Autoimmune Disease: An Invisible Epidemic

Autoimmune Disease: The Invisible Epidemic

Undoubtedly, you know a few people with an autoimmune disease. A childhood friend with lupus, an aunt with Hashimoto’s, or a neighbor with multiple sclerosis. Individually, these diseases may seem relatively infrequent. But taken together, they add up. The National Institute of Health (NIH) estimates there are approximately 24 million people with autoimmune disease with an additional 8 million people testing positive for ANA (antinuclear antibodies). (These antibodies are a group of antibodies are used to screen for autoimmune disease, though they aren’t diagnostic for a specific autoimmune disease.) This 24-32 million people is potentially a low estimate. The American Autoimmune Related Disease Association (AARDA) estimates there are 50 million people living with autoimmune disease. But even at the lowest estimate of 24 million, this means autoimmune disease is as nearly as prevalent as heart disease which affects 25 million Americans per year. Amongst chronic disease, the two are outpaced only by diabetes/pre-diabetes which affects 100 million (or 1 in 3) Americans. That’s a pretty big deal! And costs a lot of money too. Back in 2001, before he became THE Dr. Anthony Fauci, Fauci as director of the National Institutes of Allergy and Infectious Diseases estimated that annual autoimmune disease treatment costs were greater than $100 billion, and they have surely grown since then.

So, what is autoimmune disease? Broadly, autoimmune disease occurs when the body starts to produce antibodies that attack and damage its own tissues instead of an infection. Thanks to COVID, most of us are now very aware of what antibodies are! There are at least 80 known autoimmune diseases and possibly over 100. Most autoimmune diseases have a clearly identified autoantibody or set of antibodies associated with them, while some are still considered “suspected” autoimmune disease as they share a lot of commonality with autoimmune disease but an autoantibody has not been identified. And yet another group of conditions are considered more “autoinflammatory” rather than autoimmune. This means the body’s immune system is attacking itself, but no specific antibody has been identified rather it is the innate (non-specific) arm of the immune system causing the attack.

Research and awareness for autoimmune disease is complicated by the fact that each autoimmune disease is usually treated according to the tissue or organ that is being attacked. Multiple sclerosis patients see a neurologist, Hashimoto’s and Type I diabetes patients see an endocrinologist, celiac and other inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease patients see a gastrointestinal specialist, etc. From a broad perspective, this means that fewer people are studying autoimmune disease as a whole. From a personal perspective, this means that while the specialist you see is probably excellent at solving problems with the organ in question, they may not have as much experience understanding and treating the symptoms due to chronic inflammation someone with autoimmune disease undoubtedly has to contend with. As an example, many people with Hashimoto’s may be “treated” for Hashimoto’s by taking thyroid medications and still suffer from joint pain, extreme fatigue, IBS, depression, and anxiety. The thyroid medication is necessary but insufficient.

 Below is a list of some of the more common autoimmune diseases, roughly in order of prevalence.

•        Rheumatoid arthritis

•        Hashimoto’s Thyroiditis

•        Celiac

•        Grave’s disease

•        Type I diabetes

•        Vitiligo

•        Rheumatic fever

•        Pernicious Anemia/Atrophic Gastritis

•        Alopecia areata

•        Immune Thrombocytopenic Purpura

•        Multiple sclerosis

•        Lupus (systemic lupus erythematosus)

•        And many more….

While anyone can get an autoimmune disease, there are some groups higher at risk than others. 80% of autoimmune disease sufferers are women. Prevalence by race varies by specific autoimmune disease. For example, blacks are much more likely to be diagnosed with lupus but much less likely to be diagnosed with celiac disease. Interestingly, the data also varies by region which is very intriguing and suggestive of environmental influence! Note that this particular study relies on already diagnosed cases, and diagnosis is a huge problem in autoimmune disease. Again, it varies by disease but it can take multiple years, doctors, and misdiagnoses to get a correct diagnosis. Even more frustrating, considerable percentages of patients are often told it is psychosomatic (“all in their head”) along the way, 26.6% in this study on psoriatic arthritis and 36.2% overall (and 40.8% amongst the female respondents!) in this study on ankylosing spondylitis.

