The Low-Oxalate Anti-Inflammatory Cookbook by Cindy Bokma [epub | 14,61 Mb] ISBN: 1510737197

  • Full Title: The Low-Oxalate Anti-Inflammatory Cookbook: 75 Gluten-Free, Nut-Free, Soy-Free, Yeast-Free, Low-Sugar Recipes to Help You Stress Less and Feel Better
  • Autor: Cindy Bokma
  • Print Length: 184 pages
  • Publisher: Skyhorse Publishing
  • Publication Date: November 27, 2018
  • Language: English
  • ISBN-10: 1510737197
  • ISBN-13: 978-1510737198
  • Download File Format | Size: epub | 14,61 Mb
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In this cookbook, food blogger Cindy Bokma takes familiar recipes and re-creates them for anyone dealing with a limited diet that can become extremely overwhelming.

Health is like a line of dominos and once one falls, others soon follow. Most people have more than one issue that can be addressed by diet. But when gluten-free options lead you to almond flour and milk, for example, and almonds are rich in oxalates, you may then be put in the path of an illness or issue related to high oxalates.

While much is known about gluten-free, low-carb, soy-free, nut-free, and low-sugar diets, this collection highlights oxalates, a naturally occurring but potentially inflammatory substance found in a wide variety of healthy plant foods, such as almonds, rhubarb, spinach, and more. These are, unfortunately, prominent in popular diets such as paleo and ketogenic.

With Bokma’s guidance, you’ll learn how oxalates affect your body, in which foods they may be found, and how to adjust your diet so they don’t cause you inflammation or other issues. Recipes such as Chicken with Garlic and Tomato, Cheeseburger Burritos, and Easy Bake Apples are simple, familiar, and stress-free and will allow you to eat your favorite foods without worry.


Editorial Reviews


“Since I’ve known Cindy, she has been dedicated to sharing information that enhances well-being. Her latest research on oxalates is leading edge and is sure to help a lot of people who suffer from the same symptoms that Cindy has and that few people are talking about―until now. Her desire to enhance people’s lives always shines through her work and this new book is sure to be no exception.” ―Sarita Coren, founder of the Hub Of Clean Living

About the Author

Cindy Bokma researches alternative medicine, health, and healing for Hello Dollface, her healthy living blog. She loves spending time in the kitchen and experimenting with recipes. She resides near Temecula, California.




American Heart Association Low-Salt Cookbook, 4th Edition

American Heart Association No-Fad Diet, 2nd Edition

The New American Heart Association Cookbook, 8th Edition

American Heart Association Quick & Easy Meals

American Heart Association Complete Guide to Women’s Heart Health

American Heart Association Healthy Family Meals

American Heart Association Low-Fat, Low-Cholesterol Cookbook, 4th Edition

American Heart Association Low-Calorie Cookbook

American Heart Association One-Dish Meals

American Heart Association Low-Fat & Luscious Desserts

Copyright © 1995, 2012 by American Heart Association

All rights reserved.

Published in the United States by Clarkson Potter/Publishers, an imprint of the Crown Publishing Group, a division of Random House, Inc., New York.

CLARKSON POTTER is a trademark and POTTER with colophon is a registered trademark of Random House, Inc.

A previous edition of this work was published in hardcover in the United States by Times Books, New York, in 1995, and was subsequently published in paperback by Times Books in 1998 and Clarkson Potter/Publishers, an imprint of the Crown Publishing Group, a division of Random House, Inc., New York, in 2001.

Library of Congress Cataloging-in-Publication Data

Quick & easy cookbook / American Heart Association. — 2nd ed.

p. cm.

Includes index.

1. Heart—Diseases—Diet therapy—Recipes. 2. Heart—Diseases—Prevention. 3. Low-fat diet—Recipes. 4. Low-cholesterol diet—Recipes. I. American Heart Association. II. Title: Quick and easy cookbook.

