CHOCOHOLICS REJOICE! It’s Healthy(ish)! Here’s the Evidence!

I love chocolate, particularly dark chocolate.  I make no apologies, and the more I learn about chocolate and the cocoa bean, the more I realize no apologies are needed.  It’s no joke, cocoa has health benefits.  Indeed, if I ruled the world, dark chocolate would be a deductible medical expense. 

Perhaps the science isn’t quite sufficient to justify chocolate as a deductible medical expense, but it ain’t junk food either.  There’s enough info on Theobroma cacao to warrant treating it with respect.  

What Makes Chocolate “Healthy-ish”?

Chocolate is loaded with antioxidants.  It contains flavonoids, a group of phytochemicals with anti-inflammatory powers and benefits for the immune system.  There are several subgroups of flavonoids, such as anthocyanidins that give foods like Concord grapes and red cabbage their purple color, and flavones, found in celery and bell peppers.  It’s the  flavanols however, that give chocolate (and other foods like tea and blueberries) it’s healthful properties.

So, What’s Chocolate’s Impact On Health?

Improved blood flow: This review of the research studying the combination of eating cocoa flavanols and doing aerobic exercise improved cardiovascular risk factors and vascular function (read: improved blood flow).  Cocoa helps reduce blood pressure by relaxing the walls of the blood vessels, improving blood flow, not only to the heart, but also to the gray matter of the brain.  This doesn’t mean eating a candy bar will make you a genius, but there may be bennies from eating some dark chocolate regularly.

Cholesterol benefits: Cocoa consumption seems to raise the HDL cholesterol (the good form) and reduce the “LDL cholesterol” (the bad one you want less of).  It works best when your total cholesterol levels are high.

Reduces “oxidative stress”: In a just-published systematic review of 48 studies on cocoa, the researchers found that cocoa consumption “plays an important role in the human metabolic pathway through reducing oxidative stress.”  Oh, bring it on.  

What’s oxidative stress?  It’s caused by “free radicals”.  Free radicals in your body can “nick” or damage the cells in arterial walls, making it easy for plaques to adhere and build up, clogging arteries. Cocoa consumption seems to help prevent free radicals from forming.  Ever taste rancid oil or nuts?  You’re tasting “oxidized” food damaged by free radicals.

Adapted from Tuenter, et al.

In the Mood

In this review of studies that looked at chocolate, mood, and cognition, the authors developed a “mood pyramid”.  They placed more general mood benefits from the flavanols at the bottom, since these are benefits associated with flavanols in other foods as well.  Secondary mood benefits appear to come from the caffeine-theobromine combination in chocolate. 

More specific is a possible dopamine effect from a substance in chocolate called salsolinol.  This is emerging research, but the hypothesis is that salsolinol may play a role in the impact of chocolate on mood.  Just how much chocolate you’d need to eat is still unclear. 

The Fine Print

Yes, there is some.  Some of the research found benefits from low intakes of chocolate, as little as 7.5 grams.  Other studies used significantly more however, up to 100 grams a day and produced good results.  (How do I sign up?)

These cocoa flavanols are NOT present in all chocolate foods.  Read labels: if it says, “cocoa processed with alkali” you can pretty much forget getting any flavanols.  This form of cocoa is also known as “Dutch-processed”.  The process makes cocoa appear darker (see photo) and taste a tad less acidic but it blows the antioxidant content to smithereens.  Some chefs and bakers prefer this type of cocoa for recipes.  I do not.  Give me the lighter powder on the right.  I like my flavanols, thanks.

Chocolate isn’t calorie-free.  Solid bars have about 150-170 calories per ounce.  I keep it to a max of 2 ounces a day, but an ounce of good chocolate, at 170 calories, makes for a rich snack or even a lower-calorie dessert.  Fair enough.  Cocoa powder however, is low in calories and the most concentrated source of cocoa flavanols, so use it to make your own hot chocolate.  I sweeten with stevia or a no-cal sweetener to minimize added sugar calories, and often add some cinnamon or other spice (smoked paprika is a favorite of mine).   

Get a high — in percent cocoa.  The most benefits are seen with chocolate that has at least 70% cocoa solids.  Not a problem for me, but it takes getting used to.  Go gradually!

Obese? Canadian Docs Say It’s About Health, Not The Scale

I’ve worked with so many overweight and obese adults and children whose weight was seriously impacting their health: diabetes, hypertension, back and joint pain, the works.  But not all overweight people experience these problems.   Some overweight patients have told me they’re happy with their weight and don’t feel hindered by it.   

As a health professional, I know and see the risks of having too much weight.  But what about the overweight person who has normal blood pressure and lab values, a good quality of life, generally feels good.  They ask, “do I still need to lose weight?”

Not necessarily, say the doctors of Obesity Canada.  The Canadian Adult Obesity Clinical Practice Guidelines (CPGs), a two-year effort by the Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, was authored by over 60 physicians.  They reviewed over 500 published studies and a formed a consensus of both clinical and scientific issues related to weight gain.

These guidelines focus on health & quality of life,                      not “ideal weight”, as goals.

Why I Like These Guidelines

They state the facts:  Obesity is a complex chronic disease that predisposes a person to many disease conditions, including:

  • Hypertension
  • Type 2 diabetes
  • Gout
  • Non-alcoholic fatty liver disease
  • Numerous cancers: colon, kidney, post-menopausal breast, esophagus

They also admit that the causes of obesity are multi-faceted, and can include genetics, individual behavior, metabolic factors, and the person’s living environment impact a person’s weight.  I’d add social factors to this as well.

BUT – and this is just as important – they emphasized that managing it is not all about the number on the scale!  It’s just as much about overall health, quality of life, and lifespan.  Bravo!

One Size Fits ONE!

These guidelines push personalized treatment.  It’s the INDIVIDUAL’s journey, not the physician’s.  Yes, the medical pieces are important.  You can’t advise which road to take if you don’t know where you are.  After that however, being effective takes more: meeting each person where they are at that point in time, how they live, and what their own goals are.  That may include not wanting intervention right then. 

