Excerpts

Preface I grew up in an atmosphere of serious food, serious eating, and--ultimately--serious medical consequences. My grandmother was a professional chef and caterer on Miami Beach in the '40s and '50s and a truly great Jewish cook. She made delicate, fluffy matzoh balls, quenelle-like gefilte fish, and unforgettably sweet, schmaltzy chopped liver. She used three types of bones in her stocks and deglazed her pans with wine before Julia Child ever appeared on PBS. Twenty years after her death, people still yearn for her savory stuffed breast of veal. As a baker, she was half artist, half magician. She made the moistest honey cake and the mellowest, translucent strudel. Her teglach, rugalach, and buttery polymorphous cookies sweetened Jewish celebrations in South Florida for two generations. Unfortunately, my grandmother was also morbidly obese and, from mid-adulthood on, she battled two life-threatening complications of obesity: cancer and cardiovascular disease. Although she lived for many years following breast cancer surgery, they were years of hypertension, angina, congestive heart failure, multiple medications, side effects, and declining activity.     My grandmother had three food-loving sons. Two became obese adults with significant cardiovascular disease. One of them required bypass surgery (as has one of his obese children). The third son, my father, is an exceptional cook (and loves his own cooking!), but he has kept himself healthy through moderation and regular exercise.     I am clearly his daughter in many ways, but in none so marked as my lifelong interest in food and health. Between college and medical school, I worked my way through both volumes of Mastering the Art of French Cooking . During medical school, I studied hard and ate well. Jogging kept me trim and fit.     When I married my husband (also a physician) in 1984, the prevailing nutritional wisdom supported a high-carbohydrate, low-fat diet for weight control and cardiovascular health. We lived on pasta of every color and shape, polenta, couscous, bulgur, tortillas, millet, barley, wheat berries, quinoa, potatoes, and rice. I made my own bread and pizza, gnocchi and spaetzle. I bought nonstick pots and cooked with as little fat as possible. Protein appeared only at dinner, usually in the form of fish or chicken. To limit cholesterol and saturated fat, we ate no butter, eggs, or cheese and little red meat. Following my father's example, I maintained a rigorous daily exercise program that combined running with stair climbing, stationary bicycle, and skiing and rowing equipment.     To my infinite disappointment and frustration, ten years of this disciplined lifestyle resulted in a slow and steady weight gain and a "borderline" serum cholesterol. I also developed an array of musculoskeletal aches and pains from exercise-induced overuse injuries. When anti-inflammatory medications failed to help, I spent a small fortune on alternative therapies. I felt tired all the time and found myself going to bed earlier and earlier. My productivity diminished. At 44, I thought I was sliding into the inevitable physical deterioration of middle age. I was desperate and ready to try anything.     At a party, I chatted with a friend and fellow physician who suffered from a debilitating chronic disease. When I remarked on his robust appearance, he told me about his recent improvement on the Zone diet. In particular, he noted a dramatic increase in energy and an enhanced sense of well-being. The very next day, I bought and read The Zone by Dr. Barry Sears. Two days later, my husband and I began the Zone diet--the quintessential insulin-modulating regimen. Almost immediately, I discovered some of the benefits of better insulin control (weight loss, increased energy, pain relief) and I wanted to enjoy them for the rest of my life.     I could face a future without grain and potatoes, but there was one thing I could not give up: my passionate interest in cooking and food. Instinctively, I drew away from mathematically precise food formulas that made me feel hemmed in and restless. Instead, I sought adventures in cooking and eating that would serve the goal of insulin modulation. This book presents the best of my three years of insulin-conscious cooking. - Deborah Friedson Chud, M.D. Chapter One Cooking for Insulin Modulation and Flavor What do The Zone, Sugar Busters!, Dr. Atkins' New Diet Revolution, Dr. Bob Arnot's Revolutionary Weight Control Program, Protein Power , and all other "modified carbohydrate" diets have in common? They share a hormonal strategy for weight loss, blood sugar control, enhanced athletic performance, and improved cardiovascular health. If you eat (or try to eat) according