The Actual Cost of a Burger

The announcements of the recent Academy Award nominations remind me to talk again about Food, Inc., a 2010 Academy-award nominee for Best Documentary, and winner of many other awards and nominations besides. Billed as a “civilized horror movie for the socially conscious, the nutritionally curious and the hungry” as well as “an unflattering look inside America’s corporate controlled food industry,” it minces no words. Just 94 minutes long, I urge you to make time to watch it.

I am reminded of the comment from a YHIOYP reader who once wrote to me about the high cost of meat from pastured and grass-fed chickens relative to feedlot meats. She expressed the concerns of many when she said that it’s a difficult choice to make when you are purchasing and cooking for a large family. But is it true that mass-produced meat is cheaper? It is not, and Food, Inc. explains why.

The cash in our wallets turns out to be just one small part of the total cost of mass-produced, manufactured food products. The actual costs are a great deal higher, but they become invisible with their transfer to other sectors, primarily health, environment, and society as a whole. Health effects are reflected in the absurd and skyrocketing rates of obesity and diabetes, along with the medical costs of caring for those with these diseases. Environmental effects are made visible in the rivers of animal waste spewing from feedlots. And parallels between inhumane treatment of animals that become food and the workers — without whom artificially suppressed prices become impossible — who process it are not coincidental.

Food, Inc. profiles one family as they choose dollar-menu sandwiches, fries, and shakes over fresh produce, even while paying a monthly $70 for the dad’s diabetes medication. Feed lots are filmed showing thousands of animals knee deep in their own excrement. It turns out that the past several decades have seen a drop in the number of slaughter houses in the U.S. from several thousand to just 13, effectively concentrating and destabilizing the meat processing industry. The viewer is introduced to a woman who has been campaigning for safer feeding and butchering practices ever since her 2-year-old son contracted hemorrhagic colitis, caused by the bacterium E. coli 0157:H7 in the burger that he ate 10 days before his death. The diet of feedlot cattle increases the risk of illness to both the animals and people who consume them.

My great-grandfather was a butcher. He did not have a sign in his front window advertising “Grass-Fed Beef.” Do you know why? Because that’s what cows eat.

Eating well doesn’t have to be expensive. While eating meat every day is expensive, eating lentils, chickpeas, greens and whole grains (especially when purchased in bulk) is not. A few years ago, when one of my patients, a janitor in a local high school, dropped 50 pounds and half his medications over the course of a year or so, I asked how he did it. “Beans and greens,” he said with a grin as he pounded once on his chest for emphasis and then threw both arms open wide. “[It’s] the secret to my success!” I have quoted him a thousand times since that day.

Alice Waters, perhaps the first guru of simple food, knows that good food is a good investment. “You either pay up front, or you pay out back…in your health and your way of life and the health of the planet…”

In the current environment, a burger is apparently a better buy than a bunch of broccoli. Chips are cheaper than carrots. It’s an easy down-payment, but a lifetime to pay. Frankly, it reminds me of subprime, variable-rate mortgages; the actual price is untenable, unthinkable and, as we all know by now, unaffordable.

But here’s my favorite part: We remain complicit only as long as we continue to purchase cheaply manufactured calories. The fact is, your purchasing power is substantial. If you stop buying it, they’ll probably have to stop making it.

YOUR HEALTHY PLATE: Chocolate Berry Tart

It’s so good to know that there are folks out there who have figured out how to make magnificent desserts like this one, delicious and nutritious, beautiful and filling. It comes straight from Rachel at Thanks, Rachel!

Crust ingredients:
1 1/2 c. almond flour
1/4 c. unsweetened cocoa powder
1/4 c. coconut oil, melted
1 Tbsp. maple syrup
one pinch, sea salt

1/2 c. canned full-fat coconut milk
6 oz. bittersweet chocolate, finely chopped
1/4 c. 100% fruit raspberry preserves
1 pint raspberries

Use a bit of coconut oil on your finger to lightly grease a 9-inch springform or tart pan (with removable bottom).

