Doctors Fight 10,000 Year War

Pop Quiz

Killer bacteria MRSA are:

A.) a horror in our food chain
B.) a hot new political issue
C.) hot for string bikinis
D.) NOT any kind of flu
X E.) all the above

If you haven’t already heard of MRSA (pronounced “mersa‘), consider yourself lucky. For five years, Methicillin-resistant Staphylococcus aureus has been infecting 94,000 Americans and killing over 18,000 annually, more than AIDS. MRSA survivors form chatrooms and therapy groups that share some very ugly stories. An internet database search of “MRSA & horror” produced 97,000 hits. Recovered victims say things like “I was more afraid that I wouldn’t die.”

A Des Moines man talked about his MRSA ordeal, speaking anonymously because he was afraid people would ostracize his children if they heard about it.

“I went to the hospital with a bad stomach flu. A couple days later, strange pimples appeared on my stomach. They spread and turned into boils, then deep painful abscesses. One on top of my knee was so large that I couldn’t bend my knee at all. I went back to the hospital and was told I had this staph infection and that it didn’t respond to antibiotics. Then my kids got it from me. The boils had to be lanced to drain the pus. Finally at the Mayo Clinic, I was treated with the “last resort” antibiotics (Vancomycin). They actually call it that. It still took months to recover and there’s no guarantee they won’t come back,” he said.

A Brief History of MRSA

MRSA is any strain of Staphylococcus aureus (“staph“) that's resistant to the broad-spectrum antibiotics commonly used to treat it. Such infections usually remain on the skin or in the nasal cavity where they can easily be treated. If they enter the blood stream through surgical incisions, injuries, cuts, etc., they can cause life-threatening infections in bones, joints, the bloodstream, heart valves and lungs.

Until recently, MRSA had two basic forms, both potentially fatal. Hospital-acquired (HA-MRSA) strain was identified in 1963 and usually strikes older adults and people with weakened immune systems. In the 1990‘s CA-MRSA was diagnosed among otherwise healthy people, often athletes, in the wider community. That form is responsible for serious skin and soft tissue infections and for a bad form of pneumonia.

In 2004 a baby girl in the Netherlands tested positive for a new strain - ST398. Authorities investigated her family’s farm and discovered the strain on family members, co-workers and eighty per cent of the family’s pigs. A follow up Dutch study found hog farmers 760 times more likely than the general population to carry MRSA, without necessarily showing symptoms. Within two years, ST398 accounted for thirty per cent of all staph infections in Holland and also had been identified in the United Kingdom and Canada.

On the last day of 2008, etiologist Dr. Tara Smith reported a study she led by nine University of Iowa scientists. It found ST398 in over seventy percent of swine and over two thirds of swine workers sampled in the “production pyramid” of one hog company with 60,000 pigs in Iowa and Illinois. At another, smaller company, no hogs or workers tested positive for the bacterium. The scientists concluded that agricultural animals could become an important reservoir for ST398 to grow and spread.

Two months later, New York Times’ Nicolas Kristof launched ST398 into the public dialogue. He noted that seventy percent of all antibiotics in the United States go to healthy livestock and concluded “that’s one reason we’re seeing the rise of pathogens that defy antibiotics.” Kristof also reported that “dangerous pathogens are now even in our food supply.”

His column was perceived as a smoking gun in the natural food media (where this writer often hangs his hat). There it was believed that pig strain MRSA would rally public opinion and demand the end of the prophylactic use in livestock of antibiotics important to humans. That point of view built momentum four years earlier when McDonalds quit buying chickens from producers who used antibiotics for routine disease prevention.

Following Kristof’s column, Louise Slaughter (Dem, NY) introduced the Preservation of Antibiotics for Medical Treatment Act (PAMTA) in the US House of Representatives. That bill would curtail the overuse of antibiotics in food animal production. More than 350 groups, including the American Medical Association, endorsed the bill. The US Senate then introduced similar legislation.

Natural food media reacted with ecstatic optimism, even predictions about the end of confined animal feeding operations (CAFO’s) that cram tens of thousands of pigs together. For years CAFO’s opponents hoped the stench of their concentrated manure would inspire legislation. That didn’t happen in a significant way. Pig strain MRSA became their new hope.

Dr. David Wallinger, Director of Food & Health Programs for the Institute for Agriculture and Trade Policies, offered a relatively conservative explanation for why he‘s supported PAMTA legislation for decades.

“What most people should know is first that most MRSA that is found on pig farms is found on the pig farms that use the most antibiotics.

Secondly, in Tara Smith’s study, the resistance profile shows that antibiotics in the pig profile are the same antibiotics that are used importantly in human medicine. MRSA strains linked to CAFO’s drive the development of resistant strains that effect humans - salmonella included,” he warned.

When a new strain of flu virus broke out in Mexico in March 2009, investigators identified it as a unique chimera of bird, pig and human flu strains. Early investigations suggested it spread from a 950,000 hogs-a-year CAFO under a bird migration pathway where manure lagoons, recycled ground water and flies helped concoct a horrible new zygotic bastard. With surgical masks on subways and 130,000 empty seats at a soccer game, this “swine flu” virus produced photo ops and shock value. Before it infected 100 Americans or killed any, this new bug had pushed MRSA, with its literal epidemic statistics, out of the news. That left many unanswered questions.

