A Little Shocker, or You Can't Out-Exercise a Bad Diet

This past Monday, my husband and I had to see our primary care doc for labwork that his cardiologist wanted done and some med renewals.

Our first shock came when I found out the doc we'd been seeing for about 25 years has left the family practice, preferring to concentrate on his faculty duties and overseeing an intern program at a hospital local to him. He had been threatening to leave for a few years now and was only at the office about 3 hours a week as it was. At least he can now walk to work, a fact that comes in very handy if we have another winter like the last 2.

Shock number 2 came when the doc we switched to, formerly all gruff and down-to-business, was all mellow yellow, seeming genuinely interested in what we've been up to both personally and medically, since he last treated any of us. This was the doc we first had when we switched to that practice when our old doc died in a car crash, and he was the doc at my bedside examining our son when he was just a few minutes old almost 32 years ago. When he decided to concentrate on sports medicine we switched over to his brother, who preferred the more general family medicine. He was heavily into a few sports himself, winning medals for his running and biking, and while he didn't run any major marathons, he was present at every NYC Marathon since its inception and at least 15 years at the Boston Marathon. He was there for the bombing and even got an award for his work treating victims at the scene. The walls of his room at the office are decorated with medals, certificates, and photos from all the races he's participated in, as well as autographed photos from different pro athletes he's treated.

Anyway, he was glad to hear about our diet, and said because of it, he'll most likely take my husband off all his gout meds after seeing the labwork. He would prefer to take him off the statin, too, but knows that his cardiologist insists all his patients take one, and since it's about the lowest dose possible already, said it won't do him any harm. As for me, he renewed my asthma meds, discussed reducing the omega 3/DHA/EPA med I was put on for my triglycerides, and said with the cholesterol levels I had, that as long as I keep on this food plan probably don't need the red yeast rice, but again, realized the cardiologist would probably put me on a statin if I wasn't on it and said to just cut it down to half the amount I was taking. No new labwork for me because it was so good in January insurance won't pay for it again until after a year has passed. He also told me to cut my Vitamin D was down from the dose his brother had me on. He said with winter coming it's best not to stop it completely, especially with my history (first lab test showed below 4, normal is over 20). We got our "atta boy" and "atta girl" and sent on our merry way.

Next shock concerns the lab work & med renewals. In the past, this practice insisted on coming in to be examined and then they'll renew meds or order labs, or order labs and renew meds after getting the results. We always had to then make another appointment to get those lab results. They didn't believe in giving them out over the phone and would insist on seeing you face to face to explain the results. But not now. The doc said to just call the office to get the results. Wow! This is going to be a big time and money saver!

Shock #4 involves coming into the 21st century. The company that now runs the practice had been dragging its feet in giving them the necessary hardware, but by federal law says it has to be up and running before the end of the year. That also means they'll finally be able to put things in the already established on-line patient portals, like lab and test results, prescription renewal and appointment and referral requests, so all that can be done without an office visit in the future.

But the biggest shock of all came the next day while my husband was gabbing with the office manager while waiting to get his labs drawn. She apologized for the confusion around the office, how harried and rushed she is, because things haven't been the same since (our old doc) left in June and (our new doc) came back after his heart surgery in September, that they're having a hard time catching up and getting caught up with everything.

WHAT?

It seems our doc, Doctor Tall, Thin and Athletic, had a triple bypass back in July. One artery 99% blocked, the other 2 not far behind. After discussing my husband's CABG and follow up stress tests with him the day before we're very surprised he didn't mention anything about his own. No wonder he had a completely different attitude this time! Nothing like a near-death experience to make a person slow down and enjoy life a little. And no wonder he had heard of and approved of the Esselstyn diet.

So, the point of this rambling post? You can't out exercise a bad diet! This man has been very active and lean for the 35 or so years I know him. OK, his whole family, including brother, sister, parents, grandparents, cousins, are all tall and lean, so genetics. But he's also always been active. I did mention his running and biking above, right? This was such a shock! As Doctor McDougall always says:

IT'S THE FOOD!

Mushrooms McDougall

This is one of the earliest Mary McDougall recipes I ever tried. My husband loved it, yet, because I was never that much of a mushroom lover, I rarely made it. Hubby started a week's vacation last Monday and I wanted to start him off with something a little different. As I mentioned in my Family Menus post, most Sundays we eat a meal our son started calling Unchicken Dinner back when he was a little kid. Potatoes, stuffing, cranberries, a load of veggies, and some kind of gravy. Last Sunday, instead of gravy, I made making these mushrooms. Here's Mary's write-up of the recipe in the July 2004 newsletter on-line:

MUSHROOMS MCDOUGALL
I have recently rediscovered this old favorite of ours.  We like this plain, on baked potatoes and on burritos.  It is really quick if you buy presliced mushrooms!
Preparation Time: 15 minutes
Cooking Time: 15 minutes
Servings:  4