There is no single cause for autoimmune disease. It is thought to be a combination of genetic susceptibility, triggers such as infections or environmental toxins, and diet and lifestyle. While there is not much you can do about your genetics, this is thought to account for only about 1/3 of your risk. Likewise, infections can be tough to avoid. There’s a wide variety of bacteria, viruses, and parasites that have been shown to increase the risk of autoimmune disease. A few like borrelia (the bacteria transmitted by ticks) and giardia (a parasite sometimes found in untreated water) can be avoided through safe practices but most are not like this, and it is mostly just bad luck if you happen to get one. Environmental toxins are also only partially in your control. While we can attempt to control what substances we use in our home and personal care products (and I support this fully!), our regulations for toxic chemicals are frankly terrible in this country so the exposure is nearly inescapable once the chemicals enter our soil, air, and groundwater. Furthermore, the burden is disproportionally borne by the people who live in (or adjacent to) communities that are also the homes to either manufacturing plants or waste sites that contain toxic chemicals or who work in occupations where exposure is part of the job. Systemic change is what is required here. One of the most powerful things you can do is to vote for representatives who support regulating these harmful substances and powerful industries. For my fellow Californians, the California Environmental Justice Alliance produces a terrific legislative scorecard and voting guide each year to help you understand the issues and look up how your representative voted. I was pleased to see that in 2020 my local reps did pretty well:  Ben Allen received an A- and Richard Bloom received a B. Pay attention to those local elections!

There are a few other important risk factors (not necessarily causes) to keep in mind. One is simply already having an autoimmune disease. Multiple autoimmune syndrome (MAS) can occur in up to 25% of all autoimmune patients. So, if you have a diagnosed autoimmune condition you are at risk for getting another one. Another is having one of the Ehlers-Danlos Syndromes (EDS), a connective tissue disorder. There are multiple sub-types of EDS. Most types are genetic and rare, however the most prevalent type is hypermobile-EDS (hEDS) for which a genetic basis is not known. Hypermobile-EDS has been associated with a higher risk of rheumatic autoimmune conditions. Those with autoimmune disease and hEDS share a lot of the functional gastrointestinal and food intolerance issues which I discuss in much greater detail in a post co-written with Vernon Rowe, MD: “The Gut-Brain-Hypermobility Connection with Autoimmunity.” You can also learn more about Ehlers-Danlos at the Ehlers-Danlos Society webpage here.

And finally we come to diet and lifestyle both of which ARE in your control.* The diet and lifestyle guidelines in the Autoimmune Protocol (AIP) are all targeted at supporting the immune system and decreasing inflammation. The details of how that is accomplished is a topic for another day, given the length of this already lengthy blog post. But if you want to learn more now, please feel free to download my AIP Quickstart Guide here or schedule a 30 minute free call here to learn more about how it might apply to you.

*Given that I’m a health coach whose passion is to educate people about the best food choices for themselves individually, I feel surprisingly squeamish coming down too hard on individual responsibility. You are NOT at fault for your disease. There are a lot of structural problems that stack the deck against us (and some of us more than others, whether it’s food insecurity and access to healthy foods (separate but related issues), government subsidies that make processed food absurdly cheap in comparison to healthy food, or out of date government guidelines. But within these constraints, there are still a lot of things you can do as an individual than can help modify your disease. And this is not a zero sum game…if you have the resources to make diet and lifestyle changes, you may find yourself with more energy both for yourself and to become involved with some of these issues (or whatever issues you are passionate about, it certainly doesn’t need to be these). That was certainly the case with me…when my Hashimoto’s symptoms were at their peak, I had absolutely nothing left at the end of the day after barely managing my job and own family. With the energy and freedom from symptoms I’ve gained over the years from diet and lifestyle changes, and yes, also some conventional medicine, I can tackle a lot more!

Snacking

One of the most frequent questions I get from friends and clients is “Can you recommend some healthy snacks?”. Unfortunately, the tough love answer to this is…you shouldn’t be snacking! Ideally, you would eat ~3 meals per day spaced 5-6 hours apart.