All hands on deck!

These docs admit they can’t do it alone.  Obesity has many causes and therefore needs many components of treatment and a multidisciplinary approach: 

  • Medical nutrition therapy (MNT): Eureka! The physicians of Canada recognize that personalized counseling from a registered dietitian-nutritionist (RDN) is critical!  It’s evidence-based but individually focused.   
  • Exercise: 30-60 minutes of “vigorous” activity on most days. No worries here – remember everything is individualized.
  • Use all appropriate tools: medication, if needed, referrals for cognitive behavioral therapy, even psychotherapy if needed, and bariatric surgery as a last resort.

It’s “Best Weight” Not “Ideal Weight”

“Ideal weight” may be an unrealistic goal for many, especially if they’ve been overweight for years.  That’s OK.  The goal should be better HEALTH first, and whatever weight you are when you’re doing healthy behaviors – whatever weight that is. 

Silver lining: Even losing 3-5% of initial body weight reduces your health risks.  Just do what you can. 

  QUALITY of life is everything!

Cut-To-The-Chase Takeaway

These CPGs don’t give permission to disregard the pursuit of healthy behaviors and lifestyles.  They focus on YOUR best health.  That means striking that sweet spot between doing what you need to do and not leaving out what you most enjoy.  It’s not the same for everyone, so have a chat with your doctor.   The goal is better health, and better QUALITY OF LIFE.  Obsession with the scale isn’t healthy! 

COVID-19 Got You Depressed? Could Probiotics Help?

Whether COVID-19 has you sheltering-in-place, quarantining, or just frustrated by not being able to have your usual life, lots of people seem a little down in the dumps, grumpy, and yes,  even “depressed”.  The “life sucks now” feelings are real, but different from true clinical depression, which can happen for no observable reason. 

Could “Bacteria” Improve Mood?

The right kind of bacteria – probiotics – just might help truly depressed people, even those who on antidepressant medication.  This just-published study reviewed clinical research on the impact probiotic supplements had on people formally diagnosed with clinical depression.  

Probiotics are what give Greek (& regular) yogurt that tangy taste. 

Probiotics are live healthy bacteria, found in cultured foods like yogurt, kimchi, and kefir.  These are different from PRE-biotics, which are various types of dietary fiber found in fruits, vegetables, grains, nuts, and beans.  Prebiotic fiber feeds the growth of probiotic bacteria in the gut.  

What The Results Showed

In the 7 studies that met the criteria for inclusion in the review, all found that probiotic supplementation “demonstrated a significant, quantitatively evident, decrease/improvement of symptoms and/or biochemically relevant measures of anxiety and/or depression for probiotic or combined prebiotic– probiotic use.”  Whether the studies used one strain of probiotics or multiple strains, the results showed improvement in reducing depression symptoms. 

Moreover, in one of the studies that also measured “quality of life”, it increased with supplementation but returned to baseline 8 weeks after the supplementation stopped.

Why Probiotics Helped

If something works, I always want to know WHY, and this paper suggests a mechanism for how probiotics might help depression.

The gut is known to be the center of our immune system, and when probiotics have been found to be useful, as they have with conditions like ulcerative colitis, it’s often because of their ability to reduce inflammation by suppressing the production of some annoying substances, called “cytokines”. 

The gut also is known to connect with the brain via the “gut-brain axis”, part of the central nervous system, so “food and mood”, or the notion that what’s happening in one’s GI tract could impact one’s emotional state has weight behind it.

The “Fine Print” 

It would be great to learn that just by having some yogurt, your mood would soar, but alas, reality must be acknowledged.  These studies looked at persons with diagnosed, measurable depression.  Those who got the probiotic supplements seemed to become less depressed, but those supplements contained higher doses of probiotics than you’d get from a cup of yogurt. 

Tempeh is made from fermented soybeans & contains lots of probiotics, plus protein & fiber!

Probiotic foods and supplements may not be useful mood-boosters if you’re just having a down day, but there are plenty of reasons to eat foods that naturally contain probiotic bacteria, like these:

  • Yogurt, including Greek yogurt
  • Kefir
  • Kombucha
  • Tempeh
  • Miso
  • Kimchi

Look for “Live and Active Cultures” on yogurt and kefir labels, to be sure they contain useful amounts of probiotics. 

“Live & active cultures” guarantees a high amount of probiotic bacteria.

These being dairy foods, they also have a whole lot of essential nutrients we need, especially calcium and potassium, to help fill gaps in most people’s diets.

The main ingredient in kimchi is cabbage, and it’s fermented soybeans in tempeh, so they both have PRE-biotic fiber, too.  Heads up, if you’re sodium-sensitive: Miso and Kimchi can be loaded with sodium.  

Is there a down side to getting probiotic bacteria?   So far, there doesn’t seem to be, especially if you get them from food.  Getting some probiotics daily though, gives you the most benefit, and the study found this as well: depression returned when the probiotics stopped. 

Even if probiotic foods don’t lift your mood, you can definitely feel good about adding some healthy foods to your eating style!

Food Is Medicine…But Some Restrictions Apply

Did Hippocrates really say, “Let food be thy medicine and medicine be thy food”?  Probably not, but he often gets the credit for it.  At any rate, using food for medicinal purposes has been done for years, by your doctor or registered dietitian-nutritionist (RDN), or maybe grandma.  It’s also been the stuff of quackery and unproven hypotheses forever.  Elderberries, anyone?  They’re a good food, but there is no evidence they’ll cure COVID.  And we speak today of food, not supplements.

