Tuesday, December 23, 2014

What I'm Reading in the Winter Break

I want to thank everyone who wrote me messages of encouragement and shared their own stories on my last post. I am so touched and grateful that you joined in the conversation. In talking about my fears of diabetes openly, I feel like a great weight has been lifted off my shoulders. Clearly, a lot of us are in this together. I do believe that 2015 is going to be a big year of small changes for the better. 

It is cold and dreary here and I've spent most evenings this month reading or quilting. I took up a rather challenging (for me) quilt this year, making a couple of squares each month of 2014 and shocked myself by finishing it before year end!

As for reading, my three favorite books this month were all about questions and answers. 

What If?: Serious Scientific Answers to Absurd Hypothetical Questions by Randall Munroe (of xkcd comics fame) is the most delightful book I've read all year. Munroe is a physicist. Readers of his website posed absurd questions to him and he answered them as thoroughly and seriously as he could, using principles of science, math and logic.

If you have a curious nature, if you've ever wondered, "How much physical space does the Internet take up?", or "What would happen if you made a periodic table out of cube-shaped bricks, where each brick was made of the corresponding element?" or "How many unique English tweets are possible?", you'll find this book hilarious, entertaining, illuminating and very very clever.

I disagreed with a couple of his answers to biological questions. I would have answered them a completely different way. But that is the point of absurd hypothetical questions- they make you think and there is rarely one right answer, just a range of plausible ones. If science was taught this way, more kids would find themselves in STEM fields.

Big Questions from Little People: And Simple Answers from Great Minds compiled by Gemma Elwin Harris. Kids ask the most baffling questions from morning to night, and this book collects some such questions posed by kids ages 4-12 and gets experts to actually answer them. The questions range from "Why is space so sparkly?" to "Why do wars happen?" to "What should you do when you can't think what to draw or paint?" to "Who is God?". The resulting collection is a delightful collection of quirky wisdom and some very profound thoughts. I think any grown-up would enjoy leafing through this book, and if you have a child ages 5-12 (or so), it would be really fun to read some of the questions and answers with them. 

Tiny Beautiful Things by Cheryl Strayed. This is an unusual sort of book. Strayed used to be an anonymous advice columnist on a website. Readers would submit questions on love and life and the answers are compiled in this book. Reading a bunch of advice to strangers seems like a weird thing but this book is a powerful compilation of authentic and raw human emotion. This book made me "feel all the feelings and think all the things"- my litmus test for a worthwhile book. I'm very glad I read this masterpiece of heartache and hope. 

On to some fiction...

Quartet in Autumn by Barbara Pym. I have to thank Arpita for introducing me to this author. Pym has a knack for commenting on the tiny details of everyday life with wit and humor. This is a book about two men and two women who share an office and who are all approaching retirement age. This is not a plot-driven novel but a character-driven one. It is a quiet book, sad and funny in its way, as it comments on human nature. 

The Unlikely Pilgrimage of Harold Fry by Rachel Joyce is a gentle, sad yet ultimately uplifting story. This is a story both literal and metaphorical about the journey that we humans undertake. Harold Fry is recently retired, living with his wife in a tense and bitter marriage in their home at the Southern-most tip of England. He gets a good-bye letter from an old colleague who is dying in a hospice at the Northern tip of England. Harold sets out to the corner mailbox to post a reply, then somehow, without planning or preparation, keeps walking for weeks (!) to see her in the hospice. “The world was made up of people putting one foot in front of the other; and a life might appear ordinary simply because the person living it had been doing so for a long time.” 

The Mistress of Spices by Chitra Banerjee Divakaruni was on my to-read list for a long time. When I finally picked it up this month, I did not "get" the story at all. It was tedious, not fun and I returned it without finishing the book. Oh well.

Meanwhile, here's what we have been reading with Miss Lila...

Otis by Loren Long. Lila borrowed this book from her school library and she can't get enough of it. It is the sweet story about friendship between a calf and an old tractor. Lila loves to say "putt putt puddety chuff" and those sort of tractor noises from the book.

The Grouchy Ladybug by Eric Carle is so hilarious and endearing. The ill-tempered ladybug doesn't want to share a breakfast of aphids with the friendly ladybug and looks to pick a fight. When the friendly ladybug agrees to the fight, the grouchy ladybug says "Oh you're not big enough" and goes off to find progressively bigger animals to fight with.

