Yom Kippur Fast Day Tips and Pre-Fast Menu

Provided are some tips on how to physically prepare for the Yom Kippur fast day along with a pre Fast menu and recipes below. 

How to safely recover from the Yom Kippur Fast will shortly follow!

Gmar Chatima Tova – May you and your family be inscribed in the Book of Life.

Daniela Hermelin, M.D.

1.)  Start hydrating your body days before the fast.  

Drink at least 2-3 glasses of water five days before and every day leading to the fast.  Drink at least six glasses of water the day before the fast to provide adequate hydration to your body.  Think camel!

Other hydrating beverages that can be added to your hydration regimen but not used as a substitute for water, are coconut water and freshly squeezed watermelon juice.    Remember when choosing a coconut water look for unflavored, natural varieties to avoid excess sugar added to these electrolyte rich drinks.  

2.)  Reduce caffeine, refined sugar, and salt consumption

Prevent caffeine and sugar withdrawal by taking steps days before the fast to reduce the quantities consumed each day.   Set a goal.  One cup of coffee (8 ounces) has about 60-90 mg of caffeine depending on how strong it is brewed and a soda has around the same in a 12-ounce can.   Reducing your quantity to around 60 mg per day before Yom Kippur will help you safely prevent a caffeine headache on the day of the fast.   However, taking an Excedrin or another over the counter pain reliever that contains caffeine an hour before the fast may also help prevent a headache during the fast day.  

Consuming a diet of refined sugar could also cause a withdrawal headache on a fast day.   Also, begin removing these sugars from one’s diet days ahead and substituting them for healthier varieties of food.   For instance, if you are used to eating white noodles or rice, switch to the whole wheat or brown variety.   This change can benefit you all year long! 

Watch out for salt.  Start reducing your sodium intake to keep from being overly dehydrated during the fast.   Pay extra attention of not adding to much during your pre-fast meal. 

3.)  Stock up on complex carbohydrates

During a fast, the body acquires its fuel from the glycogen, or energy stores in the liver.   Therefore, bulk up on rich sources of complex carbohydrates, or complex sugars, to provide all the adequate resources your body will need to get through the physically and spiritually intense day.   Below you will find a complete menu for the upcoming Pre-fast Dinner or Seudah Mafseket accompanied by their recipes.  

Pre-Fast Menu - Seudah Mafseket  Menu:

Kalamata Olive Stuffed Mushrooms

Fennel Crusted Golden Trout with Lemon-Ginger Vinaigrette

Whole Wheat Cous Cous with Lemon, Peas, and Chives

Sautéed spinach with pine nuts

Sourdough rolls with olive oil for dipping

Mango Lassi Drinks

Fennel Crusted Golden Trout with Lemon-Ginger Vinaigrette

Ingredients:

½ cup finely chopped fresh fennel bulb

3 tbspn white wine vinegar

1 tbsp minced shallt

1 tbsp grated fresh ginger

1 tspn grated lemon peel

½ tspn salt

½ cup of olive oil

½ cup golden raisins

4 boned golden trout fillet (4-6 oz each), rinsed and patted dry

2 tbsp of fennel seeds

Directions:

1.)  Preheat oven to broil mode at 480 degrees

2.)  Lay trout fillet, flesh side up on a rimmed baking pan.  Brush some olive oil onto the fish and then sprinkle salt, pepper, and fennel seeds.   About 4-6 fillets can easily fit onto one baking tray. 

3.)  Place in the oven on the middle/top rack for until cooked around 12 minutes. 

3.)   While the fish is cooking in the oven, in a bowl, mix fennel, vinegar, shallot ginger, lemon peel and ½ teaspoon of salt.   Whisk in ½ cup of oil oil unitl combined, then stir in raisins.