Good Pig, Bad Pig

Abundant with both CAFO’s and free ranged pig farms, Cerro Gordo County offers some answers. In Thornton, Paul and Phyllis Willis of Niman Ranch let their pigs run free so that mothers can build their own nests to farrow. Those pigs are never given preventative antibiotics. Phyllis admitted that Niman had been the second control group in the University of Iowa study, the pyramid of farms on which zero hogs and zero workers tested positive for MRSA. She said the tests reinforced her belief that raising pigs under humane and sustainable protocols “is the best thing for the pigs, the product and the health of people and the environment.”

In mid April 2009, between Paul and Phyllis’ farms and one owned by her daughter Sarah Willis, multiple dumpsters on CAFO’s overflowed with dead pigs.

“The Darling (International, Inc.) dead pig truck only comes to haul them away twice a week and lately that hasn’t been fast enough to keep up with the demand. I worry about dead pigs. I worry about what killed them. I have pigs farrowing, they’re my livelihood,” Sarah Willis explained.
The next day a story broke about 215 dead hogs being illegally dumped in Franklin County. Steve McNeal of Iowa Farm Families, a Hubbard non-confinement pork company that includes several farmers, offered one possible explanation for so many dead pigs.

“Some of our farmers, who also own confinements, told us that they were losing a lot of pigs there. They traced it to a certain feed that made the hogs stop eating it. They tried to eat each other instead, mothers would even eat babies. Once they stopped using that feed, the problem went away,” he said.

Political Issue Arises

Asked about PAMTA and about links between CAFO’s and MRSA, Iowa Department of Agriculture and Land Stewardship’s (IDALS) Dustin Vande Hoef responded for the agency.

“In our feed and fertilizer bureau, their code mandated responsibilities are to make sure that all regulations established by FDA (US Food & Drug Administration) on the use of antibiotics or any other medication in animal feed are followed. We have no authority to say how they should or shouldn’t be used; we just make sure they are used consistent with FDA’s direction.

“I also spoke with our State Veterinarian, who is very aware of the issue as well and certainly understands the concerns folks have about MRSA. The discovery of the bacteria in pigs and horses as well as companion animals such as dogs and cats does highlight the need for more research,” Vande Hoef said.

IDALS Republican Secretary Bill Northey won’t be able to hide from this issue in the next election. Democrat candidate Francis Thicke has already endorsed restrictions on antibiotics in livestock.

“I support passage of PAMTA because it is important for keeping antibiotics working for human health. Some studies suggest that continuous feeding of antibiotics to animals for non therapeutic purposes may be selecting for antibiotic-resistant bacteria. PAMTA would not automatically eliminate non therapeutic antibiotic use in animals, but it would require FDA to review the antibiotics that are used in both animal feed and human medicine and rescind approval of any found to be unsafe from a resistance point of view,” Thicke said.

At the National Pork Board (NPB), Vice President for Science and Technology Dr. Elizabeth Wagstrom took issue with the way MRSA has been reported.

“I vehemently dispute Kristof’s conclusions. Saying that MRSA is food borne is ludicrous,” she began. Citing three international food safety authorities, Wagstrom said the food chain MRSA is not a contributor to MRSA in humans. She also defended prophylactic use of human antibiotics in livestock.

“We have few antibiotic approaches that are for animals only. Most all originated in human usage and were diverted to veterinarian usage. By targeting prophylaxis at points of production, we use smaller quantities of antibiotics than if we wait for problems to arise and treat them with larger doses. Most are used at times of stress, like weaning. We use less in the long run this way. It’s a health and animal welfare issue,” she said, adding that by law, NPB can’t try to influence policy.

“I can say that the restrictions in PAMTA are more severely restrictive than even those in Europe. In Denmark, the imposition of the antibiotics ban increased pig mortality by 20% without demonstrable benefits to humans,” she added, non-influentially.

Beyond Politics

Outside the political arena, infectious disease specialists fight a 10,000 year old war against bacteria. Tara Smith, the University of Iowa doctor who unleashed MRSA on the mainstream media, has also been working on Streptococcus suis, a pathogen of swine which causes a rapidly fatal disease in neonatal piglets as well as sporadic disease in humans with meningitis a common manifestation. She said that whatever might be killing unusual numbers of pigs in Iowa doesn’t sound like anything she’s seen.

“I’ve never heard of a disease that makes mothers eat their piglets,” Smith offered. Asked to explain differences between pig-strain MRSA, HIV / AIDS, salmonella and deadly e-coli strains traced to cattle confinements in the 1990‘s, Smith was more confident.

“All are zoonotic infections - microbes that can be transmitted between animals and humans. HIV has become established in the human population, and the animal reservoir is no longer needed to maintain transmission to humans. With E. coli O157 and ST398 (the "pig" MRSA), animals still seem to be the primary reservoir for these microbes, and humans become infected upon contact with the animals themselves or with contaminated food,” she explained.

Smith said that she eats pork from both confinements and free range sources, adding that she’s precautious about bacteria.

“I am a mom. Of course I'm concerned, but there needs to be a balance between germ-phobia and common sense. I use good food handling and cooking procedures. I have my kids wash their hands often, especially after playing with the pets. I know that the vast majority of germs out there are harmless, and we do what we can to minimize the possibility of infection with something nasty,” she explained.

