August 21, 2018

What Makes a Grocery Store Great?

This week I’ve been wondering what makes a grocery store great? When I travel, I like to visit grocery stores. Not only do I want to see the food itself, I want to observe and absorb the culture. Funny thing is, I do not enjoy the grocery stores in my town. Why? Well, that’s what I’m exploring. I know it feels better to shop in some stores than others. Let’s figure out what makes that so.
grocery
Yesterday, I needed a few things in addition to groceries — potting soil, toilet paper, marbles. Wal-Mart seemed like a good place to get everything at one time. I crossed the river to an adjoining town to shop at the nearest Wal-Mart. But as I drove into the parking lot, I realized I didn’t want to be there. I didn’t want to go in that store. Without even pulling into a parking space, I drove out the other side of the parking lot and to a Kroger nearby.

What pulled me toward the other store?

Both are larger than I prefer, but the second store is smaller. Wal-Mart supercenters average 178,000 sq ft. Kroger Marketplace stores average around 100,000. I really prefer the footprint of The Fresh Market, Whole Foods, or Natural Grocers stores that average under 50,000 sq ft. From this I must conclude that size matters to me…in grocery stores.

As grocery store space expands, it rarely means more fresh produce, meat, or specialty flours. The added space is typically stocked with items that are boxed, bottled, fully prepared, or not food related. There’s nothing wrong with that. I just prefer shopping where fresh food is the focus.

I also like small shopping carts. Believe me, I can fill them with plenty of food. As a short person, tall, deep carts make it annoyingly difficult to reach small items hiding in the bottom near the back of the basket. Most grocery stores have both, but the store closest to my home does not.

When I walk into a store, it’s a pleasure to be greeted with a beautiful variety of produce, but two of my favorite stores (unfortunately, not in this town) have the produce located where it’s not visible from the door. Obviously, seeing produce immediately is not a big factor in a store making my favorites list. And from a practical standpoint, I’d rather stack easily bruised fruit on top of the staples in my basket. If I begin in the produce section, it ends up on the bottom where it’s more likely to get damaged.

More important than location is the variety and freshness of the produce offered. I’m okay with seasonal variations in selection, but only if there is a moderately predictable seasonal rotation or an easily accessed online list of what is currently stocked in a given store. Because stores in different neighborhoods are stocked differently, it sometimes takes visiting 3 or 4 locations to gather the vegetables I need for a recipe.

Once I find the produce I’m looking for, I’d like for it to be fresh enough to last a couple of days. Every other week, I get home to discover that the raspberries I couldn’t see in the bottom of the container are fuzzy or the prewashed sugar snap peas smell foul even though it’s not past the use by date. This recurring issue makes me dread what I’ll find next time I put away groceries.
spices
This may not be true for everyone, but for me to think a store is great, it needs to offer a good selection of fresh meat, poultry, fish, and seafood that is unseasoned, unmarinated, and uninjected. I just want the raw ingredients, please. And I’d like a sell by date to give me an idea how long I have before it spoils.

Organic dairy products like plain yogurt with lots of active cultures and no gums or fillers, dairy alternatives without tons of sugar, high quality butter, and a wide selection of coffee improve my impression. Plenty of raw nuts, dried fruit without added sugar, and bulk spices make things even better.

Other than that, clear and accurate signs, efficient organization, and few empty spaces on the shelves go a long way toward a pleasant shopping experience. If I have to scour the health food section searching for gluten-free cereal amongst other whole grains, I will most likely skip it. I feel the same way about crackers, cookies, chips, and frozen food.
dried fruit
A final consideration is the ambience of the store. When I walk in, is it quiet and lit well but not garishly? Does it smell good? Are the aisles wide enough? Are there plenty of open checkout stations with friendly checkers? Does it feel more like a comfortable boutique than a herd-em-through warehouse? If so, I’ll enjoy being there.