4.   Transfer each fillet to a plate.   Whist vinaigrette to combine and then spoon over fillets. 

Whole Wheat Cous Cous with Lemon, Peas, and Chives

Ingredients:

2 Tbspn. Extra-virgin olive oil

½ tspn turmeric

1 cup minced onion

3 garlic cloves, minced

1 ½ cups vegetable sock

1 ¼ cups whole wheat or plan couscous

2 cups frozen petite peas, thawed

½ cup minced fresh chives

Zest and juice of 1 lemon

Kosher slat and freshly ground black pepper

1/3 cup sliced almonds, toasted (for garnish)

Directions:

1.)  Heat oil in a large heavy saucepan over medium-high heat.  Add turmeric, onion, and garlic; sauté, stirring often, until onion is tender and golden, about 5 minutes.  Stir in stock; bring to a boil.

2.)  Add couscous and stir to blend.   Remove saucepan from heat; cover and let stand 10 minutes.  

3.)  Stir in peas, chives, and lemon zest and juice.  Season to taste with salt and pepper.

4.) Transfer couscous to a serving bowl, garnish with almonds and serve. 

Kalamata Olive Stuffed Mushrooms

Ingredients:

4 large Portobello mushrooms (cleaned, fans removed)

2 tspn olive oil

1 ½ Tbspn balsamic vinegar

¼ tspn Kosher salt

½ tspn freshly ground black pepper, divided

1 ½ cups chopped tomato

1/3 cup chopped kalamata olives

1 cup fresh whole-grain breadcrumbs

½ cup (4 ounces) shreeded mozzarella cheese

¼ cup chopped fresh chives

Directions:

1. Preheat oven to 400°.

2. Place mushroom caps, gill sides up, on a rimmed baking sheet; drizzle with oil and vinegar, and season with salt and 1/4 teaspoon pepper. Bake until caps are just tender, about 10 minutes.

3. Meanwhile, combine tomato, olives, breadcrumbs, cheese, and chives in a medium bowl. Season with remaining 1/4 teaspoon pepper.

4. Divide tomato mixture evenly (about 1/2 cup per mushroom) among portobello caps. Bake 10-12 minutes or until lightly browned and mushrooms are tender. Serve hot.

Mango Lasi Drinks

Ingredients:

1 cup plain yogurt

½ cup almond milk (regular or soy milk can be substituted)

1 cup chopped mango

4 tspn of agave, to taste

A dash of ground cardamom (optional)

Directions:

Place mango, yogurt, milk, agave and cardamom into a blender and blend for two minutes.  Pour into individual glasses and serve.   Sprinkle cardamom on top to garnish. 

Rosh Hashanah Apple Picking at Eckerts Farms

Tractor ride to the orchards

Our local St. Louis Eckerts Farm has just opened up their apple harveting season this past weekend -  the perfect time to hand pick the freshest, crunchiest apples for Rosh Hashanah.   The "Honey Crisp" variety of apples are the first to ripen on Eckerts's orchards, but the Jonathan, Jonagold, Golden Delicious, and others are just about ready to pick as well.

The perfect "honey crisp apple".  The lady bug also agrees

After our short tractor ride to the orchard site, our children each grabbed a small Eckerts's draw string bag and we chose a row of trees to start our apple hunt.   My husband briefly instructed the children and how to find the "perfect apple" - one that feels firm, has a fair amount of red around it's whole body, and of course has no obvious blemishes, worm holes, or other imperfections.   Those instructions were easy enough to follow and my children were able to easily access hundreds of blossoming honey crisps.   Walking through the rows of orchards and seeing the trees filled with round, ripe apples was an incredible vision.   There was a palpable sense of Hashem's bountiful kindness and generosity in every direction.   It was a reminder of G-d's constant love and chesed. 

Apple picking at any age.

After weighing and purchasing our bags of apples, we decided how many we would keep for our own family and which we were giving out as gifts.    Then, we all chose one of the many perfect apples we picked, cleaned it off with our bottled water and took a giant bite.  K'runch.   Unbelievably delicious!  I might even suggest that these apples were so sweet, that honey may be overkill this holiday season!

