Just for fun, and on an entirely different note, I’ve been drawing biostatistics/health sciences/epidemiology humor sketches at 4 a.m. as a way to take a break from academic stress and deal with insomnia.

I’m not saying I can draw, but here they are anyway.

PERIODIC REGRESSION/COX’S PERIODIC REGRESSION

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SELECTION BIAS / BAR PLOT / X BAR

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PAIRED ANALYSIS

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HISTOGRAM

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RELATIVE FREQUENCY

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NHANES

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ECOLOGIC STUDY

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µ

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PRIMARY CARE

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A few weeks ago, Sea Breeze Farm was selling merguez, a spicy North African lamb sausage, at the farmers market.  Their sausages usually contain pork fat or pork casings —  and I don’t eat pork — but this time, the merguez had no pork mixed in, and they had some for sale that was not cased.  So, I got to try my first Sea Breeze sausage.  Spicy and delicious, with wonderful lamb flavor.

I made a few things out of it, but this quiche was my favorite.  Slow-cooked fennel and onion, and sautéed mushrooms, lamb sausage, and a few fennel or cumin seeds in the crust.  Tasty.

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Lamb Merguez Sausage Quiche With Fennel, Onion, and Mushrooms

FILLING

• 1/2 lb merguez sausage (or ground lamb plain — you can even add your own spices)
• 1 large onion
• 2 small bulbs or 1 medium bulb fennel
• 1 cup (roughly) mushrooms — shiitake, wild, button, or anything else that sautés well
• 5 eggs
• about 1/3 cup cream
• some butter, coconut oil or animal fat (lamb fat would be amazing) for cooking the vegetables
• salt

CRUST

• 1 cup mixed flours — I used about 1/3 cup coconut flour, 1/3 cup almond flour, 1/3 cup buckwheat flour for a nice, dark crust
• 3 T butter or coconut oil
• 1 T fennel seeds or cumin seeds
• pinch of salt
• a little water and a little olive oil

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Preheat the oven to 375F

1. In a food processor, combine all the crust ingredients except the water and olive oil.  With the machine running, drizzle in a little of each, alternating, until a ball of dough forms on its own.

2. Lightly grease a pie dish.  Press your dough into it and keep pressing up the sides until you have a full crust.  Bake at 375 until a little firm, about 10-15 minutes.

3. While it’s baking, start cooking your filling.  Slice onions and fennel (white part and a little of the stem) thinly.  Cook slowly with a little salt until completely clear and soft and starting to brown slightly, nearly caramelized.   (at some point in here, remember to take your bottom crust out of the oven)

4. Add a little more fat and sauté in the mushrooms, until they release their own juices.

5. Crumble in the lamb and cook.  Break pieces up as much as possible.

6. Turn off the heat.  In a separate bowl, beat eggs with cream.  Mix in lamb/vegetable mixture.  Pour all of this into the crust.

7. Bake at 375 until done, about 45 minutes.  Should be golden on top and solid all the way through.

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The Cornucopia Institute has just released a 72-page report (pdf) detailing the ins and outs of organic eggs sold in the US. Specifically, the report gets into detail about discrepancies between what consumers may imagine about the egg-laying chickens and what is sometimes a very different reality. They go into detail about some of the larger brands of organic eggs available in supermarkets

The nutritional information isn’t terribly new. The report references the Mother Earth News study demonstrating the superior nutritional value of pasture-raised chicken eggs to supermarket varieties.

That study, and this report, both gave top marks to local producer Skagit River Ranch.

About those marks, on the Cornucopia website you’ll find this great scorecard of producers. It ranks egg producers, including some small farm producers, on a detailed scale. Note that this is by no means comprehensive. I’d also expect top marks from other vendors at the farmers market who raise chickens on pasture and are intentional about feed, or farms like Biocento (which sells its eggs at Madison Market — expensive but delicious). But this is the second time Skagit River Ranch has gotten national attention for the quality of their eggs. Impressive!

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Thanks to reader Dane for this tip.  Thanks to Plays With Food for the flickr Creative Commons photo.

And thanks everyone for continuing to spread on yesterday’s post about Estrella Family Creamery.

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Have you made friends with celery root yet?  Also known as celeriac, this wrinkled bulb at the base of a celery plant  is a delicious, albeit charmingly funny-looking, friend to have in your kitchen during the colder months.