1/4 cup water
1 1/2 pounds fresh mushrooms, sliced
1 bunch green onions, chopped
2 cloves garlic, minced
1  4 ounce can chopped green chilies
2 tablespoons lemon juice
1/4 cup sherry
1/2 teaspoon Worcestershire sauce
 fresh ground pepper to taste

Place water in a large pan or wok.  Bring to a boil, add mushrooms, green onions, garlic and chilies.  Cook and stir for a minute or two, then add the remaining ingredients.  Cook over medium heat, stirring frequently until all liquid has been absorbed, about 10-12 minutes.
Serve rolled up in a burrito shell with fresh salsa; use on top of beans in a Mexican-style burrito; or serve on top of baked potatoes. This is wonderful on almost anything!

I used the pre-sliced mushrooms, but since the package no longer says they're also pre-washed I rinsed them well and let them dry for over an hour before using.

Our store only had these very small bundles of scallions, only about 8 thin scallions in each, and most of them were brown or yellowed and wilting. I was able to find 2 that weren't, and one was needed for a different recipe later in the week. I added a few freeze-dried scallions to the pan as they were all cooking to make up for it.

The last time I made these was years before my husband's gout attacks and I always had a bottle of cooking sherry in the pantry that I used. Since all alcohol is contraindicated for people with gout, I used the substitute of half apple cider vinegar and half water as suggest in numerous cooking sites on-line. If you can handle alcohol, or have access to non-alcoholic sherry, go for it, although it didn't taste that much different from what I remembered.

The finished product. My husband likes to eat sloppy foods in a bowl instead of on a plate and this was no exception. Under the mushrooms are nuked Yellow Gold potatoes and spinach. 

I think this has now earned a place on our regular rotation. We both loved every bite of this meal, and next time I make it I'll probably add a fourth box of mushrooms, just to have a bit more leftovers for lunch the next day. 

Dee's Christmas Soup

A few years ago, McDougaller "landog" posted this recipe he called "Dee's Christmas Soup," so-named because he likened the red and green veggies in it to Christmas colors. In going with my Christmas-colored food theme this week, I decided to make up a batch for yesterday's Christmas lunch. Here's how he shared the recipe:

Dee's Christmas soup
Can of diced tomatoes (no added salt)
can of tomato sauce (no added salt)
2 cans of water (rinse out the cans of tomato)
kale (lots)
chopped onions
sliced carrots
1/2 - 1 lb. frozen corn
black pepper
paprika
oregano
basil

Bring to boil, then simmer 20 minutes.


Here's how I made it:

Tomatoes - I used a box of Pomi chopped.
Sauce - 2 8-ounce cans of Hunt's no-salt added tomato sauce
Kale - About a cup of frozen chopped kale
Onions - Half a bag of frozen diced
Carrots - a cup of shredded carrots. The rest of thebag went into the lasagna for dinner.
Corn - a whole bag of frozen sweet white corn
Spices - I just went by feel and even though I added some early in the cooking, I added more near the end. I used maybe a tablespoon total of oregano, a teaspoon each of paprika and basil, then another half teaspoon of smoked paprika. Pepper I added at the table.

It went together nice and quick, perfect for a lazy holiday lolling about watching A Christmas Story for the 5th time in one day while opening gifts. Served with a slice of hearty home-made multi-grain bread and it filled our tummies nicely.

When my husband is finally able to tolerate beans again after his gout finally settles down (Dr. Fuhrman says in a few months to a year, in some posts on his forums, before reintroducing higher-oxilate foods), I'll toss a can of either kidney or cannelini beans in the pot and make this hearty enough for a dinner soup meal.

Colorful Rice

It's Christmas week, and I had planned holiday themed dinners to celebrate the season.

On Sunday I made a dish from Dr. Esselstyn's book called Colorful Rice:

Colorful Rice
Makes 6-8 servings

1 very large or 2 smaller portobello mushrooms, chopped
1 red onion, chopped
2-3 tablespoons Bragg's Aminos, or lower sodium soy sauce
16 ounce package frozen peas, or mixed vegetables
4 cups cooked brown rice (about 2 cups uncooked)
chopped fresh parsley
2 tablespoons chopped pimentos

Combine mushrooms and onions in a non-stick skillet or wok and stir-fry about 5 minutes, until soft. Add the Bragg's plus water, if needed.

Add frozen vegetable and continue to stir-fry until heated through.

Add rice and cook a few more minutes. Add parsley and another teaspoon of Bragg's according to taste and top with pimentos.


Prevent and Reverse Heart Disease
Caldwell Esselstyn and Ann Crile Esselstyn
page 235

My changes:

Because I'vw been slowly adding different foods back to my husband's diet that are known to aggravate gout, instead of a full cup of portobella mushrooms I used 2 small cremini mushrooms, a.k.a. baby bellas.