But the reason for this may not be what you think. Avoiding snacking is not just a means to cut calories. (In fact, I don’t recommend counting or restricting calories as a means to dieting in the first place.) Rather, snacking has some deleterious effects on our digestion and regulation of hormones. Specifically:

1) Your body has an internal “cleaning process” that sweeps out the intestinal track between meals. This prevents bacterial overgrowth in the small intestine. Digestion interferes with this process (which takes about 2 hours) so eating more frequently than 4 hours prevents this from happening.

2) Your blood sugar levels are controlled by hormones such as insulin, glucagon, leptin, ghrelin, and cortisol. The way these hormones and the organs which create them interact as your body processes the food you eat is complex, but the short story is that if you are constantly eating (and therefore maintaining a raised blood sugar level), you are in danger of never giving your body a chance to develop its fat burning capabilities and may even develop resistance to these hormones.

Note that no snacking does not necessarily mean you should be doing “intermittent fasting”. While this can be beneficial for some situations, I do not recommend it for people with autoimmune disease nor typically for women. For people with autoimmune disease or with chronic stress, it can be too stressful for the body and worsen leaky gut. Additionally, there is less overall data for women and the data that exists does not conclusively show any benefits (and may show drawbacks).

Transitioning to no snacking

If you are transitioning from eating processed foods several times per day to a more whole foods based approach, you might have a hard time with this! It will get easier but in the meantime, here’s a few tips:

• Make sure you are eating enough at the prior meal. This most often means not enough protein or fat but could also too few carbohydrates which some people tend to go too low on when starting AIP (or other Paleo-ish diet) as a result of suddenly eliminating their favorite refined carbohydrate sources like pasta and bread. Include 4-6 ounces protein and a starchy vegetable like sweet potatoes or other root vegetables with each meal if you are having trouble making it to the next meal.

• Make sure you are digesting your prior meal. If you ate well at your prior meal but didn’t digest it your body may still be asking for more nutrients as they aren’t being absorbed even though they were ingested. Remember to take any digestive aids you need with each meal (e.g. bitters, digestive enzymes, bile salts, betaine HCl) and to relax prior to eating.

• Are you truly hungry? Here are some things that could be confused with hunger:

• Thirst: Try drinking water with lemon and salt to see if that satisfies your craving.

• Salt: If you are craving a salty snack, you may just be craving…salt! Again, try drinking some water with lemon and salt to see if that helps.

• Boredom: Definitely a thing. Try a quick walk or movement break. If you want something to keep your hands and mouth busy, try water or tea (unsweetened, decaf if after noon).

• Stress eating: Also definitely a thing! This one is physiological and involves cortisol so don’t send yourself into a shame spiral about this one, it is not a willpower issue. But you don’t have to eat either….again, a quick walk or movement break can help normalize your stress and cortisol issues so try and get in the habit of moving instead of eating.

If you must……some snack ideas

While you are transitioning, you may have trouble eliminating snacks so here’s some ideas to minimize the effects when you do

• Focus on snacks that are high in protein and include some fat. These will be more satiating than high carb snacks.

  • Fruits and veggies: Include with some nut or coconut butter

  • Avocado with lunch meat slices (additive and sugar free)

  • Wild-caught smoked salmon: 365 has a good wild caught version, read labels, there’s lots of weird stuff in some smoked salmon brands

  • Kale Chips: I use this recipe: Cheesy Kale Chips. And it is important to NOT use a nutritional yeast that’s been fortified with folic acid which most of us can’t convert. Unfortunately, the ubiquitous Bragg’s has folic acid. I use this one from Amazon: Sari Nutritional Yeast

  • Homemade gummies: These are great for kids too! I use 1 c fruit juice (usually tart cherry), 1/3 c gelatin (Vital Proteins or Great Lakes), and 1 Tbsp maple syrup). Heat the juice and honey over medium heat and slowly add the gelatin to dissolve. Use dropper to put into silicone molds then refrigerate. I bought these molds: Gummy Mold

  • Olives

  • Bone Broth

  • Hard-boiled eggs

  • Jerky/meat sticks (additive and sugar free)

  • A handful of nuts (these can be hard to digest even if you are not allergic to them so more than a handful is too much!)