I posted a recipe previously for celery root soup.  Today’s offering, a mashed celery root recipe, is great side dish for soaking up sauces or eating with meats or veggie dishes.  It’s especially good with roasted or rotisserie chicken.  A more-flavorful alternative to mashed potatoes, it also has a lower glycemic load and fewer carbohydrates.  And it’s tasty.

Don’t be daunted by the outside.  Slice it off thinly, and chop the root up until soft.  Then, mash the pieces with whatever you’d like, whether that’s other mash-worthy ingredients like squash, cauliflower or potato, or flavor-enhancers like sautéed onions.  My favorite version is below.

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Mashed Celery Root with Onions, Mushrooms and Cream

• 1 celery root
• 1 onion, chopped
• handful of mushrooms, any variety that sautés well (shiitakes, button, chanterelles, morels, etc)
• flat-leaf parsley (optional)
• butter
• cream
• salt
• pepper (optional)

1. Slice off the thin outer portion of the celery root with a knife.  Chop the root.  Add to boiling water and cook until soft.

2. Chop the onions and cook slowly in butter with a bit of salt until they’re clear through and a little browned.  Add mushrooms (sliced or chopped) and more salt.  When the mushrooms release their liquid, add the parsley and stir until wilted.

3. Mash the celery root with as much cream as it will absorb fully.  Mix in the onion-mushroom mixture.  Adjust salt and pepper to taste.

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I wrote a few weeks ago about dealing with my beloved grandmother’s decline in health as she faces pancreatic cancer.  I wrote that the desire to bring her food was inseparable from how I express love, and how she has expressed love for me.

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Food and love has been on my mind a lot during these emotionally up-and-down months spent hoping, not hoping, living life, being distracted from life.  The emotional fluctuation is reflected in my kitchen. Some days and weeks I have little desire to cook.

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Some weeks I want to cook everything I can get my hands on, to fill my house with familiar and comforting aromas: my mother’s roast chicken, my grandmother’s mandelbrot, my favorite chicken from Thailand.  The mashed celery root that smells like a few winters ago, the ground lamb dish that smells like last summer.  Salad dressings that taste like mother’s and grandmother’s, coating greens and plenty of tomatoes.

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Familiar foods of home on the stove tell loving, olfactory lies: Things are not changing, and here is the smell and the taste of the past as proof.

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The lie is a comfort during times of grief, but cooking foods from the past paradoxically gives us a chance to create new stories for the present and future. Share a dish with a friend, and now the friend has a new memory associated with the taste, as do you.  Memory is fascinating: an original memory, already imperfect in its construction, is replaced with a fresh version each time we think about it.  The story of any dish is similarly changed each time we cook it.  I share food, and remember I’m not the only one here.  I pass on some of the love in a dish I’ve learned to make.  Eating is a shared sensory experience, a way to explain, This is a flavor I’ve tasted.  This is what it has meant to me.  What it means to me is dynamic and changing.  Let’s eat.

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It’s a way to look forward, and maybe the only way.
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I’m taking stock of memories, of present circumstances, of wishes for the future.  Of things I want to say to my grandmother.  Of things I won’t be able to share with her that I wish I could.  Of memories we’ve lived together and how not to keep them sequestered as memories, but to keep them alive, a reflection of the dynamic way the brain builds memories afresh each time we recall them.

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I’ve been sketching out some food postcards from my interactions with my grandmother.

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My grandfather, calling Frusen Glädjé ice cream Froojie Hadjie.  My grandmother laughing, mostly at how hard it made my four-year-old brother and three-year-old self laugh.

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Pot roast, when I was finally starting to eat red meat again in my early twenties.  I could have eaten the whole thing.  She was delighted.  Post roast is old-fashioned, she said, but I happen to like it.

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My mother and grandmother at Passover, debating whose charoses to make.  Don’t tell, but I like my mother’s better.

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A raspberry bush she kept planted in a pot on her patio back in Long Island.  And a blueberry bush.  Raspberries were my favorite;  blueberries, my brother’s.  She’d save the ripe ones still on the bush for our visits, knowing the thrill of finding a ripe berry.  A thrill I haven’t lost yet.

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Boxes and boxes of coffee candy.  Purchased presumably from Costco.  My grandmother sent this to me constantly in college.  I enjoyed one or two at first.  Eventually I’d unload hundreds of little gold-and-black wrapped candies on friends, before I got up the guts to tell her I didn’t like coffee candy anymore.  The box in the mail room would make me smile anyway.

