Jovina cooks: Easy fish and vegetable foil parcels

Fish and Veggie Grilled Packets

Until I started cooking fish on the grill with this method, I never realized how delicious and moist the fish would taste.
4 servings
Ingredients
16 oz Mahi Mahi fish fillets, about 1/2 inch thick and cut into 4 equal pieces
8 extra-large shrimp, cleaned and peeled
4 large sea scallops
4 fresh thyme sprigs
4 garlic cloves, finely minced
1 small red onion, cut into eighths
2 bell peppers, each cut into 12 thin slices
12 grape tomatoes, cut in half
Paprika, salt and pepper
2 tablespoons chopped chives
Extra-virgin olive oil

 

Directions
Preheat grill to medium.
To make the packets: lay two 18-inch sheets of heavy-duty foil on top of each other (the double layers will help protect the contents from burning); generously coat the top piece with olive oil cooking spray. Repeat with six more pieces of foil.
Divide the onions and bell pepper equally on bottom of the 4 pieces of heavy-duty foil.
Place a piece of fish on top. Sprinkle with salt and pepper, Add 2 shrimp and 1 scallop to each packet.
Sprinkle with salt and pepper.
Add tomatoes, garlic and chives to each packet.
Drizzle with olive oil.
Bring the short ends of the foil together, leaving enough room in the packet for steam to gather and cook the food.
Fold the foil over and pinch to seal. Pinch seams together along the sides. Make sure all the seams are tightly sealed to keep steam from escaping.
Grill the packets until the fish is cooked through and the vegetables are just tender, about 15 minutes.
To serve, carefully open both ends of the packets and allow the steam to escape. Use a spatula to slide the contents onto plates. Serve with the lemon sauce.

Lemon Sauce
1 stick unsalted butter, at room temperature
2 cloves garlic, minced
2 tablespoons chopped fresh flat-leaf parsley
2 tablespoons lemon juice
Dash or two of hot sauce
Kosher salt and freshly ground black pepper to taste
Directions
Place all the ingredients in a small saucepan. Heat on the grill or on the stove. Serve with the fish packet.

Celebrate the NHS 70th birthday with tea and cakes?

On the 5th of July the NHS celebrates its 70th Birthday.  There is a concerted effort to celebrate this with tea parties and people are meant to contribute the proceeds to an NHS charity of their choice. Diabetes UK perhaps?

The trouble could be the cakes, sandwiches, scones and stuff that is likely to be scoffed along with the tea and coffee.

My practice has been gifted a hamper to celebrate the event.

This is what it contains:

plain and fruit scones

Clotted cream

strawberry jam

tea

Fudge oat crunch cookies

strawberries and cream shortbread biscuits

If you are having one of these events at your workplace, there are many low carb alternatives you can bring instead.

It is a pity the event didn’t feature something that emphasised good health promotion instead of bad health promotion. Going for a 30 minute walk for instance.

https://nhsbig7tea.co.uk/

Jovina cooks: A traditional French feast

Madame Saucourt’s Ratatouille
Hotel Mas des Serres in Saint Paul de Vence.
Source: Mediterranean Grains and Greens by Paula Wolfert

