Chanukah 2015

December 14, 2015


Chanukah has come and gone over the past week or so.  As I look at our now forlorn menorahs, still covered in candle wax, I ponder, the complexity of this holiday and what we celebrate.


Describing the Maccabees, Simon Sebag Montefiore, in his book “Jerusalem” writes, “As the heroes of Hanukkah, Jews traditionally regard them as freedom-fighters against a genocidal tyrant, a precursor of Hitler.  But some have suggested another view, inspired by today’s struggle between American democracy and jihadist terrorism, in which the Greeks are the civilized ones fighting Maccabee religious fanatics who resemble a Jewish Taleban.”


We have always been told that this holiday does not celebrate the military victory of what some say was the first guerilla war, when the Maccabees defeated the army of Antiocchus.  Rather we learn that we celebrate the miracle of light.  Quoting Montefiore again, “In the winter of 164 BC, Judah the Hammer conquered all of Judea and Jerusalem apart from Antiochus’ newly built Acra Fortress.  When Judah saw the Temple overgrown and deserted, he lamented.  He burned incense and rededicated the Holy of Holies and on 14 December presided as sacrifices resumed.  In the ravaged city, there was a shortage of oil to light the candelabra in the Temple, but somehow the candles never went out.  The liberation and resanctification of the Temple are still celebrated in the Jewish festival of Hanukah --- the Dedication.”


This miracle of oil has given rise to a tradition of cooking with oil to celebrate this holiday.  It has become tradition to serve latkes (fried potato pancakes) with applesauce and sourcream on Chanukah.  At least in the United States.  Not in Israel where the tradition is to eat doughnuts, in particular filled jelly and cream filled doughnuts.  This idea that we are supposed to eat fried foods is to remind us of the miracle of the oil that lasted eight days in the Temple’s sacred lamps.  Of course going out of your way to eat fried food in Israel where the national dish is falafel or here in the United States where French fries are probably the single most common food purchased outside the home, seems hardly out of the ordinary.  Perhaps two millennium ago, in an era when oil was expensive and not to be wasted on deep-frying, this indulgence was more celebratory.


Jerusalem doughnuts, Chanukah 2014


Applesauce probably had no place in the early celebrations of Chanukah. At least I don’t think so.  The earliest mention of applesauce comes from a cookbook written in 1390.


"Hot Applesauce (Appulmose) for Meat and Fish.

Nym appelyn and seth hem and lat hem kele and make hem throw a cloth and on flesch dayes kast therto god fat breyt of Bef and god wyte grees and sugar and safronn and almonde mylke of fische dayes, oyle de olyve and gode powdres and serve it forthe.”


This might read something like this in modern English:

"Take apples and poach them. And let them cool and put them through a strainer. And on flesh days, add good, rich beef broth and good white grease and sugar and saffron. On fish days, add almond milk, olive oil and ground spices. And serve it forth." [1] 


This recipe’s suggested addition of sugar, saffron, olive oil and almond milk to applesauce is something we should probably try.


Michael Pollan writes that apples originated in Kazakhstan and were not particularly tasty; in the US they were grown to make hard cider, not to eat, until relatively recently. [2]


We sometimes suggest taking some medicinal foods mixed into applesauce, for example flax seed meal or modified citrus pectin (Pectasol ™).  Putting a pill onto a spoon of applesauce will make the pill easier to swallow. 


Applesauce is a good medium in which to mix a number of drugs for patients who can’t swallow pills, in particular the chemo drug nilotinib.  Nilotinib is sold under the brand name Tasigna and is a small-molecule tyrosine kinase inhibitor used for the treatment of chronic myelogenous leukemia (CML) that is resistant to imatinib. 


Patients who have difficulty swallowing pills  are often told to mix the capsule contents with something like applesauce or yogurt.  While usually either food is a reasonable choice, it makes a difference with nilotinib. Yogurt increases absorption of this drug. Adding 400 mg of nilotinib to just a teaspoon of yogurt increased absorption by about 30%.  Adding the same dose to applesauce yielded blood levels that were the same as if the drug had been swallowed in capsules. [3] 

Do not mix this drug with yogurt. 


Nilotinib is a substrate for the enzyme CYP3A4, (this is why people taking this drug avoid grapefruit juice).  Things that induce production of this enzyme increase the drug’s action and things that inhibit this enzyme (think St John’s Wort) decrease the drug’s effect. This leads one to wonder if yogurt somehow impacts CYP3a4 but no readily available data provide us with an answer.  People should not play around with dosing of chemodrugs; we want to be very careful and never eat yogurt with nilotinib.  More absorption is not better.  Applesauce though is ok.


It is also OK to dissolve venlafaxine in applesauce. [4]  This is the generic name for the antidepressant drug Effexor.  Changes in Effexor metabolism are often used as a test of how other drugs affect metabolism via these cyp enzymes. There are other studies of specific drugs mixed with applesauce.  Let me skip listing each of these papers.  The bottom line is that applesauce does not cause much trouble.


Perhaps the lessons of Chanukah are more important than ever this year, the lesson that we look aside from the story of Mattathias and his five sons and the rebellion they led against Antiochus and the Seleucid Empire.  Perhaps there is good reason to devote less attention and praise to their radical rebellion against Greek modernization and focus our appreciation on the small miracles that happen in our lives.








[1] The Forme of Cury (circa 1390), edited by Samuel Pegge, [London:1780], as reprinted and translated in Apples: History, Folklore, Horticulture, and Gastronomy, Peter Wynne [Hawthorne Books:New York] 1975 (p. 201)


[2]  Michael Pollan. Breaking Ground: The Call of the Wild Apple. The New York Times, November 5, 1998


 [3] Yin OQ, Rudoltz M, Galetic I, Filian J, Krishna A, Zhou W, Custodio J, Golor G, Schran H. Effects of yogurt and applesauce on the oral bioavailability of nilotinib in healthy volunteers.vJ Clin Pharmacol. 2011 Nov;51(11):1580-6.


[4] Jain RT, Panda J, Srivastava A.Two Formulations of Venlafaxine are Bioequivalent when Administered as Open Capsule Mixed with Applesauce to Healthy Subjects.

Indian J Pharm Sci. 2011 Sep;73(5):510-6.