If You Give a Moose a Muffin by Laura Joffe Numeroff and Felicia Bond. Boy, we've read this one so many times that Lila and I both know the words by heart. This is completely ridiculous story about a young boy who offers a muffin to a visiting moose. One thing leads to another as the easily distracted moose jumps from activity to activity making a complete mess in the process.

All by Myself by Aliki. Nothing exceptional about this book except that since the title is Lila's all-time favorite phrase, I could not resist picking it up at the library. The book goes through a busy day in a child's life, highlighting the everyday actions he learns to do by themselves, such as buttoning his shirt and brushing his teeth. 

What are you reading these days? 

Saturday, December 13, 2014

Towards a Healthier 2015

In the blink of an eye, we're counting down to the end of 2014. At this time of year, I always find myself reflecting on the year that was. As with most years, Twenty Fourteen had highs and lows for our family. We had many wonderful and memorable moments with our loved ones. The lowest low was V's father passing away. Indeed, all the sad and bad moments this year had to do with serious illness and deteriorating health among some of our close friends and family. Health is wealth, the old cliche says, but how often we take it for granted.

And that's what this post is- a long and rambling contemplation on food and wellness and where my life is headed. There's no recipe in this post but there is some food for thought- for myself and perhaps for some of you reading it. I guess I've been writing this post in my head for over 3 years and this week, I finally decided to type it and hit the publish button.

In the summer of 2011 in St. Louis, I was about two thirds of the way through a fairly uneventful pregnancy. We were happy and excited to welcome our baby daughter. My OB ordered a routine glucose tolerance test- and I failed it. I had gestational diabetes. I was surprised and not surprised at the same time. Surprised because I had the hallmarks of being healthy and low-risk with a normal BMI. Not surprised because I have a woefully strong history of diabetes on one side of my family and I knew very well how the genetic dice was loaded.

Things happened rapidly after I was flagged as having gestational diabetes. The very next day I saw a diabetes counsellor who taught me to finger-prick and test my blood glucose 4 times a day- upon waking (the fasting number) and an hour after breakfast, lunch and dinner. This was torture enough for me- I hate hate hate needles. It was all too much- I burst into tears in the counsellor's office but she was as kind and reassuring as can be. I also met with a nutritionist who taught me the basics of carb counting. The strategy was this: make sure I restrict carbs to 200 grams a day (budgeted over meals and snacks), do some brisk walking for exercise, test blood glucose, record my numbers and make sure they stayed within the acceptable range. If I could manage to control my blood sugar with diet and exercise, fine. If not, they'd dose me with insulin.

My baby's health was at stake. There was nothing I would not do for her. I pulled my act together and I was meticulous. I did everything I was told- counted carbs and walked for 10 minutes after every single meal. Working full time and trying to get stuff done before I went on maternity leave, I set alarms and did finger pricks at my desk. The numbers were always within range. My OB remarked that if all her patients were so compliant, she would see many fewer complications.

I had nine(!) friends and acquaintances who were pregnant at the same time as me. Everyone else was indulging in their favorite foods, eating for two, giving in to cravings. My life looked quite different. But at the end of my pregnancy, at a time when most women are feeling distinctly heavy and encumbered, I was feeling lighter and fitter than I'd ever felt. This whole torture of finger pricks, carb counting and brisk walks in the St. Louis August heat- it was working. Lila's birth was uneventful- although she was a smaller-than-expected baby and my OB and I realized that in my zeal, I had probably been stricter with my diet than I should have been. Two weeks after giving birth, I was back at my pre-pregnancy weight.

Gestational diabetes is situational; it resolves when the baby is born. Or more precisely, when you deliver the placenta, which is what produces the hormones that lead to insulin resistance. But a graduate of gestational diabetes learns some important things about her body's ability (or the lack thereof) to process carbohydrates and sees a big red flag that there is type II diabetes in her future if she's not careful. So in getting that warning sign, I will say that gestational diabetes was the best bad thing that has happened to me.

You'd think this episode would have changed my life immediately and forever. It did not. Humans can be exceedingly resistant to change. There's always an excuse and usually a laundry list of excuses not to change our habits. There was a new baby to care for and the next year went by in a blur. There was no mental space or physical energy to make any lifestyle changes. The year after that we moved to a new state and life just went on as usual.

