More restaurant news

Great news! I accepted the offer of one of 3 banks who agreed to underwrite my Small Business Association (SBA) 7(a) loan. While it isn’t 100% that I’m fully funded, it’s 99% and that means things are starting to happen. So for those of you who are reading and following along, I’d love some input either here, on Facebook, Twitter, or by email. Please, don’t hold back!

I met with my architect and design team yesterday. Aaron Wittkamper & Amy Reiff work together as architect and designer. A local project they did has gotten a lot attention recently, the Tattersall distillery in NE Minneapolis. The link has some photos of the place. My question about design for you is: what makes a restaurant space inviting for you? Do you like to sit at the bar and eat? Do you need a booth? A large common table? Lots of small tables that can be reconfigured quickly and easily? What works and what makes you want to come back?

And what about flow through the space? Do you prefer ordering at the counter and having the food brought to you or sitting down and having your order taken? Would you prefer to pick up wine and beer where you order food or is a separate bar area preferable? Or both?

If I have sidewalk seating but you can’t drink alcohol out there (a la The Blue Door) is that OK?

What menu items are “must haves” for you? I’ll let one secret out of the bag now; we will feature a plant-based Big Mac replica that is so close to the original it will be scary. Except instead of the plastic, non-decomposing fries we’ll have delicious crinkle cut fries made out of just potatoes! If you haven’t seen “The Smoking Fry” feature of Super Size Me! you really should click the link and watch it. It’s 5 minutes and if you are not at least moderately nauseated by it you are not paying attention.

Other meetings this week with bankers, accountant, lawyer, insurance agent, etc. It’s amazing how much time this takes to put together, but I’m super excited about doing it. Targeting an opening in the 4th quarter of this year…

P.S. I don’t remember if I’ve done this before or not, but if I haven’t, shame on me and if I have, good for me for pushing. If you don’t read Seth Godin’s blog, you should. I don’t care what you do for a living, how much a decision maker you are at work, whatever. His posts are daily and pretty short and just plain filled with wisdom. Subscribe by email and they’ll get delivered to your inbox every morning. Like a little breath of sanity each day.

Healthcare Politics Nutrition

David Katz, MD and Marion Nestle, PhD

Worry not, people, the Food Revolution Summit is almost over! I’m tuning in to just two more speakers from Saturday, so the last update may be Monday morning. Today, though, there were two great speakers, named above.

David Katz, MD

Dr. Katz is the President of the American College of Lifestyle Medicine and someone I frequently retweet, so his name may be familiar to some because of that.

Most disease is caused by environmental toxins (tobacco), poor diet, and lack of exercise. He went on to expound on Dan Buettner‘s work on the Blue Zones project and how that applies to lifestyle medicine. If you’re not familiar with Dan Buettner and the Blue Zones, take a moment to familiarize yourself. It started as a fascinating National Geographic project to find the people who live the longest on the planet and how they are similar. Dan took this work and is now trying to proactively apply it to communities. Cool stuff. Anyway, combining the Lifestyle Medicine work with the Blue Zone work Dr. Katz has a list of 6 keys to health and longevity:

  1. A primarily whole food plant-based diet (in the Blue Zones they usually supplemented with small amounts of pork, but not beef or seafood)
  2. Minimize toxins (primarily tobacco)
  3. Stay physically active (note, this does not mean “cardio”, but simple walking will suffice (although Blue Zoners often walked 10+ miles per day)
  4. Get lots of sleep, regularly
  5. Minimize your stress when you can
  6. Stay very active in being social; family, friends, groups, community

“Dinner is destiny”. I love that, simple and profound. The point is that it’s what you do every day that matters the most.

“The 2015 Dietary Guidelines are a national embarrassment”. He went on to say that the report from the Dietary Guideline Advisory Committee was actually quite good, but as I noted in my previous post, the Big Food interests and their lobbying power stifled the important messages and make the final product worthless. He also noted, as others have (including me) that the real tragedy is that the Guidelines are the basis of public policy. BTW, if you want to look at the Advisory Committee report, can do get the full 571 page report here to look at and download to your heart’s content.

Lastly, as Dr. Katz and John Robbin’s discussed optimal diets and the continual swirl of controversy and confusion, they both agreed that Michael Pollan probably said it best:

“Real food, not too much, mostly plants.”

