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The Place of the Physician in Sri Lanka’s Society

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“The Best Physician is also a Philosopher”

Galen of Pergamon (c.129 –  216 AD )

An institution, a learned society and a body of practitioners, the Ceylon College of Physicians stands at the apex of medical learning and practice in Sri Lanka. For over half a century, the College has fulfilled an integral role in medical education and the maintenance of professional standards. As an institution, it has played a valuable part in the building of our nation. As a scholar, a historian and a Sri Lankan, it is a privilege and an honour to address its 52nd assembly.

In a thought provoking conclusion to the 50th Anniversary Commemorative Volume, Dr Panduka Karunanayake, President Elect for 2017, explores new horizons. In an increasingly technological age, he underlines the great need to master the human and social aspects of healing. A profession that truly cares for its patients in every sense of the word, must seek to understand and shape the future. This demands that the physician not only advise patients but that he guide society. If as Dr. Karunanayake suggests, the physician is to shape the future, he must endeavor to understand the human being, his society and his environment.

This was a philosophy which was articulated by one of the fathers of western medicine Aelius Galenus better known as Galen of Pergamon. The most celebrated medical authority of the Roman empire, Galen was one of the greatest physicians and surgeons of the ancient world. He has authored more books still in existence than any other ancient Greek. With the exception of Aristotle and Plato, he ranks as one most influential intellectuals in the classical west.

Born into the intellectual and social elite, Galen was son of a wealthy architect with scholarly interests and he received an excellent education. He travelled and studied widely, spending several years at Alexandria in Egypt, the greatest medical centre of the age. Returning home he spent four years tending a troupe of gladiators, eventually become the personal physician to a succession of Roman emperors.

Described by the Emperor Marcus Aurelius as “First among doctors and unique among philosophers,” Galen strongly believed that science and medicine must be practised in the context of human desires and needs. For him, medicine was an interdisciplinary field where science, ethics and the arts were all interwoven He saw himself as both a physician and a philosopher and believed that the study of philosophy would make for a better scientist, hence his short treatise The Best Physician is also a Philosopher.

In an eerie evocation of a contemporary dilemma Galen attacks the medical culture of his day which

“…encourages people to value wealth over virtue. For, “it is impossible to pursue financial gain at the same time as training oneself in so great an art as medicine; someone who is really enthusiastic about one of these aims, money or medicine, will inevitably despise the other.”

Galen advocated the study of arts and letters as an essential component of scientific study. In another work An Exhortation to Study the Arts, he warns against specialized isolation and lists several arts which he categorizes as divine gifts because they are useful to life. Alongside natural science and medicine, he also lists poetry, music, and philosophy. This underlines his belief that physicians must be specialists who were not only technically competent but also humane and morally responsible. According to Galen, proper, precise scientific inquiry was indeed ‘useful for life’. However, it could not be accomplished by scientists who were not properly trained in the other arts, because they would not then possess the humanity, the sensitivity, to do that science properly.

There does not appear to be a great distance between Galen’s creed and the requirements of contemporary medicine. A modern day physician like a philosopher is trained to think, to inquire and to ask questions. It is perhaps one of the foundations of his long and rigorous education. A good physician, like a good philosopher is always asking questions. It is by asking the best possible questions that he can make conclusions and diagnose.

A real philosopher is always open to question. This is even more the case with medicine. The danger is that answers shut down questions. Therefore the physician must always be open to question. As it is a question of wellbeing, of life and death, these questions are always shifting, changing with the time and the moment. If as a physician one must come to a conclusion, one can only do that by becoming a philosopher. To do that the physician must be able to listen, to observe, to think and to question. He must have time and make time. Time to listen, time to ponder, time to think, to analyze and evaluate.

It is a dilemma which still lies at the core of modern medicine. In an age where the internet and artificial intelligence have made vast inroads into the credibility of the physician, what makes him special is that although modern technology can make diagnoses, it cannot take a judgement call. That judgement call still rests on the human element, the physician’s understanding of the social context- on factors such as belief, culture, environment, sustainability and cost. This will determine the success of the cure. As Dr. Karunanayake foresees, if the physician is to play a role in the future, he must endeavor to understand the human being, his society and his setting.

