summer garden stir fry

Last weekend my husband and I were in Austin for a beautiful wedding. I am so glad to have had that time with some dear friends - that is how I most want to spend my time before moving. I also had fun dancing. The whole weekend was a mini vacation. I cannot believe it is already the middle of June. As much as I want to just relax and take it easy for this final month before moving and medical school, I must repeatedly tell myself that it's okay to be "lazy". I do have the time for yoga every day, and cooking, and reading, and checking out garage sales, and doing fun things with my friends. It's difficult because we live in a society that has made busyness a virtue. I bet even your retired grandparents will occasionally tell you that they are busy. Here is evidence that this mentality has deep roots: the latin word ṓtium is translated as leisure and peace. The english derivative of this word is otiose, which means "serving no practical purpose or result." I find that problematic, but knowing it also helps me to understand why I experience this free-floating anxiety.

Now then, moving on. While we were still in Austin, we went to an art museum and the farmer's market. I came home with this smooth, sweet and spicy heirloom garlic.

Since then I have been quite blessed by a friend's garden and the farmer's market here in Denton.

Last night I made a stir-fry with a bunch of it. I think this is one of the best ways to eat really fresh, flavorful vegetables because they are lightly cooked and seasoned, preserving all of their inherent taste and crispness. My friend Crystal dropped by last night to deliver these patty pan squash and peppers.

I also had these "yard-long beans" from the farmer's market.

All the work of making a stir-fry is in cutting up the vegetables, cooking only takes about 10 minutes. The other great thing is that you can easily vary it based on whatever vegetables you have. I used Mark Bittman's basic stir fry recipe from How to Cook Everything. (This book has a special place on my counter top, I use it so often.)

Summer Garden Stir Fry Recipe:

2 tablespoons canola oil

1 lb. extra firm tofu, cubed and dried on a paper towel (optional)

1 tablespoon minced heirloom garlic

1 tablespoon minced fresh ginger

1 leek, thinly sliced

2 sweet italian peppers, seeds and stem removed, chopped

1 large patty pan squash, cut into match sticks

1 large carrot, julienned

2 celery stalks, sliced

1/4 cup reconstituted oyster mushrooms, sliced

1 cup yard-long beans, cut into 1-inch segments

1/4 cup water

2 tablespoons soy sauce

1 tablespoon orange mint and cinnamon basil, chopped

1 tsp. black sesame seeds.

Prepare all the ingredients before you start cooking. Put the garlic, ginger, leek, peppers, and squash into one bowl. Put the carrot, celery, mushrooms, and beans into another.

Heat a large skillet on the stove over medium-high heat until it is quite hot. Add 1 tablespoon oil, swirl it around, and add the tofu. Stir occasionally, cooking so that the tofu is golden-brown on each side, about 5 minutes. Remove to a plate lined with a paper towel, to absorb the excess oil.

Return the pan to the stove and add enough oil to coat the bottom, up to 1 tablespoon. Add all the vegetables from the first bowl: garlic, ginger, leek, peppers, and squash. Cook for about 1 minute, stirring frequently. 

Then add the vegetables from the second bowl: carrot, celery, mushrooms, and beans. Continue stirring and add the water after a couple minutes. When everything is almost finished cooking, about 5 minutes more add the soy sauce and stir. Add the tofu back to the pan and stir. Remove from heat. Add herbs and sesame seeds just before serving, or just set them on the table along with some red pepper flakes so that everyone can choose how much they would like. Serve with brown rice.

surprise

Yesterday I peeled a grapefruit to find a lovely surprise. It had been sitting in my fruit bowl for so long that one of the seeds had sprouted!

I'm going to try to grow it.

community can fill the gap

I recently visited Chicago in search of an apartment, and some of the things I observed really got me thinking. I was in the suburbs rather than downtown, but many areas had a very urban feel. What surprised me was the great contrasts that existed from one block to the next. One moment I would be in a very nice residential area, full of rather idyllic-looking homes with gardens and happy families. Then, just a few blocks away, I would see a homeless man talking to himself, somebody eating out of a garbage can, or a woman who had clearly had a very rough night. I began questioning how this could be. Not, "why doesn't somebody keep these two groups of people more neatly separated?", but rather, "why do these extreme differences coexist? how can we see this every day and do nothing about it?" Now, I am by no means suggesting any kind of martyrism or asceticism. There are so many reasons that we should be able to have happy, comfortable lives without constantly feeling guilty. What I would like to discuss is the socioeconomic gap.

