Omega-3 Rich Paleo Breakfast Porridge

For many people, porridges like oatmeal, cream of wheat or congee are quintessential breakfast foods. For people looking for lower net carb or paleo options, this recipe is for you. Chia, hemp and flax seeds are all rich in fiber and short-chain omega-3’s. This porridge thickens quickly and is a beautiful canvas for sweet and savory flavors.

This recipe is a great breakfast option when completing an elimination diet.

Porridge with 1 tablespoon cinnamon, bananas and almond pieces

Porridge with bananas, pecans and blueberries

Porridge with bananas, sweet potato, almonds and cinnamon

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Omega-3 Rich Grain Free Porridge

Ingredients:

• 1 Tbsp chia seeds

• 1 Tbsp fresh ground flax meal

• 1 Tbsp hemp seed hearts

• 1 cup non-dairy milk of choice

• Toppings and add-ins of choice: berries, apples, bananas , lots of cinnamon, pumpkin pie spice, sweet potato, nuts, etc.

Directions:

1. In a small sauce pan, mix the chia, flax and hemp seeds together with the non-dairy milk. (I like to add apples and/or bananas at this stage so they are heated with the porridge.)

2. Warm the mixture until the porridge is the desired thickness, 1-5 minutes.

3. Transfer the porridge to your bowl and add desired toppings.

Notes:

• For extra convenience, I premix equal parts chia, flax and hemp seeds together and keep the mixture in a jar in the refrigerator. I then scoop out 3 tablespoons of the mixture when needed.

• The omega-3s in flax meal are very volatile. I recommend buying flax seeds and grinding them as needed to optimize their freshness and omega-3 content. I grind about a weeks worth at a time and store in the refrigerator.

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Nutrition information for 1 Tbsp each chia, flax and hemp seeds: 11.8 grams fat, 7.8 grams carbs, 7.3 grams fiber (0.5 net carbs), 7.8 grams protein (non-dairy milk and toppings will add additional nutrients)

BACK TO SCHOOL BREAKFASTS
THE UNIVERSAL BREAKFAST HASH RECIPE

Try this Sleep Routine to Optimize Sleep

At Relish Health, sleep is my favorite “medication” to prescribe. Adequate, restorative sleep is foundational to our physical, mental and social well-being. It is as important as balanced meals and regular exercise.

In honor of the upcoming International Sleep Day, I encourage you to embrace a regular sleep routine. Creating daily habits give our days structure which helps regulate our internal clock.

Consider adapting the following routine to your needs:

(adapted from the book Younger You):

Noon: Stop drinking caffeinated drinks (or sooner if you are caffeine sensitive). The half-life of caffeine is six hours and it may take as long as 10 hours for caffeine to be completely eliminated from you system.

7 PM: Finish eating and exercising for the day. Digestion and exercise are stimulating activities. Now is the time to let our bodies unwind and start the “rest” process.

Four hours before bed: Finish your alcohol. Drinking alcohol before bed can suppress REM sleep. Since alcohol is a sedative, you may fall asleep easier, however as the night progresses, alcohol can create an imbalance between slow-wave sleep and REM sleep, resulting in poor overall sleep quality.

Three hours before bed: Start to power down your screens. Blue-light emitted from our devices suppresses the secretion of melatonin, a hormone that influences circadian rhythms. Even dim light can interfere with a person's circadian rhythm and melatonin secretion. Blue-light blocking glasses can decrease this light exposure, but they are not a free pass for prolonged screens use.

Two hours before bed: Have your last glass of liquid so you can minimize getting up at night.

One hour before bed: Turn off all screens. Indulge in a pre-bed ritual like a bath, stretch or light yoga routine.

Thirty minutes before bed: Do your relaxation practice. Meditation and deep breathing are wonderful for sleep.

Fifteen minutes before bed: Complete your personal care routine. Brushing your teeth, washing your face and other care activities completed in the same order every night can create a cue to the brain that sleep is coming.

Ten minutes before bed: Consider turning on a white noice machine or essential oil diffuser with lavender oil. Regular use may again cue the body that it is time to sleep. Read, take deep breaths or give yourself a gentle massage to promote relaxation as you are turning out the lights.

If sleep is problematic despite embracing a sleep promoting routine, I encourage you to schedule an appointment with Relish Health. Occasionally other factors like mood disorders, sleep apnea, blood sugar imbalances or cortisol concerns may hold you back from high quality sleep.

The International World Sleep Day 2023 will take place on Friday, March 17. Let’s celebrate by going to bed early that night!

THE 10 COMMANDMENTS OF SLEEP HYGIENE
SLEEP- AN IMPORTANT VITAL SIGN
LOSING SLEEP? FOUR CAUSES AND SOLUTIONS FOR INSOMNIA

6 side dishes for lower blood pressure and improved cardiovascular health

This February marks the 59th annual American Heart Month. This long tradition helps educate people about cardiovascular disease and promotes longer, healthier lives. Despite this wonderful tradition and progress, heart disease remains the single largest health threat to Americans. This month I invite you to learn more about this amazing organ system and then give it some extra TLC with common ingredients from your kitchen.

What is the endothelium?

From a big picture perspective, our cardiovascular system is composed of our heart and a complex system of vessels. At a microscopic level, these vessels are lined with a thin layer of specialized tissues called endothelial cells. This cell layer acts as the interface between the blood and underlying vascular tissue. Endothelial cells respond to moment-to-moment changes in blood flow and blood pressure. They produce factors like nitric oxide that help the vessel wall vasodilate for increased blood flow. Healthy endothelial function and blood flow are associated with improved vascular health, improved wound healing, healthy inflammation balance and better sport and lifestyle performance. Taking care of our heart includes supporting this delicate and vital tissue.

Nitric oxide (NO), an essential ingredient for healthy endothelium

Nature Reviews Drug Discovery

Nitric oxide (NO) is a molecule that’s produced naturally by your body in the endothelium. Its function is to signal the inner muscles of the blood vessels to relax. This relaxation, or vasodilation, allows blood, nutrients and oxygen to travel to every part of your body and helps control our blood pressure. Nitric oxide levels in the body can be compromised by nutritional deficiencies, smoking, elevated blood sugar, a sedentary lifestyle and advancing age among other factors. Nitric oxide production is dependent on a sufficient supply of nutrients including the amino acid arginine and key micronutrients like folate, vitamin C, and magnesium from the diet. Switching up your diet is one of the best and most effective ways to naturally boost levels of this important molecule.

6 side dishes to Boost Nitric Oxide Levels

Beets and greens in particular are rich in dietary nitrates, which your body can convert to nitric oxide. Several studies have shown that beet consumption can improve nitric oxide levels and blood pressure control. Greens like spinach, arugula, kale, and cabbage are also packed with nitrates which are converted to nitric oxide in the body. Greens come with the added benefit of folate and antioxidants. These are some favorite side dishes at my dinner table:

Herbed Beet and Lentil Salad

Kale Salad with Berries and Nuts

Roasted Carrots with Watercress

Arugula (rocket), Fennel and Citrus salad

Shaved Brussel Sprout Salad

Sautéed Spinach with Pinenuts and Raisins

Aging Clinical and Experimental Research (2021)

HOW TO ROAST VEGGIES LIKE A PRO

MEDITERRANEAN DIET FOR EVERYONE

HOW TO PREPARE LENTILS AND BEETS

Mediterranean Diet For Everyone

Beet and Lentil Salad

There are so many different specialty diets these days: Keto, Paleo, Vegan, FODMAP, and the list goes on. I've prescribed all of these diets to patients for different reasons over the years, as everyone has individual needs at times. After 20+ years of medical practice, including 7 years focused on food and nutrition, I have come to the conclusion that there is no one perfect diet. That being said, I love to teach and preach about the Mediterranean diet because it is as close to a "one size fits-all" plan that works.

While you can Google a list of specific foods and guidelines for the Mediterranean diet, it doesn't really work that way. Rather, it is really a formula for eating well rather than a specific cuisine. The basic tenants of the eating pattern are simple: focus on eating whole (unprocessed) food that is rich in fruits and veggies, whole grains, nuts, legumes, spices, and extra virgin olive oil. Do this while keeping poultry, fish, dairy, and red meat to modest amounts. No matter your dietary allegience, it is hard to argue against a diet that advocates for eating real food. 

The research behind this formula is extensive. Thousands of studies representing millions of lives consistently shows that eating like this helps maintain weight, keeps cholesterol in check and blood sugar and blood pressure low. Also, the risk of cancer, depression and Alzheimer's disease is also lower. All these benefits are gained simply by paying attention to what goes in your mouth. 

Whether you consider yourself a vegan, a paleo die-hard or follower of a specialty diet, applying a Mediterranean diet philosophy to your approach can benefit your health.

Keep the following in mind:

1. Eat lots of vegetables. There are so many choices! From a simple plate of sliced fresh tomatoes drizzled with olive oil and flaky sea salt, to garlicky greens, fragrant soups and stews, healthy pizzas, or oven-roasted medleys. Vegetables are vitally important to the fresh tastes and health benefits of the Mediterranean diet.

2. Change the way you think about meat. If you eat meat, just do it in smaller amounts. For example, add small strips of sirloin to a vegetable sauté, or garnish a dish of lentils with diced prosciutto. As a main course, have smaller portions (3-4 ounces) of chicken or pastured meat. Think of meat as an accompaniment instead of the center of the plate.

3. Consider eating seafood twice a week. Fish such as salmon, trout and mackeral are rich in heart-healthy omega-3 fatty acids. When you crave more variety add anchovies, sardines and herring. Shellfish including mussels, oysters, and clams have similar benefits for brain and heart health.