The history of medicine reveals that physicians have occupied a special role in many parts of the world. Classical scholars have always regarded the ancient Greeks as the fathers of western medicine. However recent research suggests that the ancient Egyptians practised medicine long before the Greeks. The Edwin Smith Papyrus, an Egyptian surgical treatise dating from 1600 BC suggests that medical practice was well established in Egypt 1,000 years before Hippocrates. This documents 48 injuries which were described, diagnosed and treated rationally through observation and examination. It is thought to be a copy of a much earlier work dating from the 3rd millenium BC by the Egyptian polymath Imhotep. Chief Minister to the pharaoh, a priest, a sage and an architect, over the ages Imhotep was gradually glorified and became a god of healing.

His counterpart in the Greek world was Asklepios, the son of Apollo. The legend goes that Asclepius become so skilled that Zeus, the king of the gods, feared that he might render men immortal. To prevent this Zeus slew him with a thunderbolt and over time like Imhotep, he too became a God. His shrine at the sanctuary of Epidaurus became known as the Asklepieion and it grew into the most important centre of healing in the Greek world. The legacy of Asklepios looms large in the Greek tradition of healing. Hippocrates formal name was Hippocrates Asclepiades, “the “descendant of Asclepios.” Galen too, we are told was not destined to become a physician and only took up medicine after the God Asklepios appeared to his father in a dream.

In Ayurveda, the system of medicine and lifestyle developed in Ancient India, the pre- eminent figures are Sushruta and Charuka. Sushruta is thought to have lived near Varanisi during the 6th-7th century BC. Regarded as the father of Indian medicine, he was the main author of the Sushruta Samhita, one of the most important surviving ancient treatises on medicine. The other medical text to have survived from ancient India, the Charaka Samhita, was authored by Charaka, who is thought to have practised throughout the Punjab between the 2nd -3rd century BC.

One of the oldest medical systems in the world is traditional Chinese medicine. This tradition has produced many leading figures. In the 5th century BC Bian Que (Pien Ch’iao) was the first to rely primarily on pulse and physical examination for the diagnosis of disease. He was followed by Hua Tuo (Yuanhua) the greatest surgeon in Chinese history. In 2nd century AD he became the first person in China to use anesthesia during surgery.

Throughout the ancient world the practice of medicine was associated with learning and skill, over time it become a divine gift. The physician was the incarnation of Imhotep, Asklepios, Hippocrates, Galen; he was a god, a seer, a sage, a skilled and deeply learned practitioner, a guide and a philosopher. Only in Sri Lanka however, was the physician a king.

The place of the physician in Sri Lanka’s society is documented in the island’s great historical chronicle, the Mahavamsa. Compiled in Pali by Buddhist monks, the Mahāvaṃsa and its successor, the Cūlavaṃsa, charts the history of Lanka from the 5th century BC to the 18th century AD. It is a remarkably accurate record, of seminal value for the history of India and Sri Lanka.

King Buddhadasa reigned between 341 – 370 AD. The Culavamsa recounts how he diagnosed, treated and cured patients from all walks of life. The chronicle devotes several whole sections to the practice and establishment of medicine and documents at least seven detailed case studies. This suggests that the physician had a very special place in this society and that his story was as important as the great warriors, builders, saints and the monks who shaped the history of Lanka. Each of these case studies tells us different things. Each concerns a different situation and elicits a deeply and carefully thought out remedy, based on reasoned analysis and evaluation.

In one case, it tells of how a man drinking water swallowed the eggs of a watersnake. The egg gradually grew into a snake. As it grew sucked at the man’s intestines, torturing the victim with pain. The man sought out the king, who questioned him. When he described the pain and related what had happened the king realized that a reptile must have formed inside the man. However as the reptile was lodged deep inside the intestines, the king refrained from cutting it out.

Instead he made the man fast for a week, starving the reptile within him. He then had the patient, bathed and rubbed with oil. This calmed and soothed him and he eventually fell asleep. The king knew that when he was asleep that his mouth would open. He tied a piece of meat to a string and dangled it over his mouth. Lured by the smell and driven by hunger, the watersnake reached for the meat. The king however, held the string fast and drew on it, gradually pulling the reptile out.

Another case concerned a Bhikku or Buddhist priest, the most venerated member of society. The bhikku had gone begging for alms and was given milk which had worms in it. The worms grew and fed on his bowels, causing agonizing pain. The king then asked leading questions. At what meal did the pain arise? What kind of meal was it and what was the nature of the pain? When the bhikku told him that it was a meal that he took with milk, the king recognized the symptoms.