Marion Nestle, PhD

I have seen Marion Nestle speak (in videos) several times and I have been a reader of her website and blog for several months. She is an amazing woman who has been virtually the “lone voice in the wilderness” for many years when it comes to discussing the politics of food and shining the light of truth onto the subject. She talked mostly about CocaCola and Pepsi and their battles to maintain themselves as legitimate and vital concerns now that the truth about high fructose corn syrup (HCFS, see Wednesday’s post with Mark Hyman) and it’s links to obesity and cardiovascular disease have become so widely known. She was a memeber of the 2015 Dietary Guidelines Advisory Panel and one of the principles in getting the New York City ban limiting the size of soft drinks to 16 ounces, a move that is being challenged in the courts by Big Food. She has also been instrumental in exposing Coke and Pepsi’s attempts as anonymously funding efforts to ban GMO labeling, among other nefarious deeds.

Why would Coke and Pepsi give a rip about GMO labeling? Back to the high fructose corn syrup. Apparently almost all of the corn in the US is now GMO corn, so if there is a labeling law, all soft drinks would have to carry the GMO label. As usual, it’s all about the money. This is just another blatant attempt to maintain corporate profit selling a product that is demonstrably bad for your health. But corporations are people, as the Supreme Court has ruled, and so as long as they keep making money for their shareholders they can spend however much money it takes, either publicly or anonymously, to hide the truth and raise a small level of uncertainty and doubt as to the science. It’s just like Big Tobacco and Climate Science all over. It’s the same playbook every time and we keep falling for it.

Much of the spending in New York state trying to defeat the soda ban is being done by the National Restaurant Association. So, what’s their tie? As always, follow the dollar. According to Ms. Nestle, restaurants and movie theaters pay about 1¢ for each fluid ounce of soft drink. That’s the cost, all in (i.e. the cup, the syrup, the water, the CO2 tank, the cooling and the staff to serve it). Now imagine you just bought a soft drink at a movie theater. Say you got a 20 ounce cup and the theater is one that allows “free refills”. The theater is out 40¢ for your purchase. You probably paid $3 for it. That’s a 650% profit margin. So, yeah, they have a good reason to fight this. Guess what; no soda machine in my restaurant. 🙂


A Short Post – Cory Booker

cory bookerSenator Cory Booker (D – New Jersey) was interviewed for the Food Revolution Summit yesterday. I have seen Senator Booker before on Bill Maher and Steven Colbert and, I have to say, is one of the few current politicians who actually seems to make sense. I say this after meeting Al Franken (D – Minnesota) at the infamous Johnny’s Half Shell in Washington DC (recently made more infamous by John Oliver, skip ahead to 4:10 to see more). Mr. Franken had joined my University of St. Thomas MBA class to discuss health care policy. About 5 minutes in he turned to his very young, attractive, blond assistant and asked her “what is our position on that?”. Ugh.

Senator Booker, however, seems much more informed, articulate, and cogent than the typical political knuckleheads. He is a vegan, but clearly not a militant one. He espouses a policy of focusing on what unites us rather than what divides us and seems to believe that, given the proper information, most Americans will ultimately choose the path of whole food plant-based diets. I would say that I’m hopeful that he’s right, but I’m not quite as optimistic as he is.

Both Senator Booker and John Robbins had quite a bit to say about factory farming. The Senator is working to make a Federal exclusion to the spate of “Ag-Gag” bills that some states have been passed attempting to stifle whistle blowers at factory farms with grossly inhumane practices. I am pleased to note that the Ag-Gag bill in Minnesota never made it to the floor of either house. But the fact that they keep coming up in every state is just another testament to the power of dark money in politics and their long term plan to moving to state battles rather than federal battles. At any rate, keep an eye on Senator Booker. He seems like the genuine article.


More from the Food Revolution Summit

I get it that most normal people don’t listen to hour long talks (audio only!) about food, much less 3 of them in one morning. But who ever said I was normal? Besides, as a person particularly interested in the topic and in the process of trying to open a restaurant with a plant-based menu, what could be more important for me to do (except meet with more bankers!). So rather than expect that anyone else will listen in, I did and took some notes so I can share the highlights with you. There should be at least on interesting factoid in what follows.

