Bittman’s Speedier No-Knead Bread with Olive Oil

As much as I love Jim Leahy’s no-knead bread, the reality is that by the time I get my act together to start making it, it’s too late to get a rise by the time I need to serve the bread.

Enter Bittman’s recipe for speedier no-knead bread. With a rise time shortened from 8 hours to 4 hours, you could conceivably have it ready for lunch, which was my plan for Saturday at the cottage. Unfortunately, that would require getting up before 9 am. Too much wine with dinner Friday night nixed that idea. I decided to make the bread anyway, starting at around 10 am on Saturday, figuring we’d eat it at some point during the weekend.  As you’ll see by the recipe below, I accidentally modified it by adding some oive oil to the dough, which I think was not such a bad thing,

Now we’re eating it toasted for Sunday breakfast. Given how delicious it is, there’s no way we would have had any left for today’s breakfast if we had it for lunch yesterday.

I think it all worked out for the best, don’t you?

Mark Bittman’s Speedier No-Knead Bread with Olive Oil

I have trouble finding instant yeast, so this recipe uses active dry yeast, which I proofed before using. If you use instant yeast, as Bittman does, you’ll add it to the dry ingredients and increase the water by 1/4 cup. (The Fresh Loaf has a good post on the differences between these two types of yeast.) If you don’t want to proof your yeast, eliminate the sugar. 

I mis-interpreded Bittman’s ingredient list for “oil as needed”, and added about 2 tbsp of olive oil to my dough. (He meant to use is to oil your working surface.)  On researching what I might have done, it appears that oil strengthens the bubbles in the rise and increases the storage life of bread.  In this case, it also gave the bread a chewier texture, more like a sourdough.  I like that.  

In retrospect, I should have cut back the water by that amount, which explains why my dough seemed so loose – however, it remained easy to work with, so I don’t think I hurt anything. Next time I make it, I’m going to increase the oil to 1/4 cup, which seems to be the norm in bread recipes with oil, and cut back the water accordingly. If you try it first, let me know how it turns out. 

Yields: 1 loaf

Ingredients

  • 1 packet active dry yeast
  • ¼ cup warm water
  • A pinch of sugar
  • 3 cups bread flour (I used King Arthur’s)
  • 1 1/2 teaspoons salt
  • 2 tbsp olive oil
  • 1 1/4 cups water

Directions:

1. Dissolve the yeast in ¼ cup warm water. Add a pinch of sugar. Once the yeast starts to foam, it is ready to use.

2. Combine flour and salt in a large bowl. Add dissolved yeast, 2 tbsp olive oil and 1 1/4 cups water and stir until blended; dough will be shaggy. Cover bowl with plastic wrap and let rest about 4 hours at about 70 degrees.

3. Pull dough out of bowl – it will be shaggy, but will come away in one piece if you work gently enough. Plop in onto a lightly oiled work surface (I use a large wooden cutting board) and fold it over on itself once or twice. Cover loosely with plastic wrap and let rest 30 minutes more.

4. While the dough is resting, put a 6-8 quart heavy covered pot (I use a Le Creuset round French oven) in the oven (lid on) and heat to 450 degrees fahrenheit.

5. When the dough has rested for 30 minutes, carefully remove the now very hot pot from oven. Slide your hand under the dough and drop it into pot, seam side up. Unless the dough is crawling up the sides of the pan (in which case you can shake the pan once or twice to drop it in) don’t worry if it falls a bit off center in the pot. It will straighten out as it bakes.

6. Cover with lid, put back in the oven, and bake 30 minutes, then remove lid and bake another 15 to 30 minutes, until loaf is beautifully browned. Cool on a rack.

IVF Regulation in Turkey Lowers Multiple Birth Rates, Improves Infant Outcomes

In 2010, the Turkish Ministry of Health, in a response to rising rates of multiple births and their attendent complications, passed regulations limiting the number of embryos transferred in an IVF cycle.  In women under age 35 in the first 2 cycles, only one embryo can be transferred. In subsequent cycles and in older women, the limit is two embryos

The result in one maternity center, published in this month’s issue of Human Reproduction, was a significant decline in multiple births, NICU admissions and rates of respiratory distress syndrome, necrotizing enterocolitis anemia and pneumonia in newborns, as well as the use of mechanical respiratory support in infants born at that institution.

