Recipe: Baked Glazed Salmon and Herbed Spaghetti Squash

This is a paleo-friendly modification of a meal in my Conquer Diabetes and Prediabetes book. It makes two servings.

Ingredients:

16 oz (450 g) salmon filets

4.5 garlic cloves

7 tsp (34.5 ml) extra virgin olive oil

1.5 fl oz (45 ml) white wine

4.5 tsp (22 ml) mustard

4 tbsp (60 ml) vinegar, either cider or white wine (balsamic vinegar would add 6 g of carbohydrate to each serving)

2 tsp (10 ml) honey

1.5 tbsp (15 ml) fresh chopped oregano (or 1 tsp (5 ml) of dried organo)

2 cups cooked spaghetti squash

2 tbsp fresh parsley, chopped

0.5 tsp (2.5 ml) salt

1/4 tsp (1.2 ml) black pepper, or to taste

Instructions:

Start on the herbed squash first since it may take 30 to 70 minutes to cook. Click  for instructions on cooking spaghetti squash unless you have some leftover in the fridge. To two cups of the cooked squash, add 4 tsp (20 ml) of the olive oil, all the fresh chopped parsley, a half clove of minced garlic, 1/3 tsp (1.6 ml) of the salt, and 1/8 tsp (0.6 ml) of black pepper, then mix thoroughly. The herbed squash is done. It could be difficult to time perfectly with the fish even if you have two ovens. But it’s tasty whether warm, room temperature, or cold. If you want it warm but it’s cooled down before the fish is ready, just microwave it briefly.

Onward to the fish. Preheat the oven to 400º F (200º C). Line a baking sheet or pan (8″ or 20 cm) with aluminum foil. Lightly salt and pepper the fish in the lined pan, with the skin side down.

Now the glaze. Sauté four cloves of minced garlic with 1 tbsp (15 ml) of olive oil in a small saucepan over medium heat for about three minutes, until it’s soft. Then add and mix the white wine, mustard, vinegar, honey, and 1/8 tsp (0.625 ml) of salt. Simmer uncovered over low or medium heat until slightly thickened, about there minutes. Remove glaze from heat and spoon about half of it into a separate container for later use.

Drizzle and brush the salmon in the pan with the glaze left in the saucepan. Sprinkle the oregano on tip.

Bake the fish in the oven for about 10–13 minutes, or until it flakes easily with a fork. Cooking time depends on your oven and thickness of the fish. Overcooking the fish will toughen it and dry it out. When done, use a turner to transfer the fish to plates, leaving the skin on the foil if able. Drizzle the glaze from the separate container over the filets with a spoon, or brush it on. Don’t use the unwashed brush you used earlier on the raw fish.

Servings: 2

Nutritional Analysis:

50% fat

13% carbohydrate

37% protein

600 calories

21 g carbohydrate

3 g fiber

18 g digestible carbohydrate

1,150 mg sodium

1,277 mg potassium

Prominent features: Rich in protein, B6, B12, niacin, pantothenic acid, phosphorus, and selenium

Minimize Mercury and Maximize Health With These Fish

paleo diet, low-carb, Steve Parker MD

This hunter-gatherer snagged himself a brown trout

The Environmental Working Group has a fresh article reviewing the risk of mercury poisoning from seafood consumption. I’m not familiar with EWG. I’m trying not to hold it against them that Dr. Mark Hyman is on the board of directors.

Anyway, the EWG has some advice for you if you worry about mercury toxicity from fish. I try to stay up to date on the issue since I’m convinced that consumption of cold-water fatty fish twice a week is good for your health, in general. If the mercury doesn’t kill you.

Here are some quotes from the EWG article:

…EWG has compiled a list of “moderate mercury” species that would pose a mercury risk for pregnant woman and children who eat fish regularly. This list is more comprehensive than the 2004 EPA/FDA advisory, which warned that women of childbearing age and young children, who are most susceptible to the damage done by mercury, should eat only six ounces a week of albacore tuna and should avoid four other high-mercury species – swordfish, tilefish, king mackerel and shark.

EWG rightly points out that much of the “seafood” consumed in the U.S. really doesn’t provide much of the healthful omega-3 fatty acids.

Among popular seafood species, salmon stands out as an excellent choice.  Four to eight ounces of salmon weekly, depending on the species, can provide 100 percent of the recommended amount of omega-3s. Some types of farmed salmon present significant environmental health concerns. EWG recommends that people choose wild salmon instead.

EWG’s analysis highlights several other affordable and sustainably produced species, including anchovies, sardines, farmed trout, and mussels.  Just four to eight ounces of these species weekly would meet recommended omega-3 requirements for pregnant women and people with heart disease.