From a Mercy Hospital command center decorated with antique quarantine signs, Dr. Dan Gervich fights the war in a broader context.
“We know of a handful of staph strains that have been with us since the dawn of civilization. We don’t know for sure that they didn’t precede civilization,” he said recalling that several serious human disease - including plague, the 1918 Spanish flu, mad cow disease, rabies and measles - probably sprang from animal reservoirs.

“Within my profession, MRSA qualifies as an epidemic but that’s a loaded word for the general public. How serious is MRSA? It’s serious,” he began.

“Throughout modern history, people have carried Staphylococcus aureus in between one fifth and one third of the population. When penicillin was first developed, Staphylococcus aureus was universally sensitive. When I finished my residency in 1976, people thought the war was over.

Infectious medicine was a vanishing specialty. My fellowship in Oregon was cancelled with a year to go. Of course, we had not heard of Lyme disease yet, or HIV, or AIDS, or drug - resistant tuberculosis,” he recalled.

“If we count antibacterial drugs related to penicillin, we count in hundreds. We come up with new ones and bacteria evolve to cope. Infections are like beach heads in war - the more troops you throw into the fray, the more apt you are to establish a foot hold. But bugs have leverage of adaptability. Their genesis time is 15 minutes and they can regenerate quickly into billions and trillions,” he assessed.

This general talks about his enemy on a personal level.

“It’s as if Staphylococcus aureus were trained to understand human behavior and vulnerability. They gravitate to the end of the nose, between the legs and under the arms - great places to colonize. It loves serum and blood. That’s what we feed it in labs. Once it finds its way to them - even through floor burns or tiny abrasions - it celebrates.

“Bacteria are promiscuous, I’d even say bestial. Other species share genetic material with them, extra chromosomal DNA. Within that suitcase lurks resistance to much more than what’s obvious,” he warned.
Gervich says hog confinements aren’t the only thing that could take the MRSA epidemic to drastic new levels.

“I’m worried about metrosexual styles, like shaving pubic hair. Pubic hair is there for a good reason and that’s a favorite gathering spot for MRSA. Right now I’m seeing more cases related to that, and body piercing (than to demographics suggestive of hog confinement workers),” he said.

Gervich thinks the war on staph is producing some good news. “We can now test for the presence of MRSA in an hour, at the same cost as taking a culture and waiting 3 or 4 days for the results. If you are having a hip replacement or a heart valve operation, this is major development.”
He sees more bad news though:

~ “A vaccine would be helpful but I don’t see a vaccine on the horizon.” (The National Institute of Health database includes 36 published studies on MRSA vaccine research.)

~ “Antibiotic resistant colitis is the next wave of concern. Clostridium difficile can turn toxic in the gut after antibiotics are administered. They form spores that cause all kinds of problems. There’s nothing good that you can’t get too much of.”

~“Even the newest series of antibacterial drugs is running out of efficacy. Vancomycin-resistant Staphylococcus aureus have been found in nine cases. Another new phenomenon is antibiotic-resistant tissue in intravenous use. Alternatives (Zyvox) are very expensive - $1200 a week for oral administered substitutes, compared to $50 a week.”

Overall, Gervich thinks it’s a stand-off.

”No epidemic goes on forever. Some humans develop immunities and pass those on to the population. The war has sweet and sour spots. When I began practice, we were in a sweet spot. Now, we’re in a sour spot.”

Even in an awful economy for new enterprises, three different investor groups have been trying to make 2009 the year of Caribbean dance club in Des Moines. The former Mondo’s/Joseph’s venue is slated to become The Palm’s (those plans are stalled in mid-remodeling) and the venerable Ingersoll Dinner Theatre is shooting to open by New Year’s Eve as Copacabaña, a Cuban club and restaurant. Margarita’s Latin Sports & Dance Bar beat the others to dance floor in the former Raul’s building in Clive.

While Margarita’s music repertoire is eclectic enough to include open mike nights (first Wednesday of each month) and American rock, it’s considerable buzz comes with the beat of bachata, a sexually charged music and dance form that took a long, strange trip to Clive. Bachata originated during the Dominican Republic’s Trujillo dictatorship which censored and suppressed it. The music developed - like bolero, tango and the blues - as heartsick songs for acoustic guitar played in lower class bars and brothels. It was first recorded after Trujillo’s assassination in 1961, but didn’t break out of the Dominican countryside until the 1990’s when it was electrified. Now it’s the hottest dance craze in the western world. Margarita’s teaches bachata classes during the week. On Friday nights, bachata and other Caribbean music plays in a dance club complete with VIP sections and a waitlisted clientele that knows its way around a dance floor.

The club recently launched its own restaurant, a 60 seat sports bar annex that introduces some culinary bachata moves to metro Des Moines. Churrasco presented four large pieces of marinated skirt steak with chimichurra sauce, fries and salad.

Chimichurra is the South American forefather of Des Moines’ de Burgo sauce. It’s made with garlic, cilantro and olive oil.

Venezuelan Pabellon Criollo delivered tender piles of beef in garlicky marinade, under melted cheese and served with black beans, rice and tough plantain chips. Those chips differed considerably from tostones,

which were marvelously sweet, “unripe” plantain chips fried golden and served with a large dollop of freshly made guacamole on each piece. My Cuban vaca frita didn’t appear to be fried at all, resembling the Pabellon Criollo without the cheese.