More specifically, I am interested in the socio- part, and in its effect on health. Socioeconomic status (SES) is the highest behavioral predictor of almost every health-related condition, including cardiovascular disease, respiratory disease, ulcers, psychiatric diseases, and stroke. By behavioral predictor I mean that it is the most accurate way to guess whether somebody will get one of these diseases once things like gender, age and ethnicity are ruled out. It's even more important than smoking cigarettes. And this is no minor prediction. A study done across Europe found SES to account for 68% of the variance as to who has a stroke. In some cases, the prevalence of a specific disease is ten times higher among those with the lowest SES than those with the highest. In some countries there is up to a ten-year difference in life expectancy when comparing the poorest and the wealthiest.

Why are SES and health so tightly linked? The first thought that came to my mind: lifestyle. Poorer people are more likely to drink, smoke, eat unhealthy foods, and engage in high-risk activities. Somewhat surprisingly, even when one controls for all these factors (i.e., compare poor smokers to rich smokers, etc.), lower SES is still linked to more disease. (As an aside, there are many fascinating studies linking stress to a broad range of diseases. Living in poverty certainly has its own unique set of stressors, such as long working hours, multiple dependent family members, and the unpredictability of keeping a job or having enough money for the next month's rent.) One extraordinary study looked at a single group of elderly nuns, all of whom took their vows as young adults and spent the rest of their lives in the same monastery with the same diet, etc. The patterns of disease, dementia and longevity were still predicted by the SES status they had before they became nuns 50+ years ago.

My second guess at an explanation: access to health care. Interestingly, European countries that have recently switched over to universal health care systems have not seen any improvement. Of course, even in countries with universal health care systems the wealthy do still have access to better, more timely care. However, one study conducted at the University College of London indicates that this still does not explain everything . Workers in the British civil service system range from blue-collar workers to upper-class administrators, but they all have roughly equal health care access, are paid a living wage, and do not have much fear about losing their jobs. Despite these automatic controls the rate of death due to cardiac disease is four times higher amongst the poorest. Finally, what I find to be the best argument against the idea that this gradient is simply explained by health care access, is that the same is true for diseases like juvenile diabetes and rheumatoid arthritis, which have very little to do with lifestyle or preventative health care.

So, poorer people have more disease and die sooner simply because they are poor.  This actually has an even greater effect across society than you might expect. In countries with the greatest socioeconomic gap everybody has more disease and the overall mortality rate is higher. But, isn't wealth relative? Yes, it seems that considering yourself to be rich or poor is relative and the key here is the gap itself. Income inequality has a profound effect on the health of any group of people. The SES-health gradient is much stronger in societies with greater inequality, and more subtle in more egalitarian societies. This has been shown repeatedly and on many levels. For example, income inequality predicts higher infant mortality rates across many European countries, and higher mortality rates across all ages (except the elderly) in the United States. Louisiana, the least egalitarian state has about a 60% higher mortality rate than New Hampshire, the most egalitarian. Those are overall rates, not just rates for those on the bottom of the gap. 

We seem to have figured out why this gradient cannot be explained away by the previously discussed, more obvious, factors. Kawachi explains this phenomena with the sociological concept of "social capital." Higher social capital is found in communities with a large amount of volunteerism and organizations, where people feel like they are a part of something bigger than themselves.  This is definitely lacking in  American communities, where few people know their neighbors and the rights of mobility and anonymity are sacred. 

This all comes across as rather depressing information. It means that even if we successfully provide universal access to health care, this SES gap will still exist, the poor will still be unhealthy and even the rich, try as they might to build their castle on a hill and put up a wall around it, will not be able to remain untouched by the rest of their society. This is not just about not having money, it is about poverty, and it is complex. I could most grasp the difference when I read Robert Evans' statement that "most graduate students have had the experience of having very little money, but not of poverty. They are very different things." 

Now then, where is the beauty in this? I feel like I can actually do something about it. Universal health care and welfare programs are big and complicated. I do not even have the knowledge to really understand the long-term effect these kinds of things have on individuals or on society at large. The economics and politics are so convoluted that I just want to shy away from them. But I think I can help strengthen a community. And your community isn't confined your neighborhood. It seems to me that many people have coped with the psychological distance placed between American neighbors by creating less traditional communities, like a book club or church, even though they may meet several miles away from their home. I plan to use this knowledge for inspiration to participate in or create programs for community outreach programs to educate people about a healthy lifestyle, and to let them know what resources and activities are available in their own community. 

This information came from Robert M. Sapolsky's Why Zebras don't get Ulcers. It offers an accessible, entertaining overview of the link between psychological stress and disease, and I highly recommend it. Please reference the book or send me a message if you would like more specific citations to any of the studies mentioned.