Earlier this year, we went to visit our families in India for a month. Seeing older relatives is a form of time travel because you can see your future self reflected in them. I was seeing my extended family after 5 long years. Almost everyone I know has diabetes and its painful complications. I'm not just talking about those who are affluent and have unlimited access to food. The nice lady who cleans my aunt's house and who struggles to make a living as a maid also has diabetes. Everyone is on medication and many take insulin shots. Almost no one seems to have received any rigorous counseling about nutrition and exercise. Many have had perilous cardiac surgeries. I saw people with vibrant minds who are trapped in a body that is too heavy, with joints that are literally unable to take the weight. One close relative is losing her eyesight because of diabetic complications. In a nutshell- I was scared straight.

It is not like I haven't been trying to do better all along. I read books and try to nudge my eating habits in the right direction. I've been struggling for years to get into an exercise habit. Part of my resistance to real change has been the feeling that things are not so bad the way they are- after all, I'm not overweight, and I have tons of energy and no debilitating symptoms per se.

But the logical part of my brain knows the evidence is mounting. My energy is more mental than physical and frequently a mind-over-matter thing. Climbing a couple of flights of stairs leaves me panting- this is pitiful for my age. When my toddler wanted me to jump with her, my sister overheard and commented that she hasn't seen me jump since the 1980s. I've been labeled a bookworm and a couch potato since the days of primary school and I fully embraced that label. My BMI may fall within the normal range, but I have no muscle tone. I participated in a research study last year (it was to study the effect of walking on body composition) and the scan showed that I have a very high proportion of body fat. This is called being "skinny fat", where even a person of normal weight has fat deposits coating their organs- a very high-risk situation for a variety of diseases.

Disease is a complicated thing, a subtle interplay of genes, environment and lifestyle factors. But you have to do what's in your hands even if there are no guarantees of dodging major illness. A friend of mine was athletic and robust and healthy as the proverbial horse, that is, until she was diagnosed with lymphoma. She told me that her underlying strong health helped her survive the harrowing treatment and now she's thriving again.

All these things have been running in my head for the last few months, and I sat down and identified two goals. My experience with gestational diabetes was hard at the time, but in reality, it showed that a modest increase in exercise (just brisk walks!) and a modest decrease in carb intake gave me good results in a matter of weeks. So those are my two goals at this time.

Already, I've been exercising more this year than I did before- walking and swimming. I'm gingerly getting into the exercise habit and will talk more about this in a future post if anyone is interested.

As for eating, what constitutes a "healthy" diet is a very loaded question. I'm interested in answering the question for myself, for my own body and its challenges. I don't know or care what the universally best diet is. Humans being omnivores, I highly doubt there is one ideal diet. There are likely many different ways to get to the goal of having a favorable body composition with good blood sugar control.

I eat a mainly plant based diet along with eggs and dairy and that's what I intend to keep eating. What will change is the proportions of foods in my everyday meals. In my case, I've identified the problem as eating excess carbs and for the last couple of weeks, I've started to replace some of the carbs with lots of vegetables. My goal is not to eliminate carbs or even to drastically cut them but just not to eat more than my body capable of handling. Beans, sweet potatoes, lentils are very nutritious and will be a big part of my diet. But I will find ways on cutting down on rice, tortillas, pasta and noodles at least for my everyday meals, while replacing them with a lot more cooked and raw vegetables. There's reason for me to be optimistic because I have several things going for me- I already cook in a "veggie-centric" style and know how to prep vegetables- I just have to ramp it up. I don't have a sweet tooth and rarely eat desserts anyway.

To change my habits, I have to know myself and work with myself, and not fight against my basic nature. I don't like drastic changes. However, subtle nudges in the right direction quickly become habits and stick with me for life. I am a moderator rather than an abstainer.

Publicly stating nutrition goals often attracts criticism. There will be people who think I'm going too far ("Just eat less and you will be OK, why vilify carbs?") and others who will think I'm not going far enough ("You won't be in the fat burning zone unless you cut out all beans and starchy vegetables"). But the reason I'm putting it out there is because making a public commitment is a strong motivator for changing habits. Because I was so sad to see diabetes and other metabolic disorders eroding the people I care about, and would like to talk about it. Because this discussion might strike a chord with someone else who is thinking about these issues.

Happy Holidays and Merry Christmas to all, and I will see you in the new year! We'll continue to eat well on this blog, I promise you. 

Monday, December 01, 2014

Thanksgiving Eats

Thanksgiving is a food lover's holiday and around here it has certainly been a week of good eats. The festivities started with a potluck lunch at work on Tuesday. I contributed a main dish- harvest pilaf and a dessert- pumpkin flan.