  • Cheese or full fat, plain yogurt

  • Note there are some common allergens on this list: eggs, nuts, dairy. Pay attention to your body and try a temporary elimination if you suspect an issue!

• Use digestive aids (bitters, betaine HCl, bile salts, enzymes, etc) with snacks as needed. There is no straightforward yes/no answer to whether you will need them or not. It depends on your level of need for those aids in the first place as well as the size and composition of your snack. You’ll need to experiment and see what works for you. Keeping a detailed food journal is very helpful for this. You can always take your digestive aid mid-snack or up to 20 min afterwards if you start to feel signs like excessive fullness or bloating.

• Snack intentionally just as you would for meals. Your body needs to be in a relaxed state for digestion to function properly. One of the worst things about snacking is that it is so often done on the fly or while you are working. Definitely not a stress-free state! If you are going to snack, try and stop what you are doing and sit down for a moment of peace and quiet while you do it. You might just find that you really don’t need the snack after all after you’ve done all this!

Good luck and happy (not) snacking!

·       

 Note: There are 2 notable exceptions to the no snacking rule: People with missing or dysfunctional gallbladders and/or hypoglycemia.

o   If you are missing a gallbladder or have gallbladder dysfunction, you may have trouble digesting larger meals and may need to eat more like 4-5x per day. Pay attention to the amount of fat you can tolerate at each “meal”.

o   If you have hypoglycemia, you may need to eat a snack to prevent “crashing”. However, hypoglycemia is something that can resolve over time as you follow a whole foods based/low sugar diet and incorporate lifestyle changes such as managing stress which has a huge impact on blood sugar regulation. As you start, you may indeed need some snacks but hopefully you will find less and less of a need for them as your body heals.

Some of the worst snack ideas are in this aisle! Most are full of sugar.

March Approacheth: 4 Strategies to help manage the Post-Resolution Blues

So, it’s almost the end of February and then it will be March where New Year’s Resolutions go to die. And that’s ok! It’s hard to maintain intensity for much longer than 4-6 weeks if you chose an ambitious program. Now is the perfect time to pause and reflect on how to turn those short term gains into a more sustainable way of life.

Don’t get me wrong, I actually love some of the short term programs out there…Whole30, Whole Life Challenge, and 21-day Sugar Detox are all great ones that come to mind. But what happens after? I find that after the intensity and excitement of the “program” wears off, too many people either rebel and completely go back to old (or worse) habits or flounder, not knowing what the end game really is. Of course, I have also seen the opposite happen where someone gains great comfort in following the “rules” and continues too long on an overly restrictive diet.

But you know all this, you’ve been there! So without further ado, here are my top 4 strategies to help you cope with this transition and create some lasting change.

1) If you’ve been following a “program”, review the section of the book that talks about this very topic!

This seems like somewhat basic advice, but it’s too often overlooked. Most programs I’ve encountered actually do contain some well-thought out guidelines for what happens after the 30 days (or 21 days or 6 weeks or whatever it is). Most likely you skimmed through this part in your excitement to get started and may not recall the specifics. Be a good student, go back and re-read this. You can still use the rest of my tips to critically examine whether you want to follow your program’s instructions to a tee, but you owe it to yourself after all your hard work to take a look at what the intended transition was.

2) Reflect on what worked…and keep that going

There’s likely something in your plan that you totally nailed and maybe even learned to love! So first, take a moment to be proud of your accomplishment. Creating new habits isn’t easy! The accomplishments don’t need to be grandiose. Examples could include: you successfully drank x ounces of water every day, you moved your bedtime earlier by half an hour, or you switched from a muffin for breakfast to eggs and veggies. Make a commitment to keep at least that one thing for good.

3) Know thyself.

