Brewing Black Tea (Improperly)

It's the day after Christmas, and whether you celebrate the holiday or not, I hope you're finding some downtime today to spend with friends or family. In fact, I hope you're not spending your day reading my blog! But even so, I'll give you a short piece to read. We've been alternating between posts on health issues and recipes, and it's been a few weeks since we had a recipe. I'll keep today's entry short, and so I'm just going to explain how to brew black tea the 'right' way.

There's some discussion on how to brew black tea, with the British having a very specific procedure involving warming the pot and specifications on the temperature. The truth, however, is that this is only correct for certain kinds of black tea. Black tea is more variable than many know, and some types will require differing preparation methods. Here, then, is a general procedure, with variations noted.

1. Add black tea to the pot. Generally, this is accepted to be 1 teaspoon per 8 ounces, but those who like it strong will add a bit extra - I usually use 1 1/2 teaspoons per 8 ounces. Some of the fuller, leafier black teas, such as high-end Darjeelings, will necessitate slightly more tea, because they are not as tightly packed as traditional black teas.

2. Boil the water. Tea must always (always) start as cold water and be brought to a full boil.

3. Pour the water over the tea. Most black teas must be given water at a full boil in order to bring the best flavor out. Green teas take slightly cooler water, but black teas generally need absolutely boiling water. Again, one exception is Darjeeling; some high end Darjeelings should be given cooler water, which prevents bitter flavors, and allow floral elements to fully express themselves, though for most black teas, the cooler water will result in weak, unstructured tea.

4. Steep the tea, and then either fully decant or remove the leaves from the pot. Of course, the question is on timing, and again, this is variable. Some British-style black teas grown in India and Sri Lanka will take 7-8 minutes to gain full flavor, but other will need only 5 minutes. Chinese black teas generally need only 4-5 minutes to steep. Darjeelings will not only take cooler water, but also shorter brew times. Some experimentation with brew times will be necessary to get optimum flavor.

5. Add milk if desired. Milk, while anathema to green and white teas, is regarded by many as part of the black tea experience. I generally add a small amount, enough to give the tea a rich texture and dark caramel color only. But again, this depends on the specific tea. Many black teas have been bred and processed to take lovingly to milk, though others will not. Generally speaking, Indian and Sri Lankan teas will do well with milk, whereas Chinese and Darjeeling will not, though this is not a hard and fast rule.

6. You may add sugar, but do this at your peril. Remember, you're drinking tea, not eating candy.

And finally, on the topic of re-steeping. If you've brewed using a high quality tea, it should be able to take a re-steeping. Though black tea should be re-steeped at the temperature you brewed at initially, you will have to increase brew time. Again, experimentation is key, and while an extra minute will suffice in some cases, in others you may have to add far more time. Milk may or may not treat your tea favorably on a second steeping. My experience has been that second steepings lack the tannins present in the first steeping, and so do not tolerate milk well. But again, this is only my opinion - I don't even warm the pot, so what do I know?

I hope you are enjoying your winter holiday and find time for a bit of black tea in the process. While I'm a daily drinker of green tea for both flavor and health benefits, a little black tea now and again really hits the spot, especially in the cold winter months, where the heat and heft of black tea is exactly what the doctor ordered.

Thoughts On Multivitamins

The Annals of Internal Medicine, a well-respected medical journal, recently published an editorial titled "Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements." The piece was then widely disseminated to the news media both home and abroad. The editorial claims that the research indicating the uselessness of multivitamins is now so overwhelming as to condemn their use on a vast scale.

It is with sadness that I have to critique this piece. Naturopathic physicians such as myself, both individually and as a profession, have long strived to further research into nutritional approaches to disease and complementary therapies, not to mention furthering the cause of research generally. It is rare that I have to describe an article as unconstructive, but this editorial is such a piece. As I'll argue, this editorial is poorly conceived, poorly intended, and does not engender constructive scientific dialogue.