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Boxes of hamantaschen, sent yearly for Purim, with cards or notes on pastel stationary that said Israel at the top.  I was skeptical of the triangular prune pastries at first.  “Hummies,” she said, to make them more appealing.  Savoring and spacing out the last ones in childhood (I still do) nearly to Passover because they were so good, and so rare.

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Teaching me to make hamantaschen, to roll out the dough.  To paint the x of butter in the middle of each one.  To lean on the dough just so.  Not like this, like this. This and this, for the record, look identical.

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The first year I made hamantaschen for the family.  In college.  Went to Circle Pines Center in the cold March Michigan woods to be nearly alone for a week, and to bake.  My grandmother was caring for my grandfather, who was beginning a decline into dementia.  It was the first time she couldn’t make her hummies.  I rolled out dough on the cold, stainless steel countertops of the industrial kitchen.  Bought bags of dried prunes and lemons at Meijer’s.  Talked to an occasional other visitor at the co-op, wrapped up in down coats and sipping cups of tea on metal stools in the farmhouse kitchen.  Sent the boxes from the Delton post office.  Cookies, I said, like she always does.  They’ll never understand what you mean if you explain.

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The year the hamantaschen didn’t come.  My first or second year in Seattle. My grandfather was getting worse.  She hadn’t said anything, so I assumed the hamantaschen were coming, but when they didn’t, I didn’t want her to feel bad.  Later, she called me and tentatively mentioned she was surprised I hadn’t thanked her; had I enjoyed them?  There was a long, horrified pause before we realized the box must have gotten lost in the mail.  I tried not to picture the box rotting away in a cavernous warehouse of lost mail somewhere, or a disgruntled postal officer eating the hamantaschen, far from my house.  Cookies, she might have said.  Cookies.

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Actual cookies.  My grandmother kept three cookie jars when we were kids, and at least two are still in her apartment.  Lovely ceramic jars she probably bought traveling through artisans’ shops in Vermont.  Each object she bothers to own has a story, a habit I’ve picked up.  The wide jar with the wonderful smooth, brown lid.  Lifted by the little handle, making a clinking sound on the edge.  Releasing the smells of chocolate chip cookies, always with walnuts and golden raisins mixed in.

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My grandmother at the farmers market, on a mission.  This vendor and then that; he might run out of strawberries, she might run out of broccoli, and I don’t want to miss those nice potatoes.  I may possibly have gotten this tendency from somewhere.

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Calling my mother on this last visit to California, remembering together who all my grandmother’s vendors are.  Who is the potato guy?  This is her lettuce place, right?  Collecting everything she loves, everything she might want to eat.

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A basil plant she often keeps on her patio.  The French variety with tiny leaves.  Trimming just a few sprigs at a time, for chicken or pasta.  “Your mother says I shouldn’t keep this, that she likes to use a whole lot of basil at once.  But I find this is just right for me.  Will you get me the scissors?”

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Freshly squeezed orange juice in the mornings.  My grandfather’s domain, while he was still alive, even when he as declining, just to show he could do it.  Strained for my grandmother.  Not too much, not too acidic.  Oranges bought at the market, of course, from her favorite vendor.  Loaded into the bottom of the cart she keeps in her trunk.

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Are you hungry? Have you eaten lunch? Are you sure?  She asks this of everyone in her house.  Relatives, a neighbor, her nurse.  Even when I was there last, and she was weak and depressed and needing help getting into a wheelchair, she made sure everyone had eaten and wasn’t going to be cold outside.  Laugh about Twitteleh all we might, some stereotypes hold true.

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I call her now and she’s too tired to talk much.  Am I happy?  How is school?  Am I working hard?  How is my house?  Have I been eating?  Of course, Grandma.  Everything’s fine.

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Her plum cake, which I wrote about earlier this fall.  The friends who keep writing or calling to tell me they’ve made it.  She’s glad when I tell her.

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Coming home from a college semester in Thailand, having burned off all my taste buds on hot peppers and chili pastes.  Flying into Los Angeles, staying with my grandparents.  I couldn’t taste a thing my grandmother served me.  I finally found a bottle of hot sauce in her fridge, presumably something my uncle had left there or she’d bought for guests.  I reassured her it was fine, that this way I could taste her food.  She looked at me with the same bewildered expression I’d given my Thai host sister a few months before, when I’d cooked her pasta with fresh tomato-basil sauce and she’d loaded her plate with hot sauce.  I understood now.

