15: Culinary Medicine

Scot: All right. So here we go.

Troy: Scot, I can't believe you didn't ask me what I had for breakfast, but that's okay. We'll move along.

Scot: Troy, what did you have for breakfast?

Troy: I had a banana. Thank you.

Scot: That's great. What'd you do with the peel when you were done?

Troy: Threw it away.

Dr. Doxey: Set on the sidewalk carefully.

Troy: Set it on the sidewalk, exactly.

Scot: Hid around the corner.

Troy: Hid around the corner and watched someone fall. It was really funny.

Scot: Waited for somebody to fall Looney Tunes style.

Troy: Is that how Looney Tunes sound?

Scot: Yeah. Can't you see the feet going, doing this dance?

Troy: It sounded more like a turkey though. It sounds like a turkey.

Scot: It's the show "Who Cares About Men's Health?" and we are here to prove a simple theory that we have, that men, contrary to what people say, do care about their health. And we want to provide great information so, you know, they can care even more deeply about it.

Another issue I think is that it's maybe not men don't care about it. It's just they don't talk about it. So we're also trying to normalize it. Hey, it's cool to take ownership and talk about your health.

My name is Scot Singpiel. I'm the manager of The Scope Health Sciences Radio, and I care about men's health.

Troy: And I'm Troy Madsen. I'm an emergency physician at the University of Utah and I care about men's health.

Dr. Doxey: I am Rich Doxey. I am a physician at the internal medicine clinic here at the University of Utah and I care about men's health.

Scot: Nice. We got a new one in here today.

Troy: I love how you're the only one applauding right now.

Scot: We talk on this show a lot about something called the core four plus one more, and that's that at this point in one's life before one is older, when you're still younger, if you engage in good nutrition, get some activity, manage your stress, sleep, and then know your genetics, that can really go a long way for being healthy down the road. Would you agree with that?

Dr. Doxey: Yeah, very much.

Scot: One of the things that you studied though that you told us about that we want to talk about in this episode, which I think is absolutely fascinating that we'll get to in a second, is you studied something called culinary medicine.

Dr. Doxey: Correct.

Scot: That sounds cool.

Troy: It really does. How did I miss this elective during residency?

Scot: That sounds like a fun one, right?

Dr. Doxey: It was amazing. It was my favorite rotation.

Troy: That's cool.

Scot: All right. We're going to get to that, what you learned, and maybe what we as men can learn about our nutrition through what you've learned about culinary medicine. But one of the things we do talk about here and we'd like to hear your story is, was there a moment where you had a time where you realized you needed to make some health changes, changes in what you were doing in one of these areas, nutrition, activity, stress, or sleep?

Dr. Doxey: Yeah. So in undergrad, actually, I read a book that described and talked about nutrition and its role in health, and I didn't necessarily have any medical problems, but I thought, "Well, you know, I want to prevent these things and this sounds fascinating." So that was really kind of the turning point for me. He described, you know, on the molecular level how food interacts with your genes and how food interacts with your body.

And so, I made some drastic changes in my diet as an undergrad student that have persisted since then with some bumps and ups and downs here and there. But that was kind of my main turning point and I think I've avoided a lot of illnesses because of that.

Troy: So what was the before and after of your diet here? Are we talking like McDonald's every day, hamburgers, you know, pizza?

Dr. Doxey: My mom made sure that that wasn't quite that bad. Growing up, she made home-cooked meals and really tried to serve healthy food. But it was frozen burritos for lunch sometimes. And if I was in a pinch, I'd go out to eat once in a while. And then it went from that to cooking almost all my meals at home, cooking from scratch. All my roommates would say I was in the kitchen a ton, which was true. I was either in the kitchen or I was studying. Anyway, yeah, it was more like fresh fruits and vegetables and nuts and whole grains and making . . . yeah, cooking more fresh food.

Scot: So I understand there's an eating philosophy, The Zone Diet. I mean, whether the evidence of that is true or not, one of the claims that this individual makes, Barry Sears I think is his name, is that food invokes chemical reactions in your body, just like drugs would.