Lest you worry that pregnancy rates suffered as a result, the authors point out multiple prior studies showing that the adoption of  single embryo transfer has not had an adverse impact on pregnancy rates in that country.

This is just one more study adding to the growing consensus that when it comes to fertility treatment, less can be more.

The United States lags behind Europe in adopting single embryo transfer

Single embryo transfer as first line IVF protocol in women under age 35 is increasing worldwide, although the United States is lagging behind European countries in this regard.

According to The American Society for Reproductive Medicine, only about 10% of IVF cycles in the US in 2008 were single embryo transfer, compared with 20% overall in Europe and as high as 60% in Sweden. This is despite randomized trails that show no statistical difference in pregnancy rates with single embryo vs double embryo transfer at the blastocyst stage, and a reduction in twinning from 48% to 0%.

According to ASRM, barriers to adoption of single embryo transfer in the US are both patient and provider-driven, often fueled by financial concerns on both sides.  The high cost of IVF cycles in the United States leads patients to attempt to complete their family in one cycle, a strategy that may be penny-wise but pound foolish, as the long term costs resulting from multiple gestation can be much more excessive than that of another IVF cycle.  In addition, the manner in which IVF centers are required to report their results encourages multiple embryo transfer. Finally, for single embryo transfer to be successful, IVF centers must be able to select the highest quality of embryo for transfer (not always as easy as it sounds) and have a viable program for freezing unused embryos for future cycles (not all do).

According to the CDC, the rate of twin pregnancies in the United States has risen 76% since 1980, from 1 in 53 to 1 in 31 births.  While some of the rise is explained by increasing maternal age (older moms have higher rates of spontaneous twins), the use of assisted reproductive technology accounts for two-thirds of the increase in twinning in the United States.

Although I know of no move afoot to regulate IVF in the United States the way it is in Turkey, the field is moving in the right direction. Not all centers have what it takes to lead to success with single embryo transfer, and not all patients believe they can afford the luxury of multiple IVF cycles to complete their family.  Studies have shown that when IVF cycle costs are lower, patients will choose single over multiple embryo transfer.

Who are candidates for single embryo transfer? 

Single embryo transfer works best in women under 35 who have more than one good quality embryo resulting from and IVF cycle. It’s also a great option for women undergoing donor egg pregnancy, since egg quality from the donor is expected to be high.  Older women and those with poorer quality or number of embryos will still be candidates for higher order transfers. Over time, newer technology that allows selection of the best embryos will only enhance success rates.

 

Social Media & Medicine 2012 – Slide Share

Social media & medicine 2012

Thought I’d share my slides based on a lecture on Medicine and Social  Media that I gave last week at The Salzburg Medical Seminars.  (Click on “Share my slides” to download as powerpoint file. )

If you should view all the sides, do note that the last few slides are not really meant as slide show slides but resource lists. So please don’t get all Edward Tuftee on me…

It was wonderful to meet so many wonderful young Obstetrician-Gynecologists from all across the world in Salzburg. If any of you make a website or start Tweeting, do let me know so I can follow you. And most importantly, stay in touch – we are all connected now on this wonderful thing we call the internet!

Mammograms Decline in 40-49 year Old Age Group

Since the US Preventive Service Task Force published revised guidelines recommending individualized screening schedules rather than routine annual mammograms for low to average risk women in their 40’s, the number of mammograms being done in this age group has declined.

In the year after the guidelines were published, nearly 54,000 fewer mammograms were performed on women ages 40 to 49. That represented a 5.72 percent decrease from the previous period. The authors said that the modest reductions probably reflected some public resistance to the new recommendations, in part because of conflicting guidelines from other groups that urge more frequent routine screenings.

I’m not surprised.

The study reflects what I’ve been seeing in my own practice – women in their 40’s asking “Do I really need this test?”  and “Can I wait till I am 50?”. In most cases, after confirming that a patient is not an increased risk of having concerning symptoms or exam findings, we end up compromising on an every other year schedule. This seems to be something both they and I can feel comfortable with in light of the newness of the recommendations and the current medical legal climate in the United States.  The few who have chosen to wait till 50 tend to be those who come from Europe (where mammgrams are done later than in the US) and those with prior experience, either personal or familial, of harms from mammograms.

