Coffman Integrative Nutrition Newsletter

Volume 107: Thanksgiving Food Safety and Storage: A Comprehensive Guide to a Healthy Holiday

11/23/2023

Happy Thanksgiving! Let the feasting begin! Gratitude abounds! Especially from me to you for being part of Inner Workings. Really. Thank you for being here.

You’ll want to tag or print this newsletter to support you throughout the busy holidays! We’re talking about food safety: cross contamination, how long food should stay out at what temperature, and how to store it after feasting - or even day to day. Please share this newsletter with others who need to know!

And, as always, I invite your questions.

(My husband’s aunt used to store their partially eaten stuffed turkey on top of the fridge for days and days after the meal ended. They’d still eat from it. Don’t do that).

First, and I’m calling it out because I know how the holidays get: If you are sick yourself with a cold, the flu, COVID, fever, the sniffles, sore throat, cough, digestive issues, etc., you should not be cooking for anyone else. If the meal is not made to your standard or someone is disappointed because you didn’t make a particular dish, everyone will survive emotionally. I promise.

ServSafe training taught me the “Big Five” that are easily transmitted by food: Norovirus (what we think of as “food poisoning”), Salmonella, Shigella, E. coli, and Hepatitis A virus. Good to know that you can avoid them by following this guide!

Wash Your Hands When Handling Food (and lots of other times!)

You think people know about proper hand washing, but even when they know they often don’t do it. Make your sous chefs wash, too.
Soap, very warm water, and 10-15 seconds of friction by rubbing hands together are critical:

before starting cooking;
every single time you use the bathroom, rub your eyes, blow your nose, touch your hair, eat, smoke, move dirty dishes, or touch something that isn’t for the dish you’re making;
between handling raw animal proteins and handling any other food; and
really any time you are moving from raw animal proteins to anything else.
Raw animal products contain pathogenic bacteria and other bugs that can infect your other foods, or that others can touch unknowingly on the fridge, oven handle - wherever.
Use a clean towel, ideally a paper towel, to dry them.
Don’t touch the faucet handle or bathroom door handle - use your elbow or a paper towel.

Sneezes and Coughs

They happen even to people who aren’t sick sometimes.
Walk away/point away from the prep area and absolutely cover your mouth and nose.
Wash your hands thoroughly afterward!

Keep Separate Cutting Boards and Containers for Raw and Cooked Foods

Raw meat/animal products and cooked foods must have their own separate cutting board, separate containers/pans/bowls, and separate part of the counter to avoid cross contamination.
Never, ever chop or store other foods (vegetables, fruits, breads, etc. etc.) on a cutting board or container that has had raw meat