4. Cook a vegetarian meal one night per week. Build these meals around beans, whole grains, and vegetables, and heighten the flavors with fragrant herbs and spices. When one night feels comfortable, try two nights per week.

5. Use good fats. Include sources of healthy fats in your daily meals, especially extra-virgin olive oil, nuts, seeds, olives, and avocados.

6. Switch to whole grains. Whole grains are naturally rich in many important nutrients including fiber to keep you satisfied for hours.

7. For dessert, eat fresh fruit. Choose from a wide range of delicious fresh fruits — from fresh figs and oranges to pomegranates, grapes and apples. Instead of daily ice cream or cookies, save sweets for a special treat or celebration.

8. Enjoy alcohol very sparingly (if at all). Alcohol, in moderation, has historically been associated with the cardiovascular benefits of the Mediterranean diet. After careful evaluation of the research, a committee of scientists updating the latest edition of the Dietary Guidelines for Americans is changing the current stance on alcohol. They report that studies showing alcohol can protect health are deeply flawed, and that any potential cardiovascular benefits would be outweighed by the fact that alcohol is a leading preventable cause of cancer. The committee plans to recommend that men and women who drink limit themselves to a single serving of wine, beer or liquor per day. They do not recommend drinking for health and suggest drinking less is generally better. As an alternative to alcohol, try a low sugar, organic wine or a mocktail.

Use the recipes below as inspiration to get started on a Mediterranean diet. 

Roasted Olives with Orange and Rosemary

Salmon with Lemon Walnut Relish

Mediterranean Lentil Salad

Roasted Whitefish with Sweet Peppers

Looking for a place to find low sugar, organic wine. Check out Dry Farm Wines. 

TIPS FOR DRY JANUARY SUCCESS

Mediterranean Lentil Salad

Lentils are one of my favorite legumes. These multitasking staples readily absorb a variety of wonderful flavors from other foods and seasonings. In this recipe their high nutritional value is complemented by the antioxidant rich veggies and herbs. This recipe is excellent eaten immediately, but the favors continue to deepen as the dish sits. It is perfect for a picnic or brown bag lunch.

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Mediterranean Lentil Salad

Author: Erica Leazenby, MD Time: 30 minutes
Serves: 6 (1 cup servings)

Ingredients:

1 cup dried green lentils, (French Le Puy if available)
2 bay leaves
1 clove garlic, peeled and bruised
1⁄4 teaspoon dried oregano
1 cinnamon stick
1⁄4 cup extra virgin olive oil
3 Tbsp lemon juice (about 1 med, lemon)
1 Tbsp red wine vinegar
Zest of one lemon
1⁄4 teaspoon ground cumin
1⁄2 teaspoon sea salt
1⁄2 small red onion, diced small
1 red bell pepper, seeded and diced
1 small cucumber, seeded and diced
1⁄4 cup Kalamata olives, rinsed and sliced
1⁄4 cup chopped mint
1⁄4 cup chopped parsley

Directions:

1. Rinse the lentils and pick out any debris. Place the lentils in a sauce pan with the bay leaves, garlic, oregano and cinnamon. Cover the lentils with enough water to cover the lentils by 2 inches. Add a generous pinch of salt. Bring the lentils to a boil and then reduce the heat and simmer the lentils for 18-25 minute or until the lentils are soft but still hold their shape. Drain well.

2. While the lentils are cooking, whisk together the oil, lemon juice, vinegar, cumin, zest and salt in a mixing bowl. Chop the veggies and herbs.

3. Add the lentils, vegetables and herbs to the vinaigrette and toss together.

4. Serve at room temperature.

Nutrients per serving: Calories 160, Fat 3g, Total Carbs 26g, Fiber 11g, Sugar 3g, Protein 9g

BEET AND LENTIL HERB SALAD

Boost Your Immunity with Functional Medicine

With the spread of the flu, COVID-19 coronavirus, and RSV diseases in our community, I would like to remind you that there are several steps you can take to reduce your risk of illness. Additionally, there are steps you can take to boost your immunity in the event of exposure.

The following information outlines what you can do to help keep yourself and your family safe.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression.

A plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. Join a gym, get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week.

• Manage your stress. Life can be stressful. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: FOLLOW THE BASICS OF GERM CONTROL.

Respiratory virus are transmitted through droplets created when you cough, sneeze or talk and possibly, when a person touches a surface or object that has a virus on it and then touches their own mouth or nose. A few basic measures can drastically reduce your risk of contracting or spreading an illness.

• Stay home when you are ill. Wait until at least 24 hours after your fever* (temperature of 100 degrees Fahrenheit or 37.8 degrees Celsius or higher) is gone. Temperature should be measured without the use of fever-reducing medicines (medicines that contains ibuprofen or acetaminophen).

  Not everyone with flu, COVID, or RSV will have a fever. Individuals with suspected or confirmed flu, who do not have a fever, should stay home from work at least 4-5 days after the onset of symptoms. Persons with the flu are most contagious during the first 3 days of their illness.

• Wear a mask when you have a cough or congestion: When in public settings or when around people outside of your household, wear a properly-fitting face covering. Wash your hands before putting on your face covering, put it over your nose and mouth and secure it under your chin, and try to fit it snugly against the sides of your face. Make sure you can still breathe easily.

• Hand washing: The most well-established way to prevent respiratory infections such as influenza and coronavirus is frequent and thorough hand washing with soap and water. Scrub your hands thoroughly with soap and water for at least 20 seconds.

• Hand sanitizer: Handwashing with soap and water is the best way to reduce germs, but if they are not available, alcohol-based hand sanitizers that contain at least 60% alcohol can help to reduce the spread of infection. Note: avoid any products containing triclosan, a known hormone-disrupting chemical.

• Covering your mouth and nose: Cover your mouth and nose with a tissue when coughing or sneezing; if your hands are not free or you don’t have a tissue, cough or sneeze into your sleeve, not your bare hands.

• Not touching your face: Avoid touching your eyes, nose, and mouth with unwashed hands, which can help provide the virus with a route of entry into the body. Since the average individual touches their face an average of 15 times per hour, remain vigilant!

• Keeping surfaces clean: Clean and disinfect frequently touched surfaces, especially when someone is ill. Surfaces to consider include doorknobs, phones, computer keyboards, remotes, and other surfaces that are frequently touched in rooms such as the bathroom and kitchen.

STEP 3: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. Many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent viruses with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

Consider adding 1 or more if appropriate:

• Zinc 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

STEP 4: CONSIDER VACCINATION. 

Current influenza and COVID vaccinations can decrease the severity of illness if you should become ill. These vaccines help protect you by creating an antibody response without you having to experience potentially severe illness. Talk with Relish Health or your health care provider about whether a vaccine is appropriate for you.

VITAMIN D FOR COVID-19 PREVENTION AND TREATMENT
BOOST YOUR IMMUNE SYSTEM WITH ELDERBERRY SYRUP

References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Gluten & Dairy Free Gingerbread Biscotti

Gingerbread is the scent of Christmas for me. I love a spicy cookie to dip in my coffee. This recipes is adapted from the NYT cooking website. The list of spices is lengthy, but worth the effort to assemble. There is no oil in this recipe making the cookies even more crisp and coffee perfect.

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Gingerbread Biscotti

Author: Erica Leazenby, MD
Makes: about 18-20 biscotti
Time: about 1 hour

Ingredients:

• 2 large eggs, room temperature

• 2/3 packed cup light brown sugar or coconut sugar

• 1/3 cup granulated sugar

• 1 tablespoon ground ginger

• 1 teaspoon ground cinnamon

• 1/2 teaspoon ground nutmeg

• 1/2 teaspoon ground cloves

• 1/4 teaspoon ground cardamom

• 1 whole star anise, finely ground (about a 1/4 teaspoon)

• 1 teaspoon instant espresso powder (or 1/2 teaspoon coffee extract)

• 1 teaspoon kosher salt

• 1/2 teaspoon baking soda

• 1 teaspoon almond extract

• 1/4 teaspoon lemon extract

• 1 3/4 cup 1:1 gluten-free flour mix (look for a blend that contains xanthan gum)

• 1/2 cup slivered almonds (optional for additional texture)

• 2/3 cup dark or semisweet chocolate chips (about 4 ounces)

• 1 teaspoon coconut oil

Directions:

1. Heat the oven to 350 degrees (or 325 if using a convection oven). Line a large baking sheet with parchment paper.

2. In the bowl of a stand mixer fitted with the paddle attachment, add the eggs, both sugars, ginger, cinnamon, nutmeg, cloves, cardamom, star anise, espresso powder, salt, baking soda, almond extract and lemon extract. Beat the mixture on a low speed until all the ingredients are combined, scraping down the bowl and beater as needed, then increase the mixer speed to high and beat for a full 90 seconds or until the mixture is slightly paler, thick and ribbony.

3. Add the GF flour. Beat on low speed until the flour is mostly combined. Scrape the sides and bottom of the bowl to incorporate any remaining dry bits into the dough. Stir in the almonds if using. The dough will be very sticky.

4. Divide the dough in half. Lightly flour your hands and mold the dough into two logs about 3 inches wide and 1 inch tall on the lined baking sheet. Bake the logs until they puffs slightly and spreads a little. They will turn golden brown at the edges and will be firm to the touch, about 15-18 minutes.

5. Remove the logs from the oven and allow to cool for 5-10 minutes. When the logs are cool enough to handle, transfer them to a cutting board. Using a serrated knife, cut the logs at a diagonal into ¾-inch-wide slices. Return the slices to the baking sheet, lying them on their sides. Return the baking sheet to the oven.