***

Americans eat more than 400 million pounds of canned imported tuna because it is affordable and can be stored for a long time. Canned tuna is the second most popular seafood in the U.S., after shrimp.  An average American eats an average of 2.5 pounds of tuna every year (NOAA 2012).  Albacore tuna, also called “white” tuna, contains significant amounts of omega-3s, but tests indicate that it also contains significant amounts of mercury. “Light” tuna is usually skipjack tuna but can also contain yellowfin tuna. Skipjack and yellowfin have lower mercury levels than albacore, but fewer omega-3s.

As Jim Gaffigan asked, “Has anyone even bothered to ask why the tuna are eating mercury?”

In 30 years of practicing medicine, including 12 years right on the U.S. Gulf Coast, I’ve never seen a case of mercury toxicity. Maybe I’ve missed it. Maybe it’s quite rare.

Read the whole enchilada.

Steve Parker, M.D.

h/t Conner Middelmann-Whitney

Is Dining Out Making Us Fat?

So easy to over-eat!

So easy to over-eat!

The U.S. trend of increasing overweight and obesity started about 1970. I wonder if eating away from home is related to the trend. I found a USDA report with pertinent data from 1977 to 1995. It also has interesting info on snacking and total calories consumed. Some quotes:

“We define home and away-from-home foods based on where the foods are obtained, not where they are eaten. Food at home consists of foods purchased at a retail store, such as a grocery store, a convenience store, or a supermarket. Food away from home consists of foods obtained at various places other than retail stores (mainly food-service establishments).”

***

“Over the past two decades, the number of meals consumed has remained fairly stable at 2.6 to 2.7 per day. However, snacking has increased, from less than once a day in 1987-88 to 1.6 times per day in 1995. The increased popularity in dining out is evident as the proportion of meals away from home increased from 16 percent in 1977-78 to 29 percent in 1995, and the proportion of snacks away from home rose from 17 percent in 1977-78 to 22 percent in 1995. Overall, eating occasions (meals and snacks) away from home increased by more than two-thirds over the past two decades, from 16 percent of all eating occasions in 1977-78 to 27 percent in 1995.”

***

“Average caloric intake declined from 1,876 calories per person per day in 1977-78 to 1,807 calories per person per day in 1987-88, then rose steadily to 2,043 calories per person per day in 1995.”

***

“These numbers suggest that, when eating out, people either eat more or eat higher-calorie foods or both.”

Parker here. I’m well aware that these data points don’t prove that increased eating-out, increased snacking,  and increased total calorie consumption have caused our overweight and obesity problem. But they sure make you wonder, don’t they? None of these factors was on a recent list of potential causes of obesity.

If accurate, the increased calories alone could be the cause. Fast-food and other restaurants do all they possibly can to satisfy your cravings and earn your repeat business.

If you struggle with overweight, why not cut down on snacking and eating meals away from home?

Steve Parker, M.D.

Update:

Here’s a pie chart I found with more current and detailed information from the U.S. government (h/t Yoni Freedhoff):

feb13_feature_guthrie_fig03

What’s a Cruet?

Our new cruet

Our new $8 cruet

If you’re trying to lose weight or keep from getting fat, salads are helpful. I recommend them in my Advanced Mediterranean Diet, Low-Carb Mediterranean Diet, Paleobetic Diet, and Ketogenic Mediterranean Diet.

My favorite salad dressings are vinaigrettes. They can be as simple as olive oil, vinegar, salt and pepper. The problem with most commercial vinaigrettes is the label says “_____ Vinaigrette with olive oil,” but the first listed ingredient is soybean oil (or some other industrial seed oil) and olive oil is somewhere down the line. My current favorite commercial salad dressing has water as the first ingredient!

Get around that by making your own. Here’s a recipe and a salad to try it on. Also, if you’re watching your carb consumption, the commercial dressings  may sneak in more than you want. Again, avoid that by making your own.

Cruet label

Cruet label

You can make a vinaigrette in a jar with a lid. Add the ingredients then shake to create an emulsion. Or do it in a bowl with a whisk. My wife found us a cruet at the supermarket that I was hoping would allow mixing, storing, and pouring all from the same attractive container. Unfortunately, it leaks when I shake it.

Steve Parker, M.D.

Obese Women Get Just One Hour of Vigorous Exercise PER YEAR

Steve Parker MD

Steve Parker and son Paul in a Boy Scout overnight backpacking trip on the Mogollon Rim in Arizona

Obese men in the U.S. don’t do much better at 3.6 hours. I exercise vigorously for about 50 hours a year, and many folks easily beat that. I exercise for longevity, weight management, better quality of life, and so I can keep up with the lads in my son’s Boy Scout troop.

hypoglycemia, woman, rock-climbing

Not the best exercise if you’re markedly obese

myfoxny.com has the story on exercise habits of obese women, based on a recent article in Mayo Clinic Proceedings. A quote:

What kind of lives are the most inactive people living? “I think they’re living the typical life. They drive their children to school, they sit at a desk all day long, they may play some video games and they go to sleep,” Archer said.