Joel Fuhrman, MD

As always, Joel Fuhrman is very intersting. He has shown up in a number of movies over the years as the “voice of reason” in plant based eating. He is a primary care doc with a deep understanding of nutrition. There were two big moments in his talk.

  1. Statins – an almost ubiquitous drug in the American population now, practically given away like candy. The class of drugs is officially known as HMG-CoA reductase inhibitors and as used to lower cholesterol. As any reader of my blog should already know, the way to reduce cholesterol is to adopt a whole food plant-based eating pattern and eliminate the cause, rather than continue to eat crap and then try to take a pill to poison part of your body to make your numbers look better on paper. That should seem obvious. There have been many docs over the years (and some studies too) that have suggested that the statin drugs may decrease cancer rates. Turns out that is not the case. In fact (and this was news to me, so I’m guessing (hoping???) that it’s news to most docs) that statins can actually RAISE cancer rates. Click here and read the 2013 study describing an almost 2x increase in both ductal and lobular breast cancers in women taking statins for 10 years or more. It’s been said a million times, but it’s worth repeating again. ALL DRUGS ARE POISON.
  2. Cancer is a relatively new disease for humans – I guess I hadn’t really considered this. As a general surgeon trained in the 1980’s and 1990’s cancer in it’s myriad forms is just a problem that is relatively common. As a holder of T. Colin Campbell’s Plant Based Nutrition certificate, I know that cancer has been called a “disease of affluence”, but there is evidence to support the notion that cancer as we know it is a relatively new phenomenon that has become prevalent only since the industrial revolution.

Mark Hyman, MD

Mark is the director of Cleveland Clinic Center for Functional Medicine. He has a somewhat less dogmatic style than Dr. Fuhrman and advocates a more “Peagen” approach (something between Paleo and Vegan), with emphasis on whole food plant-based eating patterns, but allowance of some animal proteins in what would be in very strict limitation to what is typically consumed on the Standard American Diet (SAD). He was all over the map, but a couple of highlights were:

  1. High Fructose Corn Syrup (HFCS) – what he calls a “neon sign” for processed food to be avoided. Like others, he notes the strong correlation between HFCS and diabetes, obesity and other diseases of affluence. He believes their inclusion into soft drinks may be one of the worst things ever and cites it as a cause of the obesity epidemic. More interesting to me, though, was the presence of mercury (Hg) in high fructose corn syrup! This 2008 study by The Institute for Agriculture and Trade Policy (IATP) documented mercury levels in several off the shelf food products with HFCS that had been processed with “mercury cell” technology, apparently an older way of refining the corn syrup. As a reminder, mercury, at any amount, is incredibly toxic. Seriously, you think you’re doing yourself a favor and grabbing an “Oatmeal to Go” and it turns out you’re getting mercury poisoned? I should note that, to the best of my knowledge, this problem has been corrected at U.S. plants. And how did the HFCS industry react to this bit of bad publicity? The way any corporation would; they rebranded! Now HFCS is seen on labels as “fructose” or “corn syrup”.
  2. U.S.D.A. and H.H.S. Food Guidelines – no small wonder that the much maligned food guidelines got discussed. Dr. Hyman’s beef (so to speak) was that the Food Guideline Advisory Panel recommended a ban all sugary beverages, but the final edition recommended “limiting excess sugar”. If you need a reminder on the folly of the Guidelines, review my previous post. As Dr. Hyman and others point out, hardly any individuals read the Food Guidelines, but they do form the basis for quite a bit of public policy, not the least of which is the food stamp program. And in 2015, the food stamp program paid for 10,000,000,000 (yes, that’s 10 Billion) servings of soft drinks for Americans. Kind of brings some clarity to the finding that low-income Americans have significantly higher diabetes rates…
  3. Citizen’s United – When asked how to improve public policy as it relates to eating patterns and the food supply, Dr. Hyman said that, in the wake of the Citizen’s United ruling, he didn’t see much hope unless things changed significantly to get money out of politics. For those not familiar, read about the Citizen’s United ruling here, read a US News and World report story of the aftermath 5 years later here, and for a chilling, depressing and meticulously documented exposé of the money and drive to get that ruling, Jane Mayer’s excellent Dark Money is a must read for anyone who cares that their country is changing from a democracy into a plutocracy.