to one of these programs, you are using food to affect your levels of the hormone insulin. In other words, you are practicing insulin modulation. | This is not a diet book; it is a cookbook for exuberant health. It supports insulin modulation through bold, imaginative, flavorful food. INSULIN MODULATION In recent years, research on insulin activity has become vigorous and controversial. Certainly many issues and mechanisms remain unclear. However, a growing body of evidence points to insulin as a major player in the failure of high-carbohydrate, low-fat diets to control obesity, cardiovascular disease, and type 2 (adult-onset) diabetes in this country. My perspective on insulin derives from the scientific literature on glycemic index and low-glycemic diets and the popular books by Drs. Sears, Arnot, Atkins, Eades, and the Sugar Busters! team of Steward, Bethea, Andrews, and Balart.     Insulin influences appetite. When the carbohydrates you eat enter the bloodstream in the form of glucose, blood sugar levels rise. In response, the pancreas secretes insulin, which sends blood sugar levels down again. This leads to the sensation of hunger. The faster the insulin response, the faster you feel hungry again after meals. "Carbohydrate craving" is the term some people use to describe this kind of rapid cycling. It commonly occurs after high-carbohydrate, low-fat meals.     Insulin also influences fat metabolism. It puts the body in the storage mode and prevents stored fat from being used as an energy source. No matter how much you exercise, you may find the fat-storing and fat-locking actions of insulin difficult to overcome. If you have had trouble losing fat on a high-carbohydrate, low-fat diet, it may be due to your response to so much carbohydrate. Scientific evidence suggests that cardiovascular complications follow from this as well. High insulin levels correlate with high levels of triglycerides and low levels of HDL (good cholesterol). This blood lipid configuration raises cardiovascular risk.     Insulin-modulating diets limit fat storage and promote fat burning by controlling the insulin response to food. They alter the insulin response by adjusting the macronutrient composition of meals (ratios of carbohydrate to protein to fat). They also control insulin by limiting the intake of certain carbohydrates (sugar and grains) and relying more on others (high-fiber fruits and vegetables).     Insulin-modulating meals contain less carbohydrate, more protein, and more fat than high-carbohydrate, low-fat meals. You eat less carbohydrate and more fat to slow down insulin secretion and lower average insulin levels. You eat more protein to enhance secretion of glucagon, a hormone whose actions oppose those of insulin. (Glucagon helps release stored fat for energy use.) These changes promote weight loss and fat loss by decreasing fat storage, increasing fat burning, and delaying the onset of hunger after meals.     Insulin-modulating diets emphasize certain types of carbohydrates. Some carbohydrates convert to glucose and enter the bloodstream more slowly than others. These carbohydrates produce a slower insulin response, less rapid cycling, and less subsequent carbohydrate craving. They minimize fat storage and maximize fat burning by lowering and stabilizing average insulin levels. They are known as "low-glycemic carbohydrates." Examples include fructose, grapefruit, cherries, lentils, and most high-fiber vegetables.     Insulin-modulating diets tend to be low-glycemic diets. The "glycemic index" of a food describes its rate of conversion to glucose and release into the bloodstream relative to other foods. Foods that convert and release quickly (for example, French bread) are fast insulin stimulators with a high glycemic index. Foods that convert and release slowly (for example, cherries) are slow insulin stimulators with a low glycemic index.     My approach to insulin control has two components. I improve the glycemic profile of meals by creating carbohydrate recipes that do not send blood sugar skyrocketing. Then I slow down insulin response even further by balancing those carbohydrates with protein and fat. The proportions of macronutrients in any meal can reflect any diet orientation, and this involves personal choice. You can follow a specific regimen strictly or loosely, or you might develop a wholly personal strategy (such as "more protein, less pasta").     