Troy: Yep, certainly.

Scot: So when you put this food in your body, you're creating these chemical reactions that are either good or they're bad, and from what you've learned, that's the case.

Dr. Doxey: Yeah. On a very general level, yeah, that's the case.

Scot: Culinary medicine, what can we learn from that? I guess we obviously learned why you ended up there. After reading this book, it sounded like you kind of took a path.

Dr. Doxey: Yeah. And I had, you know, tossed around the idea of how to really get engaged in that. In medical school, there wasn't much opportunity, but then when I was in residency, I had talked about how I wanted to do more lifestyle and so I mentioned to one of my mentors this and she said, "Well, there's actually this doctor down in New Orleans." Dr. Gourmet is his website.

Troy: You're joking.

Dr. Doxey: No. I mean, that's not his real name.

Troy: Oh, okay. I was like, "Please tell me that's his name. Please."

Dr. Doxey: He had a website called drgourmet.com that she followed and used. His real name is Timothy Harlan. And she said, "Well, why don't we connect you with him and see if he has something that you can do?" And I said, "Great." So we emailed back and forth and he said, "Yeah, have him come on down."

So I was the first resident. They have medical students go through that. I was the first resident to go down to New Orleans to their teaching kitchen and really kind of experience what that was like. And I got to run cooking classes and teach people in the community and teach medical students about food and nutrition, how to cut an onion, how to sauté things, and how to cook.

And the neat thing was he was able to take dietary recommendations from the guidelines and say, "Look, for hypertension, here's how you can make the Dash Diet really good and taste good and work on a budget, and here's how you can cook for irritable bowel disease," or for, you know, whatever the condition may be. And it was really cool.

Troy: So how did beignets fit in this diet? Is there a rule for this?

Dr. Doxey: They did not.

Troy: If you've never been to New Orleans . . .

Dr. Doxey: I did have a beignet from Cafe du Monde, yes.

Troy: You did have one?

Dr. Doxey: I did have one, yeah.

Troy: I did too. I went there for a conference a couple of years ago and that was what everyone told me before I went, is, "You have to eat a beignet." And I went there and I was like, "This is so unhealthy," but it was really good.

Scot: Why is it unhealthy? Just oily and greasy?

Troy: It's a glorified . . .

Dr. Doxey: It's a scone.

Troy: It's a Utah scone. So what we call scones in Utah are not really scones. Scones are more like a biscuit kind of thing. But basically, it's just fried bread. And so, that's what they call it in New Orleans, is beignets. In Utah, we call them scones, but it had like a thicker coating of . . . it was fried more deeply I think than the classic Utah scone, and it had powdered sugar on it. I'm sure the cholesterol content of that thing was off the charts. But I just think it's ironic there that you're doing culinary medicine in New Orleans, which I don't think of healthy food when I think of New Orleans.

Dr. Doxey: Right. And I think that was one of the inspirations or reasons why he wanted to start this program, was because he saw a need particularly in that population. He said, "Well, let's turn this thing around," and he's made a huge impact on people's lives.

Troy: I mean, it's great too that he's taking, like you said, it sounds like diets specific for disease states or different chronic illnesses and saying, "Hey, this is how you make it simple. This is how you make it affordable." And is that something now you've translated into your practice where you're teaching your patients these things?

Dr. Doxey: Yes. I've attempted through my work at the VA and then now here at the University of Utah to really counsel my patients and talk to them, and I've seen some patients make some drastic changes. It's been pretty cool. It's been really cool.

Troy: That is cool.

Scot: What obstacles do you face when it comes to getting somebody to . . . I'm taking away free will here in the way I'm wording this question, but helping them with that transformation, like from eating one way to maybe eating another that's a little bit more healthy. First, do they come to you wanting to do that at that point, or is that a conversation? Do you have to convince them first?

Dr. Doxey: It totally depends. Some patients walk in and say, "Hey, can you help me?" and I say, "Sure." And I have the training and let's talk about it. Other patients, I say, "Well, it looks like your cholesterol is getting higher and your weight's going up and change needs to happen here." And so, we have a conversation.

