It might sound a bit weird to make a sandwich using beets but the result was heaven. I got the idea from the Maine Grind in Ellsworth, Maine where I ordered it on a recent trip North. Since then I have made it for friends and family with lots of accolades and recipe requests. The recipe is simple: spread Thousand Island dressing on two slices of bread, place  cooked sliced beets, drained sauerkraut, and a slice of Swiss cheese between the bread slices. Butter the outside of  each slice of bread and grill the sandwich just as you would if you are making a grilled cheese sandwich. You want the cheese to melt and the crust to become golden and lightly browned. What a delicious sandwich. I plan to make it again soon with golden beets.

A co-worker raved about e-meals, he said it took the hassle out of shopping and helped him eat better and healthier. I was a skeptic, after all cooking is my hobby.  I do not find it tedious and I hate following recipes. I thought I would give it a try in hopes it would be good enough to recommend to patients.  I contacted e-meals and they sent me a free subscription. I have been using it for about 8 weeks and  I think it is great. I have been surprised at the quality and simplicity of recipes. Pictured below is a marinated pork dish with a side of kale and crispy garlic bread- it is part  my current low-calorie meal plan

Each week you will get seven recipes and an easy-to-use grocery list. The grocery list is ingenious, it includes the main items and a list of the staples you need to have on hand such as flour, salt, sugar and so on. It  is well organized, there is no guess work and now after using it for a few weeks I feel I can trust it. Below is a menu form the Mediterranean plan that includes the main entree, plus polenta and a side Watermelon Tomato Salad .

I am only cooking for two but I started with the Mediterranean plan for a family of 3-6. I expected portions to be small but they are not. I found I had too much and after two weeks I switched to the Low Calorie meal plan for a family of two. I love this plan because it includes so many of my favorite vegetables. Below is a picture of a lentil rice dish and squash.

Switching meal plans is a breeze . I just changed to the Low Carb plan and they just added a diabetic meal plan which I intend to try too. If you want  delicious, healthy, easy to prepare menus I recommend you try e-meals. A one year subscription costs $29.95.

Last year the delicious tasting Mediterranean diet beat out a low-fat diet for treating cardiovascular disease and a sauce known as Sofrito was part of the dietary prescription that led to healthier hearts.

Participants on the Mediterranean diets were asked to eat Sofrito at least twice per week.   The sauce is made by slowly simmering minced tomatoes, garlic and onion in olive oil with or without aromatic herbs. Sofrito can be added to fish or poultry or to make any vegetable more interesting. Sofrito was new to me last year, I now think of it as Spanish Catsup or Spanish Salsa, and I keep a batch in my refrigerator and use it as I would salsa or catsup.

Here is my recipe for making this simple condiment:

Mince: 2 onions, 6 garlic cloves and 2-3 leeks, white part only (leeks are optional).In a medium sized saucepan slowly cook the vegetables in ½ -3/4 cup olive oil until soft. Add two 28 ounce cans of chopped or whole tomatoes. Cover and cook for 60 minutes on low heat. Break-up any remaining whole tomatoes with a spoon. Cover and refrigerate.

Serve it with eggs, chicken, pasta, – the possibilities are endless. It will add flavor to every meal and using it at least twice per week could help your heart health. Of course there is more to a heart healthy diet than Sofrito.  The general dietary guidelines in the study also recommended abundant use of olive oil, 2 or more servings of vegetables daily, 2-3 servings of fruit daily, 3 servings of legumes (beans) per week, 3 servings of fish per week , at least one servings of nuts or seeds weekly, and skinless poultry was encouraged over red meats, sausage or burgers . Donuts, cakes, candy and soda were discouraged. Wine was recommended as the main source of alcohol and good chocolate (50% cocoa) was encouraged for those with a sweet tooth.

The complete article published in the New England Journal of Medicine can be read here: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. In short the study found the Mediterranean diet, even with no restriction on calories “resulted in a substantial reduction in the risk of major cardiovascular events “.

Cabbage is economical and delicious.  One cup of raw, chopped, cabbage carries 22 calories, 2 grams of fiber and small amounts of vitamins C and A and a little calcium too.