He forgot about TV.

Without a doubt, it’s hard to exercise if you’re markedly obese. Here’s how.

Read more: http://www.myfoxny.com/story/24774893/average-obese-woman-gets-just-1-hour-of-exercise-a-year-study#ixzz2u2MMctiW

Steve Parker, M.D.

QOTD: James Fell on Weight Loss and Cooking

If you want to lose weight you need to cook. Period.

James Fell

Meet the Newest T2 Diabetes Drug: Dapagliflozin (Farxiga)

We have 12 classes of drugs in our armamentarium for the war on diabetes. The latest class is SGLT2 inhibitors and the newest of these is dapagliflozin. I read the manufacturer’s U.S. package insert and updated my SGLT2 inhibitor post.

Your kidneys normally filter some blood glucose into the “urine” and then reabsorb nearly all of it back into the blood. SGLT2 inhibitors interfere with reabsorption, so glucose ends up in the urine.

If you’re thinking that might cause yeast infections, you’re right.

Fun Fact: Taking 10 mg/day of dapagliflozin leads to loss of blood glucose into the urinary tract to the tune of 70 grams a day.

That’s 280 calories down the drain. I suspect that cutting 70 grams of carbohydrate from your diet would have just as much effect on diabetes as do these drugs. Without the yeast infections.

This drug class’s mechanism of action doesn’t appeal to me intellectually.

Steve Parker, M.D.

Your Heart Works Fine on a Low-Carb Diet

Amber Wilcox-O’Hearn explains why.

Paleobetic diet, low-carb,paleo diet, Steve Parker MD, cabbage soup, diabetic diet

This cabbage soup only has 9 grams of digestible carbohydrate per 2-cup serving

Your heart beats 100,000 times a day, every day, without rest. You’d think it needs a reliable energy source, and you’d be right. One of Amber’s references (#4) reminds me that, “Fatty acids are the heart’s main source of fuel, although ketone bodies as well as lactate can serve as fuel for heart muscle. In fact, heart muscle consumes acetoacetate in preference to glucose.”

Steve Parker, M.D.

PS: Paleo-compliant Cabbage soup recipe

Does Dining Out Cause Obesity?

Home-cooked meal

Home-cooked meal

The U.S. trend of increasing overweight and obesity started about 1970. I wonder if eating away from home is related to the trend. I found a USDA report with pertinent data from 1977 to 1995. It also has interesting info on snacking and total calories consumed. Some quotes:

“We define home and away-from-home foods based on where the foods are obtained, not where they are eaten. Food at home consists of foods purchased at a retail store, such as a grocery store, a convenience store, or a supermarket. Food away from home consists of foods obtained at various places other than retail stores (mainly food-service establishments).”

***

“Over the past two decades, the number of meals consumed has remained fairly stable at 2.6 to 2.7 per day. However, snacking has increased, from less than once a day in 1987-88 to 1.6 times per day in 1995. The increased popularity in dining out is evident as the proportion of meals away from home increased from 16 percent in 1977-78 to 29 percent in 1995, and the proportion of snacks away from home rose from 17 percent in 1977-78 to 22 percent in 1995. Overall, eating occasions (meals and snacks) away from home increased by more than two-thirds over the past two decades, from 16 percent of all eating occasions in 1977-78 to 27 percent in 1995.”

***

“Average caloric intake declined from 1,876 calories per person per day in 1977-78 to 1,807 calories per person per day in 1987-88, then rose steadily to 2,043 calories per person per day in 1995.”

***

“These numbers suggest that, when eating out, people either eat more or eat higher-calorie foods or both.”

Parker here. I’m well aware that these data points don’t prove that increased eating-out, increased snacking,  and increased total calorie consumption have caused our overweight and obesity problem. But they sure make you wonder, don’t they? None of these factors was on a recent list of potential causes of obesity.

If accurate, the increased calories alone could be the cause. Fast-food and other restaurants do all they possibly can to satisfy your cravings and earn your repeat business.

If you struggle with overweight, why not cut down on snacking and eating meals away from home?

Steve Parker, M.D.

Just What You Always Wanted: A Second SGLT2 Inhibitor (dapagliflozin or Farxiga)

Open wide!

Open wide!

Where do they get these names?!

The trade name in the U.S. is Farxiga. (How do you pronounce that?) In Europe and Australia they call it Forxiga. Go figure.

MedPageToday has the details. Here’s the FDA press release, which misspells dapagliflozin. Here’s the Australian package insert for full prescribing information. Here’s my summary of both drugs in the class at one of my other blogs.

We how have 12 classes of drugs for treating diabetes.

If you’re eating the typical high-carb diabetic diet—200 or 300 grams of carbohydrate daily—you quite likely can reduce your drug requirement by cutting back on the carbs.

Steve Parker, M.D.