And usually, once we talk about something that's noticeably different, that's worse in their health record, we say, "Okay, let's start here." And I'll take a 24-hour dietary history and just say, "Tell me what you ate in the last 24 hours." And they talk about it and I say, "Okay, well, it looks like you like . . . you're a salty snacker. You like eating salty things, and it looks like you really like cheese with every meal, and it looks like . . ." you know, whatever the case may be.

And then we talk about eating a more whole food, plant-based Mediterranean diet and have them come up with one or two small changes they can make that will be beneficial to their health.

Troy: I'm glad you mentioned that. Everything I see, all the research that I see that's well done research, suggests the Mediterranean diet.

Dr. Doxey: Correct.

Troy: That's the one that's really evidence-based that makes a difference in terms of heart health. So many different outcomes. Was that your takeaway from this? Is that what you're counseling patients?

Dr. Doxey: Yes. And really the entire curriculum of culinary medicine is based on the literature from the Mediterranean diet or about the Mediterranean diet.

Scot: Is it just that's the most researched so it does have research, or have these other diet plans been researched and it's just there's no compelling evidence that they do help?

Dr. Doxey: So the best diets are either the Mediterranean diet or a vegan or whole food, plant-based diet. The argument against a completely no meat, no dairy, whole food, plant-based diet is just that it's difficult.

Scot: So sustainability for the person to be able to maintain that.

Dr. Doxey: And then you lose some things, like you lose your intake of vitamin B12 and a few other micronutrients that you arguably need. But the real thing is Mediterranean diet is more a set of principles than it is really, really strict rules, and it can be adaptable to a lot of different scenarios and you can use those principles to then say, "Okay, you can eat this way without following this book of recipes. You can adapt this."

Troy: And for our listeners, if you were to summarize the Mediterranean diet in two or three sentences, how would you summarize it or how do you communicate that to patients?

Dr. Doxey: So it's a diet that is characterized by a high intake of fruits, vegetables, legumes, and whole grains, with eating fish at least a couple of times a week and then consuming more unsaturated than saturated fats, primarily olive oil, and then eating a lesser amount, less than one serving a week, of dairy and animal products, meat, and then drinking a moderate amount of alcohol if you drink alcohol.

Scot: The dairy part is what would break my heart.

Troy: [Crosstalk 00:10:16] dairy, yeah.

Dr. Doxey: That's what most patients say, yeah.

Troy: You're saying one to two servings a week of dairy?

Dr. Doxey: So less than a serving a day.

Troy: Oh, sorry. So less than a serving a day.

Scot: All right. Well, that's not too bad.

Dr. Doxey: Well, that's a slice of cheese.

Troy: It's doable.

Dr. Doxey: But yeah, it's doable. So you view it more a condiment or as a seasoning than you would as a main part of your meal.

Scot: So a patient comes in and you have the conversation, right? Sometimes they're already there and they're looking for "How can I eat more healthy?" Sometimes they're not and you kind of have to get them there. After they leave and then come back, what are some of the struggles maintaining this type of eating?

Dr. Doxey: The initial barriers that people have mentioned are time.

Scot: That's a big one.

Dr. Doxey: It's a huge one

Scot: My wife and I don't have kids. We don't have a lot of extra responsibilities, so I can spend a lot of time preparing food. And it's shocking. I'm very single ingredient stuff. It's just like chicken on the grill, rice, potatoes. But if I'm putting together a salad, there's 10 minutes putting together a salad for the day, cutting up vegetables. It's scary time consuming.

Dr. Doxey: It can be. It can become incredibly time consuming if you don't learn a few key principles, and one of them is to realize that . . . you know, often in the curriculum they compare the time it takes to eat out to the time it takes to prepare a meal. And it's not actually that much more. Maybe the cleanup is a little bit more if you're at home, but if you can prepare a fairly simple meal . . . and then cost, obviously, is a lot lower if you're cooking at home.