Freshly picked apples will stay great for many weeks if they are refrigerated in their own space without any other types of fruits and vegetables mixed in the same container.   Make sure to remove the "bad apples" first, because they can easily contaminate the other good ones.    I don't expect any of these apples to outdate the Rosh Hashanah holiday since these guys have big plans.   In addition to slicing and sprinkling them with honey, I also plan on making unsweetened apple sauce as well as a few cranberry apple tortes, a family favorite.   I enclosed the recipes below for others to prepare and enjoy for Rosh Hashanah or any other time of the year.  

Eckerts Millstadt Farm

I hope everyone has the opportunity to go apple picking if not this year, but in the near future.   To find out more about your local harvesting farms, click here to find out more.   Also, if you are a local St. Louis native, find out more about Eckerts ripening schedule for harvesting dates and times.   The short trip outside the city is well worth your visit.  

Shanah Tova!   May you and your family be written and sealed in the Book of Life.

Cranberry-Apple Torte (Adapted from Susie Fishbein's "Kosher by Design")

Ingredients:

1 cup of white whole wheat flour
1 cup of all-purpose flour
1 1/2 cups of oatmeal
1/4 cup of brown sugar or agave
1 1/2 sticks of parve butter
2 teaspoons of cinnamon

Filling:
4 Cortland apples, peeled and cut into small chunks
1 (16-ounce) can whole berry cranberry sauce
2 tablespoons all-purpose flour, sifted

Preheat oven to 375 degrees.   Heavily coat a 9-inch springform pan with nonstick spray; set aside.  In a large bowl, mix the 2 cups of flour, brown sugar, oats, parve butter and cinnamon.   Reserve 1 1/2 cups of this mixture.   Press the remainder into the prepared pan and halfway up the sides with the palm of your hand.

In a medium bowl, combine the apples, cranberry sauce, and 2 tablespoons flour.  Mix with a spoon.   Pour the apple mixture into crust.   Sprinkle the reserved oat mixture over the top.   Use the back of a spoon to gently press the oats so that they evenly cover the top and meet the crust that is coming up the sides, this is what will enclose the filling.  Bake for 40 minutes until brown on top.


Directions:

Home-made applesauce:  (A recipe passed down from the Hermelin cookbook - thank you Safta Linda)

Ingredients:


3 lbs of Jonathan apples, or other variety (about 9-10 apples) - quartered, cored and thinly slice with peel
4 tablespoons of lemon juice
Optional - 1/4 cup of brown sugar, agave, or pure honey


Directions:

Quarter, core, and thinly slice three pounds of Jonathan apples into the bottom of a large pot with about 3 tablespoons of water added, just to coat the bottom of the pot.

After a few of the apples have been sliced, squeeze some lemon juice on them to prevent any browning.  Repeat after all the apples have been sliced.

(If you want apple sauce sweetened, sprinkle about 1/4 cup of brown sugar, agave, or raw honey on the apples and mix.)

Simmer the apples, stirring occasionally, until the apples are soft, about 40 minutes.   Periodically check to replenish water if necessary.

Grind the cooked apples in a food mill over a bowl.

Chill and serve.

Raw Honey for a Sweet and Healthy New Year!

Can one word signify Rosh Hashanah better then the word honey, devash?   Honey is a major symbolic food during the Yomim Tovim as we dip fresh apples and round challahs into honey to signify blessings for a sweet, New Year as well as eat honey on Shavuot as way to equate Torah with the sweetness of devash.    
But, in addition to the sugar-coated symbolisms, honey may provide even broader meanings that can be applied to the Yomim Tovim as well. 

As we all know, honey is a sweet food made by bees using nectar from flowers.  Rabbi Aharon Levin writes in his Sefer Drash ViHalyun,  “Bees are fascinating creatures. They possess many commendable traits. Examples include their unique sense of mission displayed in their lifelong construction of the beehive. Within the chaos of construction we find an extremely orderly division of labor… In summation the bee is a symbol of mission, discipline, respect and unity.” 

