The Doc's Kitchen - A Blog of Healthy Recipes from a Doctor and Chef

Caffeine and Coffee, Friend or Foe?

March 12, 2021 By Dr. Omar Jamil 3 Comments

Coffee, a staple beverage of American culture and cultures around the world, remains the most ubiquitously consumed psychoactive agent on earth. However, coffee and caffeine can be shrouded in misinformation and confusion. One day you may meet someone trying to cut down on their coffee consumption, and another day, meet someone determined to increase their daily intake. So, what does the evidence say? We will evaluate both the costs and benefits of drinking coffee and outline what we believe is the ideal way to drink it to maximize its upside.

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Intermittent Fasting, does it work?

January 18, 2021 By Dr. Omar Jamil 4 Comments

While it remains difficult to study how effective diet regimens are, and how they compare to each other, one stands out for being unique. While most diets recommend some foods over others, intermittent fasting does not require a person to give up any particular foods but rather dictates when they eat. So, does it work?

Evidence

The idea is that our ancestors (who were generally slimmer than we are) went long periods without eating before their meals. Our bodies, therefore, evolved to have these long fasting periods. Without them, we throw off the natural equilibrium. By feeding ourselves all of the time, we are challenging the body to do something it has not evolved to do.

In a recent review of intermittent fasting, it’s benefits and evidence, the New England Journal of Medicine (NEJM) reviewed the evidence behind intermittent fasting.

The goal of intermittent fasting is to achieve periods of ketosis, when the body exhausts itself of glucose and begins converting fat into ketones. Ketones are a backup energy source used when the body does not have access to glucose. These ketones signal to the body that the body is in fasting mode. This ‘fasting mode’ is what results in a variety of downstream physiologic benefits and weight loss.

Intermittent fasting has demonstrated better results than calorie restriction (ie simply eating less) in head to head comparisons for losing weight. Additionally, people utilizing intermittent fasting have an increase in insulin sensitivity, staving off diabetes, and reduction in waist circumference. Intermittent fasting regimens decrease cholesterol levels, blood pressure, and also markers of inflammation in the body. Fasting periods lead to cell signaling that increase antioxidant defenses and repair the energy producing components in the cells. In both human and animal studies, intermittent fasting regimens have demonstrated a positive impact on memory and cognitive performance. In other words, when the body is feeding, it is so busy metabolizing food that it neglects other essential function which return during the fasting state.

Multiple animal trials and some human trials have even shown a positive impact of intermittent fasting regimens on decreasing tumor growth in cancer patients, though this requires further investigation.

Another area that requires more evidence is autoimmune disease as there is some evidence that intermittent fasting can help autoimmune conditions such as multiple sclerosis and arthritis.

How to implement it

The NEJM article describes two basic regimens for intermittent fasting. Both regimens are broken into two basic periods; the feeding period, when a person can eat, and the fasting period, when a person refrains from eating any calories.

First, there is Time Restricted Fasting with a 6- 8 hour daily feeding period:

Using this regimen, a person can have a 6-8 hour feeding period at any part of the day that is convenient for them. Most importantly, the feeding period should stay the same, and a person should not eat any calories during the fasting period.

5:2 Intermittent Fasting- 2 days of fasting (1 meal, <500 calories total) otherwise the person eats a normal diet:

During the fasting period, a person can have water, black coffee, or tea. Adding cream or sugar would disrupt the fasting state and kick a person out of ketosis, so they are not allowed. During the feeding period, a person can eat as they normally would. A person should continue to eat responsibly but can indulge themselves and have their favorite foods during the feeding period.

Examples of 500 Calories foods to be eaten in one sitting:

Bagel with cream cheese
Omelet with veggies and cheese
2 peanut butter jelly sandwiches
Chicken breast with veggies and rice
2 pieces of fried chicken

These are only a few examples; there are plenty of meals that can fit into this 500-calorie limit. This 500 calories meal should occur at once, with the person fasting the rest of the day. While the regimens described above are ideal, it may take a few weeks to work yourself up to this point.

Practical benefits

The hardest part of any diet regimen is maintenance. Ultimately the goal is to find a diet you can maintain indefinitely. Restricting when you eat rather than the foods themselves may be a formula for sustained success. Either regimen can be adapted to suit your social life, and can generally adapt to any career or lifestyle.