If I could get a small, pleasant store with an adequate cold chain that offers a consistent variety of fresh fruit, vegetables, meat, poultry, fish, seafood, and easy to find gluten-free items that I can put in a small cart within 5 miles of my house, I’d be so giddy I wouldn’t know what to do. All of that together would truly make a grocery store great!

In the meantime, I’ll keep going to multiple stores to get what I need.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

https://retail-index.emarketer.com/company/data/5374f24d4d4afd2bb4446614/5374f2b24d4afd824cc15ebb/lfy/false/wal-mart-stores-inc-real-estate

https://www.walmart.com/

https://retail-index.emarketer.com/company/data/5374f24a4d4afd2bb4446582/5374f2834d4afd824cc15a0f/lfy/false/kroger-real-estate

https://retail-index.emarketer.com/company/data/5374f24d4d4afd2bb4446612/5374f29e4d4afd824cc15c99/lfy/false/natural-grocers-real-estate

https://retail-index.emarketer.com/company/data/5374f24e4d4afd2bb4446642/5374f2b34d4afd824cc15ed5/lfy/false/whole-foods-market-real-estate

https://retail-index.emarketer.com/company/data/5374f24e4d4afd2bb4446639/5374f2734d4afd824cc1587c/lfy/false/the-fresh-market-real-estate

August 16, 2018

Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?
health
It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.
salad
But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.
garden
Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

steam trayI’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

http://www.cooking2thrive.com/blog/get-know-food/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

August 7, 2018

Time for Another Pantry Challenge

My pantry is a mess; it’s time for another pantry challenge. My range broke recently and you can see it in my pantry. Apparently I’ve been cooking less, but buying as if I’m going through food at the regular rate. There are so many layers of lazily stacked pasta, tuna, honey, chicken stock, strained tomatoes, and baker’s chocolate I can’t see what else is in there. My sister calls making yourself use what’s in the pantry a pantry challenge.
pantry
If I make this pantry challenge a game for my grandson DJ, maybe I can accomplish two things at the same time. At the ripe old age of two, DJ has become a picky eater. He used to love broccoli, beets, sweet potatoes, carrots, butternut squash, bananas, blackberries, steak, chicken, and bacon.

Now he only wants cheese, cheese dip, cheese quesadillas, cheese crackers, and cottage cheese. Funny thing though, he doesn’t like mac & cheese or other typical kid food for that matter. He won’t eat hot dogs, hamburgers, chicken nuggets, French fries, or mashed potatoes either.

Truthfully, he likes hummus, pretzels, applesauce, grapes, raisins, dried mango, dried figs, scrambled eggs, pancakes, and pizza. But we’d really like for him to eat more green vegetables, fresh fruit, and meat, fish, or poultry. We’d also like for him to enjoy whatever we’re eating.
stove
DJ has his own stove – a metal one that I played with in my grandmother’s attic when I was his age. DJ has also started helping me cook. He likes to add salt and pepper and stir with a whisk. Maybe if I let him choose one or two things from the pantry as the basis for a meal he can help prepare, he’ll be willing to taste a wider variety of food.

If he chooses a box of pasta and strained tomatoes from the pantry, we’ll be in good shape. I’ll make pasta with some kind of red sauce that includes meat. If he chooses tuna and green chiles, I can make a southwest tuna casserole. On the other hand, if he chooses a bottle of vinegar and a bag of caramel chips I may have to think for a very long minute.

I don’t really want to reorganize the pantry until I’ve emptied some of its contents, but I may need some rules to keep this challenge headed in a positive direction. Here’s what I’m thinking…I’ll choose 6 items, sit them on the counter and let DJ choose 2 from the preselected inventory.

Then he can help me prepare something with the two items he has chosen. As long as I pick 6 things that can be mixed and matched easily, I can use the other 4 in the same dish or an accompanying one later in the day. DJ is here two days each week. Using 6 items at a time, the excess should be gone quickly.

