A taste that transcends time, an American emblem.

In Times Square’s bustling scene, I savored you,

Nathan’s masterpiece, as I toiled on Broadway’s stage.

As a part-time employee in that bustling space,

Where documents flew and deadlines gave chase,

Amidst the chorus of keys and whirring machines,

I found solace in your presence, your flavors serene.

But it was on July 4th, in Dobbs Ferry, I recall,

My first encounter with you, a revelation, overall.

At my uncle’s house, laughter filled the air,

As I sank my teeth into a grilled Hebrew National, rare.

I listened to Mel Allen’s voice on a transistor radio,

His iconic commentary filled the air with a vibrant glow.

As the hot dog sizzled on the grill, a symphony of flavors,

His voice painted the scene, enhancing the savors.

Amidst family and friends, laughter filled the space,

The transistor radio playing, a joyful embrace.

Dobbs Ferry’s charm, the hot dog’s savory bliss,

A symphony of summer, a moment not to miss.

In the sweet voice of Mel Allen, the stadium would sway,

As he announced a Mantle home run, “going, going, gone,” he’d say.

Toasted buns, untoasted buns, a debate so grand,

A choice that divides, across this great land.

Yet, as I bit into your warmth, the bun held you close,

A perfect union, each flavor enhancing the other’s dose.

Oh, hot dog, your history we must embrace,

From street carts to ballparks, a cherished place.

A symbol of immigrants’ dreams and endeavors,

Your origins intertwined with American treasures.

From German immigrants’ humble sausages, they say,

You were born in the streets of New York, they portray.

From Coney Island’s Nathan’s to Times Square’s allure,

You’ve become a culinary icon, timeless and pure.

So, let us raise a bun, a condiment-laden cheer,

To the hot dog, beloved, let its legacy be clear.

In each bite we take, a taste of history is found,

A culinary masterpiece, forever renowned.

The events are fresh in my mind though the incident had occurred 6 decades earlier. My 6th birthday party was, by all metrics, a rousing social success. A spirited game of ‘pin the tail on the donkey’, engaging conversation about the latest “Romper Room” TV episodes and gourmet entrees of Nathan’s hot dogs gave way to a highly anticipated dessert. A platter of Hostess Twinkies were brought out  and distributed by my mom to the sugar craving denizens of North Queens, N.Y. A shadowy arm crossed my plate and and as fast as you could say “Captain Kangaroo,” my Twinkie was snatched by the pig-tailed girl who hastily ran through the door with her purloined goods and back to her lair one block away. New York City penal codes, my mom explained to my inconsolable self, did not apply to minors stealing baked goods. From that moment on, I never took pastries for granted. Was there something out there that could replace that lost Twinkie? 

New York City was the crucible for inspired bakeries. The 19th Germans were more interested in wars (Austro-Prussian War , Franco-Prussian War) than dessert cuisine, encouraging  German bakers to bring their flour, butter, eggs and sugar to the land of opportunity across the Atlantic. The Glasers, a Bavarian family, established a bakery in Yorkville, New York City and in 1904 invented the black and white cookie. Frosting, atop a cake dough base, it became a metaphor for racial equality (Seinfeld Black and White Cookie) as well as an iconic cookie. In Stuttgart Germany, an emigre, William Entenmann relocated to Brooklyn, N.Y. and peddled baked goods starting in 1898 to the hungry borough. His children expanded the product line and produced the near perfect N.Y. Style Crumbcake, enjoyed by proletariat and luminaries such as  Frank Sinatra who had the cake delivered weekly to his abode. The same year as William Entenmann was delivering his horse carriage delivered sweetness, a German couple, Catherine and George Ebinger started their version of cakes and pastries in South Brooklyn. My paternal grandmother, Celia, always had an Ebinger’s 7 layered chocolate cake prominently displayed in the kitchen.

The excellence of the bakeries in Brooklyn and Manhattan spilled out to Queens by the 1960’s. Storks, a German Bakery in Whitestone, was replete with their own version of buttery-inspired petit fours, black and whites and crumb cakes. Adventurer’s Inn, an amusement park near LaGuardia Airport, had an in house bakery that deconstructed the black and white cookie and re-engineered v. 2.0: a double-decker sandwich with a 2nd base cookie layered with thick fudge in the middle.

As my dessert satisfaction score and body mass index (BMI) rose in tandem, I felt some trepidation relocating to Los Angeles to further my education. Was this going to be baked goods hell or a hidden cookie oasis? I promptly found Canter’s Deli in L.A. and scored a West Coast black and white. Entenmann’s fortuitously expanded their crumb cake empire to the West Coast in the ‘70s and introduced the left coast to the wonders of their cookies and cakes. Ramen noodles and crumb cake; Mac and Cheese and black and whites; chef boyardee ravioli and Entenmann chocolate chip cookies: these were the student Michelin 4 star meals that resonated.