The popular insulin-modulating diets differ substantially in the macronutrient ratios they recommend. Dr. Arnot's diet appears at the higher-carbohydrate, lower-protein, lower-fat end of the spectrum with 55 to 65 percent carbohydrate, 20 to 25 percent protein, and 15 to 20 percent fat. The Zone diet occupies the middle ground with a 40/30/30 allocation of calories from carbohydrates, protein, and fat. The Atkins, Protein Power , and Sugar Busters! programs are lower-carbohydrate, higher-protein, higher-fat diets. The path to the "right" balance involves a combination of faith and experimentation. If you have gained weight or failed to lose weight on a high-carbohydrate, low-fat regimen, insulin control might work dramatically for you.     Regardless of specific diet philosophy, insulin-conscious meal planning employs protein and fat to counter the hormonal effects of carbohydrates in every meal and snack. To help you with this, I have divided recipes into two major chapters: Protein Dishes and Carbohydrate Dishes , instead of the traditional categories of appetizers, main dishes, and side dishes. The special chapter entitled Condiments and Flavor Enhancers contains recipes for an array of low-glycemic carbohydrates that make food more delicious without causing insulin spikes.     Where's the fat? Even the leanest protein sources contain intrinsic fat. In addition, almost every recipe contains a small quantity of added fat--usually in the form of olive oil or nut butter. These ingredients consist primarily of monounsaturated fats, which have cardiovascular benefits and, in the quantities used here, do not affect insulin. My personal assessment of good culinary results (great flavor), rather than mathematics, determined the amount of fat used in each dish.     My cooking style evolved along parallel insulin-controlling and gourmet-satisfying tracks. You can cook healthfully from the recipes in this book, but--again--it is not a diet book, and I do not prescribe a specific program. The recipes help control insulin levels by employing those carbohydrates that convert to glucose more slowly than others. Meal planning then requires a personal decision about macronutrient ratios. If you need help tailoring a diet to your individual needs, you may need to consult a nutritionist or a diet book. Moroccan Chicken Thighs 4 SERVINGS This fragrant chicken stew, loosely adapted from Sheryl Julian and Julie Riven of the Boston Globe , illustrates one of the many uses of roasted eggplant. Since the eggplant simmers in the sauce for 10 minutes, roast it until it is tender but not soft, or it will disintegrate during the final cooking. I generally leave the skin on, but you can peel it if you wish before cutting it into cubes. If you do not have roasted eggplant, zucchini cut into 1-inch chunks will cook in the allotted time. The stew is excellent (perhaps even better) reheated the next day. NUTRITIONAL ANALYSIS PER SERVING: 388 CALORIES, 34 G PROTEIN, 23 G CARBOHYDRATE, 17 G FAT (4 G SATURATED), 99 MG CHOLESTEROL, 558 MG SODIUM, 7 G FIBER 8 bone-in chicken thighs, skin and visible fat removed Salt and freshly ground black pepper 1 tablespoon extra virgin olive oil 1 cup chopped onion 1 tablespoon minced fresh ginger 1 tablespoon minced garlic 2 cinnamon sticks 1 teaspoon ground cumin 1 cup diced canned tomatoes, drained 1½ cups chicken broth 1 cup cooked and drained chickpeas 3 cups cubed Roasted Eggplant (1-inch cubes) (page 30) 2 tablespoons minced flat-leaf parsley 1. Season the chicken generously with salt and pepper. Heat the oil in a large nonstick skillet or Dutch oven over medium-high heat. Add the chicken and brown well on both sides; then remove from the skillet. 2. Reduce the heat to medium. Add the onion and sauté, stirring, until soft, about 3 minutes. Add the ginger, garlic, cinnamon sticks, and cumin. Cook, stirring, for 1 minute. Add the tomatoes, broth, and salt and pepper to taste. Return the chicken with any accumulated juices to the pan. Baste with the sauce. Cover and simmer for 15 minutes. Add the chickpeas and roasted eggplant and simmer for 10 minutes. 3. Adjust the seasoning and remove the cinnamon sticks. Garnish with the parsley. Serve immediately. Zone yield per recipe: 16 protein blocks, 7 carbohydrate blocks Spiced Turkey Kebabs 4 SERVINGS During the summer, my local market offers "London broil-style" turkey--half a skinless boneless breast in the form of a thick steak. I cube it, marinate it overnight in Indian spices, and grill it the next day. The meat can be skewered with or without the usual shish kebab companions (peppers, onions, cherry tomatoes). If, however, you seek adventure, try combining this recipe with Broiled Fruit Skewers (page 205). Many fruits respond well to broiling and substitute brilliantly for high-glycemic chutneys. | The recipe provides plenty of extra spice mixture to use with chicken, duck, lamb, and pork. Store the excess in an airtight container in a cool, dark place and use it as needed. It should keep for up