A Parilla sampler offered all grilled meats - chicken, steak, pork and sausage with yuca and salad. A $12 T bone might be the best bargain steak in town.

From Margarita’s Mexican menu, fajitas were served sizzling with a separate full plate of rice, frijoles, salad and tortillas. Carne asada tacos were generous and hot off the grill. A Cubano sandwich provided good roast pork loin, with ham, cheese, pickles and dressings on a grilled sandwich. French fries and corn chips strangely lacked greasiness and crispness. All dishes were served on ceramic platters or colorful Fiesta ware and were nicely garnished. The full bar service offered seven Mexican beers. Flan and fried ice cream were served for desserts. Burger and a pasta menus were available and a kid’s menu ran just $4. Service was quite uneven and much better on weekends than weekdays.

Bottom line - Margaritas fills several empty niches in suburban dining and entertainment. Besides its good, unique dishes, it’s open on Sundays and until 2 a.m. on the other days of the week. It’s also a nice bargain.

Margarita’s

2060 94^th St., Clive

Mon. - Fri. 11 a.m. - 2 a.m., Sat 3 p.m. - 2 a.m. , Sun. noon - 9 p.m.

Jasmine Bowl

My paternal grandfather, a failed restaurateur, scoffed at conventional trappings of romantic dining like candlelight, linen, violins, and roses. “Romance,” he said, “is the stuff that takes you where you’ve never been.” Grandfather would consider Jasmine Bowl an epic romance on many levels.

The restaurant was created at the happy coincidence of two real life romances. Nigerian-born chef Mark Lijadu met his Thailand-born wife Suppatra when both were studying at the Iowa Culinary Institute in Ankeny. Suppatra wanted to own a bakery and Mark wanted to own a restaurant, like his family had in Nigeria. Meanwhile Tom Mauer fell in love with a Minnesotan and put Florene’s up for sale. To move the real estate in a slow market, Mauer agreed to sell his bakery recipes, an extraordinary collection gathered during his romantic and worldly education, including stints in three different Michelin three star restaurants in France. So, Jasmine Bowl is now an old fashioned bakery that also serves the best short order breakfasts in town, several southeast Asian specialties and a few choice items from Mexican, Moroccan, West African and Japanese cuisines. You’d have to travel far and wide to find that anywhere else.

Chef Mark recreated Mauer’s griddle work faithfully.

Buttermilk pancakes were thick, buttery and flaky to a degree that I have never been able to accomplish at home. Mauer never would tell me how he did it, and I begged. He obviously told Lijadu, who served them with real maple syrup and free seconds. Lijadu offered extra touches like fresh blueberries, butter-sautéed cinnamon bananas and homemade strawberry sauce with his cakes. He also duplicated Florene’s Belgian waffles. Mauer gave up the secret to those because it involves a two day yeast batter process he figured few people would have the patience to follow.

Lijadu added a southern California touch to his waffles, serving them with three giant chicken wings that had been brined before being fried to a delightful crispiness.

Breakfast, and weekend brunch, also featured: fresh sliced hash browns; home made biscuits with scratch gravy and lots of sausage; and omelets, including one made with real crab meat.

“Chicken hash” was also served on the brunch menu. The name is confusing. It’s more like a twist on the hot chicken sandwich, with an entire grilled chicken breast sliced into bite-sized pieces and laid over a slice of bread, mashed potatoes and superb stock pot gravy. Lighter breakfasts, from the bakery, were irresistible carryout temptations - bear claws, turtle muffins, magic bars, multiple turnovers, puff pastries, coffee cake, cinnamon rolls and sticky rolls. Lijadu is offering lard crust pies for the holidays, from Mauer’s recipe that always attained thick, flaky perfection rarely found anywhere these days.

Saharan lamb stew stood out on an eccentric lunch and dinner menu with wonderful sweetness coaxed out of peppers and tomatoes. It was served with spot-on perfect fried plantains, something that is rarely done well in Des Moines.  

Lijadu said it was Moroccan inspired, slow cooked tajine-style, in a spiced sauce of jalapenos and tomatoes. It was served with jasmine rice, caramelized plantains and a garnish of fresh herbs.

Acapulco pork was a winner - marinated pork steak served on brown rice with fresh peppers, onions and mushrooms and topped with fried egg.

Pad thai was made with homemade tamarind sauce and served with ground nuts.

Crab cakes were made with real crab and served with chipotle mayo. At less than $6, they are the best crab cake deal in town, by a crab claw. Curries were made with freshly mixed pastes and coconut milk. Green papaya salad was served with chicken wings. Monte Cristos were served in classic style, with egg batter and powdered sugar. All breakfast and lunch items were priced under $8 and all dinner items under $10.

Bottom line. Wonderfully unique and affordable.

Jasmine Bowl

2128 Indianola Ave., 284-0077, www.jasminebowl.com

Tues. - Fri. 11 a.m. - 2 p.m. & 5 p.m. - 8:30 p.m.; Sat. - Sun. 8 a.m. - 2 p.m.

“We announced our opening on Twitter and the first response we heard was ‘Just what we need, another frigging barbecue,’” related The Q owner Bob Conley.