Quackery aside, here are some foods that have been used to treat various conditions:

  • Chicken soup! From Dr. Grandma, given for colds, flu, and “anytime you don’t feel good.” 
  • Prunes – the original “laxative.”
  • Milk – to calm an acid stomach.
  • Coffee and tea – both contain caffeine to jumpstart the morning (bonus: they’re both loaded with antioxidants)

These foods helped in acute conditions, but taking the next step, could food actually be “prescribed”, like medicine, to treat chronic conditions, such as heart disease, diabetes, hypertension, and stroke?  These diseases may not be diet-caused, but they’re all definitely diet-influenced. We know that eating an unbalanced diet long-term can eventually take a toll on health.  It’s also clear that a lifelong healthful diet reduces your risk for chronic conditions.

Credits: Junan Sonin, Sarah Kaiser, CC 2.0
https://www.flickr.com/photos/juhansonin/14406031184/in/photostream/

 

But…A “Prescribed Diet”?

By definition, it’s a diet that’s personalized for YOU with YOUR chronic condition.  Just as a medical diagnosis can require specific medication, diet-influenced chronic conditions require specific “diet prescriptions”. 

The idea of prescribed diets is gaining traction, because of emerging evidence that such diets can improve health outcomes AND lower health costs. 

This 2019 study looked at whether medically tailored meals for chronically ill persons would impact admissions to hospitals and skilled nursing facilities.  The meals were delivered in “ready-to-eat” form to persons with a variety of chronic conditions who also had various environmental or other barriers (social, income, inability to shop or cook for themselves), placing them at nutritional risk.  The meals were customized to the medical needs of each person, but also incorporated food preferences whenever possible.  

Results?  Huge.

After two years, those who received the medically tailored meals experienced:

  • Nearly HALF the hospital admissions.
  • 72% FEWER admissions to nursing facilities
  • Health care costs reduced by 16%.

Delivering tailored meals is costly, and not everyone needs or wants that approach.  In addition to medically tailored meals, a recent analysis in the British Medical Journal also noted other programs that take a broader approach in order to have a wider reach:

Medically Tailored Groceries

These are for people with chronic diseases like diabetes and cardiovascular disease, who can prepare their own food, but are food insecure.  Specific groceries items are customized by a nutrition professional, usually an RDN, and picked up by patients at a central location, such as a clinic or community center.

The results? 

  • Better adherence to medication.
  • Better blood glucose control in diabetics.
  • Better intake of fruits and vegetables, lower medical costs!

Photo credit: pxfuel.com

Produce Prescriptions

 

Sounds gimmicky but it’s solid.  Healthcare providers distribute vouchers or debit cards for free or discounted produce to food insecure persons with chronic conditions.  They redeem the vouchers at any store that accepts them.

The results? 

  • Better blood glucose control in diabetics.
  • Reduced excess weight, fewer antibiotics in children.
  • Better consumption of fruits and vegetables.

The “Catch”

Most of the research on prescribed diets isn’t very granular, so we don’t know exactly what’s producing these improvements.  Is it the total food package?  Individual foods?  Was it just because they were able to get, and eat, more fruits and vegetables?  Or more nutrient-rich protein foods? 

These unknowns can be problematic, because it opens the door for all manner of charlatans and quacks to tell you they “know” what foods you need to eat to prevent or treat these conditions.  In these programs, food was given out directly or vouchers were provided that limited purchases to the intended foods.  

What if you’re food secure but still have these chronic conditions, what are YOUR options for a ”prescribed diet”?

Credit: Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Medical nutrition therapy (MNT) is your best option, and it’s provided by an RDN – not a trainer, coach, or “wellness expert”.  MNT from an RDN customize your dietary plans, focusing on YOUR foods for YOUR needs, taking into account your food preferences, your food culture, and food budget.  It’s not a new skill for RDNs – it’s exactly what they’ve ALWAYS done, and they have more training in the field than anyone.  Bonus: most insurance plans cover some amount of MNT.

COVID-19 Sheltering: The “Big Pause” Is Cleaning Our Air

This post is a collaboration with Beef. It’s What’s for Dinner, on behalf of the Beef Checkoff, as part of my role as a member of the Beef Expert Bureau.  This post was reviewed for accuracy by USDA.

Staying home has made us all a little grumpy and impatient.  I love banana bread, but if I see one more recipe for it, I think I’ll explode. 

Take note of how drastically “The Big Pause” has changed how we live:

  • We’re driving less, if at all. “Rush hour?”  Almost a memory.  
  • Air travel has ground to a near halt. There are 40% fewer flights worldwide, according to Forbes.
  • Business “travel”? That involves walking from your bed to your laptop.  A couple of clicks and you’re in your meeting room.  Dress code: “way casual.”
  • Leisure travel? A dream. The summer vacay you work 50 weeks a year for will probably look a little different.  Even if you can get a flight or are willing to drive or ride a train, you’ll be extremely limited once you arrive.  Even the New York Hilton locked its doors! 

Global Sheltering: An Environmental Experiment That Could Never Have Been Done

We’re subjects in an environmental research study that would ordinarily be impossible to do.  Believe it or not, there IS something good about staying home.  The good in the air is the air itself. A new report from IQAir, a Swiss-based air tech company, found an unprecedented improvement in air quality since the world started to shelter in place.

This report looked at levels of “PM2.5”, which stands for “particulate matter with a diameter of 2.5 micrometers or less”, in 10 cities around the world during a 3-week lockdown period, and compared them to the same periods in 2019.   Of all air pollutants, the PM2.5 category is considered the most hazardous to our health.  A detailed explanation is available here

Lockdowns in each nation started at different times, but most of the 3-week time periods ended on April 13, 2020.  Some examples of the PM2.5 reductions:

  • Delhi, India: ¯60%
  • Wuhan, China: ¯44%
  • Seoul, South Korea: ¯54%
  • Los Angeles: ¯31%
  • New York City: ¯25%

Peer-reviewed publications have also weighed in.  This recent study on air quality in India echoes the IQAir report. It looked at changes using the Air Quality Index, which measures greenhouse gases (GHG) and particulates in the air, using a scale from 0-500 with 0 being healthiest levels and 500 being unhealthiest levels.  In Delhi, the Air Quality Index (AQI) averages around 175 (“unhealthy”).  At the end of the 3-week period, it fell within the “good” to “moderate” range, levels that have seldom been seen – or inhaled – more than a few times in the past several years. 