Hello from Salzburg

I’m here for a week for the Salzburg Seminars, meeting and teaching wonderful physician fellows from across the globe as part of the American Austrian Foundation’s Open Medicine Program. Mr TBTAM is with me, and we’re having a grand old time. Next week, it’s off to Prague and Vienna, and maybe a spa town in the mountains.

Blogging may be a bit sporadic for a bit, but I’ll return soon with pics and tales from across the Atlantic.

Social Media & Medicine Word Cloud

I’m preparing a lecture on Practicing Medicine in the Era of Social Media, and created this word cloud for use in a slide. (I used Wordle) Thought I’d share it here in case anyone else needs it for a similar use. Or any use, really.

Inspirational: Katie Noonan – Breathe In Now

’cause I only have one second, this minute today
I can’t press rewind and turn it back and call it now
And so this moment, I just have to sing out loud
And say I love I like and breathe in now
And say I love I live and breathe in now.

Reacting & Adapting to the New Pap Smear Screening Recommendations

Pap Smear (image from Wikipedia)

Cervical cancer screening used to be easy – they came once a year, I did a pap.  High risk patients with abnormal paps stayed at the top of my radar because they came more frequently or had procedures. If they managed to slip under the radar, we caught them at their annual.

Easy.

Now, with new consensus guidelines for pap smear screening, every patient is different. (Of course, they always were, but you get my point).

  • Under age 21 – No pap. No HPV Testing. (That one’s easy…)
  • Age 21-29 – Pap every 3 years. No HPV unless pap abnormal.
  • Ages 30-65 – Pap every 3 years, or Pap + HPV every 5 years.
  • Age 65 and older – If no history cervical pre-cancer, we can stop paps.
  • Cervical pre-cancer at any age – Manage individually.

How I feel About the New Pap Smear Recommendations

Overall, I think we are moving in the right direction, but I must admit that I am not entirely comfortable with every aspect of the new guidelines.

I do like the “no paps before age 21” recommendation. Cervical cancer is exceedingly rare in this age group, and has not declined appreciably with increased screening. And there is nothing less fun for patient or doctor than a colposcopy in a teenager. Which does not mean I won’t slip in an occasional pap a year or two early in a young woman who initiated sexual activity at a very young age (like before age 16). These kids worry me.

I’m not so enamored with jumping right into every 3 year screening (as opposed to having three normal annual paps first) starting at age 21. That recommendation is based mostly on modeling and not real world results, and accepts a small increase in the number of cervical cancers in return for less colposcopies.  I also worry that an every three year pap will turn into every five years, especially as we move towards longer acting contraceptives at the same time. This could increase the rates of cancers further in this group. Finally, I’d also argue that we’ve already made huge strides towards decreasing over-treatment by observing rather than treating low grade lesions in this age group. If it had been up to me I think I would have kept annual paps in this group, at least for three years before heading off to every three year paps.

This stands in contrast to the expected outcomes in women ages 30-65, where adding co-testing for HPV leads to better pre-cancer diagnosis and less cervical cancers – I like that a lot.

I also admit that I am having a bit of a problem thinking about stopping paps in healthy 65 year olds who are having new sexual partners and may be acquiring new HPV infections. The guidelines advise not to take sexual history into consideration in this age group, but I wonder if this is based on data from a world before the baby boomers found Match.com. In having discussions with such women about stopping paps, I find myself ordering an HPV test for reassurance before backing off. And thinking about readdressing the question in 5 years or so based on interval sexual history.

I’m still waiting to see what ACOG comes up with. They wrote in support for the new recommendations, but have yet to publish their own.

Doing less paps sounds simple, but the reality is that it takes more time

Not a lot of time, but in the era of the 15 minute office visit, every minute is precious.

Actually doing the pap takes a few seconds. But deciding whether or not to do the pap takes much longer. In order to determine which screening group a given patient falls into, I now have to go back and look at all her paps, review her history and figure out where we are in a given year on her screening scedule. That takes a few minutes.