Barbecue is politically incorrect. In greater Des Moines, more new barbecues opened during the Bush administration than any other restaurant genre and, to many minds, they are associated with red state, red meat mentality. Some Obama era revisionists would like to quarantine them to Texas with the former president. Barbecue is now included in sin tax proposals and the Environmental Protection Agency has proposed levying ozone endangerment taxes on cattle and burned wood. However, eating remains an act of politics and barbecue is not going gently in any vegan good night.

KC Pedigree

In fact, The Q raises the bar for the genre in Des Moines. Tired of tentative tenants, landlord Conley decided to open his own restaurant in a venue that had briefly housed both Bordo’s and Town Hall during the last year. He recruited a smoke master from Kansas City’s Gates family, as in Gates & Sons BBQ and Gates College of Barbecue. Aaron “A-Train” Byrd says the Gates family patriarch is his godfather. He left Kansas City because he’s involved with the Iowa Chapter of Bikers Against Child Abuse and because he wants to market his own line of barbecue sauces.

The restaurant looks like an urban archeological display. The hacienda style architecture has not changed since Cabo San Lucas was here. Indoor furniture hasn’t changed since a previous tenant sanded down Sticks’ designed tables and painted them black. Conley added outdoor furniture that includes heavy wrought iron tables and rocking chairs that I have previously only seen in five star resorts. The full bar remains unchanged from previous incarnations, except that bartenders now seem to treat strangers as well as their friends.

A well dressed hostess greeted me with “Hi, how are you doing?,” a Gates signature. She didn’t take my order though, The Q is full service with a full bar.

On my first visit, briskets were being removed from the smoker and I could specify freshly sliced meat from the deckle - the staff knew what that meant too.

Byrd has the good sense to smoke his chickens in quarters, so his white meat need not be overcooked to safely cook his dark meat. Both chicken and brisket were as good as they get. Ribs, pork shoulders and burnt ends were all above average, showing smoke rings and smelling of hickory.

Ribs had been grilled, drying out the surface areas - I’d prefer lukewarm ribs, if that’s the trade off. That kept them from the status of the chickens and briskets. Broasted chicken was panko breaded, fried crisp and tender to the bone. When I asked what award the “award-winning chili” won, I was introduced to a manager whose recipe garnered a blue ribbon in the Illinois Chili Cook-off. The chili was meatier than most. Of two kinds of slaw, vinegar-based excelled. Mac & cheese was heavy on cheese. Mashed potatoes had excellent stock-based gravy. Baked beans, fries and sweet potato fries were industry products. Potato salad and au gratin potatoes were both scratch made and creamy.

House made bread pudding stood out over a pair of cobblers on the dessert menu.

On three subsequent visits, brisket that could be freshly sliced was available once and was just as good as the first time. Smoked chickens were consistently perfect. Four sauces were all sweetened yet distinctly different in flavor. All sandwiches and dinners came with two sides and were good bargains at $7 - $13.

The Q

1250 Eighth St.,, West Des Moines, 224-7440

Mon. - Sat. 11 a.m. - 10 p.m.

Des Moines’ restaurant scene reflects the vibrancy of our Latin American community. New places open so fast, even in this economy, that I had to spend entire week catching up. Fortunately, all these hard working restaurateurs stay open seven days a week.

Restaurante El Comalito joins a small group of Salvadoran specialists. Spanish language soap opera played loudly on a television ignored by mostly male customers who packed the place on my first visit. Somehow, a single friendly waitress managed quick, flawless service without falling behind on the story line. Five good salsas were offered with chilies dominating all. Crisply fried plantain empanadas were nicely dusted with confectioner’s sugar. Pupusas (corn pancakes) were stuffed with soft white cheese, loroco (a vine flower), and Central American style chicharron (finely ground pork, not rind as in Mexico). They were served with fresh curtido (slaw) and a carroty salsa.

Scratch made tacos, burritos and sopes were stuffed with one’s choice of meats, including the house’s magnificent chopped carne asada, as tender as pot roast. Drinks included a home made hibiscus flower “Jamaica.” All plates were garnished nicely with carved radishes, cilantro, halves of lime, etc.

Cactus Mexican Grill was hard to navigate. Clive constructed a new island that prevents southbound traffic from turning into businesses on the east side of 86^th Street. In fact, Cactus Grill is the only business open in its strip mall and the space next door appears to be an abandoned McDonalds, a sight as rare as civic harassment of taxpaying businesses. Bar service, reduced to margaritas and beer for now, was friendly and televisions played sports without volume. A short menu offered choices of meats in burritos, tacos and other starches. I tried some excellent pork in warmed tortillas, with good salsa, beans and rice. I’d bet that anyone who likes El Rey Burrito will like this place too.

Spanish style architectural touches dressed the walls and floors of West Glen’s Los Cabos. The menu was novella length, reminiscent of El Rodeo‘s. Most dishes were designed for suburban taste: Ground beef or chicken was standard in all combo specials; table salsas tasted more like tomato juice than chilies. More traditional roasted and fried meats, in chile salsas, were offered but hard to find on the long menu. Chile rellenos delivered a fresh, stem-on poblano, stuffed with melted Mexican cheese, battered, fried and served in a mild salsa.

An egg dish was served well done, with smooth beans and rice. Guacamole was a nice surprise on both dishes but tortillas were oddly served in aluminum foil. Neither dish was garnished, something that even humble taco trucks do well in Des Moines.