I swore I bought a bag of frozen petite peas at the grocery store in the morning, but when I reached into the freezer for them when preparing dinner they were nowhere to be found. My husband found the receipt and nope, no peas. I had an open bag with a cup of peas taken out of it in the freezer, so used that plus some country style frozen veggies to make up the lost volume. It would have looked much more festive with just the peas and pimientos - red and green - but it wasn't to be. If only I had leftover green beans, instead.

I did my usual 2 1/2 rice cooker cups of rice and mixed grains for this, just as I did in a few previous recipes.

No fresh parsley at the store that looked decent enough to buy so I used about 2 tablespoons of dried parsley flakes. I should have used way more.

Last, but not least, I used a whole 4-ounce jar of sliced pimientos. Two tablespoons just got lost in the mix and I wanted the red and green color combo to pop.

See why I preferred all peas?

It tasted okay, but a little on the bland side, even with those 2 sodium-heavy tablespoons of Bragg's. Next time I'll sauté the onions (minus mushrooms) in just a bit of water or broth and we can add any soy sauce or Bragg's at the table for more flavor at a fraction the cost in sodium.

My husband and I each had 2 fairly large bowls of this and finished the whole recipe's worth of food. We're both big eaters, especially my husband, now that he's fully recuperated from his CABG and his body wants to return to its pre-op weight. Maybe if it had more mushrooms it would be more substantial.

But no more mushrooms for this family. After almost 3 weeks of being symptom-free and a uric acid level down to 5.9, well into the low part of the normal range, a few hours after eating this meal my husband's toe started throbbing again. It's not red and swollen, so my son and I are wondering if it was just the power of suggestion, knowing that the dish contained a microscopic amount of mushrooms, but he said it was still hurting him this morning, even after taking a colchicine tablet last night, as the doc directed him to do at the first twinge of pain. So much for the doc's instructions to add those foods back in to his diet. The same day he saw the doc I put a wee bit of nutritional yeast in the dish without his knowledge and there was no complaint. I added a quarter cup of beans to a gigantic pot of tomato soup, and no complaint. I find it hard to believe that the ingestion of one mushroom triggered another flare 2 hours after knowingly eating it. Most likely it was either the yeast or the beans finally making their way through his system and causing a reaction, but to be safe, it's back to none of the known gout-triggering vegetable foods. Good thing I didn't stock up on any of them and only bought a total of 6 mushrooms. The rest I'll cook up and toss in my own lunches.

Not AGAIN?!?

Friday night/Saturday morning, a little after midnight, I get awakened by a light in the kitchen, a mere 8 feet from my face. Since my husband was no longer asleep next to me I assumed he went there to fetch a glass of water. Then I heard talking - our son, whose bedroom abuts the kitchen, has joined him in conversation. The voices start to sound a little frantic (I'm partially deaf and can't make out what's being said, just the tone of the words) so I jump up and head into the room, and the first thing I see is my son rifling through the pile of papers on my side of the table.

What's wrong?

My husband then tells me his gout is acting up again and he's looking for the written prescription for the colchicine so he can get it filled as soon as the pharmacy opens in the morning.

I tell my son to go back to bed, walk into the bathroom, open the drawer in a storage box in the bathroom closet, pull out a bottle of colchicine, toss it at my husband, and head back to bed. He forgot we got the prescription for the bottle filled the same day he got it 2 weeks ago, the same day his gout started up the last time and he started taking the pills from the last refill on the old prescription. The doc had said to fill it ASAP and to have a full round (only 12 pills) on hand at all times for these flare-ups, because the sooner he starts treating it, the less pain and swelling the flare will be.

He took his pill and crawled sheepishly back to bed. By the time he got in I had already gotten the extra pillow down to the bottom of the bed so he could elevate that foot, fixed his covers so he could easily slip back into bed and cover all but that foot up again, and started making a mental list of everything he had eaten that day and tried to identify the one food item that broke the camel's back and started the flare again. He kept moaning and groaning, tossing and turning in his sleep that it kept me awake until after 3 am and around 5am one of his snores woke me again so I just stayed up after that. Oh, that wasn't gout related - he does that most nights, even before his CABG. It's just a thing he does. He also talks in his sleep now and then.

I made the mistake once again of believing Dr. McDougall instead of Dr. Fuhrman and fed him vegetable products that are not high but moderate in purines. Dr. McD feels that vegetable sources are benign, whereas Dr. Fuhrman says to avoid them, at least for a while during and after a flare-up. While he didn't have any spinach or mushrooms, he did have plenty of beans the past few days in the shape of bean burgers, hummus and tofu. He had broccoli as well as that tofu cheese in the lasagna. He had split peas in soup. He had artichokes on his pizza. He had roasted Brussels Sprouts, which is on some lists of foods to avoid, other lists of foods to eat during a flare. He eats bread daily. If I go back through my menus or his night time snacks for the past 2 weeks I'm sure I'll find he ate something every single day that some sites say to avoid if you have gout. 