But I tell my patients to make it simple. If you get it too complicated, it's not going to work. And so, yeah, something like having, you know, steamed rice and vegetables and pour a little olive oil with a small side of chicken, boom, you've got it.

Troy: And that's the key. It sounds like if you've got a few staples, you know, certain things that are recurring meals, you know it takes 20, 30 minutes to prepare this, in my mind that's the key to really being able to sustain this. If it's too difficult, I'm just not going do it. If it takes up too much time, it's not going to happen.

Dr. Doxey: Absolutely.

Scot: I think I'm a little blessed in that I am okay with repetition, so I can eat the same thing day after day after day. Like, four ounces of chicken, three and a half ounces of rice, and a salad. I could do that every single day.

Troy: You're a machine.

Scot: So at the beginning of the week, I can make up my week's worth of chicken. I throw it in the fridge. I make up my week's worth of rice, you know, and then all I've got to do is pack it up. Are a lot of patients like that, or am I a little bit of a freak?

Dr. Doxey: No, you're not that odd.

Troy: You're not that odd.

Dr. Doxey: There's a wide range.

Troy: I like your system.

Dr. Doxey: It's great and that's what I do too. Through medical school, we got through by eating beans and rice and steamed vegetables. I mean, that was our staple dinner at least three or four times a week, and it's great.

Scot: So you run into patients that talk about time. What are some of the other barriers?

Dr. Doxey: So another barrier they often cite is cost. And that's when I say, "Well, you've got to, again, make it simple and realize that your staple foods are probably going to be brown rice . . ." Legumes are a great source of protein, a great source of carbohydrates, fiber, and they should be a staple in I think anyone's diet. And if you can focus on buying in bulk and then repurposing ingredients. So, you know, buy and make batches of things and then use leftovers or use your steamed broccoli in a soup the next day. Then you're not wasting food and you actually can save a lot of money.

Scot: So time, money, what else as far as sticking with it?

Dr. Doxey: I guess that's the crux, is just that staying power and that willingness to just keep with it. And developing new habits I think is perhaps the hardest part because patients, you know, they're like, "Yeah, I can do this." They get into it, they do it, and then it just unravels.

And I think one of the keys to having that staying power is having social support and saying, "Hey, can you do this with me?" Their spouse, their partner, their friends, someone who's willing to really be there with them and do it with them is, I think, the only way that's really going to be successful.

Troy: And that's so tough. I think you're probably seeing a lot of people after they've had a wake-up call or, you know, they come into you after they've had a heart attack or some event where they were hospitalized. Maybe they're following up with you or you saw them in the hospital. And it seems like once you have that moment, you can get that social support. Everyone's on board. But if you don't have that, I think sometimes it is challenging to get people all on board with that and to get the support you need.

Dr. Doxey: Yeah, I think it can be challenging and that's, I think, a key part of the discussion. The other thing that I haven't done personally that I think is really empowering is watching the patients . . . the only time I saw this was in New Orleans. Watching the patients actually have the cutting board and the knife and the carrot in their hands and say, "Look, I can do this." And you show them the mechanics of it and show them that this is doable in a very short amount of time and that gives them the confidence to move forward. And so, both having that social support and then having that affirming experience, I think, is really key to sustaining change.

Scot: Because those first two or three weeks, it's going to be a little rough.

Dr. Doxey: It is. And you tell them that.

Scot: You're doing something brand new. It's not in your routine anymore. It's going to take a little bit more time. It's going to seem weird. You're going to question yourself whether you're doing it right and you've just kind of got to force through that.

Plus, also, for me personally I've gone where I've eaten really well and then maybe I haven't yet eaten so well, right? And after you're on good food for a while, when I'm talking about good, I mean healthy food . . . and it sounds like some of the techniques that you learned actually makes healthy food taste good as well.

Dr. Doxey: Oh, yeah. Absolutely.