6. Bake the slices for an additional 8-12 minutes, flipping them halfway through. The biscotti should be dry in the centers. Extend the bake time if you like drier, crunchier biscotti. Remove the baking sheet from the oven and allow the biscotti to cool. When the biscotti have cooled completely, turn the slices top sides up.

7. In a double-boiler or a heatproof bowl set over simmering water, melt the chocolate and coconut oil, stirring until completely smooth. Remove the bowl from the heat using care to not get steam or water in the melted chocolate. Use a small spoon to drizzle the melted chocolate on the tops of the biscotti. Alternately, dip the tops of biscotti in the chocolate. Allow the chocolate to sit at room temperature or in the refrigerator to fully set. The biscotti will last for a few of weeks in an airtight container at room temperature.

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More gluten and dairy free holiday treats:
TOASTED MARZIPAN
TIPS TO MAKE YOUR HOLIDAY COOKIES MORE WHOLESOME

The Universal Breakfast Hash Recipe

To me, hash is a nearly perfect breakfast dish. Traditionally it is a dish of cooked meat cut into small pieces that is then cooked again, usually with potatoes. In my version, it is rich in veggies, protein and good fats to provide sustained energy for the morning.

While this recipe is no nonsense, it is amazingly versatile and delicious. You can use raw or cooked potatoes, any veggie that suits your fancy, and add egg, sausage or leave meat free. The possibilities are endless.

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Breakfast Hash

Serves: 1 generous serving
Time: 10 minutes if starting with cooked potatoes; 20-30 minutes if starting with raw potatoes

Ingredients:

• 1-3 teaspoons olive oil, avocado oil or ghee

• 1-2 Tablespoons diced onions

• Optional 1 garlic clove, minced

• 1 cup raw or cooked potatoes, diced into 1/2 inch pieces or grated

• 1 cup veggies of your choice (leftover roasted veggies, greens, peppers, mushrooms, etc.)

• Salt and pepper to taste

• 1-3 large eggs or 2-4 ounces of leftover protein from another meal

Directions:

1. Place a large nonstick skillet over medium heat. Add the oil. When the oil starts to shimmer, add the onion and a sprinkling of salt. Stir the onion until it begins to soften, about 1 minute. If using, add the garlic with the onion.

2. Add the potatoes to the pan. Reduce the heat to medium-low, and cook stirring frequently until the potatoes and onions are tender, caramelized and lightly browned, about 5-30 minutes.

3. Add firm veggies like carrots or mushrooms to the pan when you add the potatoes. Add tender veggies, like greens, or pre-cooked vegges to the pan once the potatoes are nearly done.

4. Push the potato and onion hash to one side of pan. Increase the heat back to medium. Add additional oil to the pan if needed. Crack the egg(s) into the pan or add your meat, and cook to taste. Spoon potatoes and veggies onto a plate and top with the egg(s) or protein.

5. Enjoy as is or add guacamole, everything bagel seasoning, salsa, sriracha or micro greens for extra flavor.

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HOW TO UPGRADE YOUR BREAKFAST
BUILDING A BETTER SMOOTHIE
BACK TO SCHOOL BREAKFASTS

Relish Health Gift Guide 2022

Happy Holidays from our home to yours! The season of gift-giving is officially here, and few things are sweeter to me than finding the perfect gifts for loved ones - gifts that make them feel known and loved. I’ve pulled together some of my favorite health-enhancing gift ideas, and hope this guide gives inspiration, relieves shopping frenzy, and enables you and your loved ones to savor the season.

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New home health monitoring devices:

It is amazing how many home monitoring devices are now available. I am a fan of giving people knowledge about their health. The two products listed below are ideal for specific health conditions; the Food Marble is ideal for people struggling with bloating and gas, while the Biosense monitor is helpful for those using a low carb diet to support health.

Food Marble: Take the guess work out of eating. This hand held breath testing device is for people with SIBO, IBS and certain digestive issues. Monitor your meals, stress, sleep and symptoms by testing your fermentation levels with personalized, real-time results. (Save 15% though this link.)

Biosense® is a handheld breath testing device that measures fat burn (ketones) in your breath. This devices allows you to track your metabolic health and use of glucose or fat for energy. Use coupon code 9493D2AEE95 for a discount.

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New Fitness Tools:

I’ve been increasing my weight training lately. I am fan of the products below for occasion muscle soreness.

Rebounder mini trampoline- Rebounding, or bouncing on a mini-trampoline, can help work the muscles in the legs, increase your endurance, support lymph drainage, and strengthen your bones, among a number of other benefits. This type of exercise is gaining popularity because it’s gentle on the joints but allows you to work your cardiovascular system without taxing the body.

A foam roller is a self-myofascial release (SMR) tool used to release tension and increase the mobility of your muscles, fascia, and other connective tissue surrounding a joint.

Body Back Buddy Classic- This low tech massager hits all the right points. I love this tool to massage trigger points or just gently knead tired muscles.

Massage Guns, also called percussive therapy devices, help relax and soothe sore muscles, whether you’re an athlete or just hunching over a desk all day.

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The Gift of Food:

The gift of flavorful and nourishing food is always is season.

A delicious bottle of fresh, artisanal olive oil make a wonderful gift. I like to buy my olive oil from my local specialty olive oil shop. (Pro-tip, I always ask the shop owner for the polyphenol content of the oils I buy. The higher the number the richer the heath supporting polyphenols.)

Dark chocolate is always a welcome gift. Hu chocolate is our house favorite.

Salmon Community Supported Fishery- Give the gift of a brain-supporting, omega-3 rich seafood subscriptions. Several purveyors, like Sitka Salmon Shares or Wild Alaskan Company, send a rotating selection of premium quality seafood to your door. The fish is frozen at the peak of freshness and traceable to the source.

Homemade treats like toasted marzipan, homemade granola or dark chocolate bark are lovely ways to show appreciation to your friends, co-workers, and neighbors.

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Some gifts never go out of style.
Check out the gift guides from 2018, 2019, 2020, and 2021.

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through links.)

A Primer on Histamine Intolerance

What is Histamine?

Histamine is a compound which is released by some types of immune cells in response to injury, allergic triggers and inflammatory reactions. Histamine is an important chemical that has a role in a number of different bodily processes. It stimulates gastric acid secretion, plays a role in inflammation, dilates blood vessels, affects muscle contractions in the intestines and lungs, and affects your heart rate. It also helps transmit messages between nerve cells and helps fluids move through blood vessel walls. Histamine is also released if your body encounters a threat from an allergen. During an allergic reaction, histamine causes vessels to swell and dilate, leading to symptoms like congestion, hives or anaphylaxis.

Histamine occurs naturally in some foods. Bacteria are also capable of producing histamine. Fermented foods and beverages (and left-overs) naturally contain small quantities of histamine due to fermenting bacteria or yeasts.

What is Histamine Intolerance?

Histamine intolerance is a disorder associated with an impaired ability to metabolize ingested histamine. In a healthy person, ingested histamine is broken down by two enzymes: DAO and HNMT. When one of these enzymes is not working correctly, histamine intolerance can occur. Histamine intolerance is not a sensitivity to histamine, but an indication that you have developed too much of it.

Symptoms of Histamine Intolerance:

When histamine build-up occurs, a variety of symptoms may be present:

• Skin: redness, rash, hives, itching, swelling and local inflammation

• Respiratory System: runny nose, congestion, shortness of breath and sneezing

• Gastrointestinal Tract: nausea, vomiting, cramping, bloating and diarrhea

• Circulatory System: low blood pressure and heart racing

• Neurological System: headache, palpitations and tingling

Main symptoms of histamine intolerance and possibly corresponding histamine receptors. Biomolecules. 2020 Aug; 10(8): 1181.

Causes of Histamine Intolerance:

Low levels of the DAO enzyme may be due to genetic predisposition or illness. DAO activity can also be blocked by certain medications and alcohol consumption.

DAO is made in the intestines. If the intestines are not healthy, there may not be enough DAO to break down histamine normally. Low DAO levels may explain why histamine intolerance symptoms are more common in people with gastrointestinal disorders such as inflammatory bowel disease, IBS, celiac disease, and small intestinal bacterial overgrowth (SIBO).

How to Diagnosis Histamine Intolerance:

Currently there are no tests that can confirm a diagnosis of histamine intolerance. Blood work, review of your medication use and allergy testing is recommended to rule out other causes of histamine symptoms. After a thorough evaluation, a trial of a low histamine diet is recommended. If typical symptoms of histamine intolerance improve after following of a low-histamine diet, a diagnosis of histamine intolerance is confirmed.

Treatment of Histamine Intolerance:

Histamine intolerance requires a whole-body approach to healing. Addressing underlying health issues and optimizing gut health are necessary.

• Diet: A low histamine diet is the treatment of choice. The tolerance to dietary histamine varies from person to person and the foods tolerated must be deduced by trial and error. Some people can only tolerate very small amounts of histamine rich foods, while others can be more liberal. An elimination diet for 3-4 weeks followed by careful reintroduction of foods is helpful. Following a low histamine diet can be challenging if you already have a restrictive diet. It is recommend that you work with a knowledgable health care provider to minimize your risk of nutritional deficiencies.

• Medications: Antihistamines or oral/topical steroids may be helpful for severe systemic symptoms.

• Supplements: There is little to no data on these, but the following are sometimes used: Vit C, probiotics, quercetin, N-acetyl cysteine, and DAO enzymes. Please use any supplement under the guidance of a practitioner.

• The basics: Sleep, stress management, and regular exercise are important parts of healing.

High Histamine Foods:

There are many lists available online to identify high histamine foods. The “Food Intolerance” app may also helpful.