Where Do Methane                                            & Animal Agriculture Fit In?

Prior to COVID-19, if anyone had asked the question, “What’s the biggest contributor to greenhouse gas (GHG) emissions, a likely response, albeit incorrect, might have been, “all the methane from animals, especially from beef and dairy.”  However, the transportation sector is consistently the largest contributor of greenhouse gas emissions.

The better air quality since the lockdown, however, occurred with stable livestock levels, evidence that this huge improvement in air quality was not agriculture-related. Indeed, India is nearly 38% vegetarian, so beef consumption per capita is low, yet it saw some of the most significant reductions in GHG emissions during the periods studied.  

In the United States, ALL of agriculture, plants and livestock combined, contributes only about 10% to total GHG emissions.  Livestock accounts for 3.9%, with beef contributing a mere 1.9% of total GHG emissions. 

GHG From Agriculture: More Positive News

According to a 2005 report issued by the Intergovernmental Panel on Climate Change, issued (doc page 46, PDF page 63), “Since 2000, GHG emissions have been growing in all sectors, except in agriculture, forestry and other land use.”  Indeed, global GHG emissions from agriculture have DECLINED since 2000, likely owing to advances in agricultural science, better farming technology and animal science practices, given that production has improved and the human population has increased during this period. 

I cannot speak to farming and livestock practices everywhere in the world. I do know, however, that livestock raised in the US, particularly beef and dairy cows, are raised much more efficiently, with better land stewardship and modern practices, than elsewhere in the world.

Cut-To-The-Chase-Nutrition Take-Away

I support whatever eating style you choose, provided it’s balanced, healthful and enjoyable for you.  But first get all the accurate facts and credible evidence available to you.  Then, you know you’re making an informed choice.

When a Pharmacist Talks With a Registered Dietitian/Nutritionist….

Dr. Jessica Nouhavandi, PharmD, co-founder and co-CEO of Culver City-based Honeybee Health, asked me recently what it’s like to think like a registered dietitian/nutritionist, and a little about my approach to nutrition, food, and eating.  

When did you first start working as a registered dietician (RD)? 

I have been an RD since 1980, so I’m now 40 years in! I was in graduate school back then, working on my doctorate and working part-time as a “relief” dietitian, so I’d fill in on weekends and when they needed someone during the week. It was great because, as a relief, I’d be experiencing all the different hospital units: oncology, cardiac ICU, pediatrics, the works.  

What inspired you to become an RD? 

Nutrition science was my undergraduate degree. I always enjoyed learning how the body worked, and the more I learned about how truly complex it is, the more fascinated I became.  Plus, in a nutrition curriculum, you also learn about food science, not just nutrition. Food science focuses on food before you eat it. Nutrition is what happens once you put it into your mouth.  

How would you say your approach differs from other RDs? 

My approach has definitely evolved over the years, because I keep learning, but also because nutrition is such an evolving science. I came up in a health care setting where the patient was the focus, not the statistics. My kids and families aren’t often “typical,” or they wouldn’t be in our clinic. I always felt I had to dig a little deeper with my patients and their family lives, to see what might be contributing to the child’s nutrition issues. 

There is the “cut-and-dry” approach that focuses mostly on educating people about what to eat and what a balanced diet is. However, just focusing on education doesn’t cut it any longer. It’s about motivating people to make changes. The combination of education WITH motivation can have much more of an impact than education alone.

You have a strong background in pediatrics, including working with children with special needs. Could you please elaborate on your “meet them where they live” approach to working with these children and their caregivers on nutritional issues?

When it comes to changing diets and eating behaviors, you have to remember you’re treating the child AND the caregiver. Caregivers need to know they don’t have to make huge food and eating changes all at once. I also tell them how long they should expect things to take. For a child with autism who eats 5 foods, parents need to know that he may never eat the same way as everyone else, but if he can accept at least two or three foods in each group, that’s enough.  Even that may take a year, and the only thing they need to really do is be patient and be consistent. It’s about baby steps towards improving, not big leaps to perfection. It’s about helping meet the child’s nutrient needs and also helping the caregiver feel he/she is doing their best.

What other chronic illnesses can benefit from particular diets? Can you please elaborate on one example? 

Many kids with ADHD are on medication to help them focus at school and do their best academically. When medication is prescribed, it’s often quite helpful, but there are side effects, the most common being a poor appetite. For these kids, it’s so important to get a solid breakfast into them every day. It might be the only thing they eat until dinner, so it must do double duty if possible, with calories, protein, and micronutrients. Most importantly, I stress that, once it becomes routine, it’s much easier—it’s a learning process. 

You talk about myth-busting when it comes to nutrition. The spread of misinformation has been a big issue with COVID-19 as well. What changes would you like to see to the way health information is shared online? 

One very popular online thing is “immune boosters.” Foods and supplements may “support” the immune system, but only a vaccine will actually boost immunity. That’s what it’s designed to do.  All nutrients “support” immunity, but support is such a vague term that it’s almost meaningless.

There is so much “junk science” online that credible sources get diluted or even lost. Please, follow your doctor’s or medical professional’s advice. It’s easy to get sucked in by celebrities, sports players, or others with high profiles, who talk about what they do, but it’s a huge risk.  Hydroxychloroquine is a perfect example. People are desperate for a COVID-19 cure and this just won’t do it. And anything described as a “miracle” food or supplement should be passed by.  Period.  

Can you please “cut to the chase” and give us your top 5 pieces of advice for anyone struggling to live a healthier lifestyle during these tumultuous times?