Ingredients
5 pounds eggplant
5 pounds zucchini
5 pounds sweet onion, peeled, halved, and thinly sliced
1 quart extra-virgin olive oil
2 tablespoons crushed garlic
2 tablespoons chopped fresh mixed herbs: rosemary, savory, peppermint, thyme, and celery
1 bay leaf
1/2 tablespoon sugar
1 teaspoon salt
1 teaspoon freshly ground black pepper
2 cups dry yet fruity white wine
2 pounds ripe red tomatoes, cored and seeded
5 pounds red bell peppers
A few drops of red wine vinegar
3 tablespoons chopped mixed herbs for garnish: basil, parsley, thyme
Directions
Stem and peel the eggplant. Cut the flesh into 1″ cubes and place them in a deep kettle filled with very salty water. Keep submerged with a non-corrodible plate for at least 1 hour
Stem and peel the zucchini. Cut the flesh into 1″ cubes and place in a deep colander. Toss the zucchini with salt and let stand 1/2 hour.
In a very large heavy skillet or heavy-bottomed roasting pan cook the chopped onions in 1/2 cup water and 1 cup olive oil until the onions are soft and golden, about 30 minutes. Add the garlic, chopped herbs, bay leaf, sugar, salt, pepper, and 1 cup of the wine. Cook over medium heat, stirring often, for 10 minutes.
Coarsely chop the tomatoes with their skins in the work bowl of a food processor. Add to the skillet and continue cooking at a simmer for 11/2 hours. Whenever the onion-tomato mixture starts to stick or burn, “deglaze” with a few tablespoons of water and scrape with a wooden spoon.
Grill the peppers; when cool, peel, stem, seed and cut into small pieces. Set aside.
Rinse and drain the eggplant and zucchini and lightly press dry with toweling.
Slowly heat the remaining 3 cups of olive oil in a wide pan or fryer until medium-hot. Add the zucchini in batches, and fry until golden on all sides. Transfer the zucchini with a slotted spoon to a colander set over a bowl to catch any excess oil. When all the zucchini has been fried, fry the eggplant in the same manner. From time to time return the drained oil in the bowl to the pan.
Spread the zucchini, eggplant, and peppers over the simmering onion-tomato mixture and pour in the remaining wine. Cover and cook at a simmer for 11/2 hours. From time to time remove the cover to help evaporate some of the liquid.
Place a colander over a large bowl and pour the contents of the skillet into it to drain. Stir carefully to avoid crushing the vegetables while trying to encourage any trapped oil and juices to drain. Quickly cool down the captured juices in order to remove as much oil as possible. If there is a lot of juice, boil it down until thick. Reserve all the frying oil and oil from the vegetables for another use. Pour the juices over the vegetables, taste for seasoning, add vinegar, and carefully stir to combine. Serve hot or cold. Sprinkle with fresh herbs.

Coquilles St-Jacques

Serves 6
Ingredients
8 oz. button mushrooms, minced
6 tablespoons unsalted butter
3 small shallots, minced
2 tablespoons minced parsley
1 tablespoons minced tarragon, plus 6 whole leaves, to garnish
Kosher salt and freshly ground black pepper, to taste
3/4 cup dry vermouth
1 bay leaf
6 large sea scallops
2 tablespoons flour
1/2 cup heavy cream
2/3 cup grated Gruyère
1/2 teaspoon fresh lemon juice
Directions
Heat mushrooms, 4 tablespoons butter, and 2⁄3 of the shallots in a 4-qt. saucepan over medium heat; cook until the mixture forms a loose paste, about 25 minutes. Stir the parsley and minced tarragon into the mushroom mixture; season with salt and pepper.
Divide mixture among 6 cleaned scallop shells or shallow gratin dishes. Bring remaining shallots, vermouth, bay leaf, salt, and 3⁄4 cup water to a boil in a 4-qt. saucepan over medium heat. Add scallops; cook until barely tender, about 2 minutes.
Remove scallops; place each over mushrooms in shells. Continue boiling cooking liquid until reduced to 1⁄2 cup, about 10 minutes; strain.
Heat broiler to high. Heat remaining butter in a 2-qt. saucepan over medium heat. Add flour; cook until smooth, about 2 minutes. Add reduced cooking liquid and cream; cook until thickened, about 8 minutes. Add cheese, juice, salt, and pepper; divide the sauce over scallops.
Broil until browned on top, about 3 minutes; garnish each with a tarragon leaf.

French Cassoulet
This hearty dish from southwestern France, known as a cassoulet, is a one-pot meal. A slow-simmered mix of beans, pork sausages, pork shoulder, pancetta and duck topped with a bread crumb crust , takes its name from the earthenware casserole in which it was traditionally made. My comment:You don’t need to use the breadcrumb crust.
Serves 6-8
Ingredients
1 lb. dried great northern beans
10 tablespoons duck fat or olive oil
16 cloves garlic, smashed
2 onions, chopped
2 carrots, chopped
2 large ham hocks
1 lb. pork shoulder, cut into 1″cubes
1⁄2 lb. pancetta, cubed
4 sprigs oregano
4 sprigs thyme
3 bay leaves
1 cup whole peeled canned tomatoes
1 cup white wine
2 cups chicken broth
4 duck legs
1 lb. pork sausages
2 cups bread crumbs (preferably not on a low carb diet!)
Directions
Soak the beans in a 4-qt. bowl in 7 1⁄2 cups water overnight.
Heat 2 tablespoons of duck fat in a 6-qt. pot over medium-high heat. Add half the garlic, onions, and carrots and cook until lightly browned, about 10 minutes. Add ham hocks along with beans and their water and boil. Reduce heat and simmer beans until tender, about 1 1⁄2 hours.
Transfer ham hocks to a plate; let cool. Pull off meat; discard skin, bone, and gristle. Chop meat; add to beans. Set aside.
Heat 2 tablespoons duck fat in a 5-qt. dutch oven over medium-high heat. Add pork and brown for 8 minutes. Add pancetta; cook for 5 minutes. Add remaining garlic, onions, and carrots; cook until lightly browned, about 10 minutes.
Tie together oregano, thyme, and bay leaves with twine; add to pan with tomatoes; cook until liquid thickens, 8–10 minutes. Add wine; reduce by half. Add broth; boil. Reduce heat to medium-low; cook, uncovered, until liquid has thickened, about 1 hour. Discard herbs; set dutch oven aside.
Sear the duck legs in 2 tablespoons duck fat in a 12″ skillet over medium-high heat for 8 minutes; transfer to a plate. Brown the sausages in the fat, about 8 minutes. Cut sausages into 1⁄2″ slices. Pull duck meat off bones. Discard fat and bones. Stir duck and sausages into pork stew.
Heat the oven to 300˚F. Mix beans and pork stew in a 4-qt. earthenware casserole. Cover with bread crumbs; drizzle with remaining duck fat.
Bake, uncovered, for 3 hours. Raise oven temperature to 500˚; cook the cassoulet until the crust is golden, about 5 minutes.