Scot: I don't know that I have those skills, but you start to want that. And then when you kind of eat something that's not so healthy, you're a little repulsed by it until you kind of get back into it for a few weeks. Now, all of a sudden, that's what you want. It's hard to make those shifts for me. I mean, just understanding that helps me go, "All right, it's going to be rough for the next two or three days as I kind of try to get back on track."

Dr. Doxey: Yeah. And you framed that very well. I think that is the key, is once you're eating a healthy diet consistently, you will realize how hard it is on your system to eat something that's not quite so healthy.

Scot: Talk about some changes you've seen with patients as a result of your working with them.

Dr. Doxey: One of my favorite examples, I had a gentleman come in very overweight and for him kind of the shock was realizing that his A1C . . . so his diabetes marker went up. I said, "Well, you actually are now diabetic." I mean, he's a truck driver. And he said, "I can't be on insulin shots. I've got to make some changes." I said, "Yeah, you do."

And so, we had a conversation about it and we went through the Mediterranean diet and talked about things. He had gained . . . I don't remember now. At least 100 pounds over the past five years from driving a truck and eating out and really just kind of not taking care of himself.

And so, after that conversation and a couple of others, he sent me a 24-hour dietary history. We went through it. I made some recommendations to him of how he could change his diet. And over the course of only a few months, his weight went down. His marker of diabetes dropped by about . . . I think it dropped from where it was back to where it was before, so by about 0.6 or so, which is pretty remarkable in a short period of time.

And he was able to maintain that for a while. You know, it was a little bit up and down, but he never developed full-blown diabetes. His weight kind of rolled up and down, but he never went back to his weight he was at before, and he felt really good.

Interestingly, and I've seen this pattern more than once, when patients change how they eat, they will often change how they exercise.

Scot: Amen.

Dr. Doxey: And when patients change how they exercise, they will often change how they eat. And so, if you can get them to start a making a positive change, then it'll start to snowball. And it was really cool to see.

Troy: And that's huge. I think what you said there . . . you're talking about someone who, you know, 90% of the time or more would have been giving himself insulin injections. You said that would affect his certified driving license. He couldn't drive commercially. He could have lost his job essentially just because of that issue, and completely reversed it. Maybe not 100%, but significant improvements just with dietary changes, as you mentioned, threw in some exercise.

And there's so much to be said for that, I think, for the impact of diet on diabetes, hypertension, so many chronic diseases, and it's really cool you're seeing that in your practice.

Dr. Doxey: Yeah, it was really cool.

Scot: And if a truck driver can do it, the rest of us should be able to do it because that's so hard. You're out on the road. You don't really have the ability to make food in the same way. The fast, easy grab at the truck stop or at the fast food place is going to be the easier thing to do.

Troy: Yeah, it's inspirational.

Dr. Doxey: It's so true. You know, I always tell our residents if we get a call where someone was driving a truck on Interstate 80 and AirMed picks them up somewhere in Nevada and brings them to us, you know it's bad. Those are most of the heart attacks we see, most of the aortic dissections. These are just guys who were just sitting in a truck driving cross-country and it just hits them and they get the call, they bring them in. Those are some of the worst things I've seen.

And these truckers I talk to, that's what they say. I've seen guys that are super fit that are truckers that are just compulsive about it. But so many truckers, it's like, "Hey, this is my job. I'm sitting behind the wheel for, you know, 12-plus hours a day. I can't exercise. I can't eat well. I'm eating at truck stops, eating fast food." So to see that change in someone like that, like you said, Scot, if they can do it, we can do it.

Scot: All right. Well, motivation. I like it.

Troy: There you go.

Scot: So, for somebody listening that wants to make this change, what's that first step that you would recommend for them to do? Because that activation energy, making those first steps, can be the hardest.

Dr. Doxey: So really, the first step is to assess where you are and just write down . . . think about the last 24 hours and write down going backwards what you ate. You know, in this case, what did you have for breakfast this morning? What did you have for dinner last night? What did you have for a snack? What did you have for lunch the day before?

And then once you kind of see what you're eating, then you can say, "Oh, here are some things I can change." And the key is to make one or two changes that are what I like to call congruent dietary changes. So it's really hard for someone to go from eating burgers and fries to eating hummus and carrot sticks. It's really hard.

