Do You Want Diarrhea? Cuz That’s How You Get Diarrhea.


A strange phenomenon keeps happening no matter where I go. It would seem that some days I am on my own planet when it comes to matters of sanitation. I have a pretty strict rule, really the only “rule” per se, when you enter my kitchen: wash your hands. However, I have been called into question regarding this matter quite recently. Someone even added that “it’s actually healthier to not wash your hands as often.” I’m not even sure how to respond to that statement. So…many…responses…

You see, some very, very, very simple practices would prove extremely beneficial in our society. The first and foremost rule of preventing the spread of diseases, viruses, and various other forms of germs is HAND WASHING. It’s so not difficult, yet so many people will spend more time arguing against doing it than it would take to do it 10 times. I’ve been in public restrooms where I have heard a grown woman flush, then leave without washing. I’ve seen grown people sneeze into their hands and simply wipe them off on their pants. These dirty-handed people are all around us. They are there to provide a professional, warm handshake when you greet them too. They are touching the same doorknob you touched on the way to pick up your sandwich in the breakroom. Yummy? Nope.


I’ve been called a “germaphobe” and accused of trying to “live in a bubble.” However, it is utterly disturbing to me that this (sanitation in general) is even up for debate. I know, I know…there are always those who argue “you have to be exposed to some germs to develop your immune system.” Do you really think there aren’t 10,000 other ways we are exposed to germs? They’re in the air for crying out loud. All I’m saying is that washing your hands after you’ve wiped your rear wouldn’t be all that much effort and would be far less disgusting to me.   Maybe I’m the only one; if so, I rather enjoy my hand-washing island where I have a reduced risk of contracting hepatitis A from someones nasty just-wiped-my-ass-then-made-your-sandwich hands.

Furthermore, I must mention the topic of food safety. Here are some take-home messages to summarize the importance of proper kitchen sanitation.

  • Your leftovers have a fridge life of about 4, maybe 5, days.
    • People LOVE to argue this one. “I eat anything; hasn’t killed me yet! Herherherherheeeee!”
    • All it will take is one bout of foodborne pathogenic diarrhea to make you decide to take this rule seriously.
    • Just because your food looks ok, smells ok, or even tastes ok doesn’t mean that it isn’t harboring enough harmful bacteria to make you violently ill.
  • The time-frame for restaurant leftovers is even shorter.
    • I mean think about it: the food sat on the counter for a bit before you got your order.
    • Then you picked at the food for a while as you conversed and enjoyed your meal.
    • Then you waited for the doggie bag container.
    • Then you waited for the check.
    • Then you had to drive some distance home.
    • Then you almost forgot to put the food in the fridge when you got home.
    • Ultimately that food sat out for a pretty long time.
    • I would suggest only holding restaurant leftovers 1 or 2 days at best.
  • The temperatures foods must reach for proper cooking and reheating are actually important.
    • When I was a kid, we thawed the frozen hamburger on the kitchen counter ALL DAY so it would be ready for dinner that night.
    • Again, the argument I hear all too often is “I did that my whole life and I didn’t die.”
    • Well, at least the hamburger I had as a kid came from the locker down the street, and the cow they processed came from the neighbor down the road. Far less people handled it, which means far less opportunity for pathogens to enter the picture.
    • Do you know where your meat came from? Do you know how many steps between cow to you or chicken to you took place? Was the truck that hauled it to the grocery store chilled properly? Did someone have that package of beef in his grocery cart for an hour before deciding against purchasing it and then placing it back in the meat case for you to buy?
    • A meat thermometer costs anywhere from $1 to $50 depending on how fancy you want to get. You can spend very little to get adequacy in this case.
    • Call me crazy, but don’t call me to pick up Immodium or new underwear for you if you decide that you’re too cool for a meat thermometer.
    • Here is a handy little food safety temperature chart you can print and tape inside your kitchen cupboard if you’d like.
  • On a similar note, there are only a few safe ways to thaw your food.
    • The microwave is safe for thawing smaller cuts of meat, such as steaks or chicken breasts. Larger cuts like roasts or whole chickens should not be thawed in the microwave.
    • Cold water, not hot or warm water, can be used to submerge your meat in the sink or in a tub. The meat should be either of the vacuum-sealed variety or otherwise completely airtight and encased. The water must be changed periodically. This method works well during Thanksgiving when you realize your turkey didn’t get completely thawed in the fridge.
    • The fridge is a great way to thaw any cut of meat, but requires some forethought. If you are thawing your giant Thanksgiving turkey, you might have to carve out some fridge space at least 5 days in advance. For a whole chicken or beef roast for Sunday dinner, I’d take that little guy out at least 3 days in advance. Hamburger or chicken pieces take 2-3 days to mostly thaw.
  • Do not cook frozen roasts or similar whole cuts of meat in the slow-cooker.
    • I know, there it is again: “but I’ve always done that and I haven’t died yet!”
    • A large, frozen roast or similar product stays at an unsafe temperature too long if it is being slow-cooked in an appliance. I wouldn’t recommend this practice in the oven either if you ask me.
    • You can put frozen chicken or beef or other meat pieces in the slow-cooker. The difference is that those smaller cuts can reach a safe temperature much faster than the bigger hunks.
  • Perishable food can and should only be held at room temperature for 2 hours max.
    • I simply cannot believe how much this rule gets violated. Everyone to whom I mention this tends to laugh out loud and poke fun at the germaphobe dietitian.
    • I’ve seen healthcare professionals leave lunch potluck fare out all day, then pack it up, then eat it 3 days later.
    • Typically what happens is someone gets a mild case of food poisoning, but calls it “the 24-hour flu” or something ridiculous because they can’t fathom that it is food borne illness, for sure.  Sorry, not sorry. You ate it.