Asking women to keep track is not always so helpful. You’d be surprised how many don’t know what their pap results were or how they may have been treated for abnormalities in the past. Getting old records is not always easy. The annual pap was always a great fallback position when there was uncertainty in the history.

At this point in time, my EMR has no ways of flagging the pap screening interval for me. (It still thinks I’m on an annual screening schedule with everyone.) So I’ve come up with little notes to myself in the assessment and plan – thinks like a macro that says “no hx abnormal paps, HPV neg, paps every 3-5 years”.  Next visit I can see this and carry it forward. Or putting a pap flag in the problem list – though it really isn’t a problem, is it? Until I get off schedule because I’ve lost track, that is.

Patients have their own issues with the new recommendations

Some are thrilled to have one less test. Others, not so much. Needless to say, we’re having a lot of conversations during visits about the new guidelines, which takes – let’s say it shall we? – time.

I’m not arguing that we need to to go back to one size fits all annual screening

Every woman is an individual, and deserves to be treated as such.   The new recommendations demand that we consider each woman’s risk of cervical cancer and weigh it against the harms of over-treatment in her age group. Overall, the risk-benefit ratio is favorable, but it does accept a small increase in cervical cancers in the age 21-29 age group, and a very very  small number of expected cancers in the over 65 crowd without allowing for consideration of other risk factors such as sexual activity. I’m not convinced that’s a trade off worth making. Unlike mammograms, which have had a limited impact on breast cancer mortality and none on its incidence, pap smears actually prevent cancer.  I wish we could have moved just a tad more slowly before making such sweeping changes.

_________________________________________

How do you feel about the new pap recommendations?

If you’ve come up with any little tricks for using your EMR to track individualized pap intervals for your patients, let us know in the comments section.

Leek, Spinach and Courgette Kugel (aka Persian Kuku)


I know. You’re wondering what a courgette is. I’ll give you a hint. It’s long, green, has seeds and can grow to enormous sizes. And no, it’s not a male frog’s body part, get your mind out of the gutter, will you?

Courgette is the French word for zucchini.

Courgette = Zucchini (French)

Speaking of words, although this dish, which hails from the Sephardic Jewish Jews of Turkey and Persia, is called a kugel, it is actually almost identical to the Persian egg-vegetable dish called a Kuku.

Remarkably similar words, similar ingredients, but, it seems, completely different etymology. According to the Jewish Encyclopedia, the word “Kugel” is derived from the German/Yiddish for Kugeltopf – a ball shaped ceramic jar in which puddings were cooked on the stove – while the word “Kuku” is believed to stem from  the Farsi word for fowl, which either makes a noise like the word or lays the eggs from which the dish is derived.

LEEK, SPINACH & COURGETTE KUGEL

Another recipe from Martha Spieler’s Jewish Cooking. This is one of the healthiest, most delicious ways to use the spring harvest, and is chock full of veggies, with the egg serving as more of a binder for the veggies than a main player.  Yet another reminder of what makes the Mediterranean cuisine so good for you. 

  • 6 tbsp olive oil
  • 2 large leeks, cleaned and thinly sliced
  • 1 1/2 pounds spinach, washed
  • 1 courgette (zucchini), coarsely grated
  • 1 baking potato, coarsely grated
  • 3 garlic cloves, finely chopped
  • 3 scallions, thinly sliced
  • 2 pinches ground turmeric
  • 3 tbsp matzo meal
  • 2 tbsp chopped fresh dill
  • 3 eggs, lightly beaten
  • salt and ground black pepper to taste
  • Lemon wedges to serve

Preheat oven to 400 degrees F.

Heat half the oil in a large saute pan. Add leeks and saute till just tender. Remove leeks to a large bowl and set aside.

Add the spinach to the pan with just the water that clings to it after washing. Place the cover on (it will seem like a lot of spinach, but don’t worry – it cooks way down) and saute over med high heat till just softened, using tongs to distribute and toss the spinach as it cooks down. (This step only takes a few minutes) Drain really well (use technique below if needed) , and when cool, chop roughly.

Meanwhile, grate the courgette and the potato, then drain and either squeeze in your hands to remove the excess liquid, or wrap in a clear dish towel and wring  to accomplish the same.