Combine crust ingredients in a bowl, stir together with a fork, and press evenly into prepared pan. Bake at 325F for 10 minutes. Allow to cool completely.

Add chocolate to a large bowl and set aside. In a small saucepan, bring coconut milk just barely to a boil. Pour the hot milk over chocolate, and let stand 1 minute. Mix until smooth and creamy, and then stir in the raspberry preserves. Pour filling into prepared crust, and decorate with fresh raspberries.

Chill for at least one hour, and cut into 16 small rectangles. Enjoy!

The Trans Fat Ban

This past summer, some 50 years after concerns were first raised about a possible link between trans fats and heart attacks, the U.S. Food and Drug Administration (FDA) ruled that partially hydrogenated oils, the primary dietary source of trans fats in processed food items, are no longer “generally recognized as safe” in human food. Processed food manufacturers will have three years to reformulate their products or request an exemption. This action is expected to prevent thousands of fatal heart attacks a year. Multiply that by 50 years.

Trans fats are found throughout the processed food industry in cookies, crackers, cakes and pies; frosting and shortening; potato chips, microwave popcorn, French fries, and fried chicken; doughnuts, biscuits, cinnamon rolls, and frozen pizzas; stick margarine and non-dairy coffee whiteners. They entered the food supply in the early 1900’s as Crisco®, so named for “crystallized cottonseed oil.” Crisco® was invented in the late 1800’s as William Procter and James Gamble sought an inexpensive fat to replace tallow, a costly raw material required for their candle- and soap-making businesses. By 1905 they owned eight cottonseed mills, and the knowledge to convert liquid cottonseed oil to a solid. With the candle market shrinking, they made a startling decision, in retrospect, to market Crisco® as a food. Cheap and with an unnaturally long shelf life, it quickly became a staple in homes and factories. But it was only in the kitchen that trans fats worked as predicted; with regard to their deleterious effect on human health, no one would know for generations to come.

All kinds of immigrant communities, eager to adopt American customs, became lucrative markets for processed-food manufacturers. For all kinds of newly minted Americans, margarine, “vegetable shortening” and, later, non-dairy coffee whiteners rapidly supplanted traditional fats. To attract the ethnic markets, Procter & Gamble solicited endorsements from community leaders, organized picnics and outings, printed cookbooks to showcase the use of its manufactured products in traditional recipes.

What’s Next After Trans Fats?
While Crisco® is no longer made from cottonseed oil, it still contains trans fats, which means that it will require reformulation under the new FDA guidelines. But cottonseed oil continues to predominate in many other manufactured products. Why?

From a scientific standpoint, cottonseed oil is highly stable chemically. It is not easily broken down by heat, oxygen, or time. Stability lengthens shelf life, which raises profitability. Cottonseed oil owes its stability to the fact that it contains extremely high levels of omega-6 fatty acids. Omega-6 fatty acids are strongly pro-inflammatory and, like trans fats, a likely contributor to the epidemic of chronic inflammatory diseases in Western society.

Cotton seeds entered the food supply inadvertently, at a time when science understood virtually nothing about their pro-inflammatory properties. Just as with trans fats, there is a price. We pay for the convenience of eating cottonseed oil with our health.

Replacing Manufactured Calories with Food
If present trends continue, half of all Medicare recipients are expected to carry a diagnosis of diabetes in the coming decades. Responsibility for the cost of the diabetes and obesity epidemics eventually comes to lie, therefore, at the feet of each and every one of us. Consumers have the power to transform the food supply to a greater extent than they realize. You vote every time you shop, every time a bar code passes a scanner. Why wait three years when you can stop buying trans fat now? Why wait for the FDA to initiate their evaluation of the evidence against cottonseed oil when you can decline to purchase products made with it today?

Short-term convenience must not trump the long-term health of our communities. We can learn to bake with olive, coconut, and sesame oil instead of margarine. Instead of non-dairy creamers, we can try coconut, almond, soy or rice milk in tea and coffee. Like our ancestors, we can take the opportunity to eat more fresh fruit and vegetables. If we don’t begin to spend our hard-earned dollars on real, nutritious food, then we will spend it at the pharmacy. The trans fat ban is a start.