 

BMJ: Varicoceles can be a marker for metabolic syndrome and type two diabetes

Nancy Wang from Stanford University is a urologist and says, “Varicoceles which are varicose veins of the spermatic cords, are associated with low testosterone. This in turn makes men more likely to develop metabolic risks and heart disease. No one has connected the dots before now”.

These men have higher risks of heart disease, diabetes, and hyperlipidaemia.

My comment: Varicoceles feel just  like a bag of worms in the scrotum. Up to one in 5 men will develop these over their lifetime. 

Homemadewithmess: Prawn courgetti with a red pepper sauce

courgettes spiralised
For the Red Pepper Sauce
1 red pepper – deseeded and roughly chopped
Splash olive oil
½ yellow pepper – deseeded and roughly chopped
165g cherry tomatoes – halved
2 cloves garlic – left whole
75ml red wine
Pinch sugar
1 tbsp tomato puree
150ml vegetable stock
For the courgetti
2 courgettes – spiralised
1 tbsp lemon juice
1 pinch sugar
To serve
1 red onion – finely sliced
Splash olive oil
200g raw king prawns
1 handful fresh basil
Parmesan shavings – to serve

Pre-heat the oven to 180’C
Toss the pepper in the olive oil and roast for 20 minutes
Add the tomatoes and garlic and cook for a further 20 minutes
Squeeze out the garlic from their skins and return to the dish. Stir in the red wine, sugar and tomato puree and cook for a final 10 minutes
Once cooked, blend the mixture together with the stock until smooth, and then push through a fine sieve to make even smoother.
Set-aside until ready to serve.
Spiralise your courgettes and then toss through the lemon juice and sugar and set aside.
Heat a large pan with a splash of oil and fry the onion until soft.
Add the sauce and once bubbling stir in the prawns
Cook through until the prawns have turned lovely and pink and then turn off the heat.
Fold in the courgetti and then plate up, sprinkling over your basil leaves and parmesan and enjoying with salad.

Nutritional Info:
Calories – 316
Fat – 9g
Carbs – 26g
Sugars – 15g
Protein – 28g

 

Why I bought my son a Freestyle Libre

The Freestyle Libre blood sugar monitoring system has been out for about a year now. It consists of a sensor that you put in your upper arm and a reader, a bit like a mobile phone, that tells you the blood sugar, whether the trend is rising or falling, and what your blood sugar pattern has been like over the last eight hours.

I haven’t met anyone who has tried it who didn’t prefer it to finger pricks. About the only situation that it is no good for is driving. You need to have proof of your blood sugar on a regular meter should your ability to drive while under the influence of injected insulin comes under scrutiny.

The NHS is a big organisation and no doubt funding for this will vary from area to area, but in Scotland at least, there is no prospect of my son getting one on the NHS.

The main people who will be able to get the device are pregnant women and those women who are planning a pregnancy. Since these women ideally have to get their Hbaic down to 6% or under to ensure a healthy baby, then you can see why they have the greatest need. You are looking at two patients in one and complications that can affect a child lifelong.

The other groups that are eligible are those with very frequent admissions for diabetic ketoacidosis or severe hypoglycaemia. By this is meant three times in a single year. Both these complications of diabetes can result in sudden death or brain damage and often in young people.