Harvest pilaf was nothing but my standard biryani recipe. I reduced the amount of rice, and instead loaded up the dish with all the vegetables that to me are the real stars of Thanksgiving. So in went a tray of roasted sweet potatoes and carrots, and another tray of roasted cauliflower, beans and zucchini.

I've made pumpkin flan a few years ago and we had enjoyed it- pumpkin flan has all the flavor of pumpkin pie but in a cool and light custard. This time, I used this recipe from Lucinda Scala Quinn. It uses pantry ingredients (and at this time of year, I count canned pumpkin as a pantry ingredient) and makes a nice 9 inch flan. The minor changes I made to the recipe: (1) I used only 1/2 cup of sugar in the flan mixture instead of 3/4 cup, (2) I used regular granulated sugar and used a dollop of molasses to make it "brown" and (3) I made the caramel in a small saucepan instead of in the oven. For the bain marie (water bath that keeps the flan smooth and tender), I used a huge foil roasting pan from the supermarket. You only have to buy it once and then you can keep using it any time you need a bain marie.

We had a wonderful spread, including deviled eggs, spinach quiche with a puff pastry crust, a salad with kale, shredded brussels sprouts and dried cranberries, corn casserole, mashed potatoes, mac and cheese, cranberry sauce with orange zest.

The salad was my favorite dish, a crunchy and fresh counterpoint to all the other heavy dishes. I loved it so much that I made something like it to take to our Thanksgiving dinner- which was another potluck at a friend's home. My starting point for the salad was this recipe from The Kitchn.

Here's how I made my version of Shredded Brussels Sprouts Salad.

  • Lop the stem ends off 1 lb of fresh brussels sprouts. Using the slicing disk of the food processor, shred the sprouts. Also shred a cup or so of red cabbage. Core a crisp apple (like honeycrisp or gala or fuji) and make thin slices with a mandoline. 
  • In a small saucepan, melt 4 tbsp. butter and cook it until browned and nutty. In a large bowl, whisk the brown butter with 2 tbsp. balsamic vinegar, 1 tsp. dijon mustard and salt and pepper to taste, until the dressing is emulsified. Stir in the chopped veggies and apple slices. (This salad can be made in advance). Top with roasted pecans and serve. 

For a main dish to take along to the potluck, I started out with the idea of making a butternut squash lasagna. Then I remembered that I had a box of jumbo pasta shells in the pantry and this seemed as good a time as any to finally cook those. Here's what I came up with, a mash up of various online recipes- and it was a resounding success.

Jumbo Shells stuffed with Butternut Squash and Spinach

Make the filling (I did this a few hours ahead of time):

  • Peel and cube a butternut squash (there are videos online that teach how to do this safely). On a large baking sheet, toss the butternut squash cubes with 6 unpeeled garlic cloves, olive oil, salt and pepper. Roast at 425F until tender. 
  • Cool and peel the garlic. Place roasted garlic and squash (I used 2/3 of the whole large squash here and saved the rest for another dish) in a large bowl. Mash it up coarsely with a fork.
  • Thaw a box of frozen chopped spinach in the microwave, squeeze to remove excess liquid and add to the cooked squash.
  • Add 1 cup ricotta, 1 cup diced mozzarella
  • Add 1 tsp. poultry seasoning, 1/2 tsp. red pepper flakes, salt and pepper to taste
  • Mix everything together and refrigerate until you're ready to assemble the pasta.

Cook the jumbo pasta shells according to the directions on the box. Here's what the cooked shells looked like- adorable and surprisingly sturdy. Lila was delighted and munched on a couple.

Make the sauce
I made 2 cups of basic white sauce for this dish. You could use a tomato sauce or no sauce at all.

Assemble and bake
Scoop about 2 tbsp. filling into each shell. In a 9 x 13 baking dish, pour the white sauce. Arrange the shells on top. Scatter with 1/2 cup grated Parmesan cheese. Cover with foil and bake at 350F for 30 minutes, then uncover and place under broiler for a minute or two to get the cheese browned. Ta da.

This pasta dish was full of flavor and had a pretty nice presentation (which is rare for me). Each person could conveniently serve themselves a shell or two.

I had enough cooked shells left over to make another (smaller) tray of shells the next day.

So, tell me, what's cooking in your world?