RC684.D5Q54 2012

641.5′6311—dc23 2011023671

eISBN: 978-0-307-95387-2

Jacket design by Rae Ann Spitzenberger

Jacket photography by Ben Fink

Second Edition





QUICK & EASY 1 • 2 • 3

1. Planning Principles

2. Shopping Smart

3. Kitchen Know-How


Appetizers, Snacks, and Beverages

Chickpea-Pistachio Dip

Edamame Salsa

Chunky Salsa

Cranberry Fruit Dip

Fruit Kebabs with Honey-Yogurt Dip

Layered Pesto Spread

Mushroom Poppers

Mushroom Quesadillas

Savory Snack Mix

Sugar-and-Spice Snack Mix

Homemade Corn Tortilla Chips

Banana-Kiwi Smoothies

Purple Slurp

Creamy Slurp


Skillet-Roasted Bell Pepper, Zucchini, and Vermicelli Soup

Puréed Broccoli Soup with Lemon-Infused Oil

Double-Tomato Soup

Spinach and Brown Rice Soup with Ginger

Mushroom-Asparagus Chowder

Peppery Pumpkin Soup

Chilled Strawberry-Cantaloupe Soup

Curried Shrimp Bisque

Thirty-Minute Minestrone

Rosemary-Lemon Vegetable Soup

Beef and Vegetable Soup with Cilantro and Lime


Strawberry-Spinach Salad with Champagne Dressing

Mustard-Marinated Vegetable Salad

No-Chop Cajun Coleslaw

Grilled Pineapple with Zesty Blueberry Topping

Pasta and Sugar Snap Pea Salad

Fresh Herb Potato Salad

Mediterranean Black Bean Salad


Tuna Salad Bundles with Lemon and Dill

Warm Chicken and Papaya Salad

Melon-Chicken Salad

Speedy Taco Salad

Pork and Water Chestnut Salad with Curry Dressing

Layered Two-Bean Salad with Cheddar Cheese


Pasta-Crusted Fish with Marinara Sauce

Pecan-Coated Fillets with Corn Relish

Fish and Fettuccine

Creole Catfish

Crunchy Fish Nuggets with Lemon Tartar Sauce

Broiled Halibut with Chunky Tomato-Cream Sauce

Halibut with Green Tea Glaze

Grilled Salmon with Mango-Lime Cream Sauce

Jerked Salmon with Raspberry-Mint Salsa

Spinach-Topped Salmon

Salmon and Brown Rice Bake

Spicy Sole and Tomatoes

Baked Tilapia with Pineapple Reduction

Tex-Mex Tilapia Packets

Broiled Tilapia with Black Bean Salsa

Grilled Trout with Creamy Caper-Dill Sauce

Smoky Trout with Citrus Topping

Spice-Baked Trout Fillets

Tuna with Ginger Bok Choy

Pan-Seared Tuna with Mandarin Orange Pico de Gallo

Tuna-Noodle Casserole

Tuna-Topped Barley with Kalamata-Basil Tomatoes

Dilled Albacore Cakes

Mussels in Creamy Wine Sauce

Lemon-Garlic Scallops

Sherried Seafood Sauté

Speedy Shrimp and Pasta


Marinated Hoisin Chicken

Baked Chicken with Winter Vegetables

Chicken-and-Clementine Kebabs with Peach Glaze

Baked Chicken with Crunchy Basil-Parmesan Pesto

Chinese-Style Chicken

Grilled Chicken with Strawberry-Fig Sauce

Skillet Chicken with Dried Berries

Chicken with Fresh Fruit and Veggie Salsa

Lemony Chicken with Tarragon Oil

Cheesy Oven-Fried Chicken

Chicken with Leeks and Tomatoes

Lemon-Pepper Chicken over Pasta

Coriander-Coated Chicken

Spicy Peanut Chicken

Barbecue-Simmered Chicken Chunks

Baked Dijon Chicken

Poultry and Mango Stir-Fry

Lemon-Sauced Chicken with Asparagus

Light Chicken Chili

Chicken and Rice with Herbs

Plum Good Chicken

Quick Cassoulet

Chicken Jambalay
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things began to change in a big way. Suddenly, I was taller, slimmer, and looked and felt younger. My pain diminished and I felt so much calmer. My body became more streamlined and lithe. The muscles I had overworked relaxed, and my intrinsic (or “ballerina”) muscles started revealing themselves. Best of all, I felt better. It’s safe to say that I look way better at thirty-seven than I ever did in my twenties. And, might I add, this program allowed me to maintain all of this post-pregnancy.

