Recipes from the Stanford Insulin Resistance Study
A Cookbook Journal Started December 18, 2007
(updated occasionally as time permits.)
Like many people in their mid-forties, I have been experiencing that frustrating slow weight gain that some call inevitable. In my case, I think I know the cause. I love to cook, I love to eat. Among my favorite activities I count sitting around the table with friends, chatting late into the evening around a good bottle of wine and some delightful food to nibble, like strong runny French cheeses and fresh sourdough bread. So perhaps it’s no wonder that I slowly gained about 40 pounds over the last eight years.
My wife noticed an item in the local newspaper about a study at Stanford Hospital on insulin resistance, which sought healthy subjects who were slightly overweight. The benefits included full metabolic lab tests and regular consultations with a dietician. In return they required some tissue samples, various other tests and 3-4 months adherence to a strict diet plan (or a drug protocol for the other group.) As I hadn’t seen a doctor for a full physical in decades, this looked like a good opportunity for self-evaluation.
I got accepted to the study as a control, happy to learn that I had little risk of diabetes in my future. They assigned me to the weight loss protocol, which meant I had to lose 1-2 pounds per week for three months.
The diet imposes a balance among carbohydrates, proteins and fats that previous studies show works well in reducing insulin resistance. In terms of caloric contribution, the suggested ratio is 40% Carbohydrates, 45% Fats, and 15% Protein. This is very different from the trendy “Low Carb” diets that suggest high amounts of protein. As I read it, it comes closer to a traditional Asian diet pattern.
The diet uses a point system that assigns a weight to each nutritional category. Green and leafy vegetables are free, and people should eat as much as those as possible. The other categories get counted one point as follows:
1 Carbohydrate (CHO) = 15 grams
One point equals a portion. Note that these aren’t the total weights of the foods, but rather the weight of the nutritional ingredients within the foods. In many cases, water and indigestible fiber account for much of the mass of fruits and vegetables, so we can eat larger portions of those items than of the more concentrated foods. On the other hand, an ingredient like olive oil while healthy and worthwhile in our diet - is almost 100% fat, so a mere tablespoon counts as 3 portions!
To offer some more examples (remembering that 1 oz. = 28 grams)
A 15 gram portion of carbohydrate (1 point)
A 7 gram portion of protein (1 point)
As an example of the study’s recommended ratios, my specific plan specifies the following portions for an 1800 calorie daily diet:
10 Carbohydrate portions
Add to this at least two cups of “free” vegetables such as salad greens, broccoli, asparagus, cabbage, green beans, zucchini, eggplant, etc. Other “free” items include coffee and tea, soy sauce, vinegar, lemon juice and similar low-cal flavorings.
You could imagine the challenge such a diet might place upon a person who prefers to cook by flavor and fragrance rather than gram scale and chemical analysis. I hate to measure when I cook. I had to figure out a way to turn this diet into a project with more interesting goals than mere weight loss. For me, that means trying to come up with new and interesting dishes that fill these potentially austere requirements.
So, here are some attempts to make flavorful and filling meals while trying to keep track of the parameters of a rather disciplined insulin-healthy calorie-restricted diet. These recipes appear chronologically, as I come up with them day by day throughout the study. As I experiment, I might go back to earlier attempts to suggest improvements or change serving sizes. This is a living cookbook, a work in progress.
(Breakfast, lunch sandwiches)
High Fiber Bread
Works in a bread machine, regular cycle.
2 cups rye flour
By adding the gluten, you can get away with using a much higher percentage of whole grain and fiber while still getting dough that rises in a bread machine. I have found that by following a basic ratio of 2 cups whole flour (wheat, rye, oat, etc.) to 1 cup coarser ingredients (wheat, oat, or rice bran, 9 grain cereal, rolled oats, seeds, etc) along with that extra gluten, the bread usually turns out firm and dense, but not leaden or overly dry. You might need to adjust the amount of water by a tablespoon or two depending on your choice of grains. The honey helps the yeast rise, so adding a bit more makes a more porous bread. The oil helps prevent the bread from drying out after baking, so the loaf retains a fresh texture for several days after baking.
If baking this by hand, knead for about 10 minutes, let rise for two hours, gently punch down, let rise again for an hour, and bake for about an hour at 350 F.
Smoked Turkey Salad with Veggies and Soy-lime Dressing
This dinner salad tries to provide a filling portion of raw and lightly cooked vegetables with big savory flavors, bright colors and crunchy textures. By serving the turkey and steamed vegetables warm atop the lettuce, the result satisfies hunger a bit more than a cold salad. The purple pole beans - sometimes called Navaho beans or “trail of tears” beans - have a shape that resembles snap peas, but taste like green beans only a less grassy and a bit more waxy. They have a bright purple edible pod that fades a bit when cooked. Using an acid like lime or vinegar preserves the purple color. You can substitute green beans but the purple provides nice contrasting colors. The beans would count as a "free" food or perhaps 1/2 carb.