to 6 months. NUTRITIONAL ANALYSIS PER SERVING: 178 CALORIES, 26 G PROTEIN, 2 G CARBOHYDRATE, 7 G FAT (2 G SATURATED), 58 MG CHOLESTEROL, 297 MG SODIUM, 0 G FIBER Spice Mix 1 tablespoon ground cumin 1 tablespoon ground coriander 1 tablespoon turmeric ½ to 1 teaspoon cayenne pepper 1 tablespoon salt 1 teaspoon freshly ground black pepper 1 tablespoon peanut or canola oil 1 tablespoon minced garlic 1 tablespoon minced fresh ginger 2 tablespoons minced onion 1 1/3 pounds boneless skinless turkey breast, cut in l ½-inch chunks 1. To make the spice mix, combine the cumin, coriander, turmeric, cayenne, salt, and pepper in a small nonstick skillet over medium heat. Cook, stirring, for 2 to 3 minutes until fragrant. Remove from the heat and set aside to cool. Measure out 2 teaspoons (or more to taste) into a medium-sized bowl. Reserve the extra for another use. 2. Add the oil, garlic, ginger, and onion to the spice mix. Whisk to blend. Add the turkey chunks and toss well to coat. (The turkey can be set aside in the refrigerator for up to 24 hours at this point.) 3. Preheat the broiler or prepare a hot fire in the grill. Thread the turkey chunks loosely on skewers. Broil or grill 4 inches from the heat for about 4 minutes. Turn, broil, or grill for approximately 4 minutes longer, or until the turkey is cooked through but not dry. Serve immediately. Zone yield per recipe: 16 protein blocks, 1 carbohydrate block Hot Stir-Fried Green Beans 4 SERVINGS Because of their year-round availability and rapid cooking, I find green beans almost indispensable. I always keep plain boiled ones on hand to throw into salads and eat with dips. However, when life permits, I treat them more respectfully, as in the Chinese preparation below. If you happen to have cooked green beans in your refrigerator, take the following short-cut: Heat the oil, make the sauce, and add the beans at the end just to heat them through. NUTRITIONAL ANALYSIS PER SERVING: 98 CALORIES, 3 G PROTEIN, 14 G CARBOHYDRATE, 4 G FAT (1 G SATURATED), 0 MG CHOLESTEROL, 560 MG SODIUM, 4 G FIBER Sauce 1 tablespoon bean sauce 1 tablespoon Shaoxing rice wine 1 tablespoon soy sauce 1 teaspoon fructose 1/3 cup chicken broth 1 tablespoon peanut or canola oil 4 cups trimmed green beans 1 tablespoon minced garlic 1 tablespoon minced fresh ginger 2 tablespoons minced scallions (white parts only) ½ teaspoon hot red pepper flakes 1. To make the sauce, combine the bean sauce, rice wine, soy sauce, fructose, and Chicken broth in a small bowl or measuring cup and whisk to dissolve the fructose. Set aside. 2. Heat the oil in a nonstick wok or large skillet over medium-high heat. Add the beans and stir-fry for 3 minutes. Add the garlic, ginger, scallions, and pepper flakes and stir-fry for another minute. Add the sauce mixture and stir-fry for 1 to 2 minutes. Serve immediately. Zone yield per recipe: Less than one protein block, 4 carbohydrate blocks Broiled Fruit Skewers 4 SERVINGS Availability, cost, and protein companion determine my choice of fruits for this recipe. I use apples and pears in winter; peaches, plums, and nectarines in summer; and fresh pineapple whenever it's cheap. If you wish to brush the fruits with a little oil, I suggest peanut or macadamia nut, but they cook perfectly well without it. Broiling them au naturel allows you to save your fat coupons for the rest of your meal. Double skewer the fruit for easy turning. | Served warm or at room temperature, these fruits complement grilled or roasted meats, especially turkey, pork, duck, and lamb. They particularly enhance protein dishes with Indian flavors by serving as low-glycemic chutney surrogates. They are lovely additions to composed salads and even work as dessert. Leftovers are delicious cold or reheated in the microwave. If you like, garnish them with chopped fresh basil, mint, or tarragon. (Pictured on page 111.) NUTRITIONAL ANALYSIS PER SERVING: 43 CALORIES, 0 G PROTEIN, 11 G CARBOHYDRATE, 0 G FAT (0 G SATURATED), 0 MG CHOLESTEROL, 0 MG SODIUM, 2 G FIBER 1 firm apple, tart (Granny Smith) or sweet (Fuji or Yellow Delicious), peeled, cored, and cut into 1- to 1 ½-inch chunks 1 firm, ripe pear, peeled, cored, and cut into 1- to 1-½-inch chunks or 2 cups chopped fresh pineapple (1- to 1-½-inch chunks) or 1 rounded cup chopped firm, ripe peaches or nectarines (1- to 1½-inch chunks) 1 rounded cup chopped firm, ripe plums (1- to 1½-inch chunks) 1. Preheat the broiler. Thread the fruits loosely on skewers. Broil for 3 to 4 minutes. Turn and broil for another 3 to 4 minutes, until tender. Serve warm, at room temperature, or chilled. Zone yield per recipe. Less than one protein block, 4 carbohydrate blocks Copyright © 1999 Deborah Friedson Chud, M.D.. All rights reserved.