I will digress for now; I think you get the point. It takes very minimal effort to practice some simple methods of sanitation that can prevent some pretty serious illnesses. While some think it is cute and funny to drink from a water bottle that hasn’t been washed in 2 weeks or to eat that bloody hamburger, I do not.

Keep in mind that while many of us have a tough immune system, many do not. Those who are most vulnerable include little kids, pregnant women,old people, people recovering from cancer treatment, etc. I will never, ever forget an experience I had while doing a rotation in the pediatric intensive care unit during my dietetic internship. A round of applause thundered through the halls one day. I thought that was odd until one of the nurses told me they were clapping because a little 5-year-old boy had finally peed. You might think that is weird except several of his organs had been failing just before that, including his kidneys. He hadn’t peed in weeks due to requiring dialysis to pick up the slack his kidneys weren’t able to do. He was experiencing this acute organ failure because he had eaten an undercooked hamburger that was pink in the middle. Not so cute and funny when it’s framed like that, eh?

We can’t prevent every single bad germ from entering our little worlds and giving us a cold or the runs. But we can put forth some super simple methods, such as hand washing and proper food handling, that can truly reduce the likelihood of us getting sick.

Keep it classy – wash your hands. And sneeze into your elbow for goodness sake.

xoxo – Casey

Is Sodium Against us and PhosFORus?


Nope and nope. Both sodium and phosphorus are essential for survival. Just a teensy glimpse into sodium’s pretty important jobs includes maintaining your body’s fluid balance and transporting nutrients across cell membranes. Just a couple of the things phosphorus is best known for include producing energy and building bones. Are we getting too much of these nutrients? There is more to the story than what you might think.


Sodium, which you may know from its most famous role, table salt, has become a word to be feared by us, especially with regard to blood pressure (BP). The thing to know is that while too much salt can be detrimental to our health, so can too little salt. Yeah, yeah…most would argue that too little salt is unheard of in our Standard American Diet. However, the BP-raising amounts determined by many studies to be “excessive” are also far outside what the average person consumes.  Furthermore, not much (if any) evidence exists to support the stringent recommendations for the masses to restrict sodium to 1500 mg/day or less.

Furthermore, is sodium guilty by association? When we take a look at observational data, we see that those who consume too much sodium tend to have high BP. But just as often, those who eat too much sodium are doing so by way of heavily processed, packaged foods and/or fast foods; AND they aren’t eating much in the way of vegetables or fruits. Many processed, packaged, and fast foods contain high amounts of phosphorus in various forms because it can be a useful preservative. Many types of soda, especially cola, are also a huge source of phosphorus in the diet.

Therefore, in what could be considered a “poor diet” consisting of very few (if any) fruits or vegetables and lots of packaged/pre-prepared/fast foods and soda, sodium and phosphorus are almost always consumed in excess of recommended amounts. Additionally, excessive phosphorus intake has begun to enter the spotlight as a contributor to heart disease. Eating or drinking too much phosphorus tricks your body into deteriorating your bones, which is NOT GOOD. So is it the sodium that’s harming us, or is it the phosphorus? Is it both? Is there more to the story? Yes.