A quick look in the pantry reveals these possibilities…

Wednesday’s proposed selection can be mixed and matched several ways:
Egg noodles
Black beans
Chicken stock
Tuna
Green chiles
Gluten-free breadcrumbs

Next Monday’s options lean toward something Asian:
Tamari gluten-free soy sauce
Rice
Honey
Mandarin oranges
Raw cashews
Shredded coconut

The following Wednesday could lend us cornbread:
Yellow cornmeal
White cornmeal
Sweet white sorghum flour
Sugar
Shortening
Baking powder

Another Monday will garner ingredients for a hearty salad:
Quinoa
Pimentos
Dried figs
Pecans
Pumpkin seeds
Golden raisins

As I dig deeper, I’m sure to find other suitable combinations. I’ll probably let one day be dessert treats just to keep the game fun. I know I have some chocolate chips and marshmallows hanging out somewhere in the pantry. I can make gluten-free grammy crackers in advance & we can make s’mores. Maybe we’ll make solar s’mores on the back porch. It’s certainly hot enough!

In a couple of weeks I’ll have reduced the pantry contents to a more acceptable level. At that point, I’ll reorganize and get rid of anything that’s too old. Then I can resume shopping as usual.

In the meantime…game on!

http://www.cooking2thrive.com/blog/?s=pantry

July 31, 2018

Eating Her Curds and Whey

spiderSpiders may not be the current danger for Little Miss Muffet when she eats her curds and whey. Last week, several snack cracker recalls centered around possible salmonella contamination of the ingredient whey. If you’re familiar with the nursery rhyme, you probably instinctively associate whey with milk or milk products, but what exactly is it?

Whey is the liquid that remains after you strain curdled milk. In food manufacturing, it is a byproduct of making cheese. Cheddar and Swiss cheeses leave sweet whey and cottage cheese and yogurt leave acid or sour whey.

When cheese was made at home, the remaining whey could be substituted for milk in baking. Even now, I sometimes use the liquid from yogurt in baked goods. Whey was also consumed as a beverage with honey and alcohol.

In US commercial food manufacturing, whey was a waste product dumped into rivers until the US government prohibited such dumping. Faced with a disposal problem, manufacturers began to look for other ways to use it. They first developed a filler for ice cream.

hawaiianWhey’s use as a filler in convenience foods grew from there. It is now found in products that may or may not have inhabited my snack bin – things like King’s Hawaiian Bread, Cheetos, Ritz Sandwich Crackers, Goldfish Crackers, Nature Valley Protein Bars, Luna Protein Bars, Oatmega Protein Bars, Swiss Rolls, and Similac Pro-Advance Infant Formula. Whey has also become a nutritional supplement popular with bodybuilders because of its leucine content.

The primary components of whey are water, lactose, protein, fat, and amino acids. The proteins include beta-lactoglobulin, alpha-lactalbumin, bovine serum albumin, lactoferrin, and immunoglobulins.

Three types of whey protein are produced in the food industry – Whey Protein Concentrate, Whey Protein Isolate, and Hydrolyzed Whey Protein. In theory, whey protein isolate can be safely consumed if you have lactose intolerance, but other forms of whey protein may cause symptoms.

Like most milk in the grocery store, the whey contained in convenience foods is typically pasteurized to make it less likely to harbor bacteria and safer to consume. Unfortunately, as we have recently seen, it can still become contaminated during manufacturing or packaging.

It’s no secret that I prefer fresh food prepared at home. I think it tastes better, and I feel better knowing what’s in the food. Of course that doesn’t mean that all my food will be free from a risk of salmonella, listeria, E. coli, or other contaminants.

And real life means that I sometimes reach for convenience foods. Of course, I read the labels. I have to make sure they’re free of gluten and shrimp. Right now, I’m making sure they’re free of whey.

https://www.fda.gov/safety/recalls/

http://wheyproteininstitute.org/facts/howwheyismade/wheyproteincomponents

http://www.liquidirish.com/2012/05/whey-alcohol.html

https://www.healthline.com/nutrition/whey-protein-101#what-is-it

https://www.ampi.com/home/page/130

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”