Neal Barnard, MD

Neal is the founder of the Physician’s Committee for Responsible Medicine in Washington, DC. As you may recall, I was recently in the news as the local PCRM physician advocating for Hennipen County Medical Center to stop needlessly using animals for training their Emergency Medicine residents. Dr. Barnard has recently opened the Barnard Medical Clinic in Washington and has been very active in promoting veganism.

I don’t have a specific Dr. Barnard highlight to share, probably because I am pretty familiar with his message. But I will say that listening to John Robbins (son of the founder of Baskin & Robbins Ice Cream) and Neal Barnard (son of a Fargo, ND cattle rancher) diss the dairy industry, the beef industry, and the U.S.D.A. food guidelines was fairly entertaining.

They did discuss the WHO classification of processed meats as a known carcinogen and red meat as a probable carcinogen. There is a nice review of that from the UK here. They went on to discuss the irony and overall wrongness of then having Domino’s pizza prominently advertising their pepperoni pizza as a viable school lunch in trade magazines aimed at those who prepare school lunches. Sure, the pepperoni is known carcinogen. Sure, the cheese is primarily casein, a known carcinogen. Sure, most of the kids are lactose intolerant. Sure, the sauce has HFCS, but, it’s what the kids want, so we should feed it to them. Ugh.

OK, enough rambling for one day!



More on running; perceptions

Finish LineYeah, that’s me in the white hat, gray shirt and shorts and black shoes finishing the 39th annual Get In Gear 10K run last weekend. Check here for my official times and finish line video. I “grabbed” that pic from the video, so you know what to look for if you bother to check it out. You should check it out because it will make more sense if you do.

As those of you who read my last post on running know, my running this year didn’t start as well as I’d expected. Got over the terrible hip pain only to have it return a couple of weeks later. Found that adding lunges to my exercise routine seems to make that pain a thing of the past and get started on prepping for the next 1/2 marathon (Red, White and Boom on July 4). Then patellar tendinitis set in (right knee). For those that have not experienced this wonderful condition, my symptoms were an occasional (and unpredictable) sharp shooting pain around the lower knee cap and a general feeling of knee instability. Fortunately, I caught it pretty early and stopped running and it cleared up in about a week.

In early April I decided that the Get In Gear 10K race fit in nicely with my 1/2 marathon plan, so I signed up. Last year’s race was a disaster and one I’d rather forget, but for those that missed it, I biffed it at home about 10 days before the race and had the spectacular purple forehead and gash to prove it and keep me from running.

Living in Saint Paul proper now, we decided to head over to the race on the MTC 84 bus route. A plan that proved that mass transit really can be a pretty good thing. Only about 15 minutes on the bus and we got dropped  off more or less at the park. Certainly more convenient than the park at the VAMC and take the shuttle bus over to the park routine and we timed it to arrive just 15 minutes prior to the start. Dropped the sweats (chilly morning!) off at the bag drop, get over to the start, fire up the Garmin and the iPod and we’re off.

It’s the Get In Gear, so my chip start time was just 2:42 after the gun start and I was near the back of the pack. I hate that first mile. So much jostling and jockeying for an opening and you’re just trying to find your pace. It’s super awkward, but I denied my inner Johnson, determined not to want to punch anyone in the face. The result: 9:31 for mile 1. Pick up the pace! I almost negative split each mile after, but the hill by St. Thomas took it’s toll. I’ve never run a road race with my Garmin and it was kind of cool (in a nerdy, data oriented way) to keep track of my cadence and heart rate. Going up the hill I found that both got too fast. Just at my threshold for having to walk I was able to slow my cadence and then let the heart rate come down, then back to pushing. I missed the mile 3 time by 1 second. Then turned in better times for mile 5 and 6 with what felt like a near sprint to the finish line, Garmin telling me I was doing a 7:20 pace for the last bit!

OK, did you watch the video? If not, go do it now. I’ll wait, it doesn’t take long.

Seriously, is that embarrassing or what? I look like I should have crutches or at least a walker to move at that speed and still be safe. And damn, after all the time I’ve spent trying to be a mid-foot striker there I am with my foot out in front and leading with my heel. But, there it is. And it’s all about perception. You may feel, in the moment, that you’re moving at top speed, but later you might realize you really weren’t. You might feel like your form is spot on, but when you have some time and perhaps some data, you find that there are improvements to be made. You just have to be open to the fact that what you think at any one time isn’t reality, just your perception of reality.