But before I go further into discussing the particulars, I'd like to discuss a point of irony. The point of irony is that I am not a big advocate for the use of multivitamins. In working with patients, I am far more interested in fostering good eating habits than recommending a multivitamin to "cover the bases." It is perhaps ironic therefore that I might criticize a piece whose point I do agree with. So given that, why argue with it?

Well, there are two big reasons I'm forced to differ with this editorial. The first is that despite claims of overwhelming evidence, the editorial is based on imperfect evidence. It took into account only about 32 studies, some of which are older (a colleague of mine called them "academic leftovers"). While that's no small number, compare it to the article I discussed last week, which examined nearly 300 studies in an effort to understand the role of vitamin D supplementation in disease.

The editorial was written in specific response to two studies published in the Annals of Internal Medicine this month, which bear attention.

The first article found that multivitamins did not appear to provide protection against cognitive decline. This piece suffered from significant limitations, including the fact that it was performed on physicians, who in general eat above average diets and may not need additional nutritional supplementation. Additionally, the use of a multivitamin to prevent cognitive decline is unorthodox, even in complementary medicine, and slowing of cognitive decline is not an outcome that could be reasonably expected from the use of a multivitamin. The most authoritative reference I know of, Nutritional Medicine by Dr. Alan Gaby, includes no references to the use of multivitamins in cognitive decline; this is an exhaustive reference book that draws on published medical literature as far back as the 1940s. This study then, is a prospective study examining a completely novel use for multivitamins, but has been misrepresented as a refutation of the use of multivitamins for a given condition.

The second article discusses the use of multivitamins in prevention of cardiovascular events (such as heart attack, stroke, chest pain, or death) in patients who had previously had a heart attack. Patients who were taking part in the study were also undergoing conventional medical therapy. Here also, the use of a multivitamin in preventing a second cardiovascular event is not common practice. This study is not a refutation of an accepted practice, as it is presented in the editorial, but a prospective study that failed to find a positive effect. Though individual nutrients have been studied in regards to various cardiovascular risk factors, including some with positive results, it would not have been reasonable to anticipate that a multivitamin would have the effect of preventing a second event. Additionally, this particular study was confounded by low levels of compliance with treatment, and the study authors themselves admitted that firm conclusions could not be drawn.

A weak rationale for the editorial is one reason that I have to object to the argument.

The second reason I have to object is that the tone of the editorial, especially when taken in light of the evidential basis, leads me to strongly suspect that the authors were writing with substantial bias against the use of nutritional supplements. While attitudes are changing to an extent within the medical profession, there nonetheless remains a strong undercurrent of bias against nutritional medicine and other complementary therapies. As a provider committed to integrative medicine, which incorporates the use of conventional and complementary therapies, recommended on an individual basis, I find it disappointing that the authors did not check their biases at the door. Scientific method has been developed to decrease the influence of bias in research, and it does no good to bring bias back into the equation when interpreting results.

Of course, the editorial itself is not the entire problem. Of greater frustration is the fact that this editorial was then widely disseminated via the news media, during which it received an additional level of distortion. Given that the articles that incited this process found that multivitamins did not engender an additional benefit on top of a balanced diet or conventional treatment, and for conditions that would not be expected to benefit from use of a multivitamin, it is incomprehensible that the subsequent news articles bore titles such as "Should We Toss Our Vitamin Pills?" and "Vitamin supplements are a waste of money, say scientists." It is difficult to know whether the blame lies at the feet of the journalists or the publicists, but it is clear that limited evidence was spun dramatically out of proportion as this made its way from the lab to the public. While the information gained in the clinical trials is valid and deserves to be incorporated into clinical practice, it does not warrant a massive news campaign intended to convince the public to stop taking vitamins.

Finally, experience and an understanding of scientific progress has taught me that it never pays to close doors, as these authors are suggesting. Statements of absolute certainty rarely hold up under scientific scrutiny, and the broader-reaching they are, the faster they tend to succumb to criticism and new evidence. In the final analysis, this editorial was unconstructive for this reason. It offered little new knowledge, and proposed a radical departure from well-established norms. Had the editorial been limited and stuck to concrete information, I would probably have been chiming in my agreement, because after all, we've learned that multivitamins are unlikely to prevent cognitive decline, though they may have other benefits, and that they are also not a helpful addition to conventional medical therapy immediately after a heart attack. But to take that evidence and then goad the news media into publishing articles that deride vitamins as useless is not helpful, not constructive, and frankly, bad science.