Plaza Mexico’s second area store, in Johnston, was packed on two occasions, including a Sunday when it appeared to be popular with after-church crowd. That’s easy to understand. Menus were as long as Los Cabos’ and portions were humongous with lots of beans, rice, guacamole and cheese on each dish. Recipes were tailored for suburban tastes, even more than at Los Cabos. Table salsas were mostly tomatoes. Chile “rellenos” weren’t stuffed. Instead, that dish included a chile that had been topped off, its membranes and seeds removed. and preserved in something that turned it pale green. It had been laid under a serving of melted cheese covered meat.

Carne asada brought two large pieces of nicely seared flank steak. Service stood out, waiters frequently checked in and were able to accommodate most requests. There were no garnishes but there wasn’t really room on my plates for any either.

Plaza Mexico

6110 NW 86^th St., Johnston, 270-5010

Daily 11 a.m. - 10 p.m.

Cactus Mexican Grill

1979 NW 86^th St., Clive, 223-2202

Daily 11 a.m. - 10 p.m.

Restaurante Los Cabos

5465 Mill Civic Pkwy., W Des Moines, 564-7200

Daily from 11 a.m.

Restaurante El Comalito

1100 E. 14^th St., 263-3545

Daily 9 a.m. - 10 p.m.

On my last trip to Seattle, a sassy concierge gave me the following directions: “Go straight by 12 Starbucks and turn left at the 13^th Starbucks. Your restaurant will be half way between the fourth and fifth Starbucks after that.” Sometimes you win a war by losing battles. That’s the case with Des Moines’ coffeehouse culture.

Before the mid part of this decade, Central Iowa did not fit the expansion profile of industrial coffee chains Starbucks and Caribou. That helped independent coffeehouses grow distinctive personalities. Java Joe’s nourished the independent music and art scenes. So did Zanzibar’s which also supported fresh and local farms and artisan bakeries. Grounds for Celebration developed their own gelatos. All those places roasted their own beans. Amici brought an almost fanatical Italian expression to the scene with Tuscan machines, Bolognese roasted beans, Udinese china, and an exceptional Sicilian wine list. Half a dozen other independent coffeehouses served distinct neighborhood or cultural niches, like Mars (Dogtown), Cup o' Kryptonite (comic books) and The Break Room (pet owners).

Those coffeehouses were more sympathetic to local economics than the giant corporate carpetbaggers. By the time Starbucks and Caribou brought their religious trade war to town, most of Des Moines had developed loyalties to independents. So when Smokey Row, a successful independent coffeehouse from Oskaloosa, Pleasantville and Pella, announced they were renovating an old warehouse on Cottage Grove, I wondered if they came too late to the party, even though they have a lot going for them. Their small town stores were civic icons. Every major Presidential candidate visited Smokey Row at least once during the last election cycle. Their roasted coffees are brand names too, sold at Hy-Vee in those areas. Their cheeseburger chowder drew the attention of national magazines. But Iowa is provincial and no place more so than Des Moines. Would coalmine country coffee fly in the capitol city?

After three and a half years of remodeling and highway reconstruction, the answer came quickly. Sherman Hill embraced Smokey Row as a kindred spirit, the savior of venerable old real estate that could well have fallen to the wrecking ball. A fern bar without the ferns, Smokey Row features original brick walls, hard wood floors and nostalgia theme furnishings. Antique tables and chairs don’t match each other so much as the eclectic mood. That matches the clientele: Bible discussion groups, Twelve Steppers, bureaucrats, artists and, of course, politicians. The triangular building conveniently provides five different working entrances plus a drive through window!

Coffees were in line with the other top coffeehouses - catholic in origin and mostly in $12 a pound range. The kitchen resembled an old fashioned diner. Breakfast was served at any hour and included

a good broccoli quiche, with cottage cheese and fruit, along with a short menu of bacon and egg dishes.

 Lunch and dinner included soups, short order sandwiches and salads. There was Miracle Whip but no mayonnaise, nor pickles for deli sandwiches. Loose meat beef burgers were better than patty hamburgers. All sandwiches came with good kettle chips.

Creamed chicken on home made biscuits reminded me of middle school cafeteria food, back when that was a good thing. A “hippie chic” delivered a creative mix of chicken breast, spinach, provolone and guacamole on a fresh bagel. Cheeseburger chowder mixed fresh and processed cheeses. Fountain treats maintained the nostalgia theme, with phosphates and cane sugar soft drinks sharing a menu with more contemporary drinks. AE ice cream could be ordered with waffle cones hot off the griddle. A large line of cookies, pastries and desserts was about fifty per cent home made.

Bottom line - An overnight success, almost four years in the making.

Smokey Row

1910 Cottage Grove, 244-2611

Sun. 6 a.m. - 9 p.m., Mon. - Thurs 6 a.m. - 10 p.m., Fri.- Sat. 6 a.m. - 11 p.m.

 DM's Most Italian Coffeehouse

Coffee originated in Ethiopia and became a worldly commodity in South America. The most expensive coffees come from Asia and the most famous from Jamaica. Yet almost all coffee lore comes from Italy. That is where Achile Gaggia invented a piston-powered machine that birthed an espresso culture across Europe and all the way to the Italian North Beach of San Francisco, where it percolated the howling voice of the Beat Generation and the Hungry Eye of American folk music. Italy is where Howard Schulz experienced espresso magic that he developed into the phenomenon of Starbucks.