Conversely, if there were aspects of your resolution that didn’t work reflect on whether the program/goal/approach was really a good fit for your personality. For example, I love to exercise and have discovered over the years that I really need to work out almost daily for my own emotional well-being. Does that mean I happily lace up my running shoes and head out the door every morning on a solo run? Heck no…even though I completely understand what the effect will be on my mental state I can’t seem to do it! I’ve found I really need an external commitment to keep me accountable such as a running partner or 7 people waiting in a boat in the wee hours for me. So whenever I switch up my routine, whether as part of a resolution or not, I always make sure that my new plan involves an accountability aspect. Another example from a diet perspective is to consider whether going “cold turkey” or using slower transitions are easier for you. This is one of the first discussions I have with folks considering going on the autoimmune protocol (which is a drastic change for most), and we tailor the approach accordingly.

4) Know thyself…physically! Reflect on the appropriateness of the program for your unique physical needs.

Diets can fail you (not the other way around) for a multitude of reasons that have nothing to do with willpower. Ask yourself these questions: Did you feel more tired while you were on it? Were you constantly hungry? Did you hate everything you ate? Did you never get any relief from symptoms? Did you encounter more symptoms? If the answer to any of these was yes, then there is something wrong! It’s not even necessarily a bad plan, it just is a bad plan for you. Maybe you ended up eating more of a particular food that you are intolerant to like eggs or nightshades. Or maybe it steered you into eating too low-carb for your body, and your hormones got imbalanced. The main point here is that you shouldn’t feel ashamed or like a weirdo because you didn’t respond to a diet all your friends are achieving fabulous results from. Getting to the right diet for YOU is a work in progress, and persevering with a diet that isn’t working for you isn’t productive. Working with a professional at this point can be helpful, but you can discover a lot on your own by really paying attention to how your body feels after you eat certain foods. I love food journals for this purpose….not for obsessively counting calories but for being able to spot foods that are triggers for you. Contact me at julie@neversettlehealthandnutrition if you’d like a copy of the one I use.

That’s it! Wishing you the best of luck in your health journey ALL year, EVERY year!

PS The image below is actually the result of one of my New Year’s resolutions….taking our dog for more hikes with the kids! Good for the dog and all of us to get out into nature more.

Sourcing: Seafood

After veggies, including adequate seafood in your diet is one of the best things you can do for your health. One of the main reasons is that they are the best source of long chain omega-3 fatty acids. By now, most people have heard about the importance of omega-3’s in your diet and rightfully so! Omega-3’s are a key building block of important anti-inflammatory hormones in our body. And while I will I always advocate for whole food in place of supplements, in this case it is particularly true. Omega-3 oils are very delicate and susceptible to damage due to heat and light and the process of extracting these oils, putting them into a capsule, and storing them appropriately can be problematic.

But omega-3’s are not the sole reason to eat seafood! Seafood is one of the best sources of protein containing a very balanced quantity of all of the essential amino acids (and then some) as well as being the highest food source of Vitamin D.  With all these benefits, I recommend 5-6 servings per week! (If you are worried about mercury levels with this frequency of consumption, check out this wonderful blog post from Sarah Ballantyne. There’s a lot of interesting science in this post, but the takeaway is that there’s only a few fish you need to avoid: pilot whale, tarpin, swordfish, shark, marlin, king mackerel, and tilefish.)

Unfortunately, seafood tends to be more costly especially the preferred wild caught versions. So, it really makes sense to spend some time familiarizing yourself with some of the options.

I don't tend to buy either meat or seafood at a normal grocery. While high quality seafood is definitely available at higher end stores like Whole Foods or specialty shops, the cost tends to be very high. Costco does sometimes have wild caught seafood especially in the frozen section. I’ll browse my usual stores and Costco occasionally, but there’s not enough consistency in what they offer for me to rely upon it.

One exception to this rule is canned fish: tuna, sardines, anchovies, salmon, etc. This is a very affordable and convenient way to include some fish in your diet. Some things to look for on the label: wild-caught (100% pole and line caught), BPA free cans, and what it is packed in. If the fish is packed in oil, it should be 100% olive oil. This is where labeling laws are lousy…like salad dressings the front of the can may say “Packed in olive oil”, but the ingredients list includes inflammatory oils such as soybean or canola oil. So, look at the ingredients list not just the packaging. It is perfectly fine to get fish packed in either oil or water, but if it is packed in oil you’ll want to use the oil instead of draining it in order to capture the omega-3 oils which can dissolve into the olive oil from the fish. You may recall the saying from high school chem “like dissolves like”. That’s what’s happening here!  