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What my grandmother proudly calls her “one oriental dish” which is also her one dish she’s ever made that I can’t stand.  She first made it for me in those jet-lagged post-Thailand days thinking it would taste just like what I’d been eating in Asia.  It’s some combination of tuna, Chinese dried chow mein noodles, water chestnuts, and I think cream of mushroom soup.  This dish should have been outlawed after the 1950s.  The hot sauce didn’t help.

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My grandmother’s rotisserie chicken recipe, which I wrote about in a short story.  One of my fiction classmates, in his critique, said it was unfair that he got hungry when he read my stories.

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In the story, I wrote about Monty, a curmudgeonly, old neighbor, for whom she bought a Costco rotisserie chicken every week, because that was something he liked.  He never said thank you, she told me.  My parents didn’t understand why she bothered, or why she drove him to the senior center sometimes.  He’s old, she’d say.  He has nobody.  I started; how I can I stop?  The man was a Holocaust survivor, had lost his wife, trusted few people.

When I visited, she asked me to bring him the chicken (it took a few tries; she had to call and yell at him to answer the doorbell).  He found me in the hall, alone, and told me in English and Yiddish what a beautiful thing my grandmother does, how it’s a mitzvah, how he’s all alone.  His eyes said most of it.

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Chicken sandwiches with lettuce, wrapped in waxed paper, packed for a day at the beach.  Boogie boards, sand, a smiling woman with her umbrella and chair.  More sunscreen.  Lunch is perfect.

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My grandmother refusing to eat some days.  Tea, jello maybe.  It’s rough.

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Passover this past year in New York.  So thankful I stayed.  Lox on her matzah in the morning.  Heaven, she said, just right.  Singing songs from musical theatre at the seder table (no, not Andrew Lloyd Webber; somehow we got into Guys and Dolls and A Funny Thing Happened on the Way to the Forum).  My grandmother can never remember lyrics.

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So many stories.  The grief lies in realizing that at some point the number of stories will be proven finite.  The trick to immortalizing, or continuing to count them, is to keep cooking the food, sharing the food, sharing the stories, experiencing new stories.  The mind creates new memories out of old ones, new stories from old.  The recipes and experiences continue.

The sharing, and the love, goes on.

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I went to the annual Puget Sound Mycological Society Wild Mushroom Show today.  It’s still going on tomorrow and I highly recommend checking it out.

I knew it would be interesting, but had no idea how impressively well-done it would be.  The main room is full of tables of beautifully laid out specimens organized by genus and labeled by species.  The tags are color-coded by edibility.

There are also mushroom-identifying specialists willing to examine specimens visitors have collected from the woods, kids’ activities, a cooking demonstration (with samples) lectures on topics like mushroom sex, vendors, and explanations of different uses of mushrooms (check out the gorgeously-dyed green sweaters and shawls done with local mushrooms, and the hat made of mushrooms!).

If you go, make sure to listen to the trained identifiers/mycologists from PSMS.  I tagged along listening to Hildegard Hendrickson talk about interesting species from the display table, and how to identify them.  Her crowd grew and grew, everyone engrossed.

I also spent nearly an hour listening at the mushroom identifying table.  An attendee had brought in an entire garbage bag full of carefully-separated specimens. He was showing them to chief identifier Brian Luther, who patiently went through each specimen and identified it, talking about its characteristics and edibility.  Another full-fledged identifier, who also happens to be a seven year old boy, helped label all of them.  I don’t call him an identifier in a tongue-in-cheek way; this kid actually knows thousands of varieties’ Latin names (and how to spell them) and is quite good.  I asked him about his skill once on a field trip and he shrugged and said he’d been learning since he was about three years old.

If you bring samples to a mycologist for identification, always make sure you take the entire sample, including the part in the ground, rather than cutting the stem.  In many cases, a mycologist must look at the entire specimen for an accurate identification.  Also make sure samples are kept separate by variety so they don’t contaminate one another, e.g. in brown paper bags, separate baskets, or separate pieces of aluminum foil.  If possible, remember where you found it: on or under what kind of tree?  In grass?  In woods?  Near woods?  On wood chips?  In your crisper drawer in a bag labeled Whole Foods?  Etc.