Foods that may trigger the release of histamine:

• Most citrus fruits

• Cocoa and chocolate

• Tomatoes

• Egg whites

• Fish

• Peanuts

Foods that may interfere with DAO levels:

• Alcohol

• Energy drinks

• Green, black or maté tea

Some foods and drinks that are rich in histamine:

• Alcohol

• Aged cheeses

• Canned, pickled, and fermented foods, such as sauerkraut

• Smoked products, such as sausage, ham, bacon, or salami

• Spinach

• Eggplant

• Ketchup

• Vinegar

• Canned fish, such as mackerel and tuna

Curious whether you may have a histamine intolerance?

References:

Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020 Aug 14;10(8):1181. doi: 10.3390/biom10081181. PMID: 32824107; PMCID: PMC7463562.

Which foods are high in histamine? Medical News Today. Accessed 11/9/2022.

How to Interpret Body Composition Analysis with Relish Health

Promoting good health and longevity is the goal of Relish Health, and research has shown that body composition is one of the best indicators to measure how well you are doing. Your weight is made up of muscle, fat, and water. Excess fat in relation to lean body mass, even if you are an “ideal weight,” can greatly increase your risks to cardiovascular disease, diabetes, and more. Instead of tracking how heavy you are, Relish Health uses body composition analysis to detect health risks and allow for earlier intervention and prevention of illness. Understanding your body composition allows your health plan to be tailored to your needs, often focusing on losing body fat and gaining muscle while retaining the proper amount of body water in specific areas of your body. Body composition analysis is the key to tracking and maintaining effective muscle mass and strategic weight loss. 

Relish Health uses an InBody570 bioelectrical impedance analysis (BIA) machine to complete body composition analysis in the office. BIA is a non-invasive, safe measurement of fluid and body mass that can be a critical assessment tool for your current state of health. By standing and holding onto electrodes, the machine determines the resistance to the flow of the current through the body. In about 45 seconds, the InBody machine provides very accurate measurements of the following values.

• Lean Body Mass (fat-free mass) is the total weight of all your organs, your skin, your bones, your body water and your muscles. (It isn’t the same as muscle.) It is the total weight of your body minus all the weight due to your fat mass. Optimum levels are associated with healthy aging, vitality, and better resilience against stressors.

  • Skeletal Muscle Mass (SMM) is the total weight of your muscles. SMM is muscle that can be grown and developed through exercise. Unlike Lean Body Mass, which includes everything except body fat, you can confidently interpret an increase in SMM as muscle gain.

  • Dry Lean Mass is the weight of the protein and mineral content in your body. Dry lean mass is lean body mass minus the body water. When you build muscle, you are actually building new physical protein stores that will be reflected in an increase in dry lean mass. Increased dry lean mass is a strong indicator that you actually grew muscle.

• Body Water can be found inside not only your blood, but in your muscles, fat, organs, and inside every cell in your body. A healthy body water distribution has been estimated at a 3:2 ratio of intracellular water to extracellular water.

  • Intracellular Water (ICW) is the water located inside your cells. It makes up 2/3 of the water inside your body. Increased ICW indicate improved nutrition status and improved overall health, often correlating to increased lean body mass, energy use, strength, and immune health.

  • Extracellular Water (ECW) is water located outside your cells in your blood. This makes up about 1/3 of your body’s water. Increased ECW indicates health risks like toxicity, inflammation, acidity, infection, unhealthy fat mass, and/or mineral imbalance.

• Body Fat Mass is a measure of how much body fat, both surface level (subcutaneous/under the skin) and internal (visceral/around the belly organs), makes up your weight. Excess levels of visceral fat are associated with all major degenerative diseases. Additionally, fat stores toxins, converts healthy hormones to toxic hormones and triggers insulin resistance.

• Percent Body fat (PBF) is a division of your body fat mass by your total weight and a much better indicator of your risk of obesity than body mass index (BMI). BMI is determined by dividing your weight by your height squared. BMI is just a single value that does not differentiate between fat or muscle mass. If you use BMI to track your fitness progress, you will never know if the changes were in fat or muscle. Alternatively, PBF puts your weight into context by showing how much of it is fat mass. Tracking changes in your body fat percentage lets you focus on actual fat loss, not just weight loss, which can also come from losing muscle mass.

  For PBF, the ideal ranges differ for men and women, as women tend to carry more body fat than men due to their reproductive system and genetics. For men, the healthy range is between 10-20%. For women, the healthy range is between 18-28%.

Periodic BIA measurements allows Relish Health to track your progress as you improve your health. Improving your BIA measurement, or maintaining a healthy BIA measurement, can help keep your body functioning properly for healthy aging. Your BIA results can help guide Relish Health in creating a personalized dietary and exercise plan to help you maintain optimal health and wellbeing for a lifetime.

Smoked Salmon Dip

Fish is among the healthiest foods on the planet. It is loaded with important nutrients, such as protein, vitamin B12, trace minerals, omega-3 fatty acids and vitamin D. Research suggest that at least two servings of fatty fish per week is associated with improved cardiovascular and mental health.

Smoked salmon is readily available in the refrigerator section of most supermarkets. It is an easy way to incorporate fish into your week. This dip is easy to make and keeps for several days in the refrigerator. It is a lovely appetizer to bring to a gathering, but is also an easy breakfast or lunch option for your busy work week. This protein and healthy fat rich dip is low in carbs and sure to fuel you well.

This recipe was inspired by a trip to the south region of the United States where I found fish dips to be a common item on restaurant menus. It’s time to make this delicious dish commonplace in the mid-west.

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Smoked Salmon Dip

Author: Erica Leazenby, MD
Servings: 2-4
Time: 10 minutes

Ingredients:

2 Tablespoons vegan cream cheese (I like kite Hill brand.)
1 Tablespoon mayonnaise (I recommend an avocado oil based brand.)
1 1/2 Tablespoon diced shallot
1 Teaspoon lemon juice
1/2 Teaspoon dried dill
1/2 Teaspoon capers, drained
4 ounces wild caught smoked salmon (I like Ducktrap brand.)

Directions:

1. Place all the ingredients with the exception of the salmon in the bowl of a food processor. Run the machine until all the ingredients are well mixed. (The ingredients can also be chopped small and mixed by hand if you lack a food processor.)

2. Add the salmon to the food processor bowl. Pulse the machine 3-5 times until the salmon is chopped into small pieces, but still has a chunky texture.

3. Serve immediately or store in an air-tight container in the refrigerator up to 2-3 days.

Serving suggestions:

• Serve with gluten free crackers, lettuce cups, or toast points

• Optional garnishes: capers, picked red onion, everything bagel seasoning, or fresh herbs like dill or parsley

Recipe notes:

• Different brands of smoked salmon can vary widely in salt content. You can vary the amount of capers in the recipe as needed.

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Interested in curing your own salmon, try this easy recipe: HOUSE-CURED SALMON
Looking for additional quick fish recipes, give this sardine recipe a try: LEMONY HERBED SARDINE SALAD

Lemony Herbed Sardine Salad

Sardines are unsung heroes for good mood. Not only are they affordable and sustainable, but they are rich in omega-3s and vitamin D which tend to be in short supply in most people’s diet. This lemony, herby prep is fierce competition for even the best tuna salad. Enjoy it on whole grain or gluten free crackers, lettuce wraps or a large salad.

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Lemony Herbed Sardine Salad

Author: Erica Leazenby, MD, Adapted from RebeccaKatz.com
Servings: 1-2
Time: 10 minutes

Ingredients:

1 Tbsp fresh lemon juice
Zest of 1 lemon
2-3 Tbsp fresh minced herbs including a combination of basil, parsley, and mint
1 tsp Dijon mustard
1 tsp olive oil
1 Tbsp shallot, minced
1 4 oz can sardine in water or oil, drained
Salt and pepper to taste

Directions:  

1. In a small mixing bowl, combine the lemon juice, zest, herbs, shallot, mustard and oil until well mixed.

2. Add the sardines to the bowl and gently flake them apart. Stir the sardines into the herb dressing until the fish is well coated. Taste the mixture and add salt, pepper or additional lemon juice as desired.

3. Serve over greens or crackers.

How to Upgrade Your Breakfast

Breakfast is a challenging meal for many people and often gets less priority in busy mornings while rushing out the door for work or school. However, this meal is so powerful for our bodies, it has residual effects on our sleep later that evening. If you are focused on improving your nutrition and wellness, look first to how you start your day. Overnight our bodies spend several hours repairing and rejuvenating from the activity of the previous day. The first meal after sleep provides the fuel we need to further recharge for activity and get our bodies running well. Studies show that the food we eat for breakfast influences our energy levels, cravings, emotions and clarity throughout the day.

Unfortunately, many people skip it altogether, while others may reach for something quick, processed, and packaged. Often these quick choices are high-carbohydrate, dessert-like foods which do more harm than good. These foods spike our blood sugar, drain our energy, leaving us searching for our next “fix” of sugary foods as well as caffeinated beverages to keep this false sense of energy up and prevent a sugar crash.

Luckily, a nutritious breakfast can be easy, and help us get in the habit of including nutrient-dense foods at every meal. Listed below are a few tips to help set you up for a delicious day.

Tip 1: Prioritize your P’s at breakfast: Protein and Produce

Meals that contain healthy fats, good-quality proteins, and colorful vegetables, will provide a sense of balance and satisfaction. Having balanced macronutrients creates lasting energy and brain function that encourages you to continue making healthy choices all day.