But actually my favorite two brands for tuna aren’t packed in any additional liquid which means you don’t need to bother worrying about any of that! The two brands I purchase are Wild Planet and Safe Catch. Both are available on Thrive Market and usually you can purchase a 6 pack of Wild Planet tuna at Costco.

A second exception is smoked salmon. I always pick that up at my local Whole Foods 365. Their wild caught store brand is free from sugar and other weird ingredients like dyes. A surprising number of brands are full of these (as well as other weird stuff) so read your labels! One of my favorite easy lunches is pairing some smoked salmon with salad or avocado (or both) and liberally seasoning with Trader Joe’s Everything but the Bagel blend.  

For my other seafood, if I don’t get lucky at Costco or 365, I’ve been depending on Thrive Seafood Wild-Caught Box. It’s kind of got it all-good variety, good flavor, good pricing, and delivered to your door!

If cost is no object or for special occasions some local Westside options include: farmer’s markets and Santa Monica Seafood. VitalChoice seafood is another great online option. A bit more expensive, but they are really committed to great quality.

Since I’m a nutritionist and a decent home cook but nowhere close to a chef, I confess I’m not confident going beyond basic fish, shrimp, scallops, and lobster at home. But I love eating mollusks (oysters, clams, and mussels) when I’m out! Oysters in particular are one of the must nutrient dense goods around, particularly in zinc and B12. Some local favorites: Blue Plate Oysterette (Happy Hour!) and The Albright. Santa Monica Seafood also has oysters on their Happy Hour, but I’ve yet to try them. Sadly, there’s only 3 meals a day, y’all! May at least one of them be filled with delicious and nutrient dense seafood!   

Happy Hour at Blue Plate Oysterette

Sourcing: Pantry Items

For pantry items, unfortunately you must venture into the dreaded center aisles of the store. First rule of the center aisles...Do Not Visit the Center Aisles. Because the second easiest thing you can do to improve your health through diet is to avoid processed foods. However, in addition to processed foods there are a few valuable things to be had in the center aisles so let's venture in cautiously.... 

Where?

It will be a common refrain of mine...cost and convenience aren't to be discounted! When you start eating real food, you do inevitably spend more time in the kitchen and investing in some higher quality ingredients so my goal is to help you balance that with some practical tips to help offset those factors. So again...Costco. Good quality oils can give you sticker shock for sure, so I buy most of my oils here. And because I've streamlined my shopping processes I indulge myself by going down every aisle (including clothes, but that's another story) looking for the one off deals they have that are amazing! My last two finds were huge containers of Primal Kitchen Mayo  and Vital Proteins collagen peptides. I listed some of my other regularly available items below. But I probably get the majority of pantry items from Thrive Market. There is an annual fee ($59) but when I've compared the cost of the items I purchase there versus Whole Foods or Amazon, they come out 20-50% cheaper every time. And the convenience, oh, the convenience! When I notice I need something, I just add it to my cart via the app, wait to order until I get to the $49 needed for free shipping, then it's at my doorstep in 2-3 days. I also order a lot of personal care and cleaning products on Thrive which I'll cover in a separate post. Lastly, I occasionally buy items I can't find anywhere else on Amazon. Not much to say about Amazon, if you don't know Amazon you are truly off the grid and haven't found my blog either.

Lastly, there's a great online resource for those following the autoimmune protocol diet (AIP). It's called ShopAIP and every single item is elimination phase legal! Truly a great resource when you don't want to think so damn hard about reading every label and need some convenient snacks and pantry items.

What?