Cut cabbage  in half, remove the center core. With a sharp knife chop the cabbage into slices,

cook it slowly in a large sauté pan until it is soft and creamy.Here is a recipe for Sauteed Cabbage .Serve it as a side dish with a little salt and pepper or add  cooked onion, hard boiled eggs and top with a crust to make a wonderful main dish Cabbage Pie

You may notice something new when you go to your doctor.  He or she may actually talk to you about your weight and for the first time you might hear evidenced-based guidance on weight loss.  Health care providers participating in Accountable Care Organizations (ACO) will be measuring height and weight on their ACO patients, assessing Body Mass Index (BMI) and providing a plan for those identified as being outside the normal BMI parameters. Body Mass Index (BMI) is one way to tell whether you are at a healthy weight, overweight, or obese. It measures your weight in relation to your height.

A BMI of 18.5 to 24.9 is in the healthy range. A person with a BMI of 25 to 29.9 is considered overweight, and someone with a BMI of 30 or greater is considered obese. BMI is used for children but the cut-off points are not the same. Assessing BMI is important because a high BMI increases the risk for type 2 diabetes, heart disease and stroke, high blood cholesterol, high blood pressure, kidney disease, non-alcoholic fatty liver disease (a fat buildup in the livers of people who drink little or no alcohol) and certain cancers.

Most Americans visit their doctor once per year  but less than half of obese patients report being advised to lose weight. The doctor that addresses weight and nutrition could do a lot to balance the millions of dollars spent to promote obesiogenic foods and fad diets that only lead to yoyo dieting and weight regain.

Doctors have been checking height and weight as part of patient care and physicals but now because of ACO’s, they  will need to provide ACO patients  with a treatment plan and document that they did it. I believe it is the treatment plan that has the potential to generate a thoughtful discussion about losing weight.

One of the most powerful pieces of information a health care provider can share with patients trying to lose weight,  is to tell them exactly how many calories they need to lose weight. In November 2013  the American Heart Association, American College of Cardiology and the Obesity Society  published Clinical Practice Guidelines  to guide healthcare providers in treating obesity.  To lose weight the report recommends we cut calorie intake by 500 to 750  daily. Most men can lose weight on a 1,500-1,800  calories daily. Women can lose weight on a calorie level between 1,200-1,500  per day. It might surprise you,  but many people do not know how many calories they need to lose weight and they often think it is more complicated than just portion control. The report finds any diet can work if it reduces total calories. Of course  the best diet reduces calories and includes health promoting foods  such as  fruit and vegetables, poultry over beef , whole grains over refined breads and pastry, and meals that include fish, nuts and beans.  The  Harvard School of  Public Health web page www.nutritionsource.org is an excellent resource for information about food and nutrition, this is my personal recommendation not the ACC/AHA.

I have years of anecdotal reports from patients  who  appreciated hearing  weight loss guidance from their doctor – but lets turn to the research. A meta analysis published   in the International Journal of Obesity  reviewed the published data on 32 studies a examining the impact a health care provider can have on weight loss and found advice on weight loss had a significant impact on a patients attempt to lose weight. Identifying the problem is the first step, the next step is to provide evidence based solutions . Writing in the Journal of Continuing Education authors Fruh and Flkerson found individuals are often unaware of what it takes to lose weight, and health care providers can promote an understanding of calories and help patients make healthful food choices.

In short, the ACO is asking doctors to address an issue that for far too long has been left to the free market. Most  of us obtain our weight loss advice from magazines, books, and supplement companies that profit from the confusion and ignorance that surrounds losing weight.  This approach has  not been good, and the rise in obesity has been significant.

The ACO is pushing the health care system to deal with the problem of obesity in only a select number of patients, I am hopeful discussions and weight loss plans  will trickle down to all patients. In my own practice, primary care providers are asking for simple resources such as: What is BMI to address the issue. I suspect many more primary care providers will be looking for tools to address the issue, and attending conference about the management and treatment of obesity. I am very hopeful that the end result will be an intelligent and thoughtful discussion between patient and provider about what it takes to lose weight, with the needs of the patient kept in front and the advice based on science.