            Like the bee, the Jewish people also carry a unique mission of elevating and bringing kedusha into the world by foremost recognizing Hashem’s Malchos or Kingship.   Our constant awareness of Hashem’s Chochmah and Chesed, the incredible wonders he creates and sustains the world actualizes His Sovereignty of all things.   Each of us, like a worker bee, fastidiously performs ahavas, yiras and avodas Hashem through Torah and mitzvot.   Through our recognition and appreciation of Hashem’s Malchos, we help provide the sustenance, the sweet honey, to help lift the world into holiness and the coming of the Moshiach.  
Bringing home the sweetness:

            Bring sweetness and good health onto your Yom Tov table with raw honey!   Pure honey also known as raw honey is honey that has not been heated, pasteurized or processed in any way.   The differences between raw honey and processed honey are substantial and eating processed honey is equivalent to and just as unhealthy as eating table sugar because all of the honey’s natural vitamins, minerals, enzymes, and other important phytonutrients are removed in this process of pasteurization.   Raw honey, on the other hand, is transferred directly from the hive to your honey jar without any processing in between, so it retains all the good components that make honey so medicinal. Raw honey can have anti-inflammatory, antibacterial, antiviral, and antifungal properties, and in fact, I use honey on my children’s cuts before applying a band-aid to not only stop the bleeding, but prevent any potential infection.    When selecting a honey for you and your family make sure “raw” or “unpasteurized” honey is on the label.   Don’t be surprised by it’s appearance as it will not resemble the pasteurized, golden, liquid honey!  (Check out these great tips when cooking with raw honey.)  

When honey is transferred from the hive to the jar, it is in a liquid form; however, within a few weeks it will become solid at room temperature and often looks mirky or milky.   Also it is best to purchase honey from one country of origin, for instance, 100% Canadian rather then from a mixture of Asian and other foreign countries.    Please remember that although raw honey is a fantastic remedy and great addition to the pantry, it is not safe to consume for children under one years of age.  Raw honey may contain C. botulinium spores that infants do not yet have the ability to digest, meaning if they consume raw honey they could potentially develop botulism.   Below you will find a variety of delicious recipes that use pure honey and other forms of devash to create savory Yom Tov meals.   These dishes will not only taste delicious but also have a ton of great nutritious properties!  Also, you will find your guests buzzing for more!   Shana Tova.   May you and your family be sealed in the Book of Life.  Daniela Hermelin, M.D.

Yomim Tovim Menu:

Summer Minestrone Soup

Honey Lemon Salad

Honey Mustard Chicken with Apples

Nutty Wild Rice

Roasted Romanesco Broccoli with Dates and Pine Nuts

Date Nut Spiced Bread with Parve Vanilla Ice cream

Summer Minestrone Soup

Ingredients:

3 tablespoons of olive oil
1 white onion, chopped
3 cloves garlic, minced
3 carrots, peeled and chopped
1 yellow squash, sliced and quartered
1 zucchini, sliced and quartered
Dried oregano
Chopped fresh basil
Salt
Pepper
6 cups of chicken or vegetable stock, heated
8 ounces pasta shells
2 tomatoes, diced
1 head of Romanesco broccoli or regular broccoli

Directions:

In a soup pot add olive and saute onion and garlic.   Add carrots and cook until tender, about 10 minutes.  Add squash and zucchini.  Season with oregano, basil, salt, and pepper.  Add hot chicken or vegetable stock and bring to a simmer.  Add pasta, tomatoes and broccoli.  Simmer until pasta is cooked through.   

Honey Lemon Salad

Ingredients:

5 ounces English cucumber, halved lengthwise and thinly sliced
5 ounces red leaf lettuce, washed and torn into bite-size pieces
1 tablespoon canola oil
1 tablespoon freshly squeezed lemon juice
1 teaspoon honey
1 teaspoon lightly packed lemon zest
1/2 teaspoon kosher salt
1/4 teaspoon freshly ground black pepper

Directions
Combine cucumber and lettuce in a bowl and, using clean hands, toss to mix thoroughly.

Mix remaining ingredients in a small jar with a tight-fitting lid, close, and shake until well combined. Pour over greens and toss until lettuce is well coated with dressing. Taste and adjust seasoning, as desired. Serve immediately.