And, of course, never EVER eat a wild mushroom you’ve picked whose identity you don’t know 100% or which a mycologist has not identified.  There are many look-alike mushrooms in the Northwest and beyond that can either kill you or make you wish you were dead.  Also, species differ from region to region and continent to continent, so don’t assume your knowledge from another place applies here.  For instance, I learned today that in the Northwest, the parasite that makes a lobster mushroom (which is actually a parasitization of another species) only attacks mushrooms on which the parasite will result in a non-poisonous mushroom (although I think I’ve heard that some are more tasty than others).  However, apparently in some other regions of the country, lobster mushroom parasite can attack poisonous mushrooms, and thus it’s better not to eat any lobster mushrooms in those regions.

So much to learn, and not a topic to take lightly.  But so very, very cool.

Check it out tomorrow.  Link is above.

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Mark Bittman’s blog recently caught my eye with a piece about how school lunches in the United States are worse than in many countries, including a number far poorer than we are.  In Brazil, he points out, 30% of food for school lunches has to be bought from local farmers.  Here, we get excited when we get an unfunded state mandate to include local produce in school meals.  And it’s not news to anyone that school cafeterias have very little money to work with, and often nowhere to cook actual food.

Most talk about improving school nutrition focuses on minor changes, like increasing the amount spent per child per meal by a few cents. I wish we could think bigger.  The nutrition of children, mothers, and women who plan to become mothers soon is arguably the single most important aspect of health in which we could invest.  Should we really be arguing about cents?  Shouldn’t we be thinking in terms of dollars, nutrients, and everything kids deserve?

But this isn’t a debate we’re going to win any time soon, and there’s a case to be made for starting small, picking one aspect of school diet and advocating for it to change.

Today’s target: low-fat and skim milk.  The USDA advocates for replacing whole milk with these alternatives.  They shouldn’t.

I’ve written in detail about milk before (Do you know your milk?). Low-fat milk has been associated with adult health risks, as in this study which suggested low-fat dairy is associated with anovulatory infertility (as compared with full-fat dairy). But the issue of milk in school diet deserves specific attention.

The USDA publishes dietary guidelines for school nutrition, which districts around the country follow.  One of their primary suggestions: replace whole milk with skim or 1% milk. (USDA fact sheet – pdf)

Readers of this blog are probably already aware that saturated fat is not the culprit of obesity or other markers of metabolic syndrome, but that cheap vegetable oil and sugars and plentiful carbohydrates are more to blame (post on cooking fats and oils is here, for more information).

What do studies on whole milk versus low-fat/skim milk in childhood say?  Is it true whole milk isn’t associated with increased weight gain, or that it’s somehow protective?  Could reducing milk fat actually be detrimental?  To find out, I dug up some research on milk consumption in childhood and adolescence, and the relationship to obesity, weight gain, and metabolic syndrome.

There was a study or two that seemed, at a glance, to favor reducing milk fat. But it became quickly apparent that these were not studies measuring impact on health, but studies measuring behavior itself.  It’s important to be aware that, in research about obesity interventions in school meals, studies that claim to show positive results for reducing saturated fat often do something sneaky: Instead of showing positive results for markers of health (lowered markers of metabolic syndrome, excessive weight gain, etc), they show positive results for — wait for it — reducing saturated fat intake. Yes, interventions to reduce saturated fat intake in school meals can be successful at reducing saturated fat intake in school meals.

I’m not making this up.

Here’s an example about the NYC schools and milk consumption. The authors concluded that replacing whole milk in schools with low-fat milk reduces milk fat consumption in schools. We might as well have a study proving that limiting the number of bananas served in school greatly reduces the number of yellow fruits on the school menu.

Here’s an example about an obesity intervention program among Native American school children.  In this study, the researchers spent three years (and likely a great deal of money — an entire issue of the American Journal of Clinical Nutrition was devoted to their prospective analysis) reducing saturated fat in school diet, on the theory that it would prevent obesity, and failed to produce any difference between the intervention and control groups.  Their report, with chutzpah, insisted their work had been a success, because they’d reduced saturated fat in the school diet.  Never mind that this reduction had no impact on any of their own markers of student health.

I found no study suggesting measurable health benefits for school children drinking low-fat or skim milk instead of whole milk.

However, there are actually some decent studies on milk consumption in childhood and adolescence, and the association between milk fat consumption and obesity.  I found four.  Each study found no association between increased whole milk consumption and increased obesity or other indicators of metabolic ill health.  Some studies found detrimental associations with reduced-fat milk.  Others found that whole milk intake was inversely associated with obesity or metabolic health risks.