Should you do it?

Intermittent fasting is an effective, sustainable diet regimen with both weight loss and physiologic benefits. With close adherence to the regimen, a person can find many benefits.

More information about Intermittent Fasting from The Doc himself

References

de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease [published correction appears in N Engl J Med. 2020 Jan 16;382(3):298] [published correction appears in N Engl J Med. 2020 Mar 5;382(10):978]. N Engl J Med. 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136

Adafer R, Messaadi W, Meddahi M, et al. Food Timing, Circadian Rhythm and Chrononutrition: A Systematic Review of Time-Restricted Eating’s Effects on Human Health. Nutrients. 2020;12(12):3770. Published 2020 Dec 8. doi:10.3390/nu12123770

Are chitlins safe? It’s time we talked about health concerns associated with eating chitlins.

November 28, 2020 By Dr. Ed McDonald 6 Comments

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I can think of no other food more polarizing than chitlins. Chitlins, also known as chitterlings, are fried or boiled pig intestines. In some circles, chitlins are a delicacy with a rich cultural history. In other circles, chitlins are a polarizing source of marital discord during the holidays. As a black gastroenterologist, my take on chitlins is both nuanced and complex. Ultimately, chitlins are offal (notice the shamelessly placed pun). In this post, I’ll break down the history, cultural aspects, and health concerns associated with chitlins.

My first exposure to chitlins

My earliest recollection of eating chitlins probably occurred during Thanksgiving or Christmas when I was 4 or 5 years old. I vividly remember my grandmother opening a chitlin-filled bucket. Once the pungent aroma wafting from the chitlins hit my nose, I thought someone clogged the toilet without the courtesy of closing the door and switching on the bathroom fan. The smell emanating from that bucket was beyond horrible. It was like the chitlin bucket was a gateway to the underworld.

Their taste was a combination of umami, funk, and salt

I remember my mother asking me if I wanted to try some. Against my better judgment, I tried a forkful with a smattering of Lousiana hot sauce. The chitlins had the texture of an egg scrambled hard. Their taste was a combination of umami, funk, and salt. I can’t accurately put their taste into words. Ultimately, I didn’t think they tasted bad until my mother explained what chitlins are. Once she said pig intestines, I knew that I was never going to be a chitlin advocate.

Chitlins: A brief history lesson on their culture significance

Although most people associate chitlins with African-Americans, people all over the world have eaten animal innards for centuries. Classic ethnic dishes such as Menudo (a Mexican stew) and Haggis (a Scottish dish banned in the U.S. since 1971) include animal entrails. How did chitlins become connected with African-Americans? Well…there was a peculiar institution called “Slavery”. Yes, that “Slavery”. In the United States, slaves were not given select cuts of meat such as tenderloin, baby back ribs, and the Boston butt. Have you heard of the phrase, “High on the hog?” The colloquial phrase has its origins in the location of these fancy cuts of meat towards the back (spine) of the pig. The meat that sustained “slaves” came from lower, lesser cuts such as entrails (ie chitlins and hog maws), pig’s feet, and pork belly. People often cite the transformation of these undesirable pig parts into delicacies as a testament to the culinary ingenuity that occurred in the kitchens of slaves.

The chitlin circuit

Nonetheless, the association of Caitlin’s with African-Americans grew after slavery ended. For instance, during the era of Jim Crow, the collection of auditoriums and theaters that allowed Black performers was affectionately called the ‘chitlin circuit.’ As a nod to this history and their southern roots, one of my favorite raps groups, Little Brother, released an album in 2006 entitled, “The Chitlin’ Circuit.”

As an African-American, I can appreciate cooking chitlins as reverence to our history and culinary traditions. As a man married to a woman who enjoys a bowl of chitlins during the holidays, I can even respect the fact that some people just like the way they taste. For practitioners of the nose-tail philosophy, I can also respect not letting edible parts of food go to waste. However, as a black, board-certified gastroenterologist, I feel like there’s some pig $hit we definitely need to talk about.