Honey Mustard Chicken with Apples

Ingredients:

8 skin-on, bone-in chicken thighs (2 to 2 1/2 pounds)

Kosher salt and freshly ground pepper

2 tablespoons extra-virgin olive oil

1 large onion, cut into large chunks

2 cooking apples (such as Cortland), cut into chunks

1 cup low-sodium chicken broth

2 to 3 tablespoons honey mustard

1 1/2 teaspoons parve butter, softened

1 tablespoon all-purpose flour

1 to 2 tablespoons roughly chopped fresh parsley

Directions:

Preheat the oven to 450 degrees F. Season the chicken with salt and pepper. Heat the olive oil in a large ovenproof skillet over medium-high heat. Working in batches if necessary, add the chicken, skin-side down, and cook until golden, about 6 minutes. Flip and cook 2 to 3 more minutes, then transfer to a plate. Pour off all but 2 tablespoons of the drippings.

Add the onion and apples to the skillet and season with salt and pepper. Cook until slightly softened, about 4 minutes. Mix the broth with the mustard, then add to the skillet and bring to a boil. Arrange the chicken, skin-side up, in the skillet. Transfer to the oven and roast until the chicken is cooked through, 15 to 20 minutes.

Mix the parve butter and flour to form a paste. Use a slotted spoon to transfer the chicken, apples and onion to plates. Bring the pan juices to a simmer, whisk in about half of the butter-flour mixture and boil to thicken, 2 minutes. Continue to cook, adding more of the butter-flour mixture as needed to make a slightly thick gravy. Season with salt and pepper. Pour over the chicken and sprinkle with parsley.

Nutty Wild Rice

Ingredients:  

1 (8-ounce) package wild rice

Chicken stock

1 tablespoon olive oil

1/2 cup toasted, skinless, chopped hazelnuts

1 tablespoon chopped fresh parsley leaves

Salt

Freshly ground black pepper

Directions:  

Cook the rice according to package directions, using chicken stock instead of water, and adding 1 tablespoon of olive oil to the stock. When all the liquid has been absorbed, remove from the heat and let rest for at least 10 minutes. Fluff with a fork and add the nuts and parsley. Season to taste, as necessary.

Roasted Romanesco Cauliflower with Dates and Pine Nuts

Ingredients:

1 large head Romanesco broccoli or cauliflower, cut into florets (about 8 cups)

Kosher salt and freshly cracked black pepper, to taste

4 tablespoons olive oil

1/3 cup pine nuts

1 clove garlic, minced

1/2 cup pitted Medjool dates, coarsely chopped

Directions

Preheat the oven to 425 degrees F.

Evenly spread the cauliflower on a baking sheet and season with salt and pepper. Transfer to the oven and roast, tossing once with a spatula, until golden brown at the edges, about 20 minutes.

Put the olive oil in a small skillet over medium-low heat. Add the pine nuts and cook, stirring frequently, until they're lightly golden brown, about 5 minutes. Add the garlic and dates and continue cooking until they're softened, 2 to 3 minutes more; season with salt.

Transfer the hot cauliflower to a serving bowl, drizzle the pine nut mixture over the top and toss to combine. Taste and adjust seasoning if necessary and serve warm or at room temperature.

Date Nut Bread

Ingredients:

2 cups coarsely chopped dates (10 ounces pitted)

1/3 cup orange liqueur (recommended: Cointreau or Triple Sec)

4 tablespoons (1/2 stick) parve butter, at room temperature

3/4 cup light brown sugar, lightly packed

1 extra-large egg

1 teaspoon pure vanilla extract

1 tablespoon grated orange zest (2 oranges)

2 cups all-purpose flour

2 teaspoons baking powder

1/2 teaspoon baking soda

1 teaspoon ground cinnamon

1 teaspoon ground nutmeg

1/4 teaspoon ground cloves

1 teaspoon kosher salt

3/4 cup freshly squeezed orange juice (3 oranges)

3/4 cup coarsely chopped pecans (3 ounces)

Directions:

Preheat the oven to 350 degrees F. Butter the bottom of an 8 1/2 by 4 1/2 by 2 1/2-inch loaf pan. Line the bottom with parchment paper, then butter and flour the pan.