Ingredients for each person served:
For the dressing, in a ceramic or glass bowl, heat the honey in a microwave with the soy, fish sauce and rice wine for about 30 seconds. Stir to dissolve the honey. Add lime juice, and then wisk in the sesame oil just before serving.
For the vegetables, cut asparagus spears in half if necessary, remove threads from the edges of the pole bean pods and place them all in a microwave safe dish that has a tight cover. Splash a few tablespoons of the dressing over the vegetables, cover and steam in microwave for about 4 minutes, or until lightly cooked (still a bit crunchy).
In the meantime, wash and dry enough large outer leaves of butter lettuce to stack about 3 or 4 on each plate, making a broad edible bowl. Sprinkle liberally with cilantro. Stack a mound of smoked turkey in the center. Arrange the warm vegetables on the sides, drizzle with the liquid from the vegetable steaming dish, top with crushed almonds and dust with sesame seeds. Add additional soy-lime dressing if desired.
Soba Noodle Soup w/ asparagus, chicken broth, turkey
1/2 cup cooked soba noodles (Japanese buckwheat noodles)
Cook soba noodles for about 6 minutes (about 1 dime’s diameter per person) then rinse under cold water. While the noodle water is heating up in one pot, heat another pot with chicken stock, soy sauce, fish sauce, chili sauce, and 5-spice. When the stock reaches a boil, place in the asparagus and turkey. Simmer until asparagus is just softened. As the smoked turkey is already cooked, it just needs to heat up and flavor the broth. Place 1/2 cup soba noodles in each bowl, Pour in 2 cups of broth along with asparagus and turkey. Top with chopped scallions and cilantro. This also tastes great with some leaves of Thai basil and a splash of spicy Sriracha chili sauce. It’s a hybrid of pho’ style flavorings with Japanese style noodles. For a more authentic pho’ you would use rice noodles with paper thin strips of beef flank on top.
Bean Thread w/ Tofu, Peanut, and Broccoli
Saifun (bean threads) are made from the starch of mung beans. They turn clear and shimmery when they absorb water, with a mouth-filling slippery texture. They soak up the colors and flavors around them. Many importers offer saifun in balls resembling crackly dry birds nests, one ball per serving making about 1 cup (65 grams carb, 260 Cal.) I originally tried this recipe with one ball per person, but the resulting serving was a bit too large. For the diet plan, it’s better to split one ball in half for two people. You don’t need to boil saifun. Just soak it in hot water for 6-10 minutes to soften, then drain the water and add hot flavorful broth. The following quantities are approximately per person, and can upscale to a large pot.
1/2 cup bean threads (1/2 ball saifun)
Soak the dried crumbled shiitake mushrooms and chopped dried shrimp in heated chicken (or vegetable) broth for about an hour, along with the soy and fish sauce. No need to boil yet, just let the warm pot sit on the stove. Place dry saifun bean thread in each serving bowl. When mushrooms in the pot of broth are tender, bring another pot of plain water to a boil and carefully pour that hot plain water over the dry saifun in each bowl. Let stand for about 10 minutes. Drain the unflavored water off the noodles before adding the broth. This method also serves to heat up the bowls so the soup stays hot longer at the table.
To finish the broth, add the ginger and tofu to the pot and increase heat until it boils. While that’s heating up, steam the broccoli flowerettes in a covered bowl in the microwave with a splash of water and soy sauce, for about 2-3 minutes until tender but still crunchy. You can also drop the brocoli in the broth for a few minutes, but be careful not to overcook it, or the broth will take on a vegetal flavor. Arrange the broccoli on top of the saifun noodles in each bowl. Add the tofu and broth, then top with peanuts and fresh chopped leaves of cilantro, Thai basil and parsley. Serve immediately.
Wild Mushroom Veggie Cakes with Asparagus & Prosciutto
The insulin study diet allows and encourages the consumption of large amounts of fresh whole “green” vegetables, and doesn’t count them among the point tally. The list includes zucchini, mushrooms, eggplant, onions and asparagus. I already consider these staples in my diet, so I wanted to come up with a dish that used these ingredients to satisfy a big appetite with minimal points; yet I wanted it to taste so good it feels a bit like cheating. Here’s an attempt that worked out very well. In fact, it’ll probably become a standard part of my repertoire.