Consider incorporating these quality ingredients into your morning:

• Proteins like eggs, wild salmon, leftover poultry, and for those that tolerate dairy it may include plain organic yogurt, or a high-quality plant-based protein powder 

• Healthy fats like avocado, natural almond butter, natural peanut butter, hemp seeds, chia seeds, flax seeds, coconut oil, coconut butter, olive oil, avocado oil, pesto, or high-quality cheeses

• Green vegetables such as spinach, Swiss chard, arugula, zucchini, asparagus, broccoli. These are just a few greens that work well. You can add any vegetables that you like.

• Complex carbohydrates: black beans, chickpeas, quinoa, brown rice, sweet potato, steel cut oatmeal

Tip 2: Make your carbs slow burning

When we eat refined carbohydrates like simple sugars and refined flours our blood sugar and insulin levels spike. Unfortunately, our bodies were not designed to handle the blood sugar and insulin roller coaster that many of us are on.

When we eat sugar, whether it’s in an obvious form like a donut or a non-obvious form like a sweetened yogurt cup, our blood sugar increases quickly. This fast increase then spikes insulin. When insulin removes blood sugar, you can then have a blood sugar crash, and then cortisol (our stress hormone) moves in to compensate and try to move sugar out of storage and back into the bloodstream. This process can be responsible for many carb and sugar cravings.

A simple solution to prevent blood sugar crashes is to eat a savory breakfast that includes fiber, good fats, and proteins. This will balance your blood sugar and give you more sustained energy and focus.

Tip 3: Fiber, Fiber, Fiber

Fiber is your friend for so many reasons. We know that it helps with digestion and keeping us regular, but it is also helpful in blood sugar control. Fiber slows our body’s absorption of sugar into our blood stream so that our blood sugar spikes are less significant. Fiber also feeds the good bacteria in our digestive tract that influences our metabolism and immunity. Breakfast is an easy and ideal meal to prioritize fiber consumption because again it sets the stage for the rest our day. If you are a woman then aim for at least 25 grams of fiber daily. Men should consume at least 38 grams of fiber daily.

Looking or some breakfast inspiration? Check out the recipes located at RelishHealthMD.com.

Here is a “produce and protein” recipe below to get you started:

Poached Eggs in Spicy Tomato Sauce

This elegant egg dish is traditionally called Shakshuka. It is a classic dish enjoyed widely in the middle east and Northern Africa. Although traditionally enjoyed for breakfast, it makes an easy and satisfying dinner and is a great way to increase vegetable consumption. Consider adding a can of chickpeas or artichokes to make the dish even more hearty.

Author: Erica Leazenby, MD (Adapted from the NYT Cooking website)
Serves: 4-6
Time: 30 minutes

Ingredients:

2-3 Tablespoons olive oil
1 large onion, diced
1 roasted red pepper, diced (jarred or freshly prepared)
3 garlic cloves
1 tsp cumin
1 tsp sweet or smoked paprika (or try a mixture of the two)
1 pinch red pepper flakes (optional)
1 (28-ounce) can crushed tomatoes with juice
4 handfuls of greens like spinach or chopped kale
1 tsp sea salt
Pepper to taste
6 large eggs
Chopped Cilantro for garnish (optional)
Hot sauce (optional)

Directions:

1. Preheat oven to 375 degrees.

2. Heat the oil in a large, oven-safe skillet over medium high heat. Sauté the onions and garlic until soft, about 4-5 minutes. Add red peppers, cumin, paprika, pepper flakes and stir to combine. Add the crushed tomatoes and season with salt and pepper. If using firm greens like kale, add them at this time. Allow the mixture to simmer for 10-15 minutes or until tomatoes start to thicken. If using tender greens, like spinach, stir them in just before adding the eggs.

3. Using the back of a spoon, gently make small wells for each egg in the tomato sauce. Moving quickly so that all eggs cook evenly, gently crack each egg and place in the sauce.

4. Place the skillet in the oven and bake the eggs for 5-8 minutes or until just set. Watch closely to prevent over cooking.

5. Garnish with herbs and hot sauce and serve with your favorite bread, toast or gluten- free grain.

Note: This sauce can be made in advance and reheated in individual portions if needed. For a quick morning meal, sauté the number of eggs needed and lay on top of the heated sauce.

Calories (per egg with sauce) 200; Fat 13 grams; Carbohydrates 16 grams; Fiber 4 grams; Sugar 3 grams; Protein 10 grams

BACK TO SCHOOL BREAKFASTS

The Art of a Sheet Pan Dinner

A busy cooks dream, a sheet pan dinner is similar to a one-pot meal. It does not require fancy equipment yet makes kitchen clean-up a breeze at the end of the meal. Your ingredients can be as simple or fancy as desired, just follow a basic formula that includes protein, veggies, fat and flavoring. Roast until everything is golden and marvel at your accomplishment when dinner is served. 

Adapted from NYT Cooking guide by Melissa Clark 

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Choosing Your Sheet Pan

A sheet pan is a wide, shallow baking pan made from aluminum or stainless steel. It has a low rim that prevents the pan contents from sliding off the edge of the pan, but still encourages airflow and browning. This humble tool is a kitchen workhorse; it is the go-to pan for roasting vegetables, meats and often entire meals. I encourage every kitchen to have a sheet pan (or several) in a variety of sizes.

Most sheet pans are 18x13 inches with a 1-inch rim. This size will fit in most standard home ovens. These pans are also called half-sheet pans because they are half the size a pan typically found in a commercial kitchen. Quarter sheet pans, measuring 9x13 inches, are great for smaller ovens. If you are cooking multiple items at one time it is helpful to have multiple 9x13 pans to prevent flavors from mixing or to accommodate different cooking times for varied ingredients.

When purchasing a sheet pan, look for a pan with a heavy-duty gauge — this refers to the thickness of the metal used. The higher the gauge, the thinner the pan: Anything from 13 to 18 gauges will work well.

Sheet pans are typically easy to clean, however lining your pan with a silpat baking mat or parchment paper makes clean up even easier. Silpat baking mats are sturdy, reusable mats made from food grade silicone. Silpat mats can be used in an oven up to 480 degrees. Parchment paper is single-use, disposable product. Thanks to a silicone coating, it's resistant to grease and moisture. It is flexible enough to fold but sturdy enough to not tear. Parchment paper is heat resistant up to oven temperatures as high as 450 degrees. Note: Using a pan liner may hamper the browning of your food. Parchment paper in particular may make roasted items less likely to get browned and crispy.

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The sheet pan formula

Choose Your Protein

For a well-balanced meal, I recommend starting with your protein. Build your flavors and accompanying veggies around this protein. Whether you decide on poultry, beef, pork, fish or tofu, you’ll want to start with 1⁄4 to 3⁄4 pound per serving, to be supplemented with vegetables.

Prior to roasting, gently season the meat with salt, pepper, (and herbs if using) and a light coat of oil. I recommend avocado oil for high-heat cooking.

• Poultry Notes:
  Dark meat takes longer to cook that white meat.
  Bone-in meat takes longer to cook than boneless cuts.
  All poultry should be cooked to at least 165 degrees or until juices run clear when the meat is cut. When able, use pasture-raised or organic poultry.

• Seafood Notes:
  As a general rule, fish takes 8-10 minutes to cook per inch thickness.
  Salmon can be cooked to 120 degrees for medium-rare to 125 degrees for medium.
  Shrimp should be added as the sheet pan veggies are in the last few minutes of cooking.
  When able, use wild-caught, sustainable seafood.

• Red Meat Notes:
  Use an oven safe wire rack that fits your sheet pan when cooking larger cuts of meat. This will prevent the meat from becoming soggy or sticking to the pan.
  Smaller cuts of meat can be placed on the pan directly.
  After the meat has reached its ideal cooking temperature, place the meat under the broiler for 1-2 minutes to create browning if desired.
  Beef is rarely used in sheet pan dinners. Ground beef or meatballs are an exception.
  When able, use grass-fed, unprocessed meats.

• Tofu Notes:
  Dry out your vegetable protein prior to baking to allow it to crisp and brown.
  Marinade your plant based protein prior to roasting to add flavor.
  Do not cook tofu on the same pan as watery vegetables. The moisture for the vegetables will prevent the tofu from browning.
  Dredging tofu in cornstarch prior to roasting will allow the tofu to crisp and brown. The tofu is more likely to stick to your pan if it has been dredged.

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Choose your Vegetables

Once you have chosen your protein, it is time to pick the vegetables. I recommend LOTS of vegetables. They should be the star and bulk of your meal. Vegetables cook down significantly under high temperatures, so always err on the side of more. When choosing and roasting veggies I recommend the follow tips:

• Tip 1: Choose a pan size. I recommend using the largest sheet pan your oven will accommodate.

• Tip 2: Cut veggies uniformly. Make sure that all the veggies are all cut to approximately the same size. This will ensure that they roast evenly and be finished at the same time. If you are roasting different kinds of vegetables on the same pan, make sure they have similar cooking times and oven temperatures. Many veggies roast well at 400-450 degrees.

  Tip 3: Use about two tablespoons of oil per sheet. Lightly coat the veggies with oil to help keep the interior of the veggies moist. Too much oil can cause soggy veggies.  A good rule of thumb is about 2 tablespoons of oil per baking sheet.

• Tip 4: Arrange the veggies in a single layer. Crowded veggies will steam rather than get crisp and caramelized. Spread the veggies evenly across the baking sheet. 

• Tip 5: Season with salt and pepper prior to roasting. Adding salt before roasting is a key step and can really make a difference in the final flavor. It is hard to give an exact measurement since salting is a matter of personal preference and can vary from vegetable to vegetable. A general rule of thumb is to use around 1/2 to 3/4 teaspoon of salt per baking sheet and a few grinds of black pepper. Taste the vegetables when they have finished cooking and add more seasoning if needed.