Many of the most famous “diets” such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean eating style have proven to help people reduce BP and improve many other risk factors for heart disease. The thing is, they seem to do so independently of sodium or phosphorus counts. Why/how do diets like DASH or the Mediterranean eating style improve BP and heart disease risk? Among the many attributes of the DASH diet or the Mediterranean Eating style, both of these ways of eating largely emphasize a significant increase in whole vegetables and fruits.


When we shift focus toward increasing nutrients and antioxidants via whole vegetables and fruits (rather than ordering salt-free French fries), a number of risk factors will naturally improve:

  • BP often goes down thanks (in part) to increases in potassium aiding in the fluid regulation mechanisms in our body and also from antioxidants in the fruits/veggies helping to soften and widen our arteries.
  • Weight improves because we are eating less (despite a potentially larger volume of food thanks to veggies!). A loss of weight also can improve BP by decreasing the work the heart has to do to pump all that blood through the body.
  • Cholesterol is often improved because of a decrease in omega-6 fats (often prevalent in processed/packaged/fast foods), coupled with an increase in fiber from all that produce.
  • Physiological processes can begin to work more efficiently. Without adequate magnesium, for example, insulin cannot be used properly in our bodies. Guess what has magnesium? Vegetables.
  • Energy levels. The top contenders for the factors most likely to promote jubilance instead of fatigue are:
    • Sufficient hydration
    • An adequate amount of good-quality sleep
    • A regular, consistent meal pattern
    • Balanced meals
    • Getting enough vitamins/minerals from WHOLE FOOD SOURCES, not supplements

Here’s the deal:  eating all the same crappy foods in “salt-free” versions WILL NOT IMPROVE YOUR HEALTH.  Salt-free French fries are not suddenly a salad, and low-sodium soy sauce is not suddenly “healthy.”  However, please don’t lose sleep over counting anything, including sodium or phosphorus.

IF you eat a Mediterranean style diet rich in fatty fish, lean meats, lots and lots and lots of vegetables, healthy fat, some fruits, whole grains, and calcium-rich foods, you will most likely be consuming the proper amount of sodium and phosphorus. You will also likely improve about a million aspects of your health and well-being. Don’t forget to drink lots of water, limit sugary stuff, and be as active as you possibly can no matter what that entails for you.

Love ya, mean it.
xoxo – Casey

Annoying Things: Part Two


The sequel has arrived!

If every single person who has asked me “What do you think about a) this new diet b) this life-changing multi-level marketing neon drink c) magic pill from that infomercial?” would put HALF as much effort into eating more vegetables and getting up and moving around CONSISTENTLY (not just 1-2 days a week), I feel with some degree of certainty that the rate of obesity/diabetes/fatty liver/etc. in the United States would be reduced by at least 50%.

I had a patient today who told me he bought vitamin-enriched coffee. It was as if he was thinking “screw all that stuff you’ve taught me over the last four months, Casey. I found the answer! I’ll keep eating white bread and hot dogs for lunch, because the secret to health is in vitamin coffee!” WTF? I don’t know whether to laugh or cry…

The rules haven’t changed remarkably over the years. Sure we get a little side-tracked by the smoke-and-mirrors discussions about stuff like coconut oil. But I would suspect that a large number of people spending all this time arguing about whether or not coconut oil is good or bad or ugly are not spending time on the things they already know, such as most of us are not eating nearly enough vegetables or fruit nor are we moving around enough.  I’m often just as guilty as the next guy.


Does that teensy little energy shot make you feel great? It’s not because high doses of b-vitamins are the latest, greatest thing…unless you’re deficient in them! You see, you feel like a million bucks after downing that stuff if your diet is shitty because now you just got a hefty dose of what you were missing along with a punch in the face of caffeine. Here’s a c-r-a-z-y thought: what if you ate a ton of vegetables, some good quality protein-rich foods, some fruit, some whole grains…and you got vitamins, minerals, and your “macros” there? GASP! Perhaps to top it all off, you got 7-9 hours of sleep and drank mostly water for your daily beverage? Double gasp! Casey, you’re not actually suggesting I get my nutrition from foods when I can just take a shortcut, are you?!

The cold hard truth is that the amount of salt you eat or the type of fat you put on your sammich matters MUCH LESS in the presence of good quality vegetables, fruit, whole grains, unprocessed meat, nuts, and omega-3-rich fish. It is MUCH LESS likely for you to overeat to the point of obesity with an eating style that is 50% produce, a small amount of meat/nuts/fatty fish, lots of water, and plenty of exercise. You would simply be more satisfied on less caloric load with that eating style; and, unless you are a medical marvel who beats the laws of thermodynamics, you could not support obesity with a diet like that. Sorry, you couldn’t.