Fiber Deficiency Syndrome

poop emoji

How could I possibly resist starting a post about fiber without putting up the infamous pile of poop emoji? That is not to say that what I’m about to relate is a bunch of crap, mind you! 🙂

So, I’ve been listening to some of the speakers at the Food Revolution Summit. On Saturday Dr. Michael Greger talked about foods that you should be eating, but probably are not. This morning Dr. David Perlmutter had a fascinating talk about the importance of the gut microbiome and it’s link to neurological health including Alzheimer’s, Parkinson’s and even autism. Seriously cool stuff. All of the talks at the Food Revolution Summit are free, just sign up and listen within 21 hours of them being broadcast. Not surprisingly, there is an option to purchase, but for the casual listeners the free option is groovy.

The much maligned 2015–2020 US Dietary Guidelines (see numerous previous posts if you’re confused about how I feel about them)  recommended 25–30 grams of fiber per day for adults. Studies have shown that few adults get more than 15 grams of fiber per day, which leads to a number of problems that I detailed in a previous post about constipation. In Dr. Greger’s talk he said that fiber was the #2 dietary deficiency in the United States (potassium being #1). He claimed that 92% of Americans are fiber deficient. I had never considered it in that context. Flipping the script, so to speak, from recommending supplementation as a way to meet a minimum standard to considering a low fiber diet as a disease state. While interesting, I thought it might be a stretch. To my surprise, chagrin, and amazement, I was missing a big part of the story that was filled in by Dr. Perlmutter’s talk.

It turns out that there is large and growing compendium of information regarding the previously unknown importance of what’s happening on the surface and inside our bodies and the emerging understanding of the incredible symbiosis between us and our bacteria. Really fascinating stuff with far reaching implications (beyond antibiotic use and the over-prevalence of hand sanitizers). A couple of highlights:

  1. Rice has more genes than humans. About 15,000–20,000 more. While the reason for this has been debated since it was discovered in 2002, there is an emerging belief that we humans have elected to “off load” some of our genetic programming to our symbiotic bacteria, who are much better suited to making quick changes as necessary. Just ask any physician who’s tried to treat a multiply resistant organism in a sick patient how quickly bacteria can adapt. This is considered to be similar to our current “cloud” technology (i.e. your iPhone stores your pictures in the cloud, not on your phone because it’s a more secure system (at least from loss)).
  2. There is an association between autism and C-section that has been pretty clearly described. Please note, this DOES NOT mean that C-sections CAUSE autism, just that researchers have noted that children born by C-section are statistically more likely to develop autism than vaginally delivered children. May turn out to be a statistical quirk and then again, it may not. The vagina is certainly not a sterile environment. Passage through “the birth canal” is now thought to help inoculate the newborns gut. Supporting evidence is that children with Austism Spectrum Disorder have a different gut biome than children without. This is the basis for a new realm of treatments including probiotics and possibly fecal transplant to help treat ASD. Crazy Stuff!
  3. Best quote: “Getting dietary advice from your physician is almost malpractice” Dr. Greger

The other interesting part, at least to me, is how hard it is to be a practicing physician and keep up with this stuff. It speaks volumes to  how misplaced our priorities have become that it took retirement from clinical practice for me to begin to understand the error of my, and my colleagues, ways. I’m not sure how to fix that. One of the big, big problems is that knowing your patients are fiber deficient and encouraging them to correct it doesn’t really pay. It’s definitely the right thing to do, but it’s time consuming and docs are generally financially penalized for taking time to talk to patients. Moreover, as I have discussed previously, pretty much no physician asks their patients what they eat, at least not in detail.

Last, but not least, is the critical and usually disregarded method of increasing fiber in the diet. In classic Western Reductionist thinking, most docs who recommend increasing fiber recommend adding it as a supplement, Metamucil or something like that. I was very guilty of that as a physician. My bad, though. Docs, learn from my mistake. If your patients need more fiber (and they do, I promise) make them get it the old fashioned way. Beans, legumes, whole grains, fresh fruits and vegetables. We all took the Hippocratic oath when we graduated medical school, but I bet your school forgot to pass along what was probably the most helpful thing you should have learned from Hippocrates:

“Let food be thy medicine and medicine be thy food.”