a healthier salty snack

I’ve loved popcorn since I was a small child. Maybe it was the association with movies (the watching of which became my undergraduate major.) Or maybe it’s just the combination of crunchy, salty and fatty — a flavor combination we’re hardwired to favor.

But popcorn isn’t the best way to keep your blood sugar balanced, and corn is a very common food allergen. So what’s a gal craving salty-greasy to do?

When I get a serious hankering for my beloved popcorn but it’s just not in the cards, my healthy substitution is kale chips.

Go ahead and laugh at me for being a Portland hipster. I’ll wait.

No, kale isn’t the only food out there. But it really does excel in this application. And if you have a garden, it’s easy to stay well supplied.

Kale chips take a little longer than popcorn, but they’re still a delicious salty-greasy snacking treat — with the added benefits of phytonutrients and fewer allergenic compounds.

Making kale chips is plenty easy — even for those of us who aren’t cooks. All it takes is tearing the leaves off the stems, drizzling them with olive oil and salt (I add garlic granules and some hot pepper), mixing it up with your hands, and then sticking it in the oven for a while.

The one trick is to avoid adding too many leaves to your pan. They don’t crisp as well if they’re layered too deeply. You can always make a second batch.

How to make kale chips

Ingredients:

  • A bunch of kale. (See pro tip, below.)
  • Some salt
  • Some garlic powder
  • Hot pepper or paprika to taste
  • Enough olive oil to get some on all the leaves when you mix it with your hands.

Directions:

  • Tear kale leaves from their stems and place in a roasting pan.
  • Drizzle on olive or avocado oil.
  • Add seasonings.
  • Mix it all up with your hands. Every piece of leaf should be slippery (from the oil) and a little gritty (from the seasonings.)
  • Try to space the leaves somewhat evenly.
  • Put pan into the oven, set to 415 degrees.
  • Set time for 25 minutes.
  • Check occasionally, stirring the leaves so they dry/cook as evenly as possible.
  • Remove from oven, and enjoy.

These are best when still warm.

I rarely measure seasonings. You just need enough for the leaves to feel gritty while massaging in the olive oil. When in doubt, start slow. You can always add more when the kale chips are out of the oven.

The only mistake you can make is burning the leaves. To my mind, it’s better to have a few chewy bits in among the crispy ones than to lose the whole thing. Burning makes the pan harder to clean, too. (You could get fancy and use baking parchment, but the cleanup is usually pretty easy.)

Pro tip: Kale from the grocery store or farmer’s market usually comes in bunches, and you don’t have to use it all at once! Honestly, it took me forever to figure this out. I just kept shoving more and more into the roasting pan, or dirtying a second one. Save some for next time.

Do you have favorite ways to spice up kale chips? Let me know! I’ll share these — with credit! — in a future email and on my blog.

Salúd!

—Dr. Orna

P.S. Looking for a great source of easy veggie recipes? Check out Food As Medicine, written by two of my medical-school classmates. See more of my favorite food books here.

P.P.S. If you’re looking for individualized food recommendations, my clinic is 100 percent open — and 100 percent telemedicine. If you’re in Oregon, now’s a great time to schedule.

nature is medicine: the science

I’m a big proponent of nature as a prescription — for mood, for stress, for immune resilience. It’s one of the core principles of both my practice and my profession.

(Here’s the replay video of the Vitamin N session of my Immune Resilience Action Series.)

Below is a big list of resources supporting this prescription, which I will continue to update.

Start here:

Nature is medicine

Greenspace

Gardening as connection

Looking at Nature counts

More ideas about getting your nature fix during quarantine

Great books

Physician resources

I tested negative. Am I safe?

More folks than ever are getting tested for SARS-CoV-2, the virus that causes COVID-19. Access to testing is great, and long overdue.

But the tests themselves remain problematically inaccurate, so remember that a negative test doesn’t necessarily put you in the clear.

The issue is false negatives: tests that don’t detect the virus when a person is actually infected. And these tests we’re using to determine viral presence is prone to false negatives.

This matters because people who test negative may take fewer precautions to protect those around them — even though they may actually be infectious.

If you’re sick, pay attention to your experience rather than your test results — and act accordingly. But if you’re not sick, don’t take the test’s word for it.

How bad is the problem? Researchers at Johns Hopkins School of Public Health scoured the existing scientific literature — both published, peer-reviewed studies and those that are still going through the process — to answer that question. They looked at data for the RT-PCR test, generally a very sensitive way to detect viruses, that is the primary swab-up-the-nose test used to detect active infection.

The short version: At best, one in five tests will have false negatives.

Published in the May 13, 2020 edition of Annals of Internal Medicine, the study found a sweet spot in the progression of infection. Testing on Day 8 of the infection — usually the third day of disease symptoms — is when you’re most likely to get the most reliable results.

Here’s how it breaks down:

  • Day 1 of infection (often no symptoms): 100-percent chance of a false-negative test.
  • Day 4 of infection (often no symptoms): 67-percent chance of a false-negative test.
  • Day 5 of infection/symptom onset: 38-percent chance of a false-negative test.
  • Day 8 (three days after symptom onset): 20-percent chance of a false-negative test.
  • Day 9 (4 days after symptom onset): 21-percent chance of a false-negative test.
  • Day 21: 66-percent chance of false-negative test.

These numbers represent median observations: in half the cases the chances were higher, in half they were lower. This is the middle ground of numbers that have a pretty large spread, especially when testing the early days of infection.

Going with these median numbers, you’ll see that even at the Day 8 sweet spot, one in five tests will falsely report a negative result when the person is actually positive. So at best there’s a 20% false negative rate. On other days, the false negative rate is even higher.

Why are the false negatives so high on a test that is known to be exquisitely sensitive? A physician colleague of mine working in a front-line lab suggests that incorrect or incomplete collection may be the problem. The swabs healthcare workers stick up patients’ noses may just not be catching enough viral particles. I’ve got a message out to a microbiologist friend for his take, and will update this post when I hear back.

I get that people want to know what’s going on. I want to know what’s going on. These acute tests (the swab-up-the-nose tests) more usefully inform our actions when they’re positive than when they’re negative.

If you get a positive test, talk to your doctor about appropriate medical care, stay home, stay away from people, and do everything you can to take care of yourself.

If you get a negative test, don’t assume you aren’t sick or that you can’t infect others. If you aren’t on your third day of symptoms (and even if you are), there’s a good chance the test won’t catch your infection.

Be careful, folks. And remember that getting a negative test isn’t the final word.

Salúd!

—Dr. Orna

P.S. Read the full Annals of Internal Medicine article, “Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure.” Here are the key findings if you don’t want to wade through it:

“Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% (95% CI, 100% to 100%) on day 1 to 67% (CI, 27% to 94%) on day 4. On the day of symptom onset, the median false-negative rate was 38% (CI, 18% to 65%). This decreased to 20% (CI, 12% to 30%) on day 8 (3 days after symptom onset) then began to increase again, from 21% (CI, 13% to 31%) on day 9 to 66% (CI, 54% to 77%) on day 21.”

Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure.Annals of Internal Medicine, 13 May 2020.

Photo by Hans Reniers on Unsplash