Kristen and I are not alone in our results. Over the course of the past fifteen years, I have applied this same program to everyone from top pro athletes to celebrities to everyday people of all shapes and sizes. Across the board, everyone who has completed my foam rolling program has undergone a complete transformation not only physically but also mentally and emotionally. Even more than seeing clients who transform their physique, I love to watch clients use this program as a means of combating and resolving chronic pain. It’s like giving someone the gift of freedom.

I know it sounds like hocus-pocus that ten minutes per day of foam rolling can lead to such transformative results, but there’s actually a proven science to the program I’ve designed. The foam roller works in a way that nothing else on the market right now does because it targets a newly discovered organ: fascia, or connective tissue. We’re ultimately working with the fascia on the foam roller, and that’s why this technique is so innovative. We’ll delve into what fascia is and why it matters in the next chapter, but for now, suffice it to say that the science and medical communities really only came to discover fascia and its role in our physiology in the past decade—2006, to be exact. Working with fascia is still a revolutionary, cutting-edge approach to fitness, as it essentially offers a means to simply and effectively reshape the body.

I first discovered the roller more than fifteen years ago when I was working as a personal trainer at a health club in Manhattan Beach, California. As many trainers and physical therapists do, I learned how to use the roller for self-massage. I immediately loved this technique and used it with my clients from day one to warm them up before their workout program. Fast-forward to my first Pilates workshop a few years later, and I was reintroduced to the roller as a tool for mimicking many of the elongating and core-strengthening moves traditionally performed on expensive Pilates equipment. This was a breakthrough moment for me because it allowed me to empower my clients, whenever and wherever they were, with an easy way of consistently performing the Pilates moves. I couldn’t help but notice that once my Pilates clients began incorporating the roller into their routine, their bodies transformed more rapidly. A few years later, I went to school for Structural Integration and learned so much more about the body, fascia, and the anatomy of movement. This knowledge allowed me to take rolling to an entirely new level, and formed the basis of the program you’re about to embark on over the course of the next twenty-one days.

Only recently have the medical and fitness worlds discovered a little secret that I’ve understood for a long time now—that the foam roller is good for so much more than aiding in physical therapy or just working out knots and tightness. When used regularly and correctly, it can be utterly transformative and unbelievably healing. My revolutionary foam rolling program combines lengthening and toning Pilates-based exercises with self-care movements that dig into the body’s connective tissues, thus reshaping the musculature and the actual structure of the body and releasing those toxins and blockages that wreak so much havoc. The result of this is a real, healthy, balanced body that’s nurtured, loved, strong, and appreciated. Through this program you will discover the most elongated, relaxed, femininely toned, uniformly developed, and joyful version of you. You’ll understand how freeing it feels to have a body that’s aligned (lots more to come about how and why this is so important) and a sense of yourself that’s ageless and draws you into a place where your soul can really soar. The real magic bullet to this plan is that it will make you feel fantastic about yourself and develop in you a vibrancy you probably didn’t even know was possible. And once you get to that place…well, anything is possible!

Another critical difference between the program you’re about to embark on and the others you’ve probably tried before is that this one is all about taking care of yourself rather than being a slave to working out. It’s about taking a holistic, healthy approach to fitness and wellness and doing so in a manner that actually feels good. Yes, you will get fit in the process, but you will also deepen your mind-body connectio
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d spot—it isn’t in the public consciousness in the same way as fast food: some people just don’t know that amazing alternatives to macro brews exist, or they don’t trust themselves to make the right choices on the other side of the beer aisle. In America, the craft beer industry hollered and high-fived as it passed 5 per cent of the market for the first time in 2011, but this means that 19 out of every 20 beers drunk isn’t a craft beer.


But there’s good news. Craft beers are growing in number and total volume sold around the world, while macrobreweries are losing volume. New craft breweries are opening with such regularity that it’s impossible to keep up. Drinkers are starting to learn about beers and demanding more delicious drinks: beers with provenance and flavor, something different. This is a kick-on from an increasing awareness about what we eat. That’s why we need a term such as “craft beer.” It’s there to label what we drink as different. In five or ten years’ time it’ll be an outdated term, and we’ll look back on the last decade and laugh about when we called it “craft,” but, while we’ve still got people out there to convert, we need a name for our team: Craft Beer United works for me.