New Information About Vitamin D

Vitamin D has gotten unending amounts of press lately. It's been touted for a whole number of health conditions, including cancer, immune conditions, heart disease, and diabetes. That said, research into the therapeutic effects of vitamin D supplementation have been inconsistent, and there's been some discussion of the importance of blood levels of vitamin D as a test. The version of vitamin D tested by health care professionals is not the active form of vitamin D, but is a 'pre-hormone' that acts as a reservoir and is converted into vitamin D for use by the body. Researchers are asking themselves what exactly this test measures, and whether raising those levels has a therapeutic effect.

Enter into this a paper that was recently published which suggests that serum vitamin D levels are the result of chronic disease, rather than the cause of it. The authors postulate that during chronic disease, vitamin D levels fall, rather than inadequate vitamin D levels being the cause of the chronic disease. The paper is a review of hundreds of individual studies of vitamin D, some of which looked at serum levels of vitamin D, while others looked at the effect of vitamin D supplementation on disease. While I think it's of limited clinical use to assess the effect of vitamin D on health generally, rather than on specific diseases (consider the results we'd get if we were to assess the benefits of a statin cholesterol drug on human health over a variety of conditions), the study nonetheless deserves enormous plaudits for the sheer scope of the study. With 290 studies to draw from, the information they generated should have some weight.

In summary, the findings were this: Low blood levels of vitamin D appear to be the result of chronic diseases, rather than their cause. The researchers noted many, many associations of low vitamin D with conditions such as cardiovascular disease, multiple sclerosis, mood disorders, and weight gain, but did not find strong evidence that vitamin D supplementation resolved these issues.  As stated previously, there are some issues with applying this information - reconciling the broad conclusions of this study (that vitamin D supplementation does not affect disease generally) with the specific conclusions of others will be a challenge for clinicians.

The primary concession the authors make is that among the elderly, vitamin D supplementation has a clear beneficial effect on reducing overall mortality. They were hesitant to discuss why this was, but agreed that vitamin D supplementation was an important intervention for the elderly, who are susceptible to a number of ailments.

Nonetheless, the idea that the body responds to chronic disease by lowering serum levels of vitamin D is not without precedent - it does similar things with iron. However, the reason that the body appears to do this is still unclear. Stay tuned as we continue to learn more about vitamin D.

Vitamins have risen and fallen in the past, be they vitamin C or vitamin E. This study will likely not prove to be a nail in the coffin of vitamin D, but it will certain shape our understanding of vitamin D in the future. Consumers should still note the fact that this study will not change recommended supplementation guidelines. The Institute of Medicine increased the recommended amount a few years ago from 400IU to 800IU for healthy adults, and that number still stands. Supplementing with vitamin D, despite the findings of this study, is still strongly recommended.

A Dirty Dozen Of Fish?

Smart consumers know about the Dirty Dozen, a list of vegetables and fruits includes the one most often contaminated by pesticides and other environmental toxins. The recommendation is to buy organically-grown versions of these foods in order to avoid unnecessary chemical exposure. These are contrasted with the Clean Fifteen, which aren't heavily sprayed or otherwise contaminated when grown conventionally and are fine to eat when conventionally-grown. These lists are clear, organized, and easy to use and many shoppers have the lists memorized, or at least key members of the lists.

However, when it comes to fish, things get a lot murkier. There are mercury issues to consider, there are issues related to overfishing, and questionable farming practices also enter the picture. Unfortunately, while lists for each of these criteria exist independently, none are compiled into something as clear as the Dirty Dozen.

Well, at least until now. The Food & Water Watch has put together a handout that compiles the criteria into a "Dirty Dozen" for Fish. The list includes fish that are contaminated with metals and other toxins, fish that are not sustainably caught, fish that are subject to unhealthy farming methods, and others. The list includes: Atlantic cod, Atlantic flatfish, caviar, Chilean sea bass, eel, farmed salmon, imported catfish, imported farmed shrimp, imported king crab, orange roughy, shark, and Atlantic bluefin tuna.