Taking the blood from a horse, he gave it to the monk to drink. He then waited until he had drunk it all. Then he told him that was horse’s blood. The reaction was what he had anticipated. On hearing that he had drunk the blood of a horse, the monk vomited, spitting out the blood. The worms which had caused him such pain, came up with the blood.

Compassion and feeling made up an essential part of the King’s healing skills. There is a deep feeling for life in all its forms. This applied even to the most dangerous animals. Galen had concluded that even dumb animals are not entirely devoid of reason. In Buddhadasa’s most wellknown case, the king cobra, one of Sri Lanka’s most venomous reptiles, becomes a willing patient. As the king passed by, the cobra turned over onto his back to expose his underbelly so that the king could see the tumour growing on it. After observing the growth, the king reasoned with the reptile. Although he understood its pain, he dared not touch it. Understanding the king’s dilemma, the snake stuck his whole neck into anthill so that he could not hurt the king. Whilst the cobra was immobilized, the king slit open his belly, removed the diseased growth and applied a healing remedy.

This episode suggest a high level of surgical skill. It is underlined by another. A young man had drunk water which was full of frog’s eggs. Through his nostrils an egg had penetrated into his skull and evolved into a frog. As the monsoon approached the frog became more and more agitated, causing unbearable headaches. In this case the king appears to have resorted to immediate surgery. Performing a complicated and dangerous operation, he split the skull and removed the frog and then put the parts of the skull back together.

Ancient Indic society was dominated by caste and social taboos. Despite this and ignoring own his royal status, Buddhadasa cut across every social barrier and boundary to serve the suffering. In Indian society the lowest and most menial of tasks were performed by the Caṇḍālas, outcastes who worked as sweepers and scavengers. A Candala woman who had already had seven children, became pregnant for the eighth time. This time however, her unborn child was facing the wrong way in the womb. When Buddhadasa learned that this, he intervened to save the woman’s life. In the ancient world, birth and reproduction were the preserve of women and midwives. Socially this is a unique case. It is also a complex gynecological procedure.

The understanding of the human mind is an integral part of the physician’s craft. More often than not it holds the key to the patient’s condition and his recovery. In ancient times leprosy was a common condition. Lepers were shunned and regarded with horror and leprosy deemed a curse of the Gods.

The king noticed a leper, who upon seeing him, became enraged, striking the ground with his staff. In a previous birth the king had been the leper’s slave, it maddened him to see him riding his elephant and all he wanted to do was to kill him. Learning of this, Buddhadasa set his mind to winning him over. He sent one of his men to befriend the leper and share his anger. Pretending that he too was against the king, he invited the leper to stay at his house and help him destroy his enemy. The leper was bathed, fed and given beautiful clothes and a comfortable bed to sleep. One day, when he had become happy, contented and calm, Buddhadasa’s man served him food and drink, saying, “This is the gift from the king.” At first the leper refused and then refused again. Finally he accepted. Reaching out to the most diseased and most deeply troubled member of his community, the king was able to heal his mind. It is a clear demonstration of the power of empathy, feeling for and feeling with. It is from empathy that re assurance comes. So much of healing is in the mind. If the physician can take the time and make the effort, he has the power to do great good.

All these cases make one point. The physician truly cares and feels for all his patients, no matter who they are or where they are from. In his posthumous work Galen and Galenism (2002) the Spanish historian and Physician, Luis García Ballester (1936-2000) quotes Galen as saying: “In order to diagnose, one must observe and reason.” This is the dictum which King Buddhadasa embodies. He observes closely, listens carefully and questions keenly, making every attempt to form a picture of the condition. It is then he makes his diagnosis and decides on course of action. A demonstration of the power of the mind, sustained thought and inquiry, it is characterized by understanding and feeling.

The Cūlavaṃsa praises King Buddhadasa as a “Mine of Virtue and a Sea of jewels.” This perception is based on the king’s understanding of the human and social aspects of healing, his ability to care and feel. It is probably this tradition which lies at the roots of the well known Sri Lankan saying “If you cannot be a king, become a healer.”