YOUR HEALTHY PLATE: Winter Kale and Wild Rice Salad

I’m still collecting recipes for you to make to celebrate the end of football season! I hope you like this one! Many of the ingredients for this recipe have winter written all over them, which I am very happy about, since you can probably guess that I like to eat food in season.

Salad ingredients:

  • 1 c. cooked wild rice (at room temp)
  • 2 c. cooked brown rice (at room temp)
  • 2 c. baby kale, chopped
  • 1 apple, diced
  • 1 orange, peeled and diced
  • 1/4 c. dried cranberries
  • 1/4 c. dried tart cherries
  • 2 stalks celery, diced
  • 1 green onion, thinly sliced

Dressing ingredients:

  • 1/4 c. minced shallots
  • 2 Tbsp. extra virgin olive oil
  • 3 Tbsp. water
  • 2 Tbsp. agave nectar
  • 1 Tbsp. apple cider vinegar
  • 2 Tbsp. freshly squeezed orange juice
  • 1 tsp. Dijon mustard
  • 1/2 tsp. Kosher salt
  • 1/8 tsp. black pepper

Prepare the brown rice and wild rice in advance, and set aside. You can even make these several days in advance, and then store them in the refrigerator. When you are ready to make the salad, whisk together the dressing ingredients in a small glass Pyrex bowl and set aside for 5-10 minutes. Then combine the rice, kale, fruits and vegetables in a large serving bowl.

Pour the dressing over the salad and mix well. Serve at room temperature. Makes 8 servings.

Thank you to for a prior version of this recipe.

Michael Ruhlman Quotes Sukol, and TED!

Before we go any further, I am THRILLED to announce that my #TED talk is up and ready for your viewing pleasure! Many thanks to my family, friends and colleagues, especially Gina Messina-Dysert and Melissa Celko, for their unwavering inspiration and support!! 

A few months ago, the chef and food writer Michael Ruhlman requested a meeting with me in our local supermarket, an interview of sorts, a chance to hear how I think about groceries, shopping, processed food. He asked plenty of questions, and took plenty of notes. He wrote it all up and, this past week, published an essay in the Washington Post , which then appeared in the Chicago Tribune and Crain’s Cleveland Business, about my own observations on the extent to which words are manipulated to influence consumer choices and behavior. I share here some of his thoughts along with a great big “Thank you!” for spreading the word.

He opened with an anecdote about a purchase of “fat-free half-n-half” by a woman who had no idea what that descriptor actually meant. (It means half skim milk and half corn syrup.) This example happens to be a particular favorite of mine; I never miss an opportunity to explain it to patients who still use the stuff. They are usually horrified, never having given any thought to what it might actually mean.

What Michael liked most was my take on the word “healthy.” He stopped, stared, and then wrote furiously when I started talking about how crazy it was to describe food as healthy. “It’s not the food that’s healthy,” I said, “it’s us.” We who eat nourishing food are hoping to improve our health. When we eat nourishing food, our health hopefully improves.” Kale isn’t “healthy,” it’s nutritious (though not, of course, when it’s the only thing you eat).

Michael described me as an autodidact, which I have since learned means “self-taught.” Yes, that is true. I didn’t get much more than ten minutes of nutrition education in medical school (mostly in biochemistry class, where food was not the focus), and it’s possible that it was even less, which is to say none at all. And this at one of the most visionary medical schools in the country (independently corroborated, not just my opinion). That’s a huge oversight, and one that is only now slowly, much too slowly really, being corrected.

There’s a lot to this. The only way for doctors to guide patients to make better choices is for those same doctors to first learn to make the changes themselves. No one cares what you say; they only care what you do. And if what you say doesn’t match what you do, then it’s what you do that prevails. Either way, if you really want to make a difference you’ve got to start walking the walk. That is, if you aren’t already.