My version used some unusual ingredients, which added to its interest. I don’t expect most people to have access to these items, so below I list more readily available substitutes. Instead of prosciutto, I actually used a deeply flavored one-year dry aged smoked lamb. The flavor is strong enough that minute amounts suffice to satisfy a meat craving. One could substitute German rauchfleisch (dry aged beef) or Serrano ham. One could also skip the meat entirely, as the veggie patties have enough flavor to play center stage in a vegetarian meal. The dried wild mushrooms in my version came from one of my own forays, the savory sweet Agaricus augustus, or Prince Agaric. I blended these with some dried shiitake in a spice grinder to make a mushroom powder. Since you can readily find bags of dried shiitake mushrooms in Asian markets, health stores or even Costco, I list only shiitake below.
This recipe serves two hungry people or three smaller appetites. The dietary points above reflect one person and half the recipe.
12 spears asparagus
Garnish: shredded lettuce, green onion, cilantro, balsamic vinegar or lime juice.
Using a mandolin or the julienne blade of a food processor (or lots of time and a sharp knife) grate the zucchini, eggplant, onion and carrot into very thin long confetti. With a healthy pinch of salt, toss the grated vegetables together in a bowl with your hands, let sit for a few minutes, then squeeze out excess water from the mix (compress handfuls of it over the sink if needed.) In a blender or spice grinder, make about 1/2 cup of powder from dried shiitake mushrooms, or other dried savory wild mushrooms of your choice (morels or porcini would be excellent, perhaps in slightly lower quantities due to their strong flavor.) While loosening and tossing the squeezed vegetables again with your fingers or a fork, slowly add the mushroom powder and about 1/2 cup of masa flour to the blend, getting the dry ingredients between the cracks of the damp veggies to absorb moisture. Refrigerate for about one hour. During this time, the mushrooms and corn flour will soak up more moisture and become a binder.
Crack two eggs and whisk briefly. Remove the veggie mix from the refrigerator, and blend in the eggs with a fork, fluffing the vegetable shreds to coat all the ingredients with egg. Compress the contents again with a spatula. Heat a large nonstick frying pan to medium-high, then add a bit of light olive oil, spreading it out to make a film. Taking clumps of veggie mix slightly larger than a golf ball, spread a ball of mix onto a free area of the pan with the back of a fork while smoothing the edges with a spatula. I prefer a wooden spatula for this. Cook the first side without disturbing the bottom for about 4 minutes, then quickly flip with a wide thin spatula (different from the one used to straighten the edges.) Cook the second side for 4 minutes or until golden brown. You should get about 8 cakes from the above ingredients, although vegetable sizes differ so your mileage may vary. Set cooked cakes aside on a paper towel, but serve quickly to retain the crispy exterior.
While the veggie cakes are cooking, peel the tough outer layer of skin near the base from about a dozen spears of asparagus (6 spears per person.) Steam them in the microwave, in a covered wide bowl with a splash of water for 4 minutes or until cooked but still firm.
Shred some lettuce, green onions and cilantro to act as a bed. Sprinkle with balsamic vinegar, lemon or lime juice if desired. Place the veggie cakes on the bed of garnish. Place the asparagus on top, with shavings of thinly sliced prosciutto in a prominent position on top or underneath.
Turkey-Shrimp Dumplings in Mushroom Miso
The dumpling filling lets you make about 30 dumplings. Serve 6 dumplings per person in two cups of mushroom miso broth, with broccoli and green onions for a very satisfying and light dinner. You can freeze the remaining cooked dumplings for future use. I specify sue gow wrappers for this recipe because they are half the thickness of wonton wrappers, but otherwise the same. This means they contribute half the carbs of wonton wrappers, but the same flavor and structure.
Dumpling Filling to make 30 dumplings:
Mushroom Broth per person:
1/4 cup powdered shiitake
Start the mushroom broth an hour early but don’t add the broccoli yet - and let stand on low heat to allow the flavors to integrate. Grind enough dry shiitake mushrooms in a spice grinder or blender, to make about 1/4 cup powder per person. In a pot with 2 cups water per person, plus an extra cup of water to allow for evaporation, add the mushroom powder and 1 tablesooon red miso paste per person. You might have to smash the miso between two spoons while blending it into the water, to break it up a bit. You’ll add the broccoli at the end, just before serving.
Bring a large pot of salted water to a light slow boil. In a food processor, add all of the ingredients for the dumpling filling, being careful to sprinkle the cornstarch widely rather than in a lump. (You could also blend the cornstarch with a tiny bit of water first to help it spread through the mix.) Pulse on low several times to get the blend started. Pause to scoop remaining bits from off the sides if needed. Then, blend on high for 30 seconds or so, until converted into a coarse paste.