Making beer is, in theory, a simple process: mix grain and hot water in a mash tun, separate them, and then dump the spent grain; move the liquid (now called wort) into a kettle, boil, add hops, and transfer to a fermentation tank; add yeast, let it ferment, and leave to condition before packaging (with or without filtering first); and then drink.

Making beer is, in reality, a very complicated thing. Breweries use different systems and processes, and every single ingredient or production choice will affect the final drink. The following pages look at the key ingredients as well as at how beer is made.


Don’t underestimate the importance of water: it is the main constituent of beer, and you need good water to make good beer. Because water provides the base for the beer, it has to be of great quality. Small differences in water composition can result in big differences in flavor. Soft water, for example, gives beer a soft, clean body and is especially good in lighter beer styles, such as Helles and Pilsner, while hard water gives a dryness that emphasizes hop and malt bitterness, so is good for IPAs and Stouts. Great brewing towns (such as Pilsen, in the Czech Republic, with its soft water; Burton-on-Trent, in England, with its hard water; and Bend, in Oregon, with its fresh mountain water) have grown—and continue to grow—around the best water sources.

All breweries treat their water in some way. Some breweries have a treatment plant to control the water, while others simply add different salts and minerals to the brew. This is to balance the water composition to suit the beers they make and to ensure that the brewing water (known as liquor) is always consistent.


The combination of water and grain creates the rough outline of the beer before the defining details are provided by the hops and yeast. Malted barley is the most common brewing grain but it is not the only cereal used: wheat, oats, and rye add texture and flavor to beer, while rice and maize tend to lighten flavor (and are generally only used in macrobrewing).

Grain provides the sugars needed to make alcohol, so if you want a lot of alcohol, then you need a lot of grain. It also provides body and color, and the brewer produces the foundation for the beer by combining different types of grain. For example, pale malt, Munich malt, crystal malt, and chocolate malt might give you a good Brown Ale base: replace the Munich malt with roasted barley, and you get a Stout; lose all the dark malt and increase the pale, and you’ve got an IPA.

Before it can be used in a brew, the barley has to be malted. There’s a little pearl of sweetness inside each grain that holds the starches, which are converted into sugars (these are later turned into alcohol by the yeast). As barley has a hard outer husk, it needs to germinate first, meaning it’s soaked in water so that the rootlets can crack through the shell. At this point, the germination process is stopped, the grains are dried in a kiln, and then roasted to different levels—the longer they are roasted, the darker they’ll become. Think of it like toast: it starts sweet and bready, gets caramelized and sweeter in the middle, and then, if you leave the bread in the toaster for too long, it becomes black, brittle, and bitter with no remaining sweetness.

Different malts undergo different processes to change their starch and sugar content. Crystal malt, for example, is germinated, then immediately heated to convert the starch to sugar, emulating the mashing process, and then roasted, with the end result being crystallized sugars that are unfer
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r usually won’t turn it brown on its own—just bubbly. To get a beautiful brown topping on any baked mac, we recommend separately toasting the panko beforehand (step 2, above) so you can achieve the same visual effect without overcooking the mac.

Mac Sauce (Béchamel 101)

Mac Sauce

(Béchamel 101)

This simple, creamy, and delicious sauce is the base for all of our mac and cheese recipes. The French call it béchamel. We call it Mac Sauce.

We’re pretty certain this sauce will change your life—it has certainly changed ours. Once you learn this recipe, you can make countless varieties of mac and cheese just by adding whatever tasty cheese you like, starting with little else than what you have in your fridge. And the great news is that it’s really simple—just flour, butter, milk, and salt. The secret is in the whisk—once you’ve added the milk, just keep stirring and before you know it, your sauce will be thick, creamy, and the foundation of many awesome mac and cheeses to come.

This recipe makes three cups of sauce—the recipes call for two, but it is wise to make a little extra in case someone wants their mac a bit saucier. It is also somewhat difficult to make only two cups of sauce because you don’t have much liquid to work with—so we’ve found that three is necessary for the easiest preparation. You can use Mac Sauce to make amazing biscuits and gravy if you just fry up bacon and add the bacon grease and chopped up bacon (use our biscuit recipe as the base for this). You can also make chicken à la king if you add cooked chicken and peas, and serve it over rice. Mac Sauce is also great as a base or thickener for soups like clam chowder or cream of potato.

