Table of Contents
In the prior lessons we discussed:
- how to determine how many calories we should be consuming and tips for weight management
- how to compose a healthy nutrition plan that meets the basic dietary requirements
- considerations regarding when we should eat
However, even knowing all of this information it will still be difficult for many people to implement this knowledge as there are several barriers to healthy eating. A 2018 systematic review and meta-analysis (SR/MA) of 39 studies found many barriers, and some of the most prevalent include(Zorbas, 2018):
- lack of knowledge regarding what constitutes healthy eating – addressed throughout this course
- the cost of healthy eating – addressed in this lesson
- lack of time to prepare healthy foods – addressed in this lesson
- access to healthy food (ie, living in a food desert, lack of transportation) – this is very difficult to address and I do not have a proposed solution for this other than trying to carpool for longer distances, buy in bulk, and ultimately trying to make the best of whatever situation you are in, this can include asking your healthcare provider for available resources
- negative self-perceptions – addressed in Lesson 15
- unhelpful social networks – addressed in Lesson 15
We will discuss two of these barriers in this lesson, the cost of healthy eating & the time needed to prepare foods in a healthy manner.
Food and drinks cost money; if a health-promoting diet costs more than a non-health-promoting diet this will be a barrier. Here I will discuss some tips to try to eat healthily as cheaply as desired.
- Fruits and vegetables: as discussed previously, buy canned (without added sugar) or frozen options if they are cheaper than fresh. Be careful about high-sodium options; attempt to pick lower-sodium choices if blood pressure is a concern. If lower sodium choices are not available then consider rinsing the produce, but realize this will eliminate some of the nutrients.
- Beans: For beans buy bags of dry beans and prepare them yourself as opposed to buying canned beans. Letting beans soak overnight will help decrease their gas-producing properties.
- Nuts: as discussed previously there is no strong evidence that one type is significantly superior to another, and positive health benefits can be seen with 0.5-1 ounce of nuts daily. Thus, consider purchasing the cheaper options and eating smaller amounts to still achieve health benefits while making them last longer. Keep in mind that Brazil nuts are easy to consume in excess (as discussed in Lesson 10).
- Grains: for grains such as bread and cereal many stores will have whole grain options with fiber and protein; frequently there are 1 or 2 brands similar in cost to less nutritious options. It is worth scanning through the nutrition labels and determining the cost per serving as well as servings per package to determine what the most economical/nutritious options are. Oatmeal, whole grain pasta, and brown rice are all relatively cheap options.
- Meat: For red meat as discussed in Lesson 11 you can choose the cheaper, fattier selections and remove the fat. For poultry, boneless skinless chicken breasts or at times chicken thighs may be the cheapest options. Canned, fresh, and frozen fish are all reasonable options depending on what is available and cheapest. When purchasing fish check the nutrition label for ω-3 content (some fish options do not have much and/or have fat removed, decreasing the total amount of ω-3 content) and consider lower mercury options as discussed in Lesson 11.
- Eggs: the extra vitamin D or ω-3 fatty acids in supplemented eggs are typically not worth the price; sufficient ω-3 fatty acids can be obtained from fish and it is cheaper to supplement vitamin D directly if needed.
- Dairy: milk is relatively cheap, as are certain types of cheese when purchased in bulk. Make sure to seal cheese (ie, in plastic wrap) for storage to minimize oxidation over time.
- Consider purchasing plain options (as opposed to flavored) if these are cheaper and then using a separate substance (ie, cinnamon, hot sauce, spices) to add flavor. Try to avoid flavoring options that lead to excess sodium or sugar in your diet. Artificial sweeteners were discussed in Lesson 6 and are likely ok to use in moderation.