Scot: Yeah, it is, right?

Dr. Doxey: But it's a lot easier to go from eating burgers and fries to eating burgers with tomato and onion, and maybe instead of fries, do sweet potato fries. And then after a while, then you say, "Well, why don't we do baked sweet potatoes?" And then after a while, we say, "Well, okay, why don't we do a chicken sandwich instead of a burger?" And on the chicken sandwich, put stuff and make chicken salad. And then over time, you can work your way to eating a more plant-based diet.

I think that's the other downfall to some people's attempts, is they try to just go whole hog and it devolves really fast.

Scot: Go from this to that in one day.

Dr. Doxey: Yeah. You can't go from 0 to 60 and expect to maintain that. You've got just make slow but consistent changes over time.

Troy: Yeah, that makes sense. You see the guys coming into work with their little thing of carrot sticks and celery and they just look miserable. You're like, "This is not sustainable." If you don't enjoy it, it's not sustainable.

Dr. Doxey: Exactly.

Troy: Here is Scot's Husky little cooler thing he brings into work. I'm guessing that it has carrots and celery sticks. Most people, this is not sustainable.

Scot: I don't know. Maybe it is. Maybe it's not.

Troy: Maybe some almonds? No, it's admirable. This is what you do, Scot. You're very focused on diet and you do a great job with it.

Scot: This is what I do every day. I bring my lunch in and I will admit there are times where I forget to bring my lunch or I don't have time to make it and I don't want to go to the restaurants around here because I crave what I have. I've been doing this for a while, right? And this is what I'm talking about. It does take time. So, Oh, I already ate my spaghetti with chicken sausage.

Dr. Doxey: Very nice.

Scot: I am a meat eater still. And I already ate my green beans

Dr. Doxey: All right. Good. Some vegetables.

Troy: I'm seeing some apricots here. I don't even know what that is.

Dr. Doxey: He's got some rice.

Troy: He's got some chicken and rice here. Is this all for today or do you just bring this at the start of the week and it's been sitting here for four days?

Scot: No. This is all for today.

Troy: Okay. Good. Nice.

Scot: So anyway, yeah, it's been a long time. Oh, hold on a second. Mitch, who's one of our producers here . . .

Troy: Mitch is intrigued.

Scot: I just see Scot bring this in every day. And just from what you were seeing what he was pulling out, considering your background, how is he doing?

Troy: Does he get an A-plus? Where is he on the scale here . . .

Scot: Yes, Scot gets an A-plus.

Troy: . . . on the school of culinary medicine?

Dr. Doxey: Scot's doing remarkably well. Even just in that lunch there you see, you know, several servings of fruits and the helping of salad and vegetables and whole grain there. Yeah, that's exactly what it should look like.

Troy: No, that is admirable. I mean, the fact that you're bringing that in every day too and planning ahead, like you said, at the start of the week.

Scot: For me, I have to plan ahead, and for me, I have to eat this stuff so I don't go home and go into emergency starvation mode and then start shoveling more than one serving of cheese in my mouth.

Troy: Will you please show up in the ER when I'm there and say you're in emergency starvation? It sounds serious.

Scot: Yeah. Or I'll go home . . . another thing I struggled with for a while is I probably drank more beer than I should.

Troy: So you don't bring beer to work?

Scot: Now, my deal is if I go home and I think I want a beer, I have to eat a healthy meal first.

Dr. Doxey: There you go.

Scot: And if I do that, I find often then I'm full, because I think I was drinking beer because I was hungry, and then I don't crave it anymore. So I try to replace this good food and I try to stay in a state that when I do go home and I have access to maybe not the best choices, or on the way home, I don't stop at the fast food place.

Dr. Doxey: Yeah. I think that's fantastic.

Scot: Rich Doxey, Dr. Doxey . . . I like Dr. Doxey. That just rolls off the tongue nicely. Thank you so much for being on the show with us.