The list also includes recommendations of fish and seafood that can be substituted for the "dirty" fish. In all, it makes a great guide for buyers looking to increase fish in their diets while promoting their own health and the health of the planet.

The one and only downside of this otherwise great document is the fact that it doesn't incorporate information on omega-3 content, but we can hardly fault it for that. For those interested in omega-3 content of fish, reference this handy blog that I posted last year. Eat well and be healthy!

A Spanish Stuffing Recipe

It seems like folly to let Thanksgiving pass without a recipe, so here's a Spanish-style stuffing to serve alongside your turkey. Rather than the traditional savory-bread-and-herb concoction, this one is sweet, nutty, and fatty - quite far removed from what you were probably planning. But don't worry, you can perhaps save this one for another winter feast, and if you want the full effect, cook the turkey with butter under the skin and stuffed with brandy-soaked oranges.

Ingredients:
1/2 pound pitted prunes
1/2 pound dried apricots
3/4 cup brandy
1 large onion, chopped
3 tbsp olive oil
1/2 pound ground pork (or chicken)
1 tsp salt
1/4 tsp ground black pepper
1/2 pound sweet Italian sausage without casing
2/3 cup pine nuts (or walnuts)
1/3 cup ground almonds (or almond butter)
1 tsp cinnamon

First, chop the prunes and apricots, place them in a bowl, and add the brandy. Allow to sit for at least 30 minutes. While the fruit is soaking, preheat the oven to 375 - hopefully the oven is preheated for your turkey.
Fry the onion until golden brown, and then add ground meat. Season to taste, and cook until it has changed color. Add sausage, and again, cook until it changes color. Stir in the nuts, and then add almonds and cinnamon. Add the fruit and brandy, and mix thoroughly.
Place the mixture in a casserole, cover with lid or tin foil, and bake for 40-50 minutes.

This is the richest, most decadent stuffing you'll ever have, and is practically a meal unto itself. Experiment with leftovers to make hash for breakfast the next morning, and the truly adventurous may even puree the leftovers into a thrilling pâté of sorts.

[This recipe is adapted from Claudia Roden's excellent The Food of Spain]

A Kimchi Recipe

In days of yore, our ancestors would spend much of the harvest season preparing vegetables for the long winter. Some foods would be dried, others would be stored in root cellars, and still others would be fermented as pickles. In Korea, the most popular pickle has historically been kimchi, a spicy mixture of cabbage, carrots, ginger, and peppers. As Americans have regained their interest in traditional foods, and as Korean food has become the new "It" food, kimchi has received a lot of attention of late.

Variations on the essential recipe exist, and the majority of commercially available kimchi includes fish sauce, dried shrimp, and red pepper flakes. The recipe given here is a variation on kimchi that is vegetarian, and somewhat closer to European sauerkraut, though with a strong Asian kick you won't forget any time soon. My taste for this style of kimchi was heavily conditioned by the kimchi offered by Real Pickles, a purveyor of fermented foods based in Western Massachusetts.

A note before beginning: Often times, people do not read an entire recipe before starting cooking. Please read this entire recipe first. It involves some important planning on your part.

Ingredients:
1 head Napa or Chinese cabbage (green cabbage is fine, too) shredded.
1 cup carrots, grated
1 bunch scallions, chopped
1/4 cup daikon radish, grated (optional)
3 cloves garlic, minced
1 tbsp fresh ginger, grated
1 jalapeño pepper, deseeded and minced
1 cherry bomb pepper (or other small red spicy pepper), deseeded and minced
2 tbsp fine sea salt
filtered water

Combine all veggies in large mixing bowl to achieve a homogenous mixture, and kneading them slightly to soften. Place in sealable 2 quart jar, pressing veggies down to fit into jar. Add sea salt to jar, and fill with filtered water, allowing approx. 1 inch of space at the top of the jar, and submerging the vegetable mixture. Seal jar and shake, in order to achieve even distribution of salt in water.