Combine the dates and amaretto liqueur in a small bowl and set aside for 30 minutes. Stir occasionally.

In the bowl of an electric mixer fitted with the paddle attachment, beat the parve butter and brown sugar together on medium speed for 1 minute. Scrape down the bowl. With the mixer on low, add the egg, vanilla, and orange zest. Sift together the flour, baking powder, baking soda, cinnamon, nutmeg, cloves, and salt. With the mixer still on low, add the flour mixture alternately with the orange juice to the creamed mixture, beating only until combined. By hand, stir in the dates with their liquid, and the pecans.

Pour the batter into the prepared loaf pan and smooth the top. Bake for 50 to 60 minutes, until a toothpick comes out clean. Cool in the pan for 10 minutes, then turn out onto a wire rack and cool completely.

November is National Diabetes Awareness Month

November is American Diabetes Awareness Month. According to the American Diabetes Association, “nearly 24 million children and adults
(7.8% of the population) in the United States (are) living with
diabetes, and an additional 57 million Americans (are) at risk.”
There are two major types of diabetes. Type I, also known as insulin dependent diabetes, occurs when the body does not produce insulin.
This type only affects 5-10% of the American population and results
from an auto-immune destruction of the insulin-producing cells in the pancreas. Type II diabetes, also known as insulin-independent diabetes or insulin-resistant diabetes, is a condition in which the body produces insulin but fails to use it properly. When the body becomes insensitive to the effects of insulin, a dangerous accumulation of sugar occurs in the blood leading to damage to small blood vessels and to organ dysfunction. Keeping a tighter lid on the
cookie jar may be a good start to reducing sugar consumption and the risk of developing diabetes.


What exactly is Diabetes?

When a person has diabetes it means that his or her body is not properly absorbing glucose, a type of simple sugar. Our cells need and utilize glucose for energy. Over time, however, too much glucose circulating in the blood can be toxic and lead to problems such as kidney failure, blindness, and loss of sensation. An easy way to understand the insulin-glucose connection is to think about the role of our mailman. The mailman carries and delivers our mail to our house every day, rain or shine. Insulin performs a role similar tothe mailman's because it carries and delivers glucose into our cells. When a person develops Type II diabetes, it is as if the mailman
is on strike and refuses to deliver the mail until more suitable conditions exist. When this happens, the mail just collects at the post office, we can't pay our bills, and we are left in a
financial crisis! If insulin doesn’t work, glucose accumulates in the blood and the body goes into a state of sugar turmoil. By maintaining a steady insulin-glucose balance, we can avoid these
insulin meltdowns and protect our body from experiencing toxic sugar overload. Choosing complex carbohydrates, eating smaller meals throughout the day, and watching proportion size are steps we can take to keep insulin and glucose in metabolic harmony.

Unfortunately, type II diabetes is not considered an adult disease anymore, and in fact, more and more older children and adolescents are being diagnosed. This is a very disturbing problem and reflects the obesity epidemic in our country. The good news is that eliminating excess weight, especially abdominal fat, decreases the risk of developing insulin resistance and the progression to Type II diabetes. Lifestyle therapies such as losing weight , engaging in
consistent moderate exercise and maintaining a healthy, low-fat diet filled with complex carbohydrates (whole grains and fiber rich foods) will set you on the right path toward good health. This Shabbos try snacking on sliced apples dipped in peanut butter, strawberries
drizzled with coconut flakes, or bananas sprinkled with ground flax seed. Make fruit snacks a fun dessert option by coming up with creative ways of dipping or adding toppings to them (minus chocolate and caramel sauces!). Also, this Shabbos take your children on a brisk
after-dinner/ after-lunch walk. This is a great time not only to lighten up after a full meal, but to provide an intimate time to engage in special parent-child moments. This can become a
unique Shabbos ritual shared and looked forward to each week. Play an active role in disease prevention and you will be providing one of the most important tools your child will carry throughout life – the recipe for good health.

Take a Bite Out of Your Apple Shape!