It all has to stop. He can't go on having a flare a week after his last one finished. He has to start eating an entirely different way. He can't take sandwiches of seitan in to work - he has to start taking in containers of safe foods because the yeast in the bread may be a trigger. He can't say, "I ate this before with no problem," and think he can get away with it. He can't fall back on familiar, comfortable foods and think he's immune from their effects.

I know this is all so hard on the guy. He had to change once already this year because of the CABG and his cardiovascular disease. Now the foods that are protecting his heart are killing his joints and he has to change all over again. 

I now have to go through all my menus and eliminate all the recipes that include all known gout trigger foods, and believe me, there are a LOT of them in the vegetable kingdom. I have to scour all my cookbooks and recipe files, whether they're McDougall, Fuhrman, Voisin, Moskowitz, or just a forum member, and find some that I can make that he can eat with enjoyment and satiation. I have to find something he'll actually want to take to work to eat. And I have to keep it all heart-healthy, too, so those nut-filled sauces and salad dressings on otherwise veggie-filled E2L recipes are out, also. HELP!

I'll finish off the rest of the batch of bean burgers I made the other day. I already froze all the chickpea cutlets and will work on those as time goes on, too. The pea soup has also been packed away for my future lunches, 2-cup servings poured into quart-sized freezer bags, frozen flat, then the quart bags put into a 2-gallon bag so they're all together. I left one serving unfrozen that I had for yesterday's lunch with the burger. 

Tonight I'll be making Potatohead's SNAP recipe from the McDougall forums - all safe ingredients and leftovers should cover another dinner or a few lunches. That's about as far as I got in planning so far. At least he's going to be home all week so lunches will be easy enough to do with those leftovers or various soup recipes. I have a recipe in mind for tomorrow's dinner from the McDougall Q&E Cookbook. If I do make it I'll be back with the recipe and photo. I have to double and triple check it to make sure it's gout-safe and that I have all the ingredients necessary for it. Then I just have the rest of the week to worry about.

Gout and a New Cookbook Purchase

On top of all his other dietary restrictions, my husband now has an official diagnosis of gout, and for the past few weeks I had another whole long list of foods he's not allowed to eat. Unfortunately, we had eaten something from that list every single day prior to him being put on the gout diet. Beans, spinach, cruciferous veggies, nightshades, whole grains, yeast products - either in baked goods or of the "nooch" variety - the list goes on.

For a few days, all we had were some of the veggies on the "safe" list. As his foot pain subsided when the cortisone injection and colchicine he was prescribed started working its magic, he added back some foods, like the seitan and whole wheat roll that he insisted on taking to work as lunch every day. (Yes, during the worst of his latest flare he finished his disability leave and returned to his job) No reaction to those, so each day now I'm adding one more food from the list. Sunday was beans, yesterday was broccoli. So far, so good.

All of these restrictions may even be unnecessary, because Dr. McDougall wrote in the June 2006 newsletter that it's only the animal sources of purines one has to worry about, and I read the same info on-line in an article from Johns Hopkins. But the podiatrist said it's better to be safe than sorry, and for the duration of the flare-up - current and future ones - it's best to hold off on things, especially the high purine foods like beans and spinach. 

He had 2 flares in a 6-week period, which is why he had the blood test and got the official diagnosis. It's unknown what caused them - was it the rapid post-op weight loss, the food (Extra spinach and beans after the CABG operation for his post-op anemia), or all the exercise associated with cardiac rehab. The pain first started on day 1 of the exercise program, and the second flare happened after the last day of rehab, when he went 3 days in a row instead of alternate days, then went on an hour-long walk along the Hudson River waterfront the afternoon of his last session. Because it's unknown, the podiatrist warned him this will probably happen again in the future, but if he gets the primary care doc to order long-term allourinol, it may lessen the frequency, duration and amount of pain each time they do come.

Needless to say, I've tried no new recipes in this time. But I did get a new cookbook, Dr. Fuhrman's Eat to Live Cookbook. Many of the recipes had already been posted to his web site in the members' only section, or all his other books. Some have said they hadn't come across any new recipes at all while taking a quick glance through the book. It's still nice to have them all in one place, even if there isn't anything new. The Healthy Girl's Kitchen blog is currently doing a series of posts using recipes in this book, and her photos are of professional quality, so go, take a look at her comments on the recipes. Don't forget to read the replies, too. It's there where you'll usually find out where else the recipe was before and other people's experiences with them.