Dr. Doxey: You're welcome.

Scot: It's been an absolute pleasure. It was fun learning about nutrition from you, and thank you very much for caring about men's health.

Dr. Doxey: Yeah, you're very welcome.

Scot: Okay. Post-show, Troy. It's where you and I kind of talk about what just happened. I liked Rich. He had a lot of energy.

Troy: He did. I enjoyed talking to him.

Scot: Good information too. So, any particular takeaways?

Troy: Well, the whole culinary medicine thing was new to me. I've never heard of this before, but it certainly makes sense. The whole idea of food is medicine and the reaction to foods and really focusing more on that rather than just prescribing a bunch of medications to people.

I loved his story about the patient he had who was diabetic, who was going to need to be on insulin, made changes and saw significant results because of that. So I think that was my take-home. Diet is medicine and it makes a difference.

Scot: I keep hearing about the Mediterranean diet, and I do eat fairly healthy, but I think I need to do a little bit more looking into that because, you know, the research is pointing to that's really the way to go.

And we were even talking to a different expert. Our nutritionist was talking about mice that are fat that don't have any indication of diabetes because they're on the Mediterranean diet. It all has to do with the type of fat cells they have. We need to get Thunder back on to talk about that a little more. That was fascinating.

Troy: That was.

Scot: So anyway, this is the second or third time I've heard of the Mediterranean, so I need to look into that. And the other thing I really liked was that the time spent in the restaurant is the same as preparing your own food. And at first, I was like, "No, what are you talking about?" But if you think about it, you take the time to drive there, you wait, you sit down, you're waiting for your food, you know? So I guess I could kind of see that.

Troy: That kind of hit home with me too. I'm not good about making meals, and every time I think about it, it's the time. That's the biggest barrier. And it makes sense when you look at that hour and a half to two hours invested in going out to eat and sitting down in a restaurant. It could be much less time just to make your own meal.

Scot: Time for Just Going to Leave This Here. These are our random thoughts. It could have something to do with health. It might not have anything to do with health at all. My Just Going to Leave This Here is we've declared war in our household, Troy

Troy: War on the rat, your friend the . . . I don't even want to ask what happened to your new pet the rat, but let's skip that.

Scot: No, war on single-use plastics.

Troy: Oh, wow.

Scot: And it's harder than you might think.

Troy: I bet.

Scot: Yeah. So anyway, we've switched to reusable grocery bags, which we've done for a long time. So we don't use the plastic bags, right? That's an easy change, and those things are like 75 cents.

We found some cool mesh bags for produce. So you go to the produce section, and you pull out those real thin, clear plastic bags to put your produce in? Don't use them anymore. I just will put the produce in my shopping cart without that bag and then just be sure I wash it well, or we have these mesh bags. So those are kind of cool.

Instead of Ziplocs, we have these heavier duty resealable bags to put our leftovers in that my wife found on the internet.

We go to the bulk food store now with jars as opposed to buying rice in plastic bags. We go to the bulk food store with reusable jars.

But there's still so much stuff that comes in plastic and it's just so hard. And even doing this has been a lot of effort, and I don't know ultimately if it's going to make a difference at the end of the day, but I guess I'm feeling kind of good about it. So I wanted to talk about it.

Troy: I like it. I mean, it's a simple change. Like you said, it's had its challenges, but you're finding ways to make it work. It's admirable. I wish I could say I'm doing the same, but I'm not. I think about the plastics that we have and all the stuff we throw away. And sure, you think, "Oh, I can recycle plastics." A lot of those plastics are not recyclable.

Scot: That's where this all started, was we're starting to learn more and more that a lot of the things we used to think were recyclable aren't.

Troy: They aren't.

Scot: And the little logo is . . . it's not "recycle first." I need to look this up. You know how it's like "Reuse"?

Troy: Reduce, reuse, recycle.

Scot: Yes.

Troy: Reduce the consumption, I think that's the first step.

Scot: Reduce is the top one.