Note: Cinnamon is a great flavoring option due to the numerous reported health benefits. A 2020 SR/MA of randomized controlled trials (RCTs) found cinnamon supplementation had a beneficial impact on multiple markers of inflammation and oxidative stress.(Zhu, 2020) A 2021 SR/MA of 35 RCTs evaluating the impact of cinnamon supplementation in individuals with metabolic conditions found(Kutbi, 2021):
- an overall decrease of total cholesterol (-11.67 mg/dL), LDL (the “bad” type) cholesterol (-6.36 mg/dL), triglycerides (-16.27 mg/dL), and an increase in HDL (the “good” type) cholesterol (1.35 mg/dL)
- a decrease in waist circumference (-1.68 cm)
- decreased systolic (-3.95 mmHg) and diastolic (-3.36 mmHg) blood pressure
- decreased glucose (-11.39 mg/dL), hemoglobin A1c (-0.23%), HOMA-IR (-0.59, a measure of insulin resistance), and insulin levels (-1.27 μU/mL)
In general, cinnamon intake is safe with relatively few reported adverse events.(Hajimonfarednejad, 2019) However, if using a lot of cinnamon, it is worth spending a bit extra on Ceylon cinnamon than the more common Cassia type. This is because of the difference in coumarin content. Excess coumarin consumption can lead to liver damage in a subset of people. The safe upper limit of coumarin intake is thought to be 0.1 mg/kg of body weight.(Abraham, 2010) Ceylon cinnamon has extremely low coumarin, but Cassia cinnamon has a considerably higher amount, though the actual level can be widely variable.(Blahová, 2012) Assuming ~3,000 mg/kg of coumarin in Cassia cinnamon, for a person weighing 75 kg (165 lbs) the upper limit of Cassia cinnamon intake daily should be 2.5 grams:
- 75 kg * 0.1 mg/kg = 7.5 mg max coumarin in a day
- 7.5 mg / 3,000 mg/kg = 0.0025 kg = 2.5 grams
Most people will not exceed this on a regular basis, but for individuals with liver issues or who plan to use cinnamon extensively for flavoring I recommend purchasing Ceylon cinnamon. Typically the label will specify Ceylon when it is in fact Ceylon cinnamon; it is possible to visually tell the difference between cinnamon bark (see image below) but not powder.
- Buy in bulk when possible. This assumes you have sufficient space to store everything, but if so buying in bulk will save money in the long run. Additional freezer space for storage is helpful.
- Look for coupons and use these to your advantage.
- Do not purchase organic food options unless you have a clear reason for doing so (see the next section).
Organic food – worth the cost?Organic food is a tricky topic. I go through the available literature in the box below for those who are curious, but at this point we simply do not have enough good evidence to discuss organic foods as a whole. There are some indications that consuming organic foods, specifically without organophosphates, can promote better neurocognitive outcomes in young children (also applicable to pregnant women carrying future children). Other than that, at this time I do not believe spending extra money on organic food is worthwhile.
Despite lots of popular belief that organic foods are considerably healthier than non-organic, the research does not conclusively support this.
- A 2017 review of organic food acknowledged that in blind tests there is generally little or no difference in taste, color, or flavor.(Brantsæter, 2017) Organic foods can still be heavily processed as there is no restriction on addition of salt, sugars, or fats (at least in the USA & Europe). Organic foods do generally have higher vitamin, mineral, antioxidant, and phenolic acid content, however studies have scarcely found evidence of increased antioxidant intake when looking at biomarkers. Associations between organic intake and prevention of atopy, eczema, hypospadias, and possibly a benefit for non-Hodgkin lymphoma have been seen, but the authors acknowledge there are only 5 prospective cohorts in human studies and more research is needed. Of note, researching this is difficult as organic foods are a subset of conventional food intake and there are no great biomarkers to specifically indicate organic consumption.
- A second 2017 review highlighted much of the same evidence and concludes we need more research prior to stating that organic food consumption contributes positively to beneficial outcomes.(Barański, 2017)
- A third 2017 review looking at similar evidence to the above ones indicated that other aspects associated with a lifestyle that lead to more organic food consumption, as well as reverse causation, may play roles in the beneficial findings that have been seen.(Mie, 2017) The authors noted, however, that children typically have higher urinary pesticide concentrations than adults, and the CHAMACOS cohort that examined maternal urinary organophosphate metabolites in pregnancy found these associated with adverse neurocognitive outcomes in the children up to at least age 7 years. Two separate birth cohort studies from New York (in the USA) found similar impaired cognitive development up to age 6-9 years related to maternal urine organophosphates in pregnancy. One European study (examining the PELAGIE cohort) did not find similar effects but maternal organophosphate exposure was lower in this cohort than in other European and USA/Canada studies.
- A 2018 overview comparing organic and conventional food found no strong evidence of meaningful differences in nutrition or in environmental impact, concluding that we need more research on these topics.(Suciu, 2018)
- One 2019 review indicated that organic crops may have ~20% higher phenolic compounds (which are health-promoting) but similar vitamin/mineral levels, and the difference in ω-3 fatty acid content between organic & conventional milk & meat is very small in the context of a full diet.(Popa, 2018) Additionally, the authors noted that organic products have a shorter shelf-life than conventional, which can require more frequent purchases and serve as a barrier to fruit and vegetable consumption.
- A separate 2019 review noted that organic foods can have the same or even higher contents of various environmental pollutants (ie, polychlorinated biphenyls, polycyclic aromatic hydrocarbons, heavy metals, etc).(González, 2019) The authors found that it seems proximity to traffic/bush fires/chemical industries/etc can have a large role in determining the amount of environmental pollutants, more so than many agricultural practices.