A few other things to consider when you are making your Mac Sauce—use whole milk. Don’t cut corners and use low-fat or nonfat milk or it will end up tasting watery and gross, resulting in a rather sad-tasting mac and cheese. Also, if you have one around, it’s best to use a heavy-bottomed pot to cook the sauce because it will keep the milk from burning and will allow it to cook evenly. One last thing—pay attention to the type of salt you use because it makes a difference (see “A Word on Salt”). Makes 3 cups

3 cups whole milk

½ cup unsalted butter

½ cup all-purpose flour

2 teaspoons kosher salt or 1 teaspoon table salt


1 Heat the milk in a pot over medium heat until it just starts to bubble, but is not boiling, 3 to 4 minutes. Remove from the heat.

2 Heat the butter over medium heat in a separate, heavy-bottomed pot. When the butter has just melted, add the flour and whisk constantly until the mixture turns light brown, about 3 minutes. Remove from the heat.

3 Slowly pour the warm milk, about 1 cup at a time, into the butter-flour mixture, whisking constantly. It will get very thick when you first add the milk, and thinner as you slowly pour in the entire 3 cups. This is normal.

4 Once all the milk has been added, set the pot back over medium-high heat, and continue to whisk constantly. In the next 2 to 3 minutes the sauce should come together and become silky and thick. Use the spoon test to make sure it’s ready (see picture, opposite). To do this, dip a metal spoon into the sauce—if the sauce coats the spoon and doesn’t slide off like milk, you’ll know it’s ready. You should be able to run your finger along the spoon and have the impression remain. Add the salt.

5 The Mac Sauce is ready to use immediately and does not need to cool. Store it in the fridge for a day or two if you want to make it ahead of time—it will get a lot thicker when put in the fridge, so it may need a little milk to thin it out a bit when it comes time to melt in the cheese. Try melting the cheese into the sauce first, and if it is too thick then add milk as needed.

Troubleshooting Mac Sauce

Although Mac Sauce is pretty easy to make, there are a few common mistakes that folks often encounter. The good news is that there are basically only four ways you can screw up, and three of them are easily fixable.

My Mac Sauce came out really runny—it’s just like milk.

You probably didn’t cook the flour-butter mixture long enough—only when the flour gets nice and toasty before the milk is added does it thicken up the milk properly. The other possibility is that you may not have given the flour and milk enough time to bind together over the heat. If you take your runny sauce and put it back on the stovetop over medium-high heat, and just keep whisking constantly, it will soon thicken up! This takes a little longer—but still should only be about ten minutes before you notice that your sauce is getting thick, rich, and creamy looking.

My Mac Sauce has brown flecks in it.

If you see little brown flecks and taste a nutty flavor, it means you overcooked the butter-flour mixture and the flour was actually toasted instead of just cooked. When the flour is toasted it gets a nutt
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e Garnelen auf Spieße stecken und über die Schale legen oder einzeln in der Gazpacho anrichten.


Was bedeuten die Zahlen 8/12, 16/20 oder 21/30 auf den Garnelenverpackungen?

Die Zahlen geben Auskunft darüber, wie viele Stück Garnelen ein englisches Pfund (ca. 450 g) aufwiegen. Das bedeutet, je kleiner die Zahlen sind, desto größer sind die Garnelen.

Ofenzwiebeln mit Pinienkernen, Honig und Ziegenfrischkäse

2 Personen

30 Minuten

2 kleine Zucchini

6 kleine Gemüsezwiebeln

100 g grobes Meersalz

1 EL Pinienkerne

100 g Ziegenfrischkäse (z. B. Picandou)


frisch gemahlener schwarzer Pfeffer

2 – 3 EL flüssiger Honig

Die Zucchini waschen und mit einem Sparschäler oder einer Aufschnittmaschine längs in dünne Streifen schneiden. Diese auf eine einheitliche Größe zuschneiden und etwas salzen. Die Zucchinistreifen trocken tupfen und leicht überlappend auf zwei Tellern auslegen.

Das grobe Meersalz auf ein Backblech streuen. Die Zwiebeln in der Schale daraufsetzen und im auf 180 °C vorgeheizten Backofen (Ober-/Unterhitze) garen, bis der Saft oben austritt. Währenddessen die Pinienkerne in einer beschichteten Pfanne ohne Fettzugabe goldbraun anrösten.