Add zucchini, potato and spinach to leeks, along with scallions, garlic, turmeric and salt and pepper to taste. Add the matzo meal. Stir the dill into the eggs and add to the vegetable mixture.

Pour the remaining 3 tbsp olive oil into a lasagna-type baking pan and heat in the oven for about 5 minutes. Carefully and quickly remove the pan to the top of the stove, and spoon the vegetable mixture evenly into the pan, allowing the hot oil to bubble up over the ides and onto the top of the veggie mixture.

Bake for 15 minutes, then reduce the heat to 350 degrees F and bake another 15-20 minutes till firm to the touch, golden brown and fluffy.

Sprinkle with chopped dill for garnish ad serve warm with lemon wedges to squeeze over the kugel.

ADDENDUM 6/24/12 – IRENE’S VERSION

My mother-in-law Irene, the Best Home Cook in the World, modified the recipe as follows –

One leek instead of two. 1/2 chopped red pepper in with the leek. One 10 oz. bag spinach instead of 1-1/2 lbs. 2 tbsps. matzo meal instead of 3. 2 scallions instead of 3. I stirred in about 1/4 cup of crumbled feta cheese to the finished mixture before baking it. Had some home-made spicy tomato sauce in the fridge and smeared about 1/4 cup on top, halfway thru the baking. Thanks, a great recipe and will be wonderful at Passover.

Just tasted her version and it is even better than the one I made.  She made hers in a 7 by 12 by 2.5 inch oval ceramic pan, which gave hers more height.

Moroccan Carrot Salad

Marlena Spieler’s marvelous cookbook Jewish Cooking covers the breadth of traditional Jewish cuisine across Europe, the United States, Africa and the Middle East. Accompanied by gorgeous illustrations, a fascinating historical introduction on the Jewish Diaspora and a very informative (for this Catholic-raised girl at least) chapter on Jewish dietary laws and foodstuffs, the book has become one of my favorite go-to sources for new and foolproof recipes. After all, these are the dishes that have withstood generations of cooks, with adjustments and tweaks along the way. At this point in their evolution, they’re pretty much perfect.

MOROCCAN CARROT SALAD
My only modifications on the original recipe were to lightly saute the garlic in olive oil  (I don’t like garlic too raw), eliminate the vinegar (it gives me migraines), and increase the lemon juice accordingly. ff you like vinegar, use just 1/2 lemon and add 2 tbsp of red wine vinegar.

  • 4 carrots, thinly sliced
  • Pinch of sugar
  • 3 garlic cloves
  • 1/8  tsp ground cumin (you can use up to 1/4 tsp if you prefer a stronger flavor)
  • Juice of 1 lemon
  • 3 tbsp extra virgin olive oil
  • 2 tbsp chopped fresh coriander, parsley or a mix of both
  • salt and ground black pepper to taste

Cook carrots in boiling salted water till just tender but not soft. Drain and let dry a bit, then put into a bowl. Saute the garlic in 1 tbsp olive oil till soft but not browned. Add sugar, herbs, garlic w/ oil, cumin, lemon juice and the remaining 2 tbsp of olive oil and toss. Season with salt and pepper. Serve at room temp or chilled.

Birth Control – Clarifying the (Small) Heart Attack & Stroke Risks

In a detailed analysis of a large national health database including over a million women ages 15-49, Danish researchers have clarified how various hormonal contraceptives might affect the risk for heart attack and stroke.

While these events are exceedingly rare in the young population of women using pills, the age at which women use hormonal contraception has crept up. Some women are using pills well into their 40’s and even up till menopause.  So it’s appropriate to take a gander at these vascular risks a bit more closely to ask just how much risk women are taking by using hormonal contraception.

And the answer is – not very much.

Let’s see if I can break it down for you –

The risk of heart attack and stroke is largely age-related, whether you take hormonal contraception or not. Women in their late 40’s having a risk of 6 per 10,000 compared with less than 1 per 10,000  for women under age 25.

Having diabetes, hypertension, hyperlipidemia, arrhythmias and being a smoker elevate the risk of heart attack and stroke. By about a factor of two in women up to age 49. Remember though, that the risks related to these factors will increase with age, so don’t let this low number make you too comfortable.