All things must pass, proclaimed George Harrison, and so did this pastry paradise. Cholesterol consciousness, living longer and the eating healthy mafia chipped away at my treasured baked goods. Ebinger’s went bankrupt, Glaser’s of Yorkville closed after a century of business and Entemann’s was sold and resold and nearly expunged all of their crumb cake production. Bakeries were shuttered and replaced by juice bars and  Acacia bowl outlets. Even the venerable Twinkie was re-engineered to include synthetic compounds that had little taste resemblance to earlier Twinkie generations. A dark age of baked goods was a foot. 

With a sullen demeanor, I capped off a recent lunch with apple slices and a bran muffin and set out to walk off some calories around Manhattan. Past the healthy bowl places and the passion fruit bars I went until I came across a serpentine line stretching multiple blocks down 3rd Avenue. “A new cookie store just opened” opined a prospective customer who was  at least 45 minutes from being served. Crumbl, a cookie emporium based in Utah was opening up their first store in New York City. Sullen looks turned to smiles as I contemplated the possible resurgence of the New York baked goods scene. Twinkies may come and go, I mused,  but the circle of spice arcs toward sweetness.  

We were going to the edge of civilization, as the Romans had defined it circa 2000 years ago. The Rhine and Danube were the North and Eastern boundaries of the empire, warding off the barbarians, the Goths, Vandals, Visigoths and Franks. The Franks had plundered Eastern and Western Europe, united under Charlemagne and eventually (?with the help of intermarriage and French wine) settled down in France so their ancestors could appreciate fine architecture, food and Jerry Lewis.

 The tragedies of history were retold by guides, museums and historical plaques as the craft dodged buoys and passed feudal castles. In Amsterdam, Cologne, Regensburg, Vienna, Rothenburg, Bratislava and Budapest were military monuments, holocaust memorials, mass graves, ramparts and moats, museum artifacts, artillery and ballistic impacts on stone walls that testified to perpetual war and oppression from the Middle Ages onward. The grievances are engraved in our schoolbooks: Romans v. Barbarians, Christians v. Arabs (Crusades 1-4), Protestants v. Catholics (30 Years War and others), Ottoman Empire v. “Civilized” Europe, Habsburgs v. National Uprisings in the mid nineteenth Century, Prussian Wars of the late 19th century.  The 20th century brought us World Wars I and II ending the Holy Roman and Ottoman Empires and Hitler and the Third Reich at the expense of over 60 million lives.

As we headed South and East along the Rivers, I encountered glimpses of my Jewish heritage. The Jewish Diaspora from antiquity forced migration from Western to Eastern Europe along the Rhine and Danube. Jews were  multilingual merchants, bridging the Arab and European divide and helping to create the trade routes from Asia, Africa and Europe. They were artisans in the pre-industrial world and creators of the financial world that allowed the development of city-states. Judaism financed the release of Richard the Lion Hearted of England’s release from captivity and paid for the defense of Vienna against Ottoman Invasion in the 17th century. Yet, each town’s history was marked by the same recurring theme: Jewish expulsion and persecution.

Tragedy often begets opportunity. Science, medicine and art blossomed along these European river tributaries. Booerhaave, the Dutch physician, organized hospital divisions, defined pathology and described his eponymous esophageal rupture syndrome. Dicke, an Amsterdam physician, recognized  abdominal pain and diarrhea in Dutch children reintroduced to bread following privations of World War II and described celiac disease. Down the Rhine at Erlangen, Germany, Demling and Classen devised a modified electrified wire passed through an endoscope and allowed non surgical removal of bile duct stones in a jaundiced nurse in 1973, introducing therapeutic biliary endoscopy to the world. Wilhelm Conrad Rontgen, discoverer of X rays, taught on the Mein River at Wurzburg in the late 19th century. Sigmund Freud’s psychoanalysis treatise and practice was a part of 1890’s Vienna. Laszlo Biro from Budapest, invented the ballpoint pen and freed the world from fountain pen leakage.

Music flourished along the river, providing the world with the classics from Mahler, Mozart, Beethoven and Liszt.

 History was infused in everything we saw and consumed. I ate herring in Amsterdam as the Dutch West India Company sailors did before traveling to Nieuw Amsterdam and quaffed Riesling from The Rhine Valley from Middle Age monastery vineyards. A McDonalds and statues of Ronald Reagan and George Bush in Budapest were symbols of who won the Cold War. 

The realities of the past portend the fragility of peace for the future. The murmurs from these ancient rivers give us pause to respect and cherish our freedoms. 

Through my nose, to the ethmoid sinuses, onto the olfactory epithelium and 60,000 smell neurons directed my pizza delivery directly to the frontal lobes and limbic system where Scotty’s still lived in vivid memory. This ecstatic experience is being stolen from millions by a renegade virus which has shut down the world for the last year. Expunging the smell and taste in some of the 25 million who have had COVID, which may have long lasting and permanent damage of the olfactory system. Malnutrition, depression and the loss of warning symptoms to natural gas leaks or tainted foods may be the legacy of sufferers of nasal COVID injury.