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1 — Berkey CS, et al. Milk, dairy fat, dietary calcium, and weight gain: a longitudinal study of adolescents. Arch Pediatr Adolesc Med. 2005 Jun;159(6):543-50.

This study examined dairy consumption and weight gain in a large cohort of adolescents and preadolescents ages 9-14. Overall dairy consumption was associated with weight gain but, on closer analysis, this was attributable to consumption of non-fat and low-fat milk, but not whole milk. Dietary fat was not associated with weight gain.  Dietary calcium was.  Low-fat and non-fat milk were.  This finding was contrary to the researchers’ hypothesis but, like good scientists, they reported the results.

2 — Barba G, et al. Inverse association between body mass and frequency of milk consumption in children. Br J Nutr. 2005 Jan;93(1):15-9.

Whole milk consumption was inversely associated with BMI (e.g. whole milk drinkers had lower BMI).  When skim milk was added to the picture, the association no longer held true.  The researchers controlled for a number of relevant factors, including other aspects of diet, birth weight, parental education, and parental overweight.

3 — Pereira MA, et al. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA. 2002 Apr 24;287(16):2081-9.

Dairy consumption was inversely associated with insulin resistance.   Dairy fat was not predictive of weight gain. The authors note an association between high dairy intake and other frequent foods (fruits, vegetables, saturated fat…), and that the study’s observational nature limits it from establishing causality.  This potential for confounding is a challenge of applying epidemiological methods to nutrition studies, but not one that can’t be overcome.

4 — Huh SY, et al. Prospective association between milk intake and adiposity in preschool-aged children. J Am Diet Assoc. 2010 Apr;110(4):563-70.

Assessed milk intake (whole, low-fat or skim) at age 2, compared with adiposity at age 3.  Whole milk consumption at age 2 is associated with slightly reduced risk of adiposity at age 3, but the association is null when results were restricted to those with a normal BMI.  Milk intake itself was not found to prevent adiposity, but dairy fat was also not found to contribute to it.

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Something these studies don’t mention is that taking away dairy fat means taking away a source of protective fat-soluble vitamins for kids who may already be getting inadequate nutrition.

Industrially produced milk may not be the best food there is, and milk itself may not be suitable for some kids (e.g. lactose intolerance, etc) but given the dismal state of school nutrition, we can’t afford to yield the more healthful version of industrial milk to an even less nutritious (and potentially detrimental) counterpart, especially when the argument for doing so runs contrary to available data.

If we want the USDA to make this change, we can educate about it, talk to our local school districts, or contact the USDA directly (try Janey.Thornton@usda.gov).  Change probably has to come from the USDA, since school districts receive nutrition guidelines from them.

This change may never happen. Certainly, there are political limitations.  It still seems counterintuitive to some people that dietary saturated fat is not actually a contributor to obesity.  And so making such a change, on such a high level as the USDA, sounds politically risky. Yet, years of recommending reductions in saturated fat have had no positive effect.  Efforts should instead focus on the things that work, like the reduction of sugars/sweetened beverages, packaged foods, simple carbohydrates, and vegetable oil.

Besides, by the USDA’s own data (http://www.ers.usda.gov/data/foodconsumption/FoodAvailspreadsheets.htm) our nation consumes less saturated fat, full-fat dairy, and red meat (and more fruits and vegetables) than we did thirty-five years ago.  The real changes to our diet in this time, per USDA data, have been an increase in vegetable oils and corn sweeteners, both of which spiked in the mid 1980s, at the same time the obesity epidemic began growing significantly.  It’s time to focus on these real culprits, and not on animal fat.

Allowing full-fat milk in school meals is a simple and research-based place to start.

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Thanks to bookgrl for the Creative Commons photo.

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October has started.  It’s the season of red-leafed huckleberry bushes, golden larches [blatant excuse to stick in a hiking picture], rain, wild mushrooms and… cod liver oil.

In honor of October, I’m reworking a post I wrote a few years ago at my old site, on cod liver oil and vitamin D.

Once again, the long, wet and cold season is arriving here in Seattle.  The days are getting shorter and the skies, greyer.  Stand outside too long in the drizzle, or the sun breaks, and you might start to grow moss.  But you might not start to produce vitamin D.