• Tip 6: Center your pans. If using only one sheet pan, the center of your oven is usually the best place to put it. When using multiple pans, always try to place them side by side if the oven allows. If you have to roast veggies on two different racks, make sure you put the top rack in the upper third of the oven and the lower rack in the bottom third of the oven. This will allow the heat and air to circulate better to help get the vegetables tender and caramelized. If the baking sheets are only an inch or two apart, the bottom vegetables will steam.

• Tip 7: Rotate halfway through. Another tip when using multiple pans is to rotate the pans halfway through to ensure that all veggies are getting equal exposure to the heat and have an equal chance of getting crispy and caramelized. 

• Tip 8: Consider convection. If you are using multiple pans, another option is to bake on convection, a setting where the heat is circulated by a fan. This setting can produce more even heat. This can be very helpful when you are roasting multiple vegetables at once. Beware, this setting is also more drying and cooks more quickly. A good rule of thumb is to reduce the oven temperature by 25°F when using a convection setting.

• Tip 9: Add flavor. Fresh herbs, such as rosemary or thyme can be a wonderful addition to the pan for a little extra flavor. Don’t forget to taste the vegetables before serving. You can always finish them with a sprinkle of flaky sea salt and more freshly ground black pepper.

Notes:
Dense vegetables like potatoes and winter squashes take the longest to cook depending on the oven temperature and the vegetable size.
Vegetables with a higher moisture content can take less time to cook. However, if you want to caramelize the vegetables it can take longer because the moisture needs to evaporate before browning can occur.
Leafy vegetables like kale, broccoli rabe, or Swiss chard will cook fastest. If the leaves are thoroughly dry, they will turn crisp and brown. Kale and chard can turn to brittle chips if you use enough oil.

Below are lists of popular vegetables and their suggested cooking times. Pair your veggies to the cook time of our protein. Alternatively, build your meal by placing the ingredient that requires the longest cook time in the oven first. Add ingredients to the cooking pan at intervals to allow all ingredients to be fully cooked about the same time.  

Photo credit: www.healwithfood.org

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Build Flavor

Once you have chosen your main ingredients, it is time to get creative with the seasonings. Many ingredients are delicious on their own. You can opt to season simply with salt and pepper. Or, you can build complex flavors by adding herbs and spices.

Herbs and Spices Notes:
Sprigs of sturdy, branchy fresh herbs can stand up to lengthy cooking without burning. Thyme, oregano, marjoram, rosemary, bay leaves, tarragon and sage are all good choices. Add them directly to the pan with the meat or veggies. Dried herb mixes are convenient to stock in the kitchen if mixing your own blend is intimidating.
Avoid soft herbs like basil, chives, parsley, cilantro and mint, which can turn brown at high heat. They are better added as garnishes.
Whole spices can also be tossed directly onto the pan with the other ingredients, adding fragrance and depth. Some favorites include chile flakes, coriander seeds, fennel seeds, cumin seeds and cinnamon sticks.

Bold Additions Notes:
Add whole smashed garlic cloves (peeled or unpeeled) directly to the sheet pan if desired. Peeled garlic is more intense in flavor than unpeeled garlic. Avoid minced garlic because it can burn easily.
Sliced oranges and lemons or whole or sliced fresh chiles can be added with the other ingredients while roasting to add depth of flavor to your dish. Make sure they are well coated with oil to encourage caramelization.

Finishing Touches Notes:
If you are using soft fresh herbs like mint, basil, green onions, or cilantro, add them after baking.
For a final element to brighten the meal. consider adding a squeeze of citrus or a drizzle of vinegar. Yogurt, vinaigrettes, grated or crumbled cheeses, salsas, sauces, chutneys, quick-pickled onions, chile pastes and hot sauces all add vibrancy to a finished dish.

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Assembling Your Meal

Once you have collected all your ingredients, there are a few more things to bear in mind.

Tip 1: Your ingredients and their cook times matter. Start with the slowest-cooking ingredient, then add items in a progression, ending with whatever cooks fastest.

Tip 2: Size of your ingredients also matter. The smaller an ingredient is chopped, the faster it will cook. This applies only to like ingredients: Small chunks of carrots may still take longer to cook through than larger pieces of tomatoes, mushrooms, broccoli or other less dense vegetables. Half an inch is a good starting point. This size will cook quickly while providing a satisfying bite.

Tip 3: Pay attention to placement of your sheet pan and your ingredients. The closer the sheet pan is to the heat source, the crisper and browner everything will get. Similarly, ingredients at the pan’s edges cook faster than those in the middle. The more spread out the ingredients are on the pan, the more air will flow between them, thus creating better browning. For even cooking, place larger pieces at the edges of the pan and smaller pieces in the center. Make sure to rotate your sheet pan halfway through cooking.

Tip 4. Mind your temperature. The suggested cook times listed here are based on a 400-degree oven temperature but choose a hotter temperature for deeper color with a soft center or choose a lower temperature for slower, more even cooking.

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Inspirational Meals to get you started:

Poultry:

• Roasted chicken thighs with carrots, shallots and grapes

• Greek inspired sheet pan chicken thighs (omit the feta if you are dairy-sensitive or completing an elimination diet)

Seafood:

• Rosemary Roasted Salmon with Asparagus & Potatoes

• Sheet Pan Shrimp Fajitas

• Sheet Pan Roasted Fish With Sweet Peppers

Red Meat:

• Sheet Pan Mini Meatloaf With Vegetables

• One-Pan Pork Loin With Brussels And Apples

Vegetarian:

• Summer Sheet Pan Frittata

• Sheet-Pan Crisp Tofu and Sweet Potatoes

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through an Amazon link.)

Lemon Ginger Salsa with Blackened Fish

Blackened grouper or snapper is a favorite meal at my house. For the blackening seasoning, I like to make my own spice blends so I can tailor the flavors to the palate of my family. The spice blend listed below is versatile and can be used on multiple types of seafood or proteins.

Lately I have been pairing the savory blackening flavor with the bight, acid punch of a lemon salsa. The ginger, lemons and peppers come together for a sweet, spicy complement to the blackened fish.

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Lemon Ginger Salsa

Author: Erica Leazenby, MD
TIme: 30 minutes
Makes: Approximately 1 cup

Ingredients:

• 2 large lemons, peeled and sectioned (supremed)

• 1.5 Tablespoons grated ginger

• 1 Tablespoon honey

• 2 Tablespoons chopped cilantro

• 1 jalapeño, deveined and finely diced

• 2 Tablespoons thinly sliced green onions, whites and greens

• 4 Tablespoons extra virgin olive oil

• Pinch of salt

Directions:

1. Mix all ingredients together and chill until served.

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Blackening seasoning:

Adapted from: Taste of the South
Makes 1/4 cup seasoning

Ingredients:

• 2 Tablespoons smoked paprika

• 1 Tablespoons dried thyme

• 1 teaspoon onion powder

• 3/4 teaspoons kosher salt

• 3/4 teaspoons garlic powder

• 1/2 teaspoon ground black pepper

• 1⁄4 teaspoon dry mustard

• 1⁄4 teaspoon ground red pepper

Directions:

1. Mix all ingredients in a small airtight jar. Season liberally on white fish or poultry.

Is a fiber supplement right for you?

Fiber is a type of complex carbohydrate that the human body cannot digest. Instead of breaking down into sugar molecules called glucose, it instead passes through the body undigested. Fiber helps regulate the body’s use of sugars, helps feed and support the beneficial bacteria in the large intestine and helping to keep hunger and blood sugar in check.

The Food and Nutrition Board of the US Institute of Medicine recommends a total daily fiber intake of 38 g/day for men and 25 g/day for women. However, the average American consumes only about 17 g/day of dietary fiber, and dietary fiber intake might be closer to 10 g/day in those following a low-carbohydrate diet.

Types of Fiber

Fiber comes in two varieties, both are beneficial to health:

Soluble fiber, dissolves in water and includes plant pectin and gums. As soluble fiber dissolves, it creates a gel that may improve digestion. Foods with soluble fiber include oatmeal, chia seeds, nuts, beans, lentils, apples and blueberries.

Insoluble fiber, which does not dissolve in water, can help food move through your digestive system by bulking up bowel movements, promoting regularity and helping prevent constipation. Foods with insoluble fibers include whole wheat products (especially wheat bran), quinoa, brown rice, legumes, leafy greens, nuts, seeds and fruits like pears and apples. Many foods have both soluble and insoluble fibers.

What are the benefits of fiber?

Soluble fiber

• Lowering cholesterol: Soluble fiber prevents some dietary cholesterol from being broken down and digested. Over time, soluble fiber can help lower cholesterol levels in the blood. Aim for five to 10 grams or more of soluble fiber a day for cholesterol lowering benefits. β-glucan (found in oat bran), raw guar gum, and psyllium are the types of fiber shown to lower cholesterol.

• Stabilizing blood sugar (glucose) levels: Soluble fiber slows down the digestion rate of other nutrients including carbohydrates. This means meals containing soluble fiber are less likely to cause sharp spikes in blood sugar levels.

• Lowering blood pressure: A 2018 meta-analysis of 22 randomized control trials found an overall reduction in blood pressure in people using fiber supplements or diets enriched with soluble fiber. Further analyses showed that psyllium in particular could reduce systolic blood pressure.

• Reducing the risk of cardiovascular disease: By lowering cholesterol levels, stabilizing blood sugars, lowering blood pressure, and decreasing fat absorption, regularly eating soluble fiber may reduce the risk of heart disease and circulatory conditions.

• Feeding healthy gut bacteria: Some soluble fiber-rich foods benefit our microbiome. They act like fertilizers that stimulate the growth of healthy bacteria in the gut.