Here are the specific brand names of some of my staples:

Costco: Kirkland Signature olive oil (actually one of the best quality olive oils around), Kirkland organic coconut oil, Kirkland Organic Raw Honey, Kirkland Organic maple syrup, Wild Planet canned Tuna, Kirkland Organic Chicken Broth (I use this for recipes, but it's not true bone broth I'd use therapeutically or to sip ), Italian Volcano lemon juice, Season Sardines on olive oil, Coffee-they don't seem to stock any particular brand of organic regularly so I switch this up a lot to whatever is in stock that is organic. I follow the autoimmune protocol diet (with some reintroductions) and can't eat any of the following, but I do buy the following for the rest of my family there: bread, pasta, tortillas, and red sauce. (We're working on it!)  

Thrive: Primal Kitchen salad dressings, Redmond Real Salt, Red Boat Fish sauce, Big Tree Farms coconut aminos, 4th and Heart ghee, Cucina Antica ketchup, SeaSnax seawood snacks, Inka plaintain chips, Siete grain free tortilla chips, Inka plaintain chips, Nuco coconut wraps, Nutiva palm shortening, Thrive balsamic vinegar, Specialty flours-coconut (Coconut Secret), arrowroot (Bob's Red Mill), and cassava (Otto's)  

Amazon: Aroy D coconut cream, KC Natural nightshade free sauces (these are amazing!), Sari Foods nutritional yeast (no folic acid), Gemini tigernut flour

Recent Costco haul

Sourcing: Produce

The first step to eating healthy food is getting healthy food into your kitchen! Shopping for food is more and more overwhelming due to the huge variety of stores much less the variety within the store. So, my first series of blog posts is all about sourcing to try and break it down into manageable bites (so to speak). 

Produce, produce, produce

This first post is all about produce. I'm a firm believer that eating more veggies is the #1 thing most people can easily incorporate into their lives for healthier living. And to not die.  I shoot for 8 servings a day (this includes 1-3 servings of fruit) so when I go to the store my cart is mostly filled with fruits and veggies.

Where?

Believe it or not, I buy most of my produce at a "regular" store. I'm lucky enough to have a Whole Foods 365 (the more economical version of Whole Foods) in my neighborhood so buy most of my produce either there or at Costco. I do enjoy the local and seasonal selections at farmer's markets but frankly the additional time and expense of sourcing primarily from farmer's markets doesn't outweigh the benefits for me. And eating veggies is so critical that making sure you have a convenient and reliable way to obtain them is paramount! 

In addition to my weekly 365 trip and bi-weekly Costco trip (I have a family of 5!), we get a produce box from Imperfect Produce (currently available in San Francisco, Los Angeles, Orange County, Portland, Oregon Metro, Seattle, Chicago, Indianapolis, and Milwaukee). They offer home delivery of semi-local, organic veggies with cosmetic flaws that make them unsellable to the supermarkets. I like that we are contributing to diminishing food waste and it also forces me to try new things. Imperfect Produce is cheaper than most CSA’s (which are wonderful too...find one near you here!), and I like that they make it easy to customize your box with a reminder email nearly a week ahead off delivery. Occasionally they’ve sent items that were imperfect in an inedible way but were very responsive when I emailed them and refunded the amount.

 What?

The end game is to include a wide variety of vegetables into your diet so be flexible and choose items that are in season or look the best. This is perhaps the only section of the store where the sky's the limit! My shopping list rarely says "asparagus", it might say something like "green veggie to go with steak". If you are a meal planner, God bless you, and by all means go with your detailed list. 

Take advantage of pre-cut vegetables if you find yourself crunched for prep time. And who among us is not?

If you're new to eating veggies, shopping on the fly like this might not work as well. Make sure to get 1-2 veggies you know you like then challenge yourself to make one new veggie preparation per week. Don't give up on a veggie if you don't like that preparation...for instance, I love roasted brussel sprouts with plenty of olive oil and salt or raw in a salad but can't stand them boiled.  

Lastly, I try and buy mostly organic but don't always buy exclusively organic. Eating an adequate quantity of vegetables is in my opinion far more important than exclusively eating organic. When I do buy conventionally raised fruits and vegetables, I try and abide by the EWG "Dirty Dozen" list to prioritize.

From my produce box. In my house this is a one week supply of carrots!