Troy: Reuse what you can. And then worst-case scenario, recycle if you can. There's lot of stuff you can't recycle. I'm even seeing more that the value in recycling plastics is very low because so much of that has been sent to China. China is not using it now. And even a large percentage of the plastics that were sent to China, China's dumping in the ocean because there are no regulations on that. So in some cases, even these plastics we're feeling good about recycling are ending up in the ocean, which is just . . . that's not good.

Scot: I guess I should say this war on single-use plastic started because of what you just said. We were feeling very demoralized as a result of all those news stories. We thought we were doing the right thing this whole time and it would be very easy just to go, "Screw it." So anyway . . .

Troy: That's admirable. I like it. I maybe will try that. It sounds challenging, but you're making it work.

So I'm just going to leave this here. Since we talked about food, there is a research article related to food that I found fascinating and this is in the "American Journal of Emergency Medicine." They looked at avocado-related knife injuries and the spike in these knife injuries over several years.

Essentially, what they're seeing . . . they looked at knife injuries across this entire injury national database. Between 1998 and 2000, there were about 3,000 avocado-related knife injuries. That number from 2013 to 2017 went up to 27,000. That's almost a tenfold increase in knife injuries in the emergency department.

Scot: Because of avocado.

Troy: Because of avocados. And this is so funny. My sister is a physician assistant who works in the Bay Area, and when I asked her, "What do you see a lot over there?" She said, "Avocado injuries," which is perfect because she's right there at Berkeley, which is just the haven of people who are probably eating a lot of avocados.

I don't see this as much in the ER, but it makes sense. And I was trying to think how do these happen? And you figure maybe people are trying to slice it while it's in their hand and the knife is slipping, cutting their hand.

Anyway, it was kind of a humorous article. This is actually a serious study, but it jumped out like, "Wow, there is an epidemic of avocado-related knife injuries."

Scot: It's humorous, but it's also telling that . . . that's how I cut my avocado. I have to admit.

Troy: You hold it in your hand.

Scot: I hold it in my hand and I take it, I pierce it, and then I just run the knife around the avocado, just using the seed as kind of the cutting board.

Troy: I'm guessing that's why this happens.

Scot: Yeah. So maybe that's not the wisest choice.

Troy: It's probably not. I was trying to figure that. I usually put it on a cutting board or on the counter and then I'll, you know, put the knife in and then flip the avocado over, go the other way, and pop it in half. But maybe it's because people are holding it in their hand to cut it.

Scot: Or popping it in half with a knife. Mitch, our producer, how do you cut your avocado?

Scot: I put it right in my palm and put that super sharp knife, right? You pop the thing out and then . . . yeah, there's a couple of times that knife goes a little bit through the skin, you know, and you're like, "Oh." But it's just how I've done it my whole life.

Troy: A little bit of blood in the avocado.

Scot: I've never almost injured myself. Why do you still do it then? You've almost injured yourself.

Scot: All the time. I'm just injury prone. It's just the way you do avocados.

Troy: Just living on the edge.

Scot: I love it, with my avocado toast.

Scot: With your avocado toast

Scot: So millennial.

Troy: I love it. See, that's the beauty of it. Yeah, it really hits close to home. And that's what I'm going to leave here, avocado injuries. Be careful.

Scot: All right. Wrapping it up in the post-show, things that you say at the end of podcasts. It's time for that part of the podcast where we say the things you say at the end of podcasts. If you've liked the show, rate and review it on iTunes. Give us some stars. Give us some comments. It helps other people find this content. If you liked it, they will too hopefully.

If you have any questions or comments, you can go to hello@thescoperadio.com.

And we have a new addition now to the things that people say at the end of podcasts. There's our Facebook page, and we are building a community of men who care about their health. Facebook is where we've chosen to do it and you can join that community. We would like you to join that community at facebook.com/whocaresmenshealth. Is that right?

Scot: That's it.

Scot: That's it.

Troy: That sounds correct.

Scot: Producer Mitch has given me the thumbs up.

Troy: Thumbs up.

Scot: Thanks for listening and thanks for caring about men's health.