The next step is the tricky one. By brining and submerging the cabbage, you allow beneficial lactobacillus bacteria to ferment the kimchi. These beneficial bacteria are naturally present on the cabbage itself. However, if the cabbage were simply left out, it would fall prey to non-beneficial, potentially harmful bacteria - basically, it would rot. As a result, it is vitally important to keep the kimchi mixture submerged as it ferments. This can be achieved through a variety of means - if you are fermenting in a wide-mouth jar, a bowl or plate that has been weighed down can keep the vegetables submerged, but if you are fermenting in a small-mouthed jar, a smaller vessel such as a teacup will achieve the same purpose.

It should be noted that the jar you're fermenting in, and the object you're using to weigh the kimchi down should be cleaned thoroughly before using them. They do not need to be sterile, but they do need to be clean.

Allow to sit at room temperature for three days. I typically ferment in a closed container, because fermenting kimchi may have a certain... aroma. Additionally, you should expect it to bubble and overflow slightly, so have your fermentation vessel on a plate or something else that can be cleaned easily.

Once the initial fermentation phase is through, the kimchi should be refrigerated. It will take another week until the flavor has settled into maturity. Additionally, once the initial fermentation phase is through, the kimchi does not need to be kept submerged. Most will remain under the surface of the brine, but if bits and pieces stick out the top, that's fine.

To be sure, kimchi is work, but the reward is well worth it. It lasts for months and is absolutely delicious!

What's In Your Herbs?

Recently, the New York Times reported on an ongoing issue in the realm of herbal supplements. A group of Canadian researchers purchased a few dozen bottles of commercially available herbal supplements, and, using a fairly high-tech method for assessing their content, found that the majority included herbs not listed on the label, contained contaminants and fillers not listed on the label, or some were out-and-out substitutions. Only two of twelve companies tested had products without any substitution, contamination, or fillers. The people interviewed in the Times' article then went on to express considerable concern about the quality of the herbal supplements industry as a whole.

As regular readers of this column will expect, I'm going to take a middle-of-the-road approach to the article.

Some of the commentators took a very strong stance against the natural products industry, urging public outcry to rein in the industry. Underlying all of this is, unfortunately, an approach not intended to remedy the problem and create improved access to high quality products for consumers, but rather a strangulation of the industry. This isn't merely throwing the baby out with the bathwater, but then going on to sledgehammer the tub, pull out the piping, and burn the house down. While there is need for regulation and oversight of the industry, this overly aggressive stance isn't productive and isn't actually aimed at fixing the problem.

As Dr. Duffy Mackay of the Council for Responsible Nutrition noted in his comments, laws are in place that provide for adequate oversight of the industry, but the FDA, already tasked with oversight of the pharmaceutical industry and food industry, simply doesn't have the funding or manpower to enforce the necessary discipline on the supplement industry. The chronic underfunding of the FDA as long-reaching consequences that go beyond the supplement industry, however, so don't think that it's just the natural products people who are getting off the hook.

However, let's bring this back to a consumer's point of view. How does evidence of widespread contamination and substitution affect you? First and foremost, it's important to understand why this happens. It's not due to malicious business practices, or a desire to produce substandard products on the part of manufacturers. Rather, substitutions and adulterations happen in the supply chain that goes from field or forest to the supplement company - it's the many hands through which the products pass that add or substitute substances.

Knowing that, how are we to guard ourselves? The answer is that it's best to buy supplements and herbs from manufacturers that engage in extensive testing of all raw materials. The best way to do this is through working with healthcare practitioners who have done the work to ensure the quality of the products they recommend, or retailers who have likewise extensively screened the products they provide. Though many products out there are less than they claim to be, the study noted that a portion of products are exactly what they claim to be and are free of adulterants. The companies that manufacture and sell these high quality products can be counted on to continue to do so, and are worthy of your support. Practitioners and retailers who know the industry and have gone to lengths to assess the companies are likewise worthy of your support, and by working with them, you can avoid the pitfalls that are present in this marketplace.