So, it’s really not so odd that a Des Moines man of Italian blood would model a new coffee chain after the purest of Italian experiences. Amici Espresso is a rare example of a family’s confidence in personal taste over the tyranny of focus groups and number crunching. Kyle and Sharon Krause love all things Italian. Kum & Go made them rich by catering to the tastes of the masses. Now Amici is their reward and their gift to Des Moines. With three coffeehouses and four kiosks opened in the Capital City in 2006, they have entered a market at the pace of caffeine cubed.

Until recently, Des Moines was off the radar of the warring industrial giants Starbucks and Caribou. Thus, independent coffeehouses here were far more sympathetic to local economics than those carpetbaggers. Java Joe’s, Zanzibar’s and Grounds for Celebration are beloved for their support of local artists, musicians, farmers and caterers as well as for their home-roasted beans. So, like many people, I resisted the idea that any new coffee chain could add value to that culture. Shame on me.

For starters, Amici’s espresso drinks are an epiphany, tasting like the Lombard gods intended — smoother and deeper, with full bodied, sweetly flavored crema. Amici’s espresso beans come from Filicori Zecchini, a small, 80-year-old family operation in Bologna, the culinary capital of Italy. In these days of arabica-fixation, they dare to include Indian robusto beans, which depart more crema, but the key, according to barista supreme Tony Sadiq, is that “they are sun dried and not roasted.”

If the beans were all that mattered, then the Filicori Zecchini mix would make a good cup of coffee in my drip machine at home. They don’t. They are dependent on the La Marzocca FB70, the state of the art dual boiler espresso-making technology, handmade in Florence. That, plus keeping the porcelain, which is custom-made in Verona, warm — so one never needs to steam it before dispensing the elixirs.

You can get all the usual coffeehouse drinks here plus some things you can’t find elsewhere: bicerini (layered espresso, hot chocolate and foamed milk), custom estivos (artfully layered espresso, cream and foamed milk). In Milanese fashion, they have a full liquor license, hence you can sip grappa, limoncello and Campari, or hot cocktails like caffe coretto, amazza café and the “Amici Nose Warmer” (coffee, Frangelica, Tia Maria, Bailey’s and Grand Marnier). The 12-bottle, all-Italian wine list ($14 - $22) features Sicilian discoveries from Sharon Krause’s travels.

Italian style is created locally. The architect of all locations is Brian Schiffler, the photography and design is by Patty Housby and Diane Cutler. There is a drive-by window plus live local music with no cover charge, a strong, free Wi-Fi signal and hi-def satellite TV with live football. Of course, that means Serie A (Italian soccer) not NFL.

The Return of the Fern Bar - Part One

35th Street Café

The re-opening of 35th Street Café this month signaled the final stage of a long, controversial makeover of the Ingersoll Avenue Dahl’s, a neighborhood anchor since the Truman Administration.

The original store opened in 1952 with a band, an elephant and a donkey, plus building-sized photos of presidential candidates. It introduced brave new concepts to Des Moines including an underground train that transported groceries to a Dahl House pickup station, a Kiddie Koral, rotisserie chickens and an in-store café. The restaurant kept loyal customers until it closed in the first phase of the makeover. Scores of regulars were then displaced after decades of sitting around three oval counters that facilitated conversation and camaraderie but not table turning and profits. The café stayed packed for most of 55 years, with people waiting for a seat to open at rush hours and retirees chatting over coffee during off hours. Because the store’s customer base is heavy on nostalgic senior citizens, expectations for the reopening were high. Too high.

Like the new store itself, 35th Street Café is more spacious and has a far bigger menu. New furniture includes over stuffed couches, a giant fireplace and six person booths. On a recent Sunday, customers rearranged furniture to try to simulate the old open counters. The fireplace’s artificial glow seemed a poor surrogate for the warmth of the old design. One long time regular said that the old store had 200 parking places within 125 feet of the entrance and the new store only has 55. He said he paced it off and counted. Another old-timer said his friend had too much time on his hands. I did some counting and pacing and think his math might be right though. The parking lot mystified customers by sacrificing good parking for five lanes of drop-off space, “like one sees in a big Las Vegas casino.” It gives up more good parking for huge islands of mulch. One customer said it was designed by someone who likes pretty drawings, not someone who thought about the client. Bad parking might not be the only reason but on successive days at rush hour, the number of people I counted eating in the café stayed in single digits.

Spaciousness provided some positives, too. Customers are allowed to buy food in the deli and eat it sitting down. The old café was too busy to permit that. Now it’s highly encouraged by an “all you can eat” buffet that dominates the dining area. On one occasion, $7 delivered four kinds of pasta dishes, meatballs, sausage and peppers, a potato dish, desserts and a 37 item salad bar, with fresh mesclun and extra virgin olive oil. Though there are no waitresses, the old menu was nostalgically provided. From it, I ordered a hamburger that betrayed memory with an industrial meat patty on a plain, soggy dinner roll instead of the old toasted and buttered Dahl’s egg bun.

A hot beef sandwich was as bad as they get, tough beef almost as salty as dried beef, with institutional gravy. A breakfast special was less disappointing, though toast was served with margarine only.