This is the challenge which western science and learning faces in one of the world’s oldest living cultures. This context demands that the physician be conscious of the rhythms of a society, whose needs, values and way of life are often quite distinct from western norms and practices, often very much older. If as an invited guest, I can make one suggestion, it is that Sri Lanka’s physicians begin to study their past. For it is through comparative traditions that we learn deeply about ourselves.

If he is to truly guide as well as “Cure, Relieve And Comfort,” the Physician must also strive be a Philosopher.

He must not only ask the best possible questions, most of all like King Buddhadasa, he must care, be concerned and compassionate. For that he must have time.

TITLE; SINHARAJA/ APRIL 4



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Peanuts good to keep heart healthy

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The peanut, also known as the groundnut, goober, pindar or monkey nut, is a legume crop grown mainly for its edible seeds. It is widely grown in the tropics and subtropics, important to both small and large commercial producers. It is classified as both a grain legume and, due to its high oil content, an oil crop. Wikipedia

Scientific name: Arachis hypogaea

Health Benefits of Peanuts

Surprisingly, peanuts are not actually in the nut family. They are classified as legumes along with foods like green peas, soybeans, and lentils. The peanut plant likely originated in South America in Brazil or Peru. Scientists have found 3,500-year-old pottery in the shape of peanuts, as well as decorated with peanuts, in South America.

Peanuts grow below ground as the fruit of the peanut plant. In the early 1800s, Americans started growing peanuts as a commercial crop. On average, Americans eat more than 6 pounds of peanuts per year. Today, 50% of the peanuts eaten in the United States are consumed in the form of peanut butter.

Health Benefits

Many people believe the peanut is not as nutritionally valuable as true nuts like almonds, walnuts, or cashews. But actually, peanuts have many of the same health benefits as the more expensive nuts and should not be overlooked as a nutritious food.

Heart Health

Much attention has been paid to walnuts and almonds as “heart-healthy” foods, given their high content of unsaturated fats. But research suggests that peanuts are every bit as good for heart health as more expensive nuts.

Peanuts help prevent heart disease by lowering cholesterol levels. They can also stop small blood clots from forming and reduce your risk of having a heart attack or stroke.

Weight Loss

Foods with a lot of protein can help you feel full with fewer calories. And among nuts, peanuts are second only to almonds when it comes to protein count. Studies have shown that people who include a moderate amount of peanuts in their diet will not gain weight from peanuts. In fact, peanuts could help them lose weight.

Longer Life Span

Eating peanuts might help you live longer too. A large-scale study found that people who regularly ate any kind of nuts (including peanuts) were less likely to die of any cause than were people who rarely ate nuts.

Because the study was observational, it cannot prove that peanuts were exactly what caused the lower death rates, but they are definitely associated with them.

Lower Diabetes Risk

Peanuts are a low-glycemic food, which means that eating them won’t cause a spike in your blood sugar levels. Studies have shown that eating peanuts can lower the risk of type 2 diabetes in women.

Reduce Inflammation

Peanuts are a good source of fiber, which helps reduce inflammation throughout your body as well as aids your digestive system.

Cancer Prevention

Research has demonstrated that for older people, eating peanut butter may help lower the risk of developing a certain type of stomach cancer called gastric non cardia adenocarcinoma.

Nutrition

Peanuts are rich in protein, fat, and fiber. While peanuts may have a large amount of fat, most of the fats they contain are known as “good fats.” These kinds of fats actually help lower your cholesterol levels.

Peanuts are also an excellent source of:

= Magnesium

= Folate

= Vitamin E

= Copper

= Arginine

= Nutrients per Serving

A ¼ cup serving of raw peanuts contains:

= Calories: 207

= Protein: 9 grams

= Fat: 18 grams

= Carbohydrates: 6 grams

= Protein: 9 grams

= Fiber: 3 grams

= Sugar: 1 gram

Things to Watch Out For

While peanuts are healthy foods, not everyone can enjoy them. An allergy to peanuts is the most common food allergy in the United States, causing the majority of all food-allergy-related deaths.

A mild peanut allergy shows symptoms like itchy hives, nausea, or swelling of the face. However, a severe peanut allergy can cause a life-threatening reaction known as anaphylaxis. Symptoms of anaphylaxis include trouble breathing; a change in alertness; nausea; vomiting; seizure; chest pain; swelling of the tongue, face, or lips; extreme drowsiness; and feeling dizzy, confused, or light-headed.