If you are struggling with your weight, something about your eating isn’t right. If you can’t figure out what, consult a registered dietitian nutritionist for a series of counseling visits. It won’t be free, but I’ll bet you it will be so worth it.   Ps – a personal trainer is NOT a nutrition expert. Sorry, not sorry.


So, here are my unsexy, not-breaking-news, undazzling, evidence-based, tried-and-true thoughts on the matter:

  • Ideally, your plate should be about 1/4 whole grains or starchy vegetables.
    • 100% whole grain, not “made with whole grain,” not “wheat.” Look at the ingredients. Enriched = white flour.
    • Some of the most common starchy vegetables include potatoes, sweet potatoes, beans, peas, and corn. There are more, but those are the most frequent flyers.
    • WHITE POTATOES ARE NOT BAD FOR YOU. Stop saying it, because it isn’t true. Too many potatoes aren’t too great for you. News flash: too much of anything isn’t good for you. Stop demonizing white potatoes (and corn for that matter)!
    • Fun fact: cup for cup, white potatoes have more potassium than bananas. If you’re avoiding potatoes because your sister’s dog walker’s hairdresser’s uncle’s wife told you they are “bad for you,” then this is your lucky day.
  • Fill your plate with1/4 protein-rich foods.
    • Gold medal: wild-caught fatty fish like salmon, tuna, trout, cod, halibut, and sardines. Canned is absolutely fine. Stop obsessing over salt; the latest research has finally admitted that it isn’t as big a deal as the other crap we are eating. Stay tuned for more on salt later…
    • Silver medal: plant-based proteins like nuts, seeds, and beans. Read more ideas here.
    • Bronze medal: meat, poultry, dairy foods (cottage cheese, cheese, milk) and eggs. Better quality exists in those types of animal meats that were fed good things (grass-fed beef for example).
  • Fill the rest of your plate (1/2 if you’re keeping tally here) with non-starchy vegetables.
    • What vegetables are non-starchy? Well, the simplest way is to scroll back up and look at the list of common starchy vegetables. If it isn’t on that list, then it is non-starchy.
    • Examples include, but are not limited to, leafy greens, carrots, peppers, onions, and cucumbers.
  • Drink more water than any other beverage.
    • The less often you have sugary beverages, the better luck you have with improving your health.
    • Add lemon or cucumber or a hunk of orange to your water if you want to flavor things up a bit.
    • Drink black coffee or plain tea if you want; just don’t go crazy, and try to have those things between meals rather than with them so they don’t interfere with nutrient absorption.
  • Move.
    • Even if you “don’t have time,” move around at the office; move around at home in the kitchen. Sit less, move more. Whatever that means to you is whatever that means to you. The more you sweat and engage your muscles and heart, the better.

This advice is by no means limited solely to those seeking weight loss. ALL of these tips apply to each and every living, breathing human being regardless of age. Granted, age changes things a bit. For example, all of these tips apply to your teensy little kiddos, only they have much smaller plates.

annoying23Even if you are a “healthy” weight clinically, it is not a free ticket to eat poorly. Regardless of weight, you can still be at risk to develop a chronic disease or several. Some examples of conditions that can often be prevented include fatty liver, kidney stones, type 2 diabetes, high cholesterol, high blood pressure, cardiovascular disease, chronic kidney disease, periodontal disease, and many others.

There are exceptions to everything. Some people eat terribly and somehow don’t have any health issues (rare). Some people lead a super healthy lifestyle and still have ugly cholesterol. Some people run five miles per day and still have ugly blood sugars. But those situations are less likely than the ones I see on a daily basis. If you are one of the rarities (and I know some of these people personally), I really do get it. But this advice is not geared toward you. You are the exception, not the rule.

Indulge once in a while. Live a little bit. Have a bowl of your favorite ice cream every now and again. The key is that what you are doing MOST of the time makes those little indulgences matter less and less over time. We also have to be real about how often we are finding ourselves indulging, and just how much we are consuming.

Eat. Stop counting stuff. Stop trying to find the next shortcut. Stop obsessing over nutrients and focus on FOODS. Stop dieting. Stop buying packets of crap to put in your water and just drink water. Choose colorful, vibrant plant foods more often. You will feel so good you’ll want to keep doing it.

Until next time…Casey – out.