Comfort food is perfectly understandable for the short term, but we’re in this for the long haul and we need to get back on track.  Here are some great ways to get started:

  • Protein matters! It comes in plant and animal forms, and unless you’re a vegan, get it from both animal and plant sources. Every meal, every day. 
  • MOVE! It’s absolutely safe to go outside and walk or be otherwise physically active. In fact, you should if you can as long as you wear a mask and keep your distance from others. If the benefits of physical activity were derived from a drug, it would be the most demanded drug ever. It’s not in pharmacies though, it’s in your shoes. Use them.
  • Best diet? Maybe it’s a screen diet. Cut it off at least an hour before bedtime and give yourself permission to do nothing. The world will spin without you and still be there in the morning. You’ll have missed nothing and improved your chance for better sleep.
  • Sleep is medicine, in my book, so for most people, no eating at least 2 hours before bedtime. You’ll have a better quality, deeper sleep when your digestive system isn’t working so hard breaking down food.  
  • Yes, fruit and vegetables are critically important, and there’s no substitute for them nutritionally. Frozen and canned are fine (canned beans should be in every pantry) and they last, but include fresh when you can, too. Summer fruit is unbeatable. Aim for at least 2 cups a day, total, but the more the better.

Anything else you’d like to add?

One thing people ask me about is if I’m a vegetarian or vegan. I’m neither. I eat everything and I don’t like wasting food. That said, people think you have to be strict about being vegan or vegetarian but you don’t. That’s a self-imposed thing, but being a “flexitarian” is perfectly fine.  Or just being an omnivore who sometimes eats vegan or vegetarian meals. It doesn’t have to be either/or. And I’m just glad dark chocolate fits all the above eating styles.

Dr. Jessica Nouhavandi, PharmD is the co-founder and co-CEO of Culver City-based Honeybee Health. Dr. Nouhavandi combines ethics, patient care and passion to create the ultimate patient experience. She earned her bachelor’s degree in bioethics and became a Doctor in Pharmacy from Western University of Health Sciences in 2011. Dr. Nouhavandi left her traditional retail pharmacy to start her own accredited online pharmacy, Honeybee Health, once she realized she could dramatically reduce medication costs for patients by cutting out industry middlemen such as insurance companies and pharmacy benefit managers. Honeybee Health now provides direct access to affordable, high-quality prescription medications to patients—without the need for insurance or coupons. You can read more about her and her company at www.honeybeehealth.com.

And The Survey Says: COVID-19 Changed How We See, Eat, & View Food

During “This Challenging Time” may people’s usual food concerns gave way to more immediate priorities: stocking up on staples like proteins, milk, canned goods and the like.  (Count me in – I bake our bread and I’m one of those who found it hard to find yeast and flour.)   Right after sheltering-in-place (SIP) began, our attention went towards all things comfort: in our food, our home, our down time, everything.

The International Food Information Council (IFIC) conducted their 2020 Food & Health Survey of adults, ages 18-80, in mid-April, during the pandemic.  More than 8 out of 10 of us changed how we ate and prepared food in response to COVID-19.  People under 35 made the most changes – but not all changes were good ones.

Here are other survey highlights about how we see food and health right now:

We’re eating better – or not

More than 1 in 5 say they’re eating healthier, but there’s another group, about 1 in 7, who felt they were making less healthy choices.

We’re cookin’!

About 3 in 5, were doing more cooking at home.  Not a surprise, since most restaurants were closed.  Grocery stores continued selling their prepared foods at a pretty good clip, however, so cooking at home still was still able to be avoided by some.

You can bet that people working from home and now forced to produce 3 meals a day, probably relied more on help from the prepared foods section of the supermarkets.  Supermarket sales in almost all sections of the store were way up.

Got kids?  You got snacking!

More than 3 in 5 (41%) parents with minor children were snacking more than they normally did, vs less than 3 in 10 parents with grown children.  With more kids at home all day, it figures that there will be more snacking going on, and parents serving snacks are probably more likely to join them. Even so, about 1 in 4 said they were now snacking multiple times each day.

What worries us more about food now? 

  • More than half had concerns about eating food away from home or eating food prepared outside the home. Roughly half of survey respondents were at least somewhat concerned about either eating away from home or food prepared away from home (take-out, restaurant deliveries, etc.).  This was somewhat more so for African-American and Hispanic consumers than for whites.
  • Put into simple language, people want to know if the person/persons who made this dish I brought home were careful about proper food safety when they made it.
  • “Food handling/food preparation related to risk of COVID-19” had never been asked in this annual survey, but it became the number 1 concern for consumers, knocking off the top 4 food safety concerns of 2019. On the home front, we’re also washing our fruits and vegetables more.

What worries us less?

  • Food-borne illnesses from bacteria.
  • Chemicals, carcinogens, and pesticides in food.

These were still concerns, but issues related to COVID-19 knocked them off most people’s “top concern” list.  It’s consistent with the huge increase in purchases of items like canned and frozen vegetables – foods that people know are safe and have a long shelf life.

Health vs. Weight: Which Matters to People More?

Health mattered a little more than weight but not much.  Most participants valued both equally, but women and overweight persons put slightly more priority on weight.

More “style” in our eating!

A consistent trend the past few years is following some form of eating style.  Nearly 3 in 5 persons reported trying some type of diet or eating style.  Top reason: to try and lose weight.

Top eating style for 2020?  Intermittent fasting.  It bumped last year’s “clean eating” from first place.  Keto/high fat dieting was third.

The survey offered hope, though. “Nearly 6 in 10 place more emphasis on their overall health now in comparison to how they made decisions a decade ago.”  Healthier weight will follow – another “two-fer”!

Cut-To-The-Chase Takeaway

We CAN and DO make changes to how we eat – if we’re motivated.  Let’s not lose sight of that.  Instead of our motivation coming from fear, let it be wanting to feel better. And knowing we deserve that.