It’s important to talk to a doctor if you experience any uncomfortable feelings while eating peanuts.

– BBC

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Authentic Pakistani restaurant

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Khayaban stands out for it’s aromatic and sometimes spicy flavours. The all-new authentic Pakistani restaurant, located at Food Studio at the lower ground floor of the One Galle Face Mall, is now home to the rich flavors of Pakistani cuisine.

Pakistani cuisine can be characterized by a blend of various regional cooking traditions from South Asia,  Central  and Western Asia, as well as elements from its Mughal legacy. The country’s various cuisines are derived from its ethnic and cultural diversity.

Some of the dishes available are Karachi Buriyani, varieties of naan and rotties. The relishing buriyani which is considered to be the king of South Asian cuisine and a loved-by-all dish is very popular dish made by Pakistani chefs.. Brought by migrants from India, people who would come to be called Muhajirs, Biriyani was once a dish for royalty. In the decades that followed, it took on a life of its own. border

Yet another exiting dish served happens to be Pulao Rice. In each of the regions that make up the land, the less elaborate rice dish has historically been more popular. Plainer than buriyani, in Pakistan, Pulao is cooked with basmati rice and meat, usually either mutton or beef, and an array of spices including coriander seeds, cumin, cardamom, cloves, and others. And this style of Pulao is often embellished with sliced carrots, almonds, and raisins, fried in a sweet syrup. The restaurant also serves a variety of unique curries and dishes such as Tikka, Malai boti, Reshmi Kebabs and Makhini Handi as the perfect accompaniment to your meal!

Khayaban is yet another unique product of FS Culinary Concepts brand which is a part of Food Studio – the food court at One Galle Face. Khayaban is now open to the public at the One Galleface Mall for both dine-in and takeaway. Visit Khayaban for a uniquely Pakistani experience unlike any other.

FOOD STUDIO

Introduced to Sri Lanka through the high-end shopping malls of Colombo’s most prestigious mixed-use development projects, Food Studio is more than simply a food court, the Food Studio experience begins from the moment customers enter the sweeping market-style layout, with specially designed seating areas and thematic installations that adds a certain aura to the display of flavours. Our patrons are treated to a mouth-watering array of cuisines, many of which are plated up by Sri Lankan homegrown brands.

Food Studio is always specially laid out to bring together the right mix of eateries, with the tastiest ranging from the adventurous to the nostalgic, from street food to fine dining, and from East Asian sushi to artisanal gelato. Under one roof, customers can be assured of quality, variety, affordability and comfort.

www.foodstudio.lk
Pix by Nishendra Silva

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The truth about Japanese tempura

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When 16th-Century Portuguese came to Japan, they brought a special dish with them. Today, in Japan, it’s called tempura and has been a staple of the country’s cuisine ever since.

In 1543, a Chinese ship with three Portuguese sailors on board was headed to Macau, but was swept off course and ended up on the Japanese island of Tanegashima. Antonio da Mota, Francisco Zeimoto and Antonio Peixoto – the first Europeans to ever step on Japanese soil – were deemed ‘southern barbarians’ by the locals because of the direction from which they came and their ‘unusual’, non-Japanese features.

The Japanese were in the middle of a civil war and eventually began trading with the Portuguese, in general, for guns. And thus began a Portuguese trading post in Japan, starting with firearms and then other items such as soap, tobacco, wool and even recipes.

The Portuguese remained in Japan until 1639, when they were banished because the ruling shogun Iemitsu believed Christianity was a threat to Japanese society. As their ships sailed away for the final time, the Portuguese left an indelible mark on the island: a battered and fried green bean recipe called peixinhos da horta. Today, in Japan, it’s called tempura and has been a staple of the country’s cuisine ever since.

No-one knows the exact origins of peixinhos da horta. “We know it existed in 1543,” said Michelin-starred chef Jose Avillez when I met up with him at Cantinho de Avillez, one of his acclaimed Lisbon restaurants. “But before that, it’s anyone’s guess.”

Green beans, it turns out, changed food history.

However, peixinhos da horta was only one of many dishes the Portuguese inspired around the world. In fact, Portuguese cuisine, still heavily overshadowed by the cuisines of Italy, Spain and France, may be the most influential cuisine on the planet.