Insoluble fiber

• Preventing constipation: As an indigestible material, insoluble fiber moves through the gastrointestinal tract absorbing fluid and sticking to other byproducts of digestion that are ready to be formed into stool. Insoluble fiber speeds up the movement and processing of waste, helping the body optimize normal elimination and reduce constipation.

• Lowering the risk of diverticular disease and cancer: By preventing constipation and intestinal blockages, insoluble fiber helps reduce the risk of developing small folds and hemorrhoids in the colon. It may also reduce the risk of colorectal cancer.

Both Soluble and insoluble fiber

• Feeling satiated or full longer after meals: Soluble fiber slows down how quickly foods are digested, meaning most people feel full longer after fiber-rich meals. Insoluble fiber physically fills up space in the stomach and intestines, furthering the sensation of being full. These properties can help people manage their weight.

• Helping lower disease risk: Due to fiber’s many health benefits, a high-fiber diet is associated with a lower risk of many diseases, including obesity, cardiovascular disease, diabetes, metabolic syndrome and others.

Where to find fiber naturally

Good food sources of fiber include whole grains, whole fruit and vegetables, legumes, nuts and seeds.

Some Food Sources of Dietary Fiber Linus Pauling Institute Oregon State University

Types of fiber supplements:

β-Glucans

β-Glucans are soluble fibers found naturally in oats, barley, mushrooms, yeast, bacteria and algae. β-Glucans extracted from oats, mushrooms, and yeast are available in a variety of nutritional supplement capsules without a prescription.

Glucomannan

Glucomannan, sometimes called konjac mannan, is classified as a soluble fiber isolated from konjac flour. Glucomannan is available as powder and in capsules, which should be taken with plenty of liquids.

Pectin

Pectins are soluble fibers most often extracted from citrus peels and apple pulp. Recipe for pectin-rich stewed apples.

Inulins and oligofructose

Inulins and oligofructose, extracted from chicory root are used as food additives. They are also classifies as prebiotics because of their ability to stimulate the growth of potentially beneficial Bifidobacteria species in the colon. Inulin is produced by many plants and is composed mainly of fructose. A number of dietary supplements and packaged “high fiber foods” containing inulins and oligofructose.

Guar gum

Raw guar gum is used as a thickener or emulsifier in many food products. Dietary supplements containing guar gum have been marketed as weight-loss aids, but there is no evidence of their efficacy. Unlike guar gum, partially hydrolyzed guar gum (PHGG, Sunfiber) has no effect on serum cholesterol or blood sugar levels. However, PHGG is a low FODMAP fiber and is less likely to trigger bloating or cramping in people with irritable bowel syndrome.

Psyllium

Psyllium, a soluble, gel-forming fiber isolated from psyllium seed husks, is available without a prescription in laxatives, ready-to-eat cereal, and dietary supplements. Psyllium (the main component of Metamucil) is proven to be effective to lower serum cholesterol and improve blood sugar balance. Because it also normalizes stool form, psyllium is the only fiber recommended by the American College of Gastroenterology to treat chronic constipation and irritable bowel syndrome.

Wheat Dextan

Wheat dextrin (Benefiber) is a form of wheat starch. The manufacturers considers it gluten-free because it contains less than 20 parts per million (ppm) of gluten. However, people with gluten intolerance or celiac disease should not use Benefiber unless directed by a doctor.

Polycarbofil

Polycarbofil (Fibercon) is a synthetic polymer that is used as stool stabilizer to treat constipation, diarrhea and abdominal discomfort.

Methylcellulose

Methylcellulose (Citrucel) found in fiber supplements is a synthetic product derived from cellulose. Methylcellulose is not broken down and digested in the intestines, but rather absorbs water and becomes gel-like to add bulk to the stool. Because methylcellulose does not ferment, it may cause less gas and bloating in some individuals.

Polydextrose

Polydextrose is a complex carbohydrate made from glucose. It is made in a lab and is not digested by the body. Polydextrose is often used as a prebiotic to support the growth of beneficial bacteria in the microbiome.

**Do not take fiber supplements within 1 hour of other medications or some supplements including calcium, iron, and zinc. Fiber can interfere with absorption.

PREBIOTICS VERSE PROBIOTICS
ADVICE FOR STAYING REGULAR WHEN YOU TRAVEL

Tips for Healthier Grilling

Grilling is the hallmark of summer and food. In addition to bringing people together, it gets us away from the hot oven in the kitchen and into the outdoors. It can also help us slow down, add variety to our diet, and give us new flavors to enjoy. We need to be careful, though. Grilling can make some foods more inflammatory to our bodies. However, there are steps you take to help you get the best nutrition from your outdoor fire.  

Why could grilling be a risk to your food and your health? Advance Glycation End products (AGE’s) are compounds that are produced when sugars combine with certain proteins or fats. These can form inside our body or in the food we consume. Manufacturing techniques of sugary or highly processed foods contribute to AGEs, but cooking methods that use high heat to brown or char foods, such as grilling, roasting, and broiling, have the largest impact on the amount of AGEs we consume. Also, AGE’s can accumulate in our body over time and contribute to inflammation, which increases our risk of insulin resistance and type-2 diabetes. Learning to avoid AGE’s can lower our diabetes risk and help improve insulin sensitivity.

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Use the following tips to enjoy your next cookout and optimize your health:

1. Choose lean cuts of meat and trim any visible fat so that less fat drips during cooking.

2. Marinate meat before you grill. Research suggests that citrus, vinegars, cider, herbs and vegetable oils can reduce the formation of AGE’s. Sugar can increase AGE’s, so avoid marinades that have significant amounts of added sugar.

3. Try precooking meat in the oven and finish on the grill to lessen the exposure and risk.

4. Use lower heat by waiting for the coals to burn less hot or by turning down the gas.

5. Raise the grill rack farther from the heat.

6. Bigger is NOT better.  Grill thinner cuts of meat to reduce cooking time.

7. Go vegetarian. When veggie burgers, tofu and vegetables are grilled, there is little or no formation of AGE's.

8. Stay up-wind from grills to avoid breathing in smoke, which also carries health risks. No smoke is good smoke.

9. Use an untreated cedar plank for fish.  It’s always good to have a buffer between your food and the heat source.

10. Choose grass-fed meats which provide extra cancer-fighting Vitamin E (from grass), Conjugated Linoleic Acid and Omega-3 fats while being lower in inflammatory Omega-6 fats.

11. Never eat charred or blackened meat.

12. Eat foods rich in antioxidants with your grilled meats. Research shows topping a hamburger with avocado or other anti-oxidant rich veggies helps reduce AGE’s inflammatory effect.

GRILLED TUNA WITH MARINATED ARTICHOKES

How to make fresh fruit sorbet and other summer treats

These hot summer days may have you screaming for ice cream. I hear you. In my opinion summer is not complete without a few icy treats. Luckily, there are ways to indulge in “ice cream” that still honor our health.

For those of us avoiding dairy and watching our sugar intake we have a few options including sorbets, granitas and ice creams made with non-dairy “milks.”

A Primer on types of frozen treats

Sorbet is a French word for sherbet. It is any frozen dessert that does not contain dairy or eggs. (What Americans traditionally call sherbet is a dairy containing frozen dessert that has less milk or cream than traditional ice cream.)

Granita (Italian) or granité (French) is coarse-textured ice water that does not contain milk or dairy products and traditionally has less sweetener than sorbet.

Gelato (Italian ice cream) is a custard-based ice cream, typically made with more eggs and milk and less cream than French ice cream.

Traditional ice cream is a frozen dessert containing milk or cream, sweetener, and flavorings.

Guidelines for sorbet and granita preparation

Master Recipe for Sorbet:

1. Freeze 3-4 cups peeled, pitted, and chopped fruit in a single layer until firm (try peaches, plums, cherries, berries, pineapple, kiwi or combinations).

2. In a food processor, combine the frozen fruit pieces with 6 tablespoons maple or agave syrup, 2 tablespoons lemon or lime juice, and 1-3 teaspoons of alcohol* like vodka, mezcal, bourbon, rum, etc. until smooth. You can adjust the amount of sweetener as needed depending on the ripeness and sweetness of your fruit. Non-nutritive sweeteners like monk fruit, erythritol and stevia can be used.

3. Serve right away or freeze in a silicone container or loaf pan lined with parchment.

*The alcohol is optional, but it does help ensure a smooth consistency and prevents your sorbet from freezing rock solid. If you omit the alcohol, increase the sweetener to about 1/2 cup total to help keep your sorbet scoop-able.

Master Recipe for Granita:

1. Make a simple syrup by simmering 2 1⁄2 cups water and 1 3⁄4 cups sugar. Use about one cup of this syrup with about 3 pounds of fruit. Blend ingredients to a consistency that will thinly coat a spoon.

2. Freeze the granita in a shallow, rectangular container with a tight-fitting lid. Check granita occasionally (every 30-60 minutes or so) and scrape with a spatula, ice cream scoop, or fork as it freezes. Most granitas need to freeze about 24 hours.

Tips to keep in mind:

• Cold dulls flavor, therefore over flavor and over sweeten before freezing.

• Alcohol does not freeze; it adds creaminess to frozen treats (but too much prevents freezing). Adding a small amount of high proof alcohol can make your final product smooth and less “icy.”

• Sugar also helps prevents ice crystals. You can substitute monk fruit or erythritol for the sweetener, but your final product may be icier (but still delicious).

• Incorporate your solids when the treat is almost set. Don't add in chocolate chips, nuts, drizzles, etc. to the mixture while it is still a liquid.

• Store your ice treat properly. Keep them sealed in your freezer.