Taking estrogen containing birth control increases the risks of heart attack and stroke, but those risks are very, very small. Just how small?  If you are age 20 years old and are on the pill with no additional risk factors, your overall risk of a heart attack or stroke is about 100 times less than 1%.  If you are 45 and on the pill, your risk is increased from about 6 per 10,000 to 12 per 10,000, a risk that is about 10 times less than 1%.

The risk of stroke and heart attack from estrogen-containing hormonal birth control goes away when you stop taking it. That’s good, since the age at which women stop needing birth control is around the time heart disease risks start to rise.

The risks for heart attack and stroke are estrogen-dose related. This means that the higher the estrogen exposure, the higher the risks.

Here is a very simplistic rendering of how the vascular risks compared between methods. This rendering may not be entirely correct statistically, but I have to place the data into clinical context, and this works for me –

Vascular risks of Hormonal Contraception

Patch, Ring & 50 ug pills > 30 ug pills ≥ 20 ug pills > POPs > Mirena & Implanon

(POPs = progestin-only pills. ug = amount of ethinyl estradiol)

Overall, the difference in risk between the highest and lowest risk hormonal methods is still quite small. Within a given estrogen dose class, the differences between brands of pills is negligible. In some cases, the risk of a 30 ug pill may be the same or lower than some 20 ug pills.

Noticeably absent from the analysis were the 20 ug norethindrone and levonogestrel pills, my personal go to pills for new pill starts these days.

There is also a new pill being marketed that contains just 10 ug of estrogen. If you’re willing to put up with a bit of breakthrough bleeding and want what this study suggests will be a lower risk of vascular side effects, that pill is sure to be a good choice for you.  I personally like it in the over 40 crowd.

Finally, it’s worth noting how good Yaz looks in this study – it’s a 20 ug pill, and no heart attacks were noted among Yaz users in this study. Their numbers were small relative to other pills, however, and the researchers caution that differences between different formulations of pills of the same estrogen dose were not statistically significant.

Bottom Line

Nothing in life is risk free, and that includes birth control. The good news is that the risks are low, and we now have data that women and their doctors can use in deciding between methods based on vascular risks. Or, as Diana Pettiti, MD, MPH states in her excellent editorial accompanying the article

Women, their physicians, and the public should be reassured not only by the Danish study but by the vast body of evidence from epidemiologic studies of hormonal contraception that have been done over the past five decades. This body of research documents the small magnitude of the problem of arterial thrombotic events in women using combined estrogen–progestin hormonal contraceptives. The research shows that the small risk could be minimized and perhaps eliminated by abstinence from smoking and by checking blood pressure, with avoidance of hormonal contraceptive use if blood pressure is raised.12 With the addition of the Danish data, evidence is now even stronger that progestin-only formulations of hormonal contraception have vascular risks that are undetectable with modern epidemiologic methods. Although hormonal contraception is not risk-free, the evidence is convincing that the low and very low doses of ethinyl estradiol (<50 μg) in the combined estrogen–progestin contraceptives studied by Lidegaard and colleagues — whatever the progestin and whether delivered orally or by means of the patch or the ring — are safe enough.

How you can use this data in making contraceptive choices

If you don’t want vascular risks, however small, stick with a progestin only method. The price you’ll pay is some degree of menstrual irregularity, whether its unpredictable bleeding (Impanon), breakthrough bleeding (POP’s, Mirena, Depo- Provera) or over time, no periods at all (Mirena, Depo-Provera).  Progestin only methods also may not benefit skin the way estrogen-containing methods do, and some (like Depo-Provera) can lead to weight gain.   POP’s have slightly less efficacy that estrogen-containing methods and the other progestin-only methods.

If you’re willing to accept the small but real vascular risks of estrogen containing contraceptives, you can potentially minimize that risk by starting with a 10ug or 20 ug pill. These pills do have higher rates of breakthrough bleeding than the 30 ug and higher methods.  Some studies have suggested that in obese women, more perfect compliance is needed to maintain efficacy with these pills meaning you have less leeway to miss a pill occasionally than a thinner woman. Other studies have suggested that these ultra low dose pills may not be as good for bone protection in teens, who are building bone they will need for their adult lives.