Set up a large sheet of waxed paper next to the wrappers, a bowl with one whisked egg to use as glue, and the blended filling. Holding a wrapper in one hand, brush a bit of egg around one half of the edge of the wrapper with your fingertip. With a teaspoon, place a little ball of filling in the center and fold the wrapper in half around the filling, pinching slowly from the top edge around to the sides while trying to remove most of the air from inside. Too much trapped air will expand and might cause the wrapper to burst. Try to avoid putting too much filling in each dumpling. You’ll quickly learn that it squishes out the sides while folding. Usually about a teaspoon-full is right, a bit bigger than a grape.
Set the folded dumplings down on a large sheet of waxed paper until you have enough ready to start cooking. You can keep folding while cooking, but you want to be able to add each batch into the water at the same time. Prepare a draining rack next to the pot of boiling water (I use a cookie cooling rack, placed on top of a cookie sheet to catch the water.)
Slowly drop the dumplings into the gently boiling water, one or two at a time, being careful to prevent them from sticking to the bottom when they fall. Add 8 or so dumplings to the pot for each round of cooking, so the pot doesn’t get overcrowded, causing the dumplings to stick together. Cook on gentle boil for about 8 minutes. The dumplings will float to the top then get wrinkly. Fish them out when cooked with a slotted spoon, and arrange on the draining rack. Then start the next batch. Three or four rounds of cooking should complete 30 or so dumplings.
Bring the mushroom miso broth to a light boil. If you wish, you can add the excess egg from the wrapping process into the broth, to make it an “egg drop” broth. Add the broccoli and steep it in the hot broth for a few minutes. Pour the broth into bowls while portioning the broccoli, then add 6 dumplings to each bowl. Sprinkle with chopped chives, green onions, or other fresh garnish. Excellent with Sriracha sauce if you like things spicy.
Seared Ahi w/ Green Beans and Dumpling Soup
If you observe the sequence of recipes in this journal, you'll notice that certain ingredients repeat themselves a few times in proximity. That's because I cook at home with the ingredients at hand; and after making certain dishes, I have leftovers that might last for a few days. Then each meal turns into a challenge to re-frame the leftovers into something interesting.
I found some excellent quality frozen ahi tuna at Costco, vacuum packed in 4 oz. bags. These little pre-measured portions make excellent quick meals. I thaw a pack per person in a bath of cold water for an hour or so, then season and sear them on smoking hot cast iron for a minute or two, leaving the fish raw on the inside. This meal combines that method with a bit of stir-fried green beans and some dumplings from the freezer (see previous recipe) in a broth that flatters the tuna as well as the dumplings.
According to the diet plan, this recipe falls a bit heavy on the protein, and not enough on the carbs and fat. To solve that imbalance, you can reduce the size of the ahi, and use noodles instead of dumplings in the broth. In my case, the other foods I have in the day tend toward carb and fat (toast for breakfast, celery and carrots with peanut butter as a snack for example.) So, the weight toward protein at dinner can actually put me closer to a daily balance.
When eating this dish, I like to soak the seared ahi directly in the flavored broth to moisten it and add to its rich savory flavor.
4 oz. sushi grade ahi tuna
1 cup green beans (a dozen or so fresh, or more if desired)
3 dumplings (see recipe above)
This dinner is very simple. Heat a bit of turkey stock (or chicken stock, fish, etc.) with a splash of soy sauce, some shredded ginger, and pinch of five spice powder. Use the hot broth to thaw several frozen dumplings while cooking the rest of dinner. (Of, make dumplings fresh from the above recipe.) The remainder goes quickly.
Grind some Sechuan pepper corns (hua 'do) or black pepper if those are unavailable, along with half as much salt. Spinkle a pinch on both sides of the raw tuna steaks and let stand for a few minutes.
Heat a cast iron skillet or wok. Add a bit of sesame or vegetable oil, and thinly coat the wok with oil using a wooden spatula; then, toss in the green beans. Sautée on high heat for 3-4 minutes, until slight charring occurs and beans are cooked but still crunchy. Toss in garlic and a splash of soy sauce at the very end and turn off heat. These last ingredients will burn and get bitter if cooked on high heat for very long. Scoop beans out of wok or pan, onto dinner plates, and return the pan to high heat. When pan starts smoking very hot, add a new film of oil if necessary, then add the tuna. Sear tuna on all sides for about 2 minutes, until a slight char occurs but steaks are still basically raw inside.
Plate the seared ahi tuna atop the green beans and alongside the broth with dumplings. Sprinkle chopped chives, green onions or cilantro onto the broth, and sprinkle crushed roasted peanuts on the fish and beans. Serve immediately.