- A 2019 SR comparing organic & conventional food included 35 studies (15 publications for 13 trials, 20 publications for 13 cohorts).(Vigar, 2019) Most of the trials showed either no or limited differences in biomarkers when switching from conventional to organic foods, though there was a significant drop in pesticide levels after only a few days. None of the clinical trials were long-term. As fruits, vegetables, and whole grains all can have considerable amounts of pesticides, the authors note that for individuals who follow the dietary guidelines (and thus consume many servings of these) it may be safest to preferentially consume organic, or at least pesticide-free, versions. However, they also noted that it is unclear if there is any clinical benefit to decreased pesticide exposure.
- One 2020 review highlighted that organic material of plant origin has fewer pesticides, nitrates, toxic metals, and more vitamin C & polyphenols, while organic animal origin products have more unsaturated fatty acids.(Glibowski, 2020) However, this depends on other factors as well and overall the nutritional differences are not overly significant. Other benefits of organic food consumption seen in cohort studies include a reduced risk of overweight and obesity, decreased non-Hodgkin lymphoma in women, less eczema in infants (with organic dairy products), and a decreased risk of pre-eclampsia in pregnancy (with organic fruit & vegetable consumption). Additionally, decreased organophosphate exposure prenatally was associated with improved cognitive development in children. While these findings may be due to decreased pesticide intake, as these are findings from cohort studies it is unclear if residual confounding factors contribute to the associations.
- A 2020 review highlighted there is a lack of evidence overall that organic foods are healthier despite the decreased risk of pesticide consumption, noting other contaminants get in the food supply that can impact the results of research.(Mesnage, 2020) Additionally, most of the evidence base is epidemiologic in nature, and there are significant confounding variables associated with individuals who typically consume organic vs. non-organic items.
- A 2021 review highlighted many different aspects of organic farming that allow various pollutants to accumulate.(Ramakrishnan, 2021) This can vary by location and environmental factors.
- A separate 2021 review highlighted the many different characteristics of organic vs conventional fruits and vegetables, regarding quality and safety aspects.(Rahman, 2021) The authors found that while there are some distinctions between organic and conventional, often the differences are not consistent as they depend on other aspects of production that can vary by location. Whether the differences would lead to any substantial changes in health outcomes long-term is unclear.
So overall at this point there is not much research indicating meaningful health benefits of organic food consumption, though there is evidence indicating detriment of organophosphate consumption in pregnant women and young children. However, it’s not completely clear to what degree dietary intake will contribute to this vs other environmental considerations.(Holme, 2016)
Regardless, for those who want to minimize exposure to exogenous pesticides but cannot afford to buy exclusively organic food, there are a couple options. Washing produce with baking soda helps remove some of the pesticides(Yang, 2017) and is discussed with practical considerations here. Some types of fruits and vegetables yield more pesticide exposure than others; one can consider specifically purchasing organic for higher risk types. An overview of the potential risk of different types of produce is here. However, it is important to consider just how much of the pesticide-laden foods would need to be consumed to pose a problem, and when doing so there does not seem to be much if any reason to be fearful, as discussed here.
Thus, I generally believe that purchasing organic is more of a gimmick than evidence-based practice, though there could be merit regarding avoiding organophosphates in pregnant women and small children. As we see frequently in the fields of nutrition and health, more research is needed to better determine the true merits, if any, of organic food.
Example: In the US, more groceries are purchased at Walmart than any other store. Walmart is known for having relatively cheap options available. If we look at some select items from Walmart we can see the cost of a basic healthy day of eating:
The above costs and nutrition facts come from walmart.com; prices may vary at different locations. Thus, with the cheaper food selections it is possible to develop a 3 meal diet with 2,040 kcals, 4 servings of whole grains, >4 servings of fruits + vegetables, 2 servings of dairy, and 1 serving of nuts that has ≥28g protein at each meal, <6% kcals from saturated fat, >40g fiber, <1,500mg Na, and very little added sugar, all for <$4.00. Plugging a diet similar to this into cronometer.com shows a deficiency in ω-3 & ω-6 fatty acids, vitamin D, and mild deficiencies in vitamin C & E. This could be counteracted with the substitution of salmon for chicken (as salmon has high amounts of vitamin D & ω-3 fatty acids) a couple times weekly and taking a vitamin D supplement. Rotating food selections would also help to even out any other micronutrient deficiencies, while as discussed in Lesson 5 a deficiency of ω-6 fatty acids is unlikely to prove harmful.
It should be noted that Walmart has cheaper prices than most other places, not all of these items will cost the same at all stores, some may not be in stock on any given day, and some people do not even have access to a Walmart. Nonetheless, the point stands that it is generally possible to develop a relatively healthy diet at a relatively low cost. Many other stores have comparable food selection items. For people who live in food deserts or who do not have steady transportation and cannot access any stores regularly, carpooling, buying in bulk, purchasing online, and looking at nutrition labels of the food items that are available will help you optimize your current situation.
