjögren’s syndrome, rheumatoid arthritis, lupus, sarcoidosis, and psoriasis.

So what can you do to keep your skin moist and healthy? Drink plenty of water, limit the amount of exposure of your skin to water, protect your skin from the sun, avoid allergens, and moisturize regularly.

Avoiding irritation and dehydration

You would think that more water equals more hydration.  That may be true for ingested water, but it’s the opposite for water that makes direct contact with your skin.  For example, every healthcare worker soon learns that there is a positive correlation between the dryness of their hands with the amount of times they wash their hands per day.  Don’t get me wrong washing your hands is very important to prevent the spread of infection, but it certainly does a number to your skin.  Some things simply cannot be avoided.  That being said, if you suffer from dry skin, try to limit the amount of time you spend washing in the shower.  Make it a quick 5 min instead of a long 30 min shower.  Another tip is to use lukewarm water instead of hot water.

For people who shave, try to shave immediately after you shower.  The hair will be much more malleable at this time.  Always use a sharp razor and always shave with the line the hair grows.  These will lessen the amount of irritation caused by shaving.

This may sound obvious, but it’s really important to prevent your skin from burning.  Burnt skin = dehydration.  If you plan on being in the sun, try to stay in the shade between 11 AM and 3 PM.  The UV is at its highest during these hours.  Aim to cover up with clothing made of light-colored cotton.  Light colored clothing adds a few extra SPF points.  Broad-brimmed hats and sunglasses are your friends.  Use sunscreen liberally.  At least 15 SPF.  For people suffering from lupus, plan for a much high SPF as UV can actually trigger a full-fledged systemic flare.

What I mean by avoiding allergens means, try to avoid anything that may cause some form of allergic reaction.  Again allergic reaction = inflammation = deterioration of skin barrier function = dehydration.  Obviously, it’s impossible to avoid everything but it may be a good idea to swap perfumed household products for hypoallergenic ones: laundry detergent, softener, soap, shampoo, moisturizer etc.  Anything that directly or indirectly makes contact with your skin.  It’s important to note that even, “all natural” products can potentially contain allergens.  For example, most people aren’t allergic to Shea butter, but some are.  Learn to know your skin.

Hydrate you skin

Are you as confused as I am when it comes to moisturizers?  Which ones are good?  Which ones are bad?  What’s the difference between a lotion, cream, and an ointment?  What goes where?  How much should I apply?  How often?

It’s essential to moisturize daily particularly those suffering from dry skin conditions.  Simply put, dry skin is determined by the amount of transepidermal water loss and this in term is determined on the integrity of the skin barrier function.  The composition of the moisturizer determines whether the treatment helps skin barrier function or not.  I can’t tell you which moisturizer is better than the other, because I haven’t found any blinded head-to-head evidence-based studies addressing this topic.  If you do find one, let me know.  I’m all ears!

Moisturizers come in various forms: lotions, creams, and ointments.  Lotions are the least greasy and ointments are the greasiest.  Typically, the greasier the moisturizer, the longer it lasts.  The questions what goes where and how often and how much to apply, may actually be over-complicating the matter.  The goal is to keep the skin nice and hydrated.  When you really think about it, consistency is key.  Would you wear a thick greasy ointment on your hands all day long?  I wouldn’t because it’s uncomfortable and quite frankly not practical.  Due to my job description, I wash my hands nearing 100 times a day.  I’d rather use a cream or lotion and simply apply it more often.  The ointment might be better tolerated at night before going to bed?  If I’m comfortable, I’m more likely to wear the moisturize regularly.  How much to apply?  Apply enough so that the skin feels moist.

Like I said, there’s no need to complicate things.

One word of advice, when applying a moisturizer, try to stoke it onto the skin in the direction that the hair naturally falls.  This can prevent folliculitis.

Caution

A little bit about miracle cures.  They don’t exist.  Any product marketing itself to be a “cure for psoriasis”, is probably a product to be avoided.   A lot of these products have high doses of corticosteroids, which may initially make the skin look more hydrated and look “healthier”.  If you suffer from psoriasis, it may even clear it up.  But in the long run, regular application will cause permanent skin thinning, aging, and atrophy.  Just like food, read the ingredients on the packaging of your moisturizer.

When it comes to diet, in general beware of any diet advocating cutting out lists of foods.  For the most part, these are not founded in evidence and you actually may be doing more harm than good.  Nothing beats a clean diet and plenty of water.  What that actually means, is a matter up for debate.  For more information regarding clean eating, I recommend visiting the Blue Zone Project by Healthways.  The Blue Zone principles were derived from a National Geographic study identifying practices in cultures where people tend to live longer, i.e., greater than 100 years of age, and healthier as compared to the normal population.  When you have entire populations of people living longer and healthier over  thousands upon thousands of patient years, it makes me think they’re onto something.

Parting words

I hope you’ve found this information useful.  If you would like more information, please contact your local physician.  Love your skin, keep it nice and hydrated!

References

Dermatology Secrets Plus, 5th edition copyright 2016 by Elsevier

American Academy of Dermatology

Loden M. Effect on moisturizers on epidermal barrier function. Clin Dermatol. 2012 May-Jun;30(3):286-96.

Penzer R. Providing patients with information on caring for skin. Nurs Stand. 2008 Nov 5;23(9):49-56.

Subscribe

Enter your email address to receive notifications of new posts.