From 9 Top Nutritionists: Positive Take-Aways From COVID-19

In a very short time period, COVID-19 turned how we live upside down.  We’re suddenly living, eating, and shopping differently than perhaps ever before. Has all this impact been negative?  I spoke with 8 nationally-known registered dietitian-nutritionists to get their take on what they think are the POSITIVES that might come out of the current pandemic, what they’ve learned, and a few noted what they’d like to keep from the whole pandemic experience.

Newfound Respect for Some Pantry Standbys

Amy Myrdal Miller hopes people “appreciate the benefits of canned fruits, vegetables, and beans and frozen fruits and vegetables. For too long people have believed ‘fresh is best.’  This points out the reality that canned and frozen foods offer nutrition benefits and convenience.”  If the increased demand for canned and frozen foods is any indication, this appears to be happening.

Neva Cochran agreed, noting that consumers returned to these foods as well as beans, beef, pasta, and others, “that are often mis-characterized as not being healthy or nutritious.”  Since the onset of the pandemic, she continued, “Concerns about buying organic, meat-free, non-GMO, all-natural, no added hormones, antibiotic-free and gluten-free have taken a back seat when people are concerned that there may not be enough food.”

Gratitude was also expressed.  “I’ve never been more grateful for all these non-perishable options – and the farmers who bring them to my table,” said Nicole Rodriguez.  “Whether it’s a simple box of raisins with my daughter during ‘home school’ snack time, cottage cheese topped with a pre-portioned serving of cling peaches, or frozen berries heated up as a makeshift jam,” she said she has a deeper appreciation for fruits in all forms.  As do I, including fresh fruit!  (See my Cut-To-The-Chase Take-Away below for more!)

Isolation – The Good Part

Photo credit: Andrea Piacuadio, pexels.com

Some found appreciations that had nothing to do with food or nutrition.  Chris Mohr’s normal schedule has him on the road constantly.  Being grounded (literally!) has been an unexpectedly positive experience for him, his wife and their two daughters.  “I love the increased level of connection among us.  We’ve each grown closer because we’re not socializing, traveling for work or anything else.  And I will work really hard to keep that up once we are ‘released’ from our homes”.  Probably something we all might focus on.

Having a less structured schedule during isolation has allowed Karen Ansel some freedom.  She’s found that she can do things “at times of day that mimic my body’s natural energy flow instead of when I’m “supposed” to do them.  I’ve been spending a lot of time spinning my wheels trying to be productive at the wrong times of day.” While she realizes all this may change when isolation is relaxed, “normal” life resumes, she does want to maintain take some of this new-realization.  “I do plan to really try to follow my body’s internal energy cues as much as possible.” 

Teachable Moments

If your kids show an interest in cooking, all the at-home time is great for getting into the kitchen with them to practice.   Toby Amidor, author of numerous cookbooks, has found it’s allowed her to, “Cook with my kids in the kitchen and actually see how my girls can cook without me in the kitchen.”  She sees how much they’ve learned from their mom, adding, “Now we are focused on further developing their cooking skills into more complex dishes they want to learn to cook.”  Sounds like “teacher” and her students have both learned something.

Rosanne Rust loves that people are sharing more time with their families in general, but including in the kitchen. “Teaching the kids how to bake, or working together at home, is a win-win for both the parents and the children. Even if at times it seems stressful.”  Good point.  If you’re new to teaching your kids cooking skills, start with goof-proof, entry-level skills: boiling an egg, baking a potato, steaming a vegetable.  Baby steps here!

As a retail dietitian (as in supermarket), Leah McGrath thinks many have gained a new appreciation for how hard supermarkets and restaurants work to make sure there is food available to us.  “Perhaps we won’t forget to take a moment when we’re shopping for groceries or eating out to remember that with a kind word, a smile or, when appropriate, a generous tip.”  Active on social media (@InglesDietitian), she’s using the #QuarantineKitchen hashtag.  “I think many have surprised themselves with their culinary creativity and ingenious substitutions to make meals for themselves and their families.  Necessity is the mother of invention!”

Beyond teaching cooking skills, food has always been part of family culture, too.  Notably, our isolation has occurred during Easter and Passover periods.  Christine Rosenbloom sees this isolation as, “An opportunity for kids and families to learn to cook and bake.  Teaching kids family heritage through foods and sharing treasured recipes,” is something she recommends during all the enforced down time.

I hear that.  Growing up, we celebrated what we called “regular” Easter (the one recognized nationally) and “Greek” Easter (the Eastern Orthodox one, which usually falls on a different Sunday).  This year, I did my part by making this braided Easter bread, like my Greek grandmother made, pictured here. (I hope she’s lenient – I reduced the amount of anise seeds by half and added some nuts – personal preference!)   

Cut -To-The-Chase Take-Away:

I join my colleagues in valuing all those pantry staples people have forgotten or dismissed.  They are – and always were – safe and nutritious to eat.  BUT…SO IS FRESH PRODUCE! 

Moreover, farmers need your help!  Many are plowing under or discarding perfectly good crops because of lower demand by consumers too afraid to handle and purchase fresh fruits and vegetables. 

You CANNOT get COVID-19 from food.  Why?  I explain it to you backed by facts!) in a previous post here.  So, when you do shop, buy fresh, too.  Remember – farmers aren’t “first responders”, they’re CONSTANT responders, through all.

News Flash: Fresh Produce Is Safe To Eat!!!

When I hit the supermarket these days, I’m seeing canned and frozen vegetables and fruits flying off the shelves.  All good, because they’re shelf-stable and many folks are minimizing trips anywhere, including to the supermarket.  Yet the fresh produce section, loaded with colorful, delicious fresh fruits and vegetables, isn’t feeling the love. 

That’s a problem.  There seem to be concerns about buying and eating produce these days, especially if it’s sold in bulk, since other consumers might have handled it.  