Overall, it should be clear that with careful planning it is usually possible to eat healthily at a relatively low cost, and potentially even more cheaply than if one were to spend money on fast food and various snack items.
Cooking can take a lot of time, especially when preparing elaborate meals. Cooking every day will be infeasible for many people. Thankfully, it is generally possible to cook in bulk so that this is not necessary. Let’s go over some tips to do this.
- If you can afford a standalone freezer and have the space for it, this will allow storage of large amounts of food and cut down on total food preparation time significantly.
- If you can afford to purchase plenty of Pyrex or equivalent, this will allow many meals to be prepared and stored. Consider freezer-friendly storage options if you intend to prepare and store meals in the freezer.
- Meal preparation is very helpful. The idea is to prepare enough food to last for several days or even weeks in one session; that way after doing the large amount of preparation work very little time has to be spent daily on meals.
- Various meats (chicken breast, ground beef, salmon, etc): purchase large amounts in bulk, prepare all of it at once, divide it into portions, wrap it in aluminum foil, and store it in a freezer. Servings can be taken out 1 day prior to use to thaw in the refrigerator. Alternatively, a serving can be taken out as needed and put in the microwave to thaw quickly.
- Beans: prepare a large amount at once, divide them into portions in plastic bags, and store them in a freezer. You can take out enough for a few days at a time and let them thaw in the refrigerator.
- Fruits and vegetables: purchase canned or frozen and store the latter in a freezer. Frozen vegetables can be prepared and then left in the refrigerator for several days; typically after several days a greater amount of nutrients will be lost so consider taking them out of the freezer twice weekly.
- Eggs: can be prepared in a variety of different ways and stored in the refrigerator for a few days at a time.
- Oatmeal: can be prepared in the microwave with milk or water very quickly, several servings can be prepared at once and stored in the refrigerator or freezer.
- Potatoes: can bake many at once, divide them into portions, and store them in the freezer.
- Sandwiches: can prepare a variety of different types at the same time and store them in the refrigerator or freezer.
EXAMPLE: Using the same foods in the table above, if you have access to a freezer you can purchase all of them and prepare them for storage in one morning:
- the night before your day of cooking set out beans to soak
- 8:45am: rinse the beans, place them in fresh water, and then set them to simmer for 90-120 minutes
- 9am: turn on the oven, prep the chicken breasts to go in the oven, and bake them at 400 degrees Fahrenheit for 45-50 minutes. While they are baking, scrub/rinse the potatoes.
- 10am: take out the chicken breasts and put in the potatoes to bake at 400 degrees Fahrenheit for 60-75 minutes. While the potatoes are baking cut the chicken breasts, divide them into portions, let them cool briefly, then wrap them in aluminum foil to store them in the freezer. After this, prepare enough pasta for 3 days and microwave a few days’ worth of vegetables, then divide these into servings to be stored.
- 11:00am: rinse the beans, divide them into portions, let them cool, and freeze them
- 11:15am: take out the potatoes, cut & divide them into portions, then let them cool prior to storing them. After this, make several peanut butter sandwiches and store them in the refrigerator. Divide the nuts into several days of servings and store them. Wash any fruit you intend to eat so that this can be grabbed quickly when desired. Prepare eggs in whatever fashion you choose for the next several days. Prepare several servings worth of oatmeal that can be divided into separate containers and stored.
- 12:15pm: with everything now cooled off, combine things into meals of your choosing, and store these in the refrigerator or the freezer depending on how many you have made.
By this point you can have most of your meal preparation done for a full week if you have enough refrigerator + freezer space to store a week of meals. You can continue cooking more throughout the day if desired or you can call it there and repeat in one week; if you prepared large amounts of some of these items (ie, chicken breasts) you may not need to prepare those again for several weeks.
Similar with cost, the real key here is planning. With careful planning one can determine how to prepare food in such a way that it can be stored for longer periods of time and this will lead to less time cooking overall. If you have access to a freezer then quick meals can always be stored such that if you are on the run you can grab something and take it with you as opposed to getting fast food while you are out. It is definitely worth the effort to think about how to apply meal preparation to your own situation, discuss with other family members who share storage space, and see how you want to apply these concepts to yourself, as this can ultimately save a lot of time and make it much easier to stick to your own desired diet.
In this lesson we have addressed two of the most significant barriers people face when attempting to eat healthily; cost and time. With appropriate planning, healthy diets can generally be constructed in a cost-friendly and time-efficient manner. It is worth spending considerable time upfront to plan out exactly what you want to do as this typically saves time and money in the long run and makes it easier to stick to your goals.
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