Those people whose HbA1cs are over 8.5% or who test their blood sugars more than six times a day will also be considered. Since most people attending hospital diabetic clinics will have blood sugars over this threshold it is a big group.  Perhaps diabetic athletes will also be considered.

The group that won’t be given the device and sensors on the NHS are the ones who are already making great efforts to reduce complications by eating low carb diets, exercising consistently and monitoring frequently.  Using the Freestyle libre should help this group adjust their insulin and food more finely, in particular avoiding hypos, since their blood sugars are wiggling around normal much of the time anyway.  As they are already at much lower risk for complications they are saving the NHS a great deal of money just by being so committed to their task, yet something that would make the job easier is denied them because they are not “bad enough”.

So, I’ve just bought my son one. So far he is thrilled with it. The sensors are £45 (VAT exempt) a fortnight and the initial outlay is £137 (VAT exempt) including two sensors.

There are two great advantages as far as I’m concerned. Peace of mind. And Christmas and Birthday presents for the foreseeable future are sorted.

 

 

 

 

 

BMJ: Bariatric surgery best done before a BMI of 50

More than a third of patients who had bariatric surgery got back to a BMI of 30 or less after one year. Some patients respond better than others, and some operations are more effective than others.

Having a BMI of less than 40 made it more likely for the person to reach their goal weight. Obviously, they had less to lose. Only one out of ten patients who had a BMI of 50 or over got down to a BMI of 30, which corresponds to the limit between being considered overweight and being considered obese.

Sleeve gastrectomy, gastric bypass or duodenal switch operations were the most effective. Adjustable gastric bands were less effective.

BMJ  9 Dec 2017 from JAMA Surg 2017

Jovina cooks Spanish: Gazpacho

Gazpacho_in_Mijas.jpg
This cold soup is delicious and refreshing—a perfect summertime starter.
Ingredients
1 clove garlic, roughly chopped
1/2 red onion, roughly chopped
1/2 red bell pepper, seeded and roughly chopped
1/2 green bell pepper, seeded and roughly chopped
1 cup peeled, seeded and roughly chopped cucumber
3 cups  good quality tomato juice
1 tablespoon extra virgin olive oil
1 teaspoon white wine vinegar
1/2 teaspoon sea salt
1/4 teaspoon ground black pepper

A few drops of Tabasco for added kick (optional)
Garnish: chopped cucumber, onion or bell pepper
Directions
Place all ingredients in a food processor or blender and process until smooth.
Chill in the refrigerator for twenty four hours for the best flavor.  Garnish with chopped vegetables, if desired.

Natural Low Carb Store: Choc chip cookies

Looking for something sweet to eat that still works with your diabetes? Try this…

choc chip cookies

150g almond flour

100g desiccated coconut (unsweetened)
1 tsp baking powder
120g butter (softened)
60g inulin powder (or granulated sugar substitute)
1/2 tsp vanilla extract
1 large egg
30g 72% dark chocolate (chopped)

Pre-heat your oven to 160°C and line a baking sheet. In a bowl mix together the almond flour, coconut and baking powder. In a separate bowl cream the butter with the inulin, then beat in the vanilla and egg until well combined. Add the dry ingredients and the chocolate to form a dough. Divide the dough into 1 inch balls and place 2 inches apart on the baking sheet. Press each ball gently with the heel of your hand to flatten to about 1/4 inch thick. Bake for 12-14 minutes until just browning. Remove from the oven and allow to cool on the baking sheet. Option – drizzle with melted chocolate for decoration!

(NB: Don’t try to cut up the chocolate in a mini chopper. I broke one attempting this. Katharine)

 

Canagliflozin reduces onset of cardiac failure compared to other anti-diabetic drugs

 

Adapted from BMJ 10 Feb 18

A large population based cohort study showed that patients who started canagliflozin had a markedly reduced risk of being admitted to hospital with cardiac failure compared to three other types of anti-diabetes drugs.  There was no increase in heart attacks or stroke.

The study was based in the USA and the comparative drugs were DPP-4 inhibitors such as Victoza and Byetta, Gliptans such as Linagliptan and Sitagliptan, and sulphonylureas such as Gliclazide.   There was a 30-49% decrease in hospitalisations for cardiac failure.

None of the patients had a history of cardiac failure or cardiovascular disease at the start of the study and the patients were compared to others with the same HbA1C to ensure a fair comparison.

The reduction in cardiac failure could be a class effect of the Flozin drugs but further studies would be needed to find out. No other Flozins were used in the study as comparators.

Between 17,354 and 20,539 pairs of patients were matched for each comparison making this a very large study indeed.