Feel Good About Eating Fresh Produce

No reason in the least to avoid eating fresh fruits and vegetables.  Yes, you need to wash it.  You’ve ALWAYS needed to wash it.  You DON’T need to wash it with anything special.  Here are 7 terrific tips, straight from the FDA website, for washing fruits and vegetables so you can eat them with confidence, :

  • Wash your hands for 20 seconds with warm water and soap before and after preparing fresh produce.
  • If damage or bruising occurs before eating or handling, cut away the damaged or bruised areas before preparing or eating.
  • Rinse produce BEFORE you peel it, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.
  • Gently rub produce while holding under plain running water. There’s no need to use soap or a produce wash.
  • Use a clean vegetable brush to scrub firm produce, such as melons and cucumbers.
  • Dry produce with a clean cloth or paper towel to further reduce bacteria that may be present.
  • Remove the outermost leaves of a head of lettuce or cabbage.

COVID-19 note: Your risk of getting it from food is slim to none.  Check This graphic from the University of Georgia Extension.  I love it because it tells you how you WON’T get COVID-19, and you won’t get it from food. 

Your stomach acid HATES this virus as much as you do.  It’s part of our body’s protective barrier.  Stomach acid has a very low pH (meaning it’s a strong acid) and the virus can’t survive that.  Plus, the virus needs to get to you through your respiratory tract, not your GI tract.  The tips on washing your produce however, still holds.  Consider it part of “best practices” on the home front.

 

Long before COVID-19, I wanted to be prudent and remove whatever dirt and such that might have accumulated on the skin.  In our home, we’re eating lots of root vegetables like carrots, beets, and potatoes, especially now, because that’s what’s left in the farmers’ market, and since these veggies grow in the ground, it makes sense to give them a good scrubbing.  (Note, in the photo below there’s also kohlrabi and celery root on the left and right, respectively — other root veggies definitely worth trying!) I do the same for oranges and apples, too, though.  Food safety is not just a farmer’s responsibility, it’s mine and all of ours as well. 

Biggest Pandemic: 9 Out of 10 STILL Don’t Eat Enough Fruits & Veggies!

The latest from the 2020 US Dietary Guidelines Advisory Committee established that average COMBINED intake of fruits and vegetables is just under 2½ cups a day, and that includes 100% fruit juice.  Specifically, average consumption of fruit is 0.9 cups a day of fruit and 1.4 cups of vegetables.  This accounts for all of it – including your 100% juice and the lettuce on your sandwich.  This is about what it’s been for the past 20 years.  Not much progress.

I’m not going to bother you with the Mt. Everest of research about the bennies of eating 5 cups a day of fruits and vegetables.  Unless you’ve been licving under a rock for the past 50 or so years, you know how beneficial eating fruits and vegetables can be for your health – and your taste buds.   I’m just going to say we can do better.

Cut To The Chase Nutrition take-away: I don’t’ split hairs here.  While 2½ cups of vegetables and 1½ cups of fruit are the recommended minimums, don’t obsess.  If your consumption adds up to at least 4 cups a day, in any combo, and regardless of whether they’re fresh, canned, frozen or dried, take a bow.  Keep the juice to a max of 1 cup though, and the dried fruit to 1/4 cup or so if you’re watching calories. 

Otherwise eat up.   

COVID-19: 5 Steps To Make Some Lemonade Of It ALL!

Amid a pandemic like COVID-19, the hysteria seems to build and change by the hour.  Businesses are shut, so are many workplaces and offices.  Gyms, malls, anything even slightly optional, not happening.  We don’t know when things will return to normal but the world isn’t ending either.  In fact, there are some real positives for our lifestyle and our health that can come from all this disruption.

Positives?  From COVID-19?  Yes.  The disruptions are forced upon us, but everyone’s at the same place.  Let’s work it.  Here’s where I see the lemonade from “sheltering in place”:

Everyone. Slows. Down.

Less pressure to get all the errands done and on time.  Indeed, none of us can “do it all,” because so much of “it” has been cancelled!  There is also no rushed commute, no traffic snarls, no morning scramble to get kids to school, no mad dash after work to meet friends or get home to make dinner, and fewer errands to run.

Avoid Going Nuts & Enjoy The Extra Time 

It’s time to get to things you’ve been putting off – especially the “me” things that help clear our heads and bust our anxiety.  Some options to consider: 

  • Move it!   No marathons, just get out and walk.  It’s still OK, even if you’re under “shelter-in-place” orders.  You’re not under house arrest, so get on your sneakers and walk as briskly as you can, staying at least 6 feet from others.  About 100 steps a minute – done outside or inside – is considered a “brisk” pace and that’ll get you a mile for every 20 minutes of walking.  Or ride a bike, dance to a video, or do online yoga!  Exercise is well-known as a great mood lifter. It clears your head, gives you a mental boost, and makes life more manageable.  Make it part of your “me” time.  About that marathon though, check out this story of a guy in France who ran the distance of a marathon on his 23-foot balcony!
  • Give yourself a 30-minute “organizing” task. The task may take longer, but spend 30 minutes a day doing it.  That might be de-cluttering your home office desk (the bane of my existence), cleaning out a closet, gathering clothes and knick-knacks to donate, or going through the pantry to throw out expired condiments and food.  You can do it at a leisurely pace and end up with so much extra room!
  • Do fun stuff. Got a hobby you never seem to have time to do?  It’s time, and make it a priority.  Aim for an hour a day here, too.  I hope you make it a habit you’ll continue, even after this all passes.
  • Family meals are back!  Make these a priority, too, and make them last at least 30 minutes.  No technology at the table, just re-acquaint with conversation and socializing.  Some of the best memories of my childhood were sitting around the dinner table with parents and grandparents.  We’d talk about everything: the meal, friends, goals, you name it, and everyone was welcome to participate.  To me, it’s what a family meal should be, but make your own family meal style you’ll enjoy.
  • Rediscover the joy of cooking!  It’s WAY more enjoyable when you’re not pressured.  You can finally get to making those recipes you’ve collected but never got around to trying.  No cookbooks? No problem.  There are tons of great sites online.  Try www.beefitswhatsfordinner for starters.  It’s my go-to resource for all things beef, and their recipes are excellent and don’t require a degree from Le Cordon Bleu.    Check out Dr. Keith’s Pot Roast recipe.  I’d never cooked one before and adapted a NY Times recipe.  Turned out to be lean and the best pot roast I’d ever eaten!  The prep doesn’t take very long, you just have to be home for a few hours.  And since you’re home anyway, enjoy the aroma and eat the reward – and it stretches for more than one meal!