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WATERMELON GRANITA

Yield: About 3 cups

Ingredients:
3 cups watermelon (about 1 pounds), seeded and cut into chunks
1⁄4 cup lime juice (about 4 small limes)
3 Tablespoons agave syrup or maple syrup
Pinch sea salt
Mint sprigs for garnish

Directions:

1. Process the watermelon, lime juice, sweetener, and salt in the blender. Strain out the excess pulp with a nut bag strainer or 2 layers of moistened cheesecloth.

2. Transfer the watermelon juice to a shallow, rectangular dish. (Ideally the juice should be about 1/4 inch up the side of the pan.)

3. Transfer the mixture to the freezer for about 1 hour.

4. Remove the pan from the freezer and use a fork to scrape any ice crystals that have formed on the side or bottom of pan. Return the pan to the freezer and repeat the scraping every 30 minutes for 3-4 hours.

5. Once the mixture is thoroughly frozen, scrape once more with a fork and returning the granita to “dry” in the freezer for another half hour before serving.

6. Garnish the granita with mint sprigs and serve.

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POMEGRANATE GRANITA

Yield: 1 pint

Ingredients:
2 cups pomegranate juice
1/2 cup orange juice (about 2 oranges)
2 teaspoons sugar, coconut sugar or maple crystals

Directions:

1. In a saucepan over low heat, simmer the pomegranate and orange juices with the sweetener until the crystals dissolve.

2. Pour the mixture into a rectangular pan and transfer it to the freezer for about 1 hour. (The mixture should be about 1⁄4 inch up the side of pan.)

3. Remove the pan from the freezer and use a fork to scrape any ice crystals that have formed on the side or bottom of pan. Return the mixture to the freezer and repeat scraping every 30 minutes for 3-4 hours.

4. Once the mixture is thoroughly frozen, scrape once more with a fork and returning the granita to “dry” in the freezer for another half hour before serving.

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STRAWBERRY SORBET

Yield: about 3 cups

Ingredients:
2 pints strawberries, stemmed and rinsed
1⁄2 cup maple syrup
2 tablespoons agave syrup
2 tablespoons balsamic vinegar
Pinch sea salt
Pinch freshly ground black pepper
2 tablespoons chopped basil leaves

Directions:

1. In a blender, puree the strawberries, maple syrup, agave syrup, and balsamic vinegar until smooth. Transfer the mixture to a medium bowl and whisk in salt, pepper, and basil.

2. Transfer the mixture to an ice cream machine and freeze according to its directions. Once the mixture has thickened, transfer it to a silicone container or loaf pan lined with parchment. Freeze for forty minutes to one hour or until the sorbet firms to scoop-able consistency.

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Mint Chocolate Coconut Ice Cream

Yields: about 1 quart

Ingredients:
2 cans full fat organic coconut milk, chilled
1/3 cup raw honey, agave, or maple syrup
1 teaspoon peppermint extract or more to taste
1/2 cup chocolate chips or chopped dark chocolate, coarsely chopped and melted

Directions:

1. Blend the coconut milk, sweetener, and extract in a blender until smooth.

2. Transfer the coconut milk mixture to an ice cream maker and follow the manufacturer's instructions for ice cream.

3. While the mixture is churning, melt the chocolate carefully in the microwave or in a double boiler on the stove top.

4. Once the coconut mixture has thickened, transfer 1/3 to a silicone container or loaf pan lined with parchment. Drizzle 1/3 the melted chocolate over the ice cream. Continue to layer the ice cream and chocolate drizzle in the pan until all the ingredients are transferred. (Alternately, you can add the chopped, un-melted chocolate pieces to the mixture when it has started to thicken. In this case the chocolate will be in larger chunks and not thin, Stracciatella-like pieces.)

5. Freeze the ice cream for 1-2 hours before serving or until the ice cream has firmed to scoop-able consistency.

No ice cream machine? No problem. Check out this post by food-blogger David Lebovitz for tips on how to make ice cream without a machine.

(This blog post is not sponsored by any manufacturer. However, at no cost to you, Relish Health may receive a commission on purchases made through an Amazon link.)

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The Ultimate Blood Sugar Test: Understanding your A1c

At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated”) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.

What Is Diabetes And Prediabetes?

Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. For the development of the disease, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar. These insulin management concerns can start to occur years or decades before a formal diagnosis of diabetes.

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The CDC estimates that more than 1 in 3— American adults have prediabetes with more than 80% unaware of their condition.

How Is Diabetes And Prediabetes Diagnosis?

There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to confirm the diagnosis.

Measuring A1C:

The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:

• A normal A1C level is below 5.7%

• Prediabetes is diagnosed if the level is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes.

• Type 2 diabetes is diagnoses if a level is above 6.5%

Fasting Plasma Glucose (FPG):

This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
A fasting glucose is only designed to measure glucose levels during the fasting period. It does not give a full picture of how a person’s body is handling sugar over a period of days or weeks. It does not provide any predictive insight into trends toward diabetes, prediabetes or other blood sugar handling issues. Fasting glucose levels can be highly affected by factors completely outside of diet such as poor sleep the night before or high stress levels.

• Normal Fasting Glucose: less than 100 mg/dl

• Prediabetes: 100 mg/dl to 125 mg/dl

• Diabetes: 126 mg/dl or higher

Oral Glucose Tolerance Test (OGTT):

The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.

• Normal OGTT: Two-hour blood glucose less than 140 mg/dl blood

• Prediabetes: Two-hour blood glucose of 140 to 199 mg/dl

• Diabetes: Two-hour blood glucose of greater than or equal to 200 mg/dl

Random Plasma Glucose Test:

This test is a blood check at any time of the day when you have diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.

What Are Optimal Glucose Levels?

In functional medicine, we are always looking beyond “normal” when it comes to lab marker ranges. When interpreting labs, “normal” does not necessarily equate to optimal if you are interested in preventing disease.

Optimal/Functional A1c Ranges:

• Optimal Range for A1c: less than 5.3%

• Less than Optimal/Pre-diabetic stage: A1c 5.4-6.0% (Your lab will call this “normal” but, in functional medicine we consider this a concerning zone.)

• Sub-optimal: Any A1c above 6.0% reveals a problem with blood sugar control.

In functional medicine, and at Relish Health, we want to catch blood sugar issues as early on as possible. The A1c test offers us a window into your last 8-10 weeks of blood sugar balance. It gives us clues into how sugars may be affecting your cells and tissues and can predict if you may progress to having diabetes. Prediction is key to prevention when it comes to disease. 

Health Effects of Chronically High A1c

The consequences of sub-optimal blood sugar balance over time include an increased risk of:

• Certain cancers

• Cardiovascular disease including elevated blood pressure, increased risk of heart attacks and strokes, and even impotence

• Diabetes

• Increased annual brain shrinkage and risk for cognitive decline

What Causes A High A1c?

It is tempting to place all the blame for a high A1c levels on too much sugar in the diet. In reality, there are many lifestyle factors that can directly affect your A1c levels such as:

• Sleep issues. Sleep deprivation is a leading causal factor behind blood sugar imbalances.

• Stress. Chronic stress can trigger excessive stress hormones that raise blood sugar and can create insulin resistance.

• Too many carbs, or too many of the “wrong” carbs. Excessive consumption of sugar and refined carbohydrates can trigger blood sugar imbalances. However, not all carbs will hurt you. “Good carbs” like those found in moderate amounts of whole fruits, vegetables and even sweet potatoes or white potatoes with the skins-on can be included in a healthy diet.

• Artificial sweeteners. Artificial sweeteners like aspartame, sucralose and saccharin have recently been shown to affect blood sugar and insulin levels.

• Not enough muscle mass and lack of exercise. Muscle helps your body regulate blood sugar. If you have a low lean muscle mass due to lack of exercise this could contribute to higher A1c levels.

Ways to Lower your A1c Levels

Relish Health can help you develop a personalized plan, but in general you can lower your A1c levels by:

• Reducing your intake of refined carbs and sugar. Minimize consumption of pastries, bagels, breads, pastas, cereals, and candy. Focus on eating non-starchy vegetables, proteins, fats, and small amounts of whole grains, fruits, and starchy veggies like sweet potatoes or beets.

• Increase your protein intake. Protein helps stabilize blood sugar while increasing satiety. Aim to have a small amount of lean animal or plant-based protein at every meal and snack. Relish Health can help you determine your protein needs with body composition analysis.

• Exercise regularly. Focus on exercises that build muscle mass. High intensity interval training (HIIT), weight training, yoga, and other weight-bearing exercises are excellent choices.

• Manage stress. This is one of the most profound things you can do to impact your blood sugar levels. Stress managing activities include exercising, listening to music, journaling, spending time with friends, laughing, meditation, spending time in nature and limiting your screen time.

• Optimize your sleep. Aim for 7.5-9 hours of sleep a night. Sleeping less may cause your blood sugar balance to suffer.

How Often Should You Check Your A1c?

Physicians typically recommend patients with type 2 diabetes check their A1c every three to six months to ensure adequate treatment. At Relish Health, we believe in the same vigilance to make sure that your lifestyle changes are giving you the results you want. If your A1c level falls in the concerning zone, we will recommend you check your A1c progress at least every 6 months.

If your A1c level is currently at an optimal level, we recommend checking your A1c once a year or every other year as part of routine preventative care. Many lifestyle choices over time can influence insulin resistance and blood sugar imbalances. Knowing your A1c level empowers you to manage your blood sugar balance proactively before it ever has the chance to become disease.

Tips for Reducing Sugar in your diet

IMPROVE YOUR SLEEP, IMPROVE YOUR HEALTH

TESTING Routinely ordered at Relish HEalth