Zum Anrichten

Das weiche Innere der Zwiebeln aus der Schale drücken und mit dem grob zerbrochenen Ziegenfrischkäse, sowie den gerösteten Pinienkernen auf den Zucchinistreifen anrichten. Anschließend mit Salz und Pfeffer würzen und mit etwas Honig beträufeln.


Solche Zwiebeln habe ich in einem Sommerurlaub in Ligurien gegessen und war begeistert. Daher weiß ich: Das ist ein ideales Essen, wenn es heiß ist und man sich zu Hause wie in der Sommerfrische fühlen will …

Gebackenes Ei mit Nussbutter-Spinat

2 Personen

ca. ­30 Minuten

Für die gebackenen Eier

2 Bio-Eier

1 EL Mehl, Type 405

1 Ei, verquirrlt

1 EL Pankomehl (japanisches Brotmehl, alternativ geriebenes Weißbrot)

Sonnenblumenöl zum Frittieren

Für den Spinat

400 g frischer Spinat

2 EL Butter


frisch gemahlener schwarzer Pfeffer

Für die gebackenen Eier

In einem Topf reichlich Wasser zum Kochen bringen. Die Eier ins Wasser gleiten lassen und darin 5 Minuten wachsweich kochen. Dann die Eier aus dem Wasser heben, kalt abschrecken und schälen. Die geschälten Eier leicht mit dem Mehl bestäuben und mit dem geschlagenen Ei, sowie dem Pankomehl panieren. Reichlich Öl in einem Topf erhitzen. Wenn sich an einem eingetauchten Holzstiel Blasen bilden die panierten Eier goldbraun ausbacken. Dann auf Küchenkrepp abtropfen lassen.

Für den Spinat

Den Spinat putzen, waschen und trocken schleudern. Die Butter in einer beschichteten Pfanne bei mittlerer Hitze bräunen und den Spinat hineingeben. Nachdem die Spinatblätter zusammengefallen sind, mit Salz und Pfeffer würzen.

Zum Anrichten

Den Spinat auf zwei Schalen verteilen und die Butter darüberträufeln. Die gebackenen Eier vorsichtig halbieren und auf den Spinat setzen.


Da Pankomehl eine gröbere Struktur hat als unser Paniermehl, wird es beim Ausbacken besonders knusprig und die Panade bleibt auch länger kross.

Pochiertes Rotweinei mit Ziegenfrischkäsetapenade

2 Personen

30 Minuten

Für das Rotweinei

250 ml trockener Rotwein

40 ml Rotweinessig


2 Eier

80 ml roter Portwein

1 Knoblauchzehe

1 Lorbeerblatt

5 weiße Pfefferkörner

½ TL Speisestärke

50 g kalte Butter

frisch gemahlener schwarzer Pfeffer

1 EL Butterschmalz

2 Scheiben Kastenweißbrot, ohne Rinde

Für die Tapenade

4 Anchovis (Sardellen)

2 EL schwarze Oliven, ohne Kern

1 TL Kapern, abgetropft

1 Knoblauchzehe, geschält

1 EL Olivenöl, extra vergine

1 Zweig Thymian

1 Bio-Zitrone

100 g Ziegenfrischkäse

Für das Rotweinei

Den Rotwein mit dem Essig zum Köcheln bringen und leicht salzen. Die Eier einzeln in eine kleine Schöpfkelle schlagen, langsam in den köchelnden Rotwein gleiten lassen und ca. 3 Minuten pochieren. Herausnehmen und warm stellen.

200 g Rotweinsud abnehmen und zusammen mit dem roten Portwein in einem Topf auf ca. 50 ml einkochen. Die Knoblauchzehe mit der Breitseite eines Messers etwas andrücken und zusammen mit dem Lorbeerblatt und den weißen Pfefferkörnern in den Sud geben.

Den reduzierten Sud durch ein Sieb in einen Topf passieren. Bei mittlerer Hitze die Reduktion leicht mit der Stärke abbinden und die kalte Butter einrühren. Mit Salz und Pfeffer abschmecken. Die pochierten Eier in dieser Reduktion kurz nachziehen lassen. Das Butterschmalz in einer beschichteten Pfanne bei mittlerer Hitze erhitzen und die Weißbrotscheiben darin goldbraun rösten.