Chocolate Geeks! Have You Tried These Delicious Artisan Bars?

I’ve loved chocolate – dark chocolate – ever since I can remember.  As a little kid my dad would whisper to me, “Hey, you want some “bittersweet?” Then he’d lead me to his workshop in the basement and share a few bites of the dark stuff.   

Now I find out I was born on National Dark Chocolate Day (February 1), and suddenly it all makes sense: my affinity for good chocolate was genetically determined.  Rather than fight it, I embrace it.    

My partner loves chocolate, too, and we’ve assembled our own list of artisan chocolatiers in Paris that make for a great 3- or 4-day walking tour, structured so we log 7-9 miles a day. 

He likes truffles and filled chocolates, but I head straight for bars, with 70% cocoa content as a minimum.  At that level, quality really shows its hand.  Low quality beans can be disguised when a bar is only 30% chocolate and has lots of sweetness and flavors added.  At 70% or 80%, the cards are on the table.

Artisan Chocolate: A Kinship With Wine

Artisan chocolate bars are like wine.  Each has a taste all its own, influenced by many factors:

  • Single variety from a single plantation
  • Blend of beans
  • Method of fermenting, roasting, and processing
  • Soil, weather, location

Tasting points: Yes, it tastes “chocolatey” but there’s so much more to an artisan bar.  Some of the tasting notes you’ll find: coffee, “red fruit” (think raspberries and cherries), spices, and even floral notes.  Within these taste groups there can be specifics.  Some tasters will report notes of honey, vanilla (even though no vanilla was added), smoky or oaky notes, tangerine or grapefruit, etc.  I’ve even found hints of olives and green bananas. 

Bars also come with additions, like nuts, dried fruits, nougat and more. I’m paying a premium for the chocolate, so hold the groceries, thanks. Spices and herbs, like cinnamon, smoked paprika, and turmeric, and infusions like Earl grey tea are fantastic when done well. 

Wanting to track my favorite bars, their flavors, and notes about them, I started tracking them by making a list of each bar, “rating them from 1-100, and providing short descriptions for myself so I’d remember whether I wanted a repeat if I saw them again. 

The list now contains hundreds of domestic and international bars, it’s 42 pages long (single spaced) and nearing 20,000 words as of this posting. 

I was planning on listing my current favorite bars when New York Times food writer, chef, and author Melissa Clark had the same idea.  I discovered we liked some of the same bars.  She has a fabulous palate and I love her articles, but I know I’ve probably tasted more artisan bars. 

A FEW of My Favorite Brands & Bars:

Chocolate Bonnat: My all-around go-to brand for outstanding chocolate bars, especially the “Haciendas El Rosario” (75%) bar.  Real roasted flavor and aroma, a bit smoky, typical of Venezuelan cocoa.  The 75% Porcelana and Chuao bars are superb — and expensive. 

Pralus: A French maker, most bars are 75% but milk chocolate lovers have options, too.  My favorites here are the Indonesie bar for its woodsy, chocolatey, and intense flavors.  Traditional French roasting method makes it seem richer than a typical 75% bar.  The Chuao and Porcelana bars, two of their “Grand Crus”, are top line favorites, when I can find them. 

 

Chapon:  Like Bonnat, this is another chocolatier who nails it every time.  I first bought it in Paris and the link is to his online shop.  Not cheap, but a chocolate nerd would love it.  I’ve loved all the dark bars I’ve tried.  Most bars have only two ingredients: cocoa paste (ground beans) and sugar.  Has a good “snap” and intense cocoa flavor and aroma.  Favorites: Venezuela Rio Caribe, the Chuao bar (notes of hazelnuts and figs) and the Cuba bar (notes of coffee, caramel, and vanilla).  The latter two are among this line’s  “Cocoa Rare” bars, using exclusive, high quality beans.

Domestic Artisan Chocolatiers, Too! 

Right here in New York City is MarieBelle Chocolate!  I’ve written about the founder, Maribel Lieberman, before.  A native of Honduras, she uses primarily beans from there and deals directly with cocoa growers, especially women, helping them grow their businesses and giving them a US market.  My favorite is the 70% bar sweetened only with milk powder.  It makes for a VERY creamy bar, yet very intense as well.  No added sugar and actually has some protein and calcium!  You’ll either like it or not, but taste it more than once.  Believe me, it grows on you and it’s worth it. 

Arete: I’ve had chocolate from this Tennessee maker before, (their India bar is great) but I just tasted their 709% bar made with Tennessee sour mash whisky and it’s a winner.  The cocoa butter added to the cocoa bean paste is infused with the whisky.  No bitterness at all, it has notes of caramel and vanilla along with the whisky and it’s very friendly to the palate.  I’ll get it whenever I find it.  Note: the maker’s website sells their bars but as of press time their sold out of a lot. 

Without going to Paris, some great online sources for artisan brands:

Chocosphere – Great online source for artisan chocolate, carries a lot of brands.

Barandcocoa.com  Another source online, not cheap but it’s there when you need them and they also have a fairly broad variety.

And the best…Chocolate Covered: UNBELIEVABLE variety — over 1000 different bars in this quirky, small small shop in San Francisco.  It’s my go-to place whenever I’m in town and I always find bars I haven’t tried.  Jack Epstein is the owner and a very nice guy.  If you tell him “Keith from New York” sent you, he’ll know exactly who you mean.