You’ve heard vitamin D called “the sunshine vitamin,” but it’s not actually Seattle’s clouds that constitute the primary culprit in our winter vitamin D deficiency.  True, most of our days are so cloudy that we get very little sunlight, but even when the sun is out, studies suggest we don’t actually get a significant amount of vitamin D from sunlight in winter at this latitude.  In one study, people in Boston (lower latitude than Seattle) couldn’t produce cutaneous vitamin D3 on sunny days between November and February, while people in Edmonton, AB (higher latitude than Seattle) couldn’t produce it between October and March.

To stay healthy, it’s important to get adequate vitamin D3 from a reliable source, one where the vitamin is natural, and appears with other fat-soluble vitamins and omega-3 fatty acid. So, this is a good time of year to start thinking about adding cod liver oil as a supplement to your diet.  Cod liver oil is rich in vitamin A, omega-3 fatty acids and vitamin D3.  Vitamin D doesn’t appear in many foods, so, at least in warmer months, sunlight is our primary source of vitamin D.

I actually just had my vitamin D levels checked and they’re not too bad, but most of us are deficient most of the time.  And actually, latitude isn’t the only problem. Vitamin D deficiency is rampant, even in summer, and even in equatorial countries where residents get a lot of sunlight.  We often hear behavioral reasons for this: we’re outside less in every country, people wear long clothing in many equatorial countries, etc.

But in reality, it’s often factors like diet and obesity that interfere. There are reported relationships between vitamin D deficiency, obesity, latitude, and glucose metabolism. And not only does vitamin D deficiency contribute to obesity, but obesity seems to make it harder to correct vitamin D deficiency in some studies.  The correlation between the two is strong. Add enough cheap vegetable oil, sugars, flour and fast food to a country’s diet and you’ll see obesity levels skyrocket, along with vitamin D deficiency.  Worse, natural fats that disappear from diet (like traditionally-rendered animal fats from animals on pasture) were actually a good dietary source of vitamin D in many of our cultures.  Oops.

In previous eras, vitamin D deficiency was associated almost exclusively with the presence of rickets. However, research in the last decade or so [like this] has moved awareness of this hormone-vitamin to a more prominent place in our understanding of health and nutrition. Vitamin D deficiency may play a preventative role in other diseases attributed largely to environmental conditions. Meanwhile, cod liver oil, or equivalents thereof (e.g. oolichan grease in Northwest native cultures) used to be routinely given to children and adults, particularly sick ones, in winter.  This information has gone culturally by the wayside.

The list goes on. Vitamin D3 is an essential vitamin and also facilitates absorption of other critical nutrients.  It’s associated with bone health, mood, and protection against a number of diseases, including cancer, and autoimmune diseases like  multiple sclerosis as well as diabetes and insulin resistance.  There also seems to be an association between vitamin D intake and lowered cardiovascular disease risk. There is some indication of a link between vitamin D deficiency and asthma, another disease correlated with exposure to environmental pollutants. An overview of gestational vitamin D deficiency noted links to future health effects such as cardiovascular disease, diabetes, obesity, cancer, and permanent disruptions to the central nervous system’s formation, as well as future vitamin D responsiveness in the infant brain. This makes vitamin D sufficiency yet another aspect of health incredibly important for pregnant women or women of child-bearing age who are considering future pregnancy at all. I wrote a little more about the connection between vitamin D deficiency and autism here and here (a series I’ll repost and finish here at the new blog at some point).

The recommended daily dosage of vitamin D has been lower than it ought to be for years.  By some estimates, the recommended daily allowance is only about a tenth the amount we need.  This is slowly changing.  Recently, the American Academy of Pediatricians recommended doubling the childhood dose of vitamin D, after years of seeing deteriorating childhood health and disease susceptibility strongly correlated with poor vitamin D intake.  High intake of vitamin D is also essential for pregnant and breast-feeding mothers, so their children can have adequate vitamin D at early stages of life.

But wait… cod liver oil? Doesn’t that taste terrible?  The terrible taste, and past generations’ memories of it, has not helped its, uh, branding reputation in our culture.  My grandmother remembers hiding under the bed to avoid the dreaded spoon.  It’s also considered old-fashioned; a German friend of mine balked when I asked him if it was still used in Germany.  No, he said, that’s something his grandmother would have done, along with making sauerkraut.  A stereotype!  I broke it to him that I both take cod liver oil and make sauerkraut.  No offense intended.