Portuguese cuisine may be the most influential cuisine on the planet

When the Portuguese turned up in Goa, India, where they stayed until 1961, they cooked a garlicky, wine-spiked pork dish called carne de vinha d’alhos, which was adopted by locals to become vindaloo, one of the most popular Indian dishes today.

In Malaysia, several staples, including the spicy stew debal, hail from Portuguese traders of centuries past. Egg tarts in Macao and southern China are direct descendants to the egg tarts found in Lisbon bakeries. And Brazil’s national dish, feijoada, a stew with beans and pork, has its origins in the northern Portuguese region of Minho; today, you can find variations of it everywhere the Portuguese have sailed, including Goa, Mozambique, Angola, Macau and Cape Verde.

Peixinhos da horta were often eaten during Lent or Ember days

(the word ‘tempura’ comes from the Latin word tempora, a term referring to these times of fasting), when the church dictated that Catholics go meatless.

“So the way around that,” Avillez said, “[was] to batter and fry a vegetable, like the green bean. And just to add to it, we called it peixinhos do horta, little fish of the garden. If you can’t eat meat for that period of time, this was a good replacement.”

The word ‘tempura’ comes from the Latin word tempora

And it had other functions too. “When the poor couldn’t afford fish, they would eat these fried green beans as a substitute,” Avillez said. And sailors would fry the beans to preserve them during long journeys, much in the way humans have been curing and salting meat for preservation purposes for centuries.

Perhaps not constricted by tradition, the Japanese lightened the batter and changed up the fillings. Today, everything from shrimp to sweet potatoes to shitake mushrooms is turned into tempura.

“The Japanese inherited the dish from us and they made it better,” Avillez said.

Avillez said Japanese people sometimes turn up at his restaurants and see the fried bean dish and say, “Hey, Portuguese cuisine is influenced by Japanese cuisine.” He added, “And that’s when I say, ‘No, in this case it’s the other way around’.” A Japanese-born sous chef at Avillez’s two-Michelin-starred Lisbon restaurant, Belcanto, even chose to train in Portugal instead of France because he recognized the influence on his home cuisine, particularly in peixinhos da horta.

Avillez said his one complaint about the dish, in general, has always been that the beans are often fried in the morning and so they go cold and limp by the time they get to the table later that day. He remedies this by not only cooking them on demand, but by adding a starch called nutrios that keeps them crispy. After the bean is blanched, it gets rolled in the batter of wheat flour, egg, milk, and nutrios and then flash fried.

Other chefs I talked to in Portugal had their own recipes for the fried green beans, but they didn’t deviate much. “It’s a very simple dish,” said chef Olivier da Costa, when I met up with him at his Lisbon restaurant Olivier Avenida, located in the Avani Avenida Liberdade hotel.

“I use a batter of flour, milk, eggs, salt, pepper and beer,” he said. “Beer?” I asked. “Yes! It ferments the batter and the beer foam gives it a better taste.” He didn’t have the dish on his menu at the time so I had to take his word for it.

One reason why Portuguese love peixinhos da horta so much, da Costa said, was nostalgia. “We all eat it as children and thus have fond memories of it. These days it’s been making a comeback, not just because people are eating more vegetarian food, but because a younger generation are taking more interest in our local cuisine and because they want to be taken back to that simpler time.”

Avillez is taking this newfound interest in super traditional Portuguese cuisine to a new level. Along with his Japanese-born sous chef, he plans to temporarily offer a tasting menu called ‘1543’, the year the Portuguese first showed up in Japan, offering peixinhos da horta and other Portuguese dishes that have inspired Japanese cuisine. Alongside the Portuguese dishes, he plans to serve the Japanese versions that evolved from the Portuguese presence in Japan four-and-a-half centuries ago.

Each bite was like taking a first bite

Back at Cantinho de Avillez, an order of peixinhos da horta appeared in front of me. They were rigid like pencils with a lumpy texture and a yellow-ish hue. Each bite was like taking a first bite: crisp, light and super flavourful, the crunchy texture of the batter complimenting the sturdy feel of the bean. The dish has been one of the only consistent items on the menu at Cantinho de Avillez, which opened in 2012.

“I can’t take it off,” Avillez said. “My regulars would be enraged.” (BBC)

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