Für die Tapenade

Die Hälfte der Anchovis, der Oliven und der Kapern mit etwas Olivenöl und dem Knoblauch in einem Mörser zu einer Paste zerreiben.

Mit Salz und Pfeffer, dem Thymian und der abgeriebenen Zitronenschale abschmecken.

Zum Anrichten

85 study. Israel lies much closer to the equator than Scandinavia. Yet American- or European-born Israelis suffer hip fractures at rates almost as high as those in Sweden and Finland.

Consider Washington, DC. It receives much more daytime sunlight than Scandinavia, but according to the 1985 study, white people in the nation’s capital suffer as many hip fractures as Scandinavians. In the 1992 report as well, whites in the United States have hip fracture rates similar to Scandinavia.

Or consider the 2000 study: Germany and the Netherlands are located at more or less the same latitude, but Holland’s hip fracture rate is less than one-third of Germany’s.

Finally, consider the 2006 study: the former East and West Germany lie at the same latitude, but hip fractures are more of a problem in the West than the East.

Perhaps vitamin D deficiency has something to do with worldwide differences in hip fracture risk. But by itself, vitamin D deficiency provides no compelling explanation for these differences or for the calcium paradox.


Weight-bearing exercise plays a key role in bone strength and fracture resistance. Meanwhile, Americans are notoriously sedentary. According to the Centers for Disease Control and Prevention (CDC), only 48 percent of Americans get the recommended thirty to sixty minutes of regular, moderate exercise (walking, biking, swimming, gardening, and so forth) every day. Some osteoporosis experts blame a sedentary lifestyle for America’s high rate of hip fracture. This makes sense—until we look at the rates worldwide.

Consider Saudi Arabia. In Saudi society, women are largely confined to their homes. Many are not allowed to appear on the street without a male relative escort, and by U.S. standards their educational, employment, and activity opportunities are quite limited. It’s hard to see how the typical Saudi woman could get much exercise. Yet, in the 2000 study, Saudi women’s risk of hip fracture is less than half that of American women.

Now consider Singapore, a technologically advanced, densely urbanized country filled with motor vehicles where most people live in high-rise apartment towers and do as little physical labor as most Americans. In all four studies, Singaporeans’ risk of hip fracture is considerably lower than Americans’.

Perhaps differing rates of exercise have something to do with worldwide differences in hip fracture risk. But by itself exercise provides no compelling explanation for these differences or for the calcium paradox.


Many studies show that hip fracture rates vary substantially among the races, with whites having higher rates than Africans or Asians. As a result, some researchers have suggested that racial genetic differences govern bone strength.

At first glance this appears plausible. Consider the 1985 study. Whites and African-Americans living in Washington, DC, have similar sun exposure, but the whites have almost twice the risk of hip fracture. The situation is similar for whites and the native Maori in New Zealand and for European- versus African-born Israelis. In every case the whites suffer considerably more hip fractures.

But if race determines bone strength, we would expect all whites, all Asians, and all Africans to have approximately the same fracture risk. This is not the case. In all four studies, Asian residents of Hong Kong have higher rates than other Asians—in the 2000 study more than twenty times the rate in China. In addition, African-American women in Washington, DC, have much greater hip fracture risk than black African women.

Finally, in the 2000 study, Nigerians have a tiny hip fracture rate, just 1 per 100,000, much less than any figure for African-Americans. Meanwhile, the ancestors of most African-Americans were taken from the area around Nigeria. This happened only four hundred years ago, nowhere near long enough for genetic differences to have developed. In other words, Nigerians and African-Americans come from similar genetic stock, but African-Americans suffer much more osteoporosis.

While race may play some role in fracture risk, by itself it offers no compelling explanation for worldwide differences or for the calcium paradox.

Epidemiology: A Science of Insights—and Limits

As the four studies show, osteoporosis is not an epidemic in much of Asia, Africa, or Latin America. But it has reached epidemic proportions in the United States and much of Europe. As a result, it has attracted interest from epidemiologists, who focus on the big picture—the forest, not the trees.

Epidemiology’s strength is its ability to discover associations. One of its greatest triumphs was the discovery of the association between smoking and lung cancer. An association may show scientific researchers where to look for cause-and-effect relationships, but it never proves a cause-


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