Being overweight is a very strong risk factor for the development of many chronic diseases such as diabetes, heart disease and certain forms of cancer. Assessment of body weight involves two key measures: body mass index and waist circumference. The body mass index or BMI is a calculation that was developed to determine the amount of body fat based on a person’s height and weight. Once calculated, a person may be defined as underweight if BMI <> 30). (Quickly calculate your BMI at http://www.nhlbisupport.com/bmi/). There are some limitations when calculating one’s BMI. First, athletes and others who have larger muscle mass may have an overestimated BMI because the weight of these individuals is disproportionate to their height due to the increased amount of muscle. The opposite is true of older individuals who have decreased muscle mass. These individuals may have an underestimated BMI and may have more total body fat then calculated. Because the body mass index calculation has its drawbacks, a more important tool in evaluating body weight is measuring the abdominal or waist circumference measurement (WCM). When measuring one’s waist circumference, you are essentially measuring abdominal fat, which is a stronger predictor of developing risk factors for heart disease and diabetes. It seems that the distribution of fat stores, especially abdominal fat, is more important in determining risk factors than the total amount of fat. In fact, it has been documented that individuals who suffer from diabetes or heart disease tend to have “apple-shaped” figures storing excess body fat around the abdomen. To measure your waist circumference, place a measuring tape snugly around your waistline right above your belly button. Waist measurements over 40 inches in men and over 35 inches in women are considered above normal. A cluster of risk factors has shown to promote the risk of developing Diabetes and Heart Disease and of all the risk factors, abdominal obesity has the strongest association with insulin resistance. In fact, the concept of a cluster of metabolic abnormalities, including abdominal obesity, hypertension, impaired fasting glucose, and hyperlipidemia (high blood lipid levels), leading to the development of insulin resistance, diabetes, and heart disease has been understood for the past sixty years and was originally referred to as Syndrome X or the Deadly Quartet. In 1998, the official name, Metabolic Syndrome was coined by the World Health Organization. The Mayo Clinic defines Metabolic Syndrome as “a cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes.” In 2002, the American Association of Clinical Endocrinologists (AACE), designed the criteria for diagnosing Metabolic Syndrome involves having three of more of the following components:

Impaired fasting glucose (100 -126 mg/dl) or 2-h post oral glucose (≥ 140 mg/dl)

• Blood pressure ≥ 130/85 mmHg
• Abdominal obesity (waist circumference >102 cm (men) or 88 cm (women)
• HDL-cholesterol <>
• Body mass index ≥ 25 kg/m2
• Other risk factors: family history of type 2 diabetes, hypertension or cardiovascular disease; PCOS, aging, physical inactivity, ethnic susceptibility to type 2 diabetes or cardiovascular disease

The good news is that most of the risk factors are modifiable and by managing your risk through lifestyle therapies, you may reduce the major risk factors for Diabetes and Heart Disease. Lifestyle interventions include weight loss, increased physical activity and healthy eating habits.

http://www.metabolic-syndrome-institute.org/news/2005/2005-05-19-document-view2.php

http://www.americanheart.org/presenter.jhtml?identifier=4756

http://www.thedoctorwillseeyounow.com/articles/nutrition/fatdistribution_1/#1

The Skinny on Fats and Breast Cancer

A considerable amount of research has been linked to high fat diets and the risk of breast cancer. In response to these findings, dietary recommendations have evolved directing women to maintain a “low-fat” diet to help reduce the chances of developing this frightening disease that effects 1 out of every 10 women. Although we have been given explicit instructions to lower fat intake, it is important to understand what is low and which types of fats actually propose the most risk. Generally, to maintain a “low-fat” diet the American Heart Association recommends to eat no more than 25% of total calories as fat, and that less than 1/3 of this twenty-five percent should come from saturated fats. That means based on an average 2000-calorie diet, a woman should not consume more than 500 calories in fat or 56 grams of fat per day. However, only 16 grams or 144 calories of fat can come from the saturated form. For example, one cup of 2% milk contains 3 grams of saturated fat, but substituting low-fat milk to skim milk reduces your saturated fat intake to zero! For the most part, large amounts of saturated fats are found in animal based products such as eggs, milk, cheese, and red meat. Certain vegetable oils also have saturated fats; however, their ratios of saturated fats to the healthier variety of mono or polyunsaturated fats are very different then in animal based counterparts. For instance, take a look at the following table that shows the breakdown of types of fats in different types of foods.