And actually, it doesn’t taste as bad as it used to.  The kinds on the market are pretty palatable these days, and it doesn’t take long to get used to them, and if you take it daily, you really do.   I may enjoy cod liver oil less than I enjoy grass-fed butter or huckleberries, but I do enjoy knowing I’m taking care of an essential part of my health.  And actually, I don’t mind the taste.  By the way, for those who have experienced the unpleasant side effect of burping up the flavor of cod liver oil, this symptom is reduced for a lot of people by taking the oil right before or with a meal.

To make it go down easier, I usually down some whole milk or cream right after taking it.  This adds fat, which is good since these are fat-soluble vitamins.

I take this brand of cod liver oil, Blue Ice (and no, there’s no official sponsorship; they have no idea who I am or that I recommend their cod liver oil.  I don’t take sponsorships.).  Some brands of cod liver oil are processed in such a way that the naturally-occurring vitamin A and D are removed, and synthetic versions are added back in.  That’s not true of this one.  Also, it claims to be sustainably harvested.

So help your body resist the winter blues this year.  Strengthen your immune system and disease resistance.  Down a half spoonful of cod liver oil every day, and see how you feel this winter.  For even better intake of essential fat soluble vitamins, take it with some grass-fed butter, and you’ll also be getting some Vitamin K2 MK-4.  Plus, you’ll get to eat butter.  Or, you can get their version of cod liver oil that has grass-fed butter oil (concentrated butter) mixed in.

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Some reading:

Weston A. Price Foundation on cod liver oil (with links to articles)

Rajakumar K, Fernstrom JD, Holick MF, Janosky JE, Greenspan SL. Vitamin D status and response to Vitamin D(3) in obese vs. non-obese African American children. Obesity (Silver Spring). 2008 Jan;16(1):90-5.

Heaney RP. Lessons for nutritional science from vitamin D. Am J Clin Nutr. 1999 May;69(5):825-6.

Alemzadeh R, Kichler J, Babar G, Calhoun M. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism. 2008 Feb;57(2):183-91.

Weiss ST, Litonjua AA. Childhood asthma is a fat-soluble vitamin deficiency disease. Clin Exp Allergy. 2008 Mar;38(3): 385-7. Epub 2008 Jan 2.

Levenson CW, Figueirôa SM. Gestational vitamin D deficiency: long-term effects on the brain. Nutr Rev. 2008 Dec;66(12):726-9. Review.

Grey V, et al. Prevalence of low bone mass and deficiencies of vitamins D and K in pediatric patients with cystic fibrosis from 3 Canadian centers. Pediatrics. 2008 Nov;122(5):1014-20.

Kalueff AV, Eremin KO, Tuohimaa P. Mechanisms of neuroprotective action of vitamin D(3). Biochemistry (Mosc). 2004 Jul;69(7):738-41.

Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab. 2002 Apr;13(3):100-5.

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Even in the summer, I like to eat hearty stews, ragoûts, casseroles, and generally filling dishes of meats and vegetables cooked together.  But fall and winter invite these dishes onto our plates, into our freezers, into our bellies.

Now that grad school has started back up and I’m spending more of my time doing things like trying to understand baffling biostatistics software, I’m also enticed to make the kind of dishes I can stick in the fridge and eat for lunch all week.  This dish fit the bill.  It’s easy to assemble, it makes the house smell good, it’s filling, and it’s good for you.

The dish is based around grass-fed ground beef and fresh cauliflower, two cheap and healthy foods that get better cooked slowly with other flavors. You can vary the recipe up.  I made it grain-free, but it would taste good with brown rice.  You can add other vegetables, like broccoli or mushrooms.

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Cauliflower Ragoût with Beef, Tomato Sauce and Parmesan

• 1 head cauliflower
• 1 pound ground beef
• 1 pint tomato sauce
• 1 large onion
• 1 small head garlic, or half a large head
• greens, especially Italian kale or collards
• parmesan cheese to taste/cover
• a pinch of saffron
• salt and pepper to taste

Preheat the oven to 375F

1. In a casserole dish that can go both in the oven and on the stove, cook chopped onion in fat — I combined olive oil and beef tallow.  Add some salt.

2. When the onion is soft, clear and browned, add garlic and beef.  Add salt and pepper to taste.  Brown the beef.

3. Pour in tomato sauce and crumbled saffron, and stir.  Add cauliflower, chopped up, and stir until it’s covered with sauce.  Stir in any greens.

4. Grate or slice parmesan onto the top.  Drizzle some olive oil over it, and grate on some black pepper.

5. Cover and cook for 45 minutes, or until the cauliflower is melted-soft.

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