Chitlins and health concerns

Am I advocating for an all-out ban on chitlins like the U.S. banned Haggis? No. Are chitlins healthy? Like many comfort foods, I wouldn’t call chitlins healthy. Are chitlins dangerous? They can be if not properly prepared.

Here are two videos about preparing chitlins. One reminds me of my grandmother. The other reminds me of gentrification.

Nonetheless, improperly prepared chitlins provide the opportunity for feces to end up on your plate. You don’t have to be a gastroenterologist to know that eating poop is bad. In the case of poorly prepared chitlins, how bad is it?

Well…try googling chitlins and safety. The first hit that pops up is an article from the CDC (I’m mad they used big momma as the cover pic). The article points out that chitlins can lead to a gastrointestinal infection with a bacteria called Yersinia enterocolitica. This infection can cause severe bloody diarrhea, vomiting, and cramping. It can even mimic appendicitis. Astonishingly, Yersinia enterocolitica can cause a long term condition called reactive arthritis in individuals with a genetic variation called HLA-B27.

Chitlins and Yersinia Enterocolitica

I first encountered Yersinia enterocolitica in real life when I was training as a gastroenterology fellow. At that time, an African-American woman from the West Side came to the ER during the holidays with bloody diarrhea and abdominal pain. Her stool studies revealed Yersinia enterocolitica. I remember several medical students asking the patient if she lived on a farm, worked in a petting zoo, or traveled to a foreign country. I’m not sure if the students didn’t know the right question to ask or if they were uncomfortable asking her if she ate some chitlins due to political correctness. For medical students reading this, asking anyone who tests positive for Yersinia enterocolitica about chitterlings or undercooked pork is 100 percent reasonable. However, assuming that every black person with diarrhea has Yersenia from chitlins would be egregiously inappropriate. Back to the patient, she claimed she only cleaned the chitlins without actually eating them.

After reviewing articles on Pubmed about Yersinia enterocolitica and Chitlins, I found that both the preparation and consumption of chitlins can present health hazards.

Outbreaks of Yersinia in infants exposed to chitlins

The first outbreak of Yersinia from chitlins I could find was published in 1899. In this study, 42 individuals with a mysterious gastrointestinal illness bought chitlins from the same English butcher on the same day. They weren’t the only people who bought chitlins from that butcher on the same day. However, only the people who did not re-boil the chitlins after they were originally cooked became ill. Tip #1 – reheat your chitlins before eating them #IJS.

Fast forward 100 years, there was an outbreak of Yersinia enterocolitica amongst Black infants in Tennessee. Researchers investigated the outbreak found that the infants were exposed to chitlins, not through actually consuming chitlins’, but through the contamination of pacifiers, baby bottles, and other items with bacteria containing chitlin juices. Tip #2 Keep the baby and baby bottles out of the kitchen when prepping chitlins #IJS.

Other tips for avoiding illnesses from chitlins

Tip #4 Don’t eat chitlins. (This should have been Tip #1. A little shade goes a long way.)

Tip #5 Use vinegar during the preparation process. Although not perfect, acetic acid (active ingredient of vinegar) may kill off Yersinia by lowering the pH of the chitlins. This whole time I thought my grandmother used vinegar for the taste.

Tip #6 Check out these tips on the CDC’s website

Buy already cooked or pre-cooked chitlins, when possible, because they should be safer to handle.
If you will prepare raw chitlins, freeze them unless you plan to clean and cook them within 2 days.
Thaw frozen raw chitlins in the refrigerator in a completely covered bowl or bucket to prevent drips. Drips can contaminate your refrigerator and any food or containers in it. Cook raw chitlins within 2 days after thawing them.
Boil raw chitlins in water for at least 5 minutes before cleaning. This will reduce germs that may get on your hands, counter, and utensils while you are cleaning the chitlins.
Boil and simmer chitlins until well cooked and tender before frying or serving. Do not taste them until they are well cooked.
Refrigerate or freeze leftovers within 2 hours (or within 1 hour if the temperature outside is higher than 90°F).

Tip #7- Recognize that chitlins are typically loaded with salt. THIS means be careful eating them if you have salt sensitive conditions such as high blood pressure, cirrhosis, chronic kidney disease, or heart failure.

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