If remembering to take a pill is your issue, and you’re not willing to accept the menstrual cycles changes associated with the long acting progestin only methods, consider the ring or patch.  You’ll be accepting a slightly higher risk of vascular side effects, but if you’re under age 40, those risks are exceedingly low.

If you are over age 40,  progestin-only  methods and the lower dose estrogen-containing methods are good first line choices. Women without risks for heart disease remain good candidates for estrogen-containing hormonal contraception, and the pill in particular can ease the perimenopausal transition.

The above is just a rough outline of one approach to take. There are as many options and choices to make as there are individual woman. Other considerations, such as cost, availability, previous experience with a given method, other medical and gynecologic conditions,  other side effects and personal preference need to be taken into account in making contraceptive choices.

______________________________________________________________________

Good reporting on this story

The Best Carrot Cake I’ve Ever Eaten

The original Frog Commissary Carrot Cake
The Original Commissary Carrot Cake (embed from visitphilly.com on Flicker)

The best carrot cake I’ve ever eaten was the one they served at Steve Poses’ long-gone Commissary Restaurant in Philadelphia. That carrot cake was insanely over the top – pecans and raisins in the cake, three layers with pecan cream filling between, cream cheese frosting on the outside with baked coconut topping and an icing carrot on top. I’ve made it before, and it’s incredible. (Though mine never looked as good as the one up there…)

But the original Commissary carrot cake is very, very rich. It’s also a lot of work. As Poses says in his cookbook –

This cake is most easily made if you start it at least a day ahead, since the filling, for one thing, is best left to chill overnight. In fact, the different components can all be made even several days in advance and stored separately until you are ready to assemble the cake.

Right. I can barely get started cooking in time for dinner, let alone start a cake a day ahead of time.

So I started making the cake without the make-ahead filling and the coconut topping, and discovered that I much prefer it that way. This simpler version allows the sumptuous cake flavor and texture to shine, and the pecans and raisins become stars instead of just members of an ensemble cast.

I usually make this cake in a tube pan. But this time, planning to serve the cake as dessert at a small pre-theater dinner at our apartment, I decided that I did not want leftovers to tempt me next day.  So I made individual cakes in a large muffin tin to use that night, and with the rest of the batter made cupcakes that I froze to frost and serve at some later date.

If you want to make the original Commissary Carrot Cake,  Steve Poses has posted the recipe on his blog. Better yet, buy the Commissary Cookbook. The cake was not the only amazing thing on that restaurant’s menu.

CARROT CAKE ala THE COMMISSARY

I used canola oil instead of corn oil. Be sure to use high quality golden raisins ( I got mine at Fairway)  I always wondered how this cake would taste using brown sugar, but never had the nerve to change it. Let me know if you do. 

  • 1 1/4 cups canola oil
  • 2 cups sugar
  • 2 cups flour
  • 2 teaspoons cinnamon
  • 2 teaspoons baking powder
  • 1 teaspoon baking soda
  • 1 teaspoon salt
  • 4 eggs
  • 4 cups grated carrots (about a 1-pound bag)
  • 1 cup chopped pecans
  • 1 cup golden raisins

Preheat the oven to 350°.

Grease and flour a 10 inch tube pan (or a large muffin tin and two cupcake tins)

Sift together the flour, cinnamon, baking powder, baking soda and salt.

Whisk oil and sugar together in a large bowl. Stir in half the dry ingredients.Then alternately add in the rest of the dry ingredients while adding the eggs, one by one. Combine well. Add the carrots, raisins, and pecans. Pour into prepared pan and bake (70 mins for tube pan, 30-40 mins for large muffin size and 20-30 mins for cupcakes.)  Cool upright in the pan on a cooling rack.

When completely cooled, remove cake from pan and cut into two layers using a serrated knife. Frost.

Cream cheese fosting

  • 8 ounces soft unsalted butter
  • 8 ounces soft cream cheese
  • 1-pound box of powdered sugar
  • 1 teaspoon vanilla extract
Cream the butter well, then beat in cream cheese. Add sugar and  vanilla. Refrigerate till use.