Deli specials were much better. One day there were 13 entrees and 40 side dishes to choose among. An entrée, two sides with roll and margarine cost just $5.50 - $7. Chicken and noodles, beef stew and pot roast were excellent cafeteria style dishes. (Why not make the hot beef with the pot roast?) Baked cod was a mistake; it dried out in a hot case. Among side dishes, vinegar and oil slaw stood out with crisp veggies and tangy dressing. The café could use a veggie plate special, as none of the entrees were vegan.

Bottom line — A Gateway Market executive told me that he was “happily under whelmed” by what he saw here. I share his assessment but not his joy.

I recently participated in a focus group for a think tank commissioned by the real estate industry. Mainly, we were asked to explain apparent discrepancies in market research about human attachments to neighborhoods. For instance, large percentages of people surveyed will rank the “proximity to a sushi bar” as “very important” or “essential” when they choose a location to buy or rent. Yet a smaller percentage from the same sample groups admit to have “visited a sushi bar in the past 12 months.”

What is it about Japanese food that makes people want it to be convenient even if they don’t actually want it? Sociologists, psychologists, urban planners, realtors and food writers phrase their answers a little differently but they all can be translated this way: Sushi bars are cool and upgrade the perceived value of the neighborhood. Des Moines’ two newest sushi bars are each the first ever Japanese cafés in their neighborhood. I went looking to see how well they fit.

Dogtown is not a typical free enterprise zone. Drake owns so much of the real estate that they have been able to exert more control over tenants than is typical in other campus commercial areas. Fast sandwich stores and coffee shops abound but far fewer bars and beauty parlors have opened here than one would expect from the demographics of the neighborhood. From my experiences at 21, sushi could be a back door to the tavern market. I visited three times and never saw anyone else eating sushi. On one of those visits, the place was quite busy with folks having a good time. They weren’t ordering sushi though. I had five different waiters and none seemed to be aware of what the last might have said or done.

Sushi was fresher one day than another, which is common in Des Moines. One dish was not as described by a previous waiter and another was served without key ingredients. When I brought this to the attention of a different waiter, he apologized and brought me a comp beer. When I declined, another customer grabbed my beer and chugged it in a single gulp. Another customer, whom I have never met, offered to buy my a shot. Like I said, people were having fun. While going out the door, I was handed a bag with the missing contents of my order - excellent tempura. Values were quite good, if you don’t mind a little chaos.

Sushi fits Ingersoll more conventionally. That neighborhood considers itself the city’s most foodie and most multicultural. Noah’s, Jesse’s Embers, Kwong Tung, Ted’s, El Patio, the lunch counters of Dahl’s and Bauder’s and most of the boulevard’s taverns have all been thriving for around half a century. Flanagan’s,and Wellman’s aren’t a whole lot younger either. Star Bar and Bistro Montage are but they are forgiven because they are among the best restaurants in all Iowa.

Sakari’s crowd was a little older (sushi customers have the lowest average age among restaurant genres in America) than 21’s. The place was packed on two of my four visits. A Saturday night crowd was a hip mix of very well dressed Asian women and African American men, plus intense sports fans of all races who seemed to care more about style points in sushi, or vodka, than wardrobe. When an over-under number for a TV game went over, a customer offered me a free drink. People were having a lot of fun here too but most of them were also eating.

Along with hairdresser Jason Simpson (Sahar’s) and engineeer Sang Cam, Sakari is the latest venture of Nick Sisomphane, a young restaurateur from Eastern Iowa. At age 32, he grew up in family restaurants in Fairfield determined to get into “any business except restaurants.” But after dabbling in business management studies, he says he found himself enrolling at a sushi academy in California. After a three year stint as head itamae at Three Samurai in Iowa City, he opened his own teppanyakki house in Cedar Rapids, then sold his share of that and opened the very successful Sushi Kicchin in the Old Capitol Mall in Iowa City.

Nick says that he has high hopes for the Ingersoll venture where the menu is currently split about half traditional and half American style sushi, the latter adding fats like mayonnaise, cream cheese and avocado. Bento boxes have been ordered and large early crowds have encouraged him to offer off-the menu specials that he likes -

hamachi kama (yellowfin cheeks) were superb on a pair of my visits.

“The trucks that deliver fresh fish don’t come to Des Moines every day and all sushi places pretty buy from the same supplier. The key is fish maintenance. I try to keep fish fresh for two days as raw fish and then it gets cooked. It really helps when business is good right away.”

To that end, both the tuna tataki and grilled salmon delivered good value for less than $10. I tried four soups, three on the menu, and all had excellent stock, seafood in an Udon, beef bone in a pho and the “clear” and white soy paste in a miso.

Of 37 rolls, 9 were vegetarian. Nigiri included red and white tuna, snapper and four kinds of roe, but no belly or uni yet. Nick promised both as the customer base begins asking for them.

Bottom line - Both these places complement their neighborhoods in appropriate fashion. Neither is in Miyabi 9’s class yet.

21 Sushi

2311 University Ave., 369-7253

Mon. - Sat. Noon - 2 a.m.; Sun. 5 p.m. - closing

Sakari Japanese Restaurant

2605 Ingersoll Ave., 288-3381

Mon. - Fri. 11 a.m. - 2 p.m.; 5 p.m. - 10 p.m. with bar and appetizers available till 2 a.m.