BREAKDOWN OF FATS

Food – 1 tablespoon	Saturated Fat in grams	% Saturated Fat	% Monounsaturated Fat	% Polyunsaturated Fat
Butter	8	70	5	25
Olive Oil	2	14	78	8
Canola Oil	1	7	62	31

Although studies have shown a positive correlation between saturated fats and breast cancer, the consumption of mono and polyunsaturated fats such as oleic acid (a major constituent of olive oil) as well as omega-three fatty acids (found in fish oil) have actually reduced the risk of breast cancer. There are many ways to transition into a low-fat diet and following website gives 10 easy ways to get started.

http://lowfatcooking.about.com/od/lowfatbasics/a/tensteps05.htm.

In addition to lowering saturated fats and increasing the amount of “healthy fats”, there are a couple of “Super Foods” that have a protective effect toward the developing of breast cancer including: walnuts, decaffeinated green tea, fiber, Vitamin D, Folic Acid, and Soy. The following recipe taken from Mark Reinfield’s fantastic new cookbook coauthored with Jennifer Murray titled “Vegan in 30 Minutes” is a perfect example of cancer-protective meal, combining the proper proportion of “healthy fats” with some of the suggested “Superfoods”. The spinach really packs a punch in this salad and provides the fiber (2 grams per serving) and folic acid (58.2 mcg per serving). The walnuts and olive oil provide the proper proportion of healthy fats into your diet.

Warm Spinach Salad

(Serves 4)

8 cups of prewashed spinach, lightly packed

4 Cremini mushrooms

¾ cup thinly sliced red onion

2 Roma tomatoes, thinly sliced into whole circles

1 ½ tablespoon of red wine vinegar

1 teaspoon of agave nectar

1 ½ tablespoons Dijon mustard

2 tablespoons water

½ teaspoon sea salt, or to taste

¼ teaspoon black pepper, or to taste

½ cup chopped walnuts

3 tablespoons of olive oil

1.) Place the spinach in a large mixing bowl with the mushrooms, onion and tomatoes

2.) Place the vinegar, agave nectar, mustard, water, salt, and pepper in a small bowl and whisk well

3.) Place the walnuts in a small sauté pan over medium heat and dry-roast for 2 minutes, stirring frequently. Add the olive oil and cook for 2 minutes, stirring frequently. Add to the bowl with the liquids and mix well. Pour this into the large bowl with the spinach and gently toss well.

Variations: You can sauté the mushrooms before adding to the salad. Add them to the pan after adding the olive oil and cook for 3 minutes, stirring frequently.

Protection By Early Detection

October is National Breast Cancer Awareness Month. Breast cancer is the most common cause of cancer, other than skin cancer, in women in the U.S. In addition to mammography, annual breast exams are one of the most important tools in regard to early cancer detection. All women over age 20 should perform monthly breast self-examinations. The following link from the American Cancer Association contains intructions and demonstrates the proper way to perform a breast self-exam.
http://www.cancer.org/docroot/cri/content/cri_2_6x_how_to_perform_a_breast_self_exam_5.asp

In addition to self-exams, the American Cancer Society (ACS) recommends a baseline mammogram for all women by age 40. Locally, in St. Louis you can get your "mammogram to go" by making an appointment to visit one of Barnes-Jewish Hospital’s Mammography Vans, which brings quality mammography services to women in St. Louis and surrounding areas (Funded mammograms available for those without health insurance).

http://www.barnesjewish.org/cancer/default.asp?NavID=3253

If you live in other parts of the United States, you can perform a search through the American College of Radiology to identify a mammography center closest to you.

http://www.acr.org/accreditation/accreditedFacilitySearch.aspx

Or you can also try calling your local hospital to find out if there are any promotional mammography testing normally offered during this time of the year. Make early detection your best protection for good health and wellness.