The least regarded of the five senses, smell and taste have taken a back seat in medical training and in popular culture. Medical school has few lectures on the proper function and diseases of smell and taste. Medical history taking neglects inquiry of one’s nasal and lingual capabilities. Olfaction has been a butt of jokes for generations of comics from the Simpson’s “smell you later”, Hawkeye Pierce’s ridicule on food sniffing in M*A*S*H and  Mel Brooks flatulence scene in “Blazing Saddles.” 

The dismissal of this forsaken sense is belied by its prominent location. The olfactory nerve, the shortest of the cranial nerves, sits in the front of the brain and sends projections to multiple areas including the emotional hub, the limbic system. Our evolutionary ancestors and current mammalian brethren rely on scent to distinguish friend from foe and food from poison. Our beloved canine, Millie, the Jack Russell Terrier from times past would apply the sniff test and rarely made a bad decision on food or domicile choices.

Obscure medical jargon has entered the mainstream with anosmia (lack of smell), parosmia (smell that fails to correctly match the odor) and phantosmia (phantom smells) appearing on long hauler COVID social sites. “Everything smells like burnt coffee” I heard a patient exclaim. “No longer can I taste the citrus in my tea,” another laments. “I ate a hamburger and I miss the onion smell and taste.” Essential oil kits are hawked on Amazon in the hope that olfactory re-education may hasten recovery. While the long term outcomes are not apparent in so recent a disease, it appears that up to 5% of smell sufferers may not  regain perception at 6 months.

“Don’t it always seems to go that you don’t know what you’ve got ’til its gone,” Joni Mitchell’s ballad went in the ’60’s.  And so it goes with Scotty’s appetizing, fragrant pies from the same decade. Enjoy your senses and don’t forget to stop and smell the pizza.

Our human engagement with infections is played out daily through our immune system. Ironically, we are dependent upon our commensal microbes that happily reside in our bodies to assist in the fight against environmental, viral and bacterial invaders.  Over one hundred trillion bacteria and untold fungi, archaea and microscopic multicellular microbes take up residence in the gut after birth.  These microbes are a virtual army responsible for innate immunity and the initial fighting response to pathogenic agents. Furthermore, these bacteria contribute forty times more genes in the gut than human genes in the entire body. The exact role of these genes is uncertain, but they may produce proteins that may influence the bodies fighting power.  It is believed this gut bacterial diversity and their metabolites protect us by establishing an intact mechanical barrier, facilitating the release of bacterial and human antimicrobial chemicals and competing with pathogens for nutrients. They trigger the inflammasome, a coordinated release of immune stimulating chemicals (cytokines) that arm the lymphocytes, macrophages, neutrophils, dendritic and plasma cells that produce the coordinated inflammatory response.  A delayed innate response can result in a virus that gains a foothold that cannot be stopped. Similar to friendly fire, an over exuberant immune response can injure tissue from toxic inflammatory chemicals long after the pathogen has been vanquished.

Older age, diabetes and obesity are clearly risk factors for severe adverse outcomes with COVID-19. The common metric of these risks are a dysfunctional immune response. A slow initial response or an unregulated and injurious inflammatory reaction can result in devastating consequences for the infected host.  The gut microbes and their genes, the so called microbiome, are fundamental for a proper defense to infectious agents. A healthy microbiota is still being defined, but with new molecular biological techniques, a diverse population of organisms is critical to drive down the middle lane of life–away from infectious disease and autoimmune/allergic disorders. Altered microbiota or dysbiosis, is the hallmark of obesity and diabetes. And our country is flush with these risks. Over 40% of the U.S. is obese, representating a four-fold increase in prevalence since the 1960’s.

The microbiota can be malleable and is dictated by food for good or bad. And, food choices in our country may have steered us into more fatal outcomes with COVID-19. Processed food, hydrogenated and trans fats, high fructose corn syrup, larger portion size with higher calories and antibiotic tainted meats have assaulted the beneficial microbes in us. Could this be one of the reasons we are the leading country in COVID-19 cases and deaths?

Social distancing and masks are first line defenses against the Coronavirus fight.  Food choices MAY be another volitional pathway to maintain health. Fermented foods can select for beneficial commensal bacteria that make-up one’s microbiota. Greek yogurt, sauerkraut, tempeh, kimchi, and miso can favor the growth of Lactobacilli and Bifidobacter genera, both known to be healthy members of the microbiome.  Germany, Korea and Japan have low per capita rates of disease, attributed to timely public health measures and widespread COVID-19 testing. Might these differences be partly explained by eating sauerkraut in Germany, kimchi in Korea and miso in Japan?  Do some long standing cultural food preferences select for a healthier microbiome that is protective for Coronavirus infection or helps to modulate an appropriate immune response?  It seems to this clinician that it’s worth a clinical study as we, the people of every culture and nation, come together to collectively look to each other for any possible clue to mitigate the ravages of this virus.