My pet peeve with the term “refined” got a major shout out! Yes, to refine means to remove the coarse impurities! So if you want people to buy more white flour, then you’re definitely going to want to call it refined. But if you want consumers to know that whole-grain flour is more nourishing and way better for their health, then you should just call the other stuff what it is, which is “stripped.”

Stripping removes not just the nourishing germ (oil) and bran (fiber). It also removes a lot of micronutrients, which are going to need to be replaced if folks aren’t going to develop obvious nutritional deficiencies. That’s why Congress passed legislation requiring the food industry to “enrich” bread with iron and B vitamins. And to “fortify” it with folate (vitamin B9). Why does the processed food industry strip it in the first place? To increase shelf life and profitability. Not a small thing. And what about the more subtle nutritional deficiencies? I believe that I see these in my office every day.

Here’s the overarching point: it’s not a problem if, knowing your choices and their consequences, you choose to eat something that someone else might consider less than ideal. It’s your choice, after all. However, it is a problem when you can’t figure out what your choices and their consequences are in the first place.

When industry capitalizes on your ignorance, and that drives up healthcare costs, then it’s time to look at the words. That’s where I come in, and so here is my straight talk: Eat nourishing food. Be healthy.

At work last year I won our “Yoda of Wellness” Award. Don’t get too excited about this — I work in the kind of place where everyone gets an award. But I do still love that award, and I am channeling it when I say that there is “Eat nourishing food.” There is “Be healthy.” There is no try.

To quote Michael Ruhlman: “Words matter. And those that we apply to food matter more than ever.” “And until we have better information and clearer shared language defining our food, smart choices will be ever harder to make.”

I couldn’t have said it better.

YOUR HEALTHY PLATE: Roasted Garlic, Parsnip and White Bean Soup

Here’s a soup to, yes, satisfy your sweet tooth! One thing I really love about certain foods, like garlic, parsnips, and onions (tomatoes, too), is that their sweetness develops rather dramatically when you roast them or leave them to cook slowly. And, frankly, there just aren’t enough parsnip recipes around for my taste. Remember though, that if you want to be able to enjoy the subtle sweetness of foods like these, you will want to moderate your intake of sugar and especially corn syrup, both of which tend to overwhelm your tastebuds and raise your threshold for tasting the lesser (though more complex and satisfying) kinds and amounts of sweetness in fruits and vegetables. Continue reading

Cholesterol: The good, the bad, the ugly

The first thing I’m going to say about cholesterol is that we don’t understand it well enough. On my first day of medical school back in the early 1990’s, Dr. Kirby, our Dean of Students, said that half of what we were about to learn over the next four years would turn out to be false. The problem was that no one knew which half! Here are some of the things I learned in medical school that have turned out to be false: Continue reading

YOUR HEALTHY PLATE: Creamy Homespun Hummus

It’s never too early to start collecting recipes for the upcoming end of football season! A plate of this creamy hummus to share, drizzled with olive oil and sprinkled with spicy paprika, and you will be in seventh heaven, no matter what the score! Continue reading

YOUR HEALTHY PLATE: Sweet Potato & Chickpea Soup

This post will be the third and final of YHIOYP’s one-pot Back to Life recipe series (see the prior two blog posts here and here). This time, I’m back to my old standby, my trusty crockpot, from which so many wonderful meals have come, and I’ve decided to make my own version of Gypsy Soup, originally from Mollie Katzen, the author of the famous Moosewood Cookbook. Through the years I have made so many recipes from that cookbook that it is now ancient and falling apart, even despite having been taped together with leopard-spot-pattern tape somewhere along the way). Continue reading

YOUR HEALTHY PLATE: Yellow Lentil Stew

In this, the second of three one-pot Back to Life recipes (see the introduction in my blog post from this past Sunday, January 3rd), my new #Staub cast-iron Dutch oven made its debut on our kitchen table and was everything I’d dreamed of! My family chose the dark green color, which looks beautiful wherever it sits. Magnificently designed, it is simply a gorgeous pot that squeezes every last molecule of flavor out of its ingredients, and then holds its heat like a brick wrapped in bunting. And, no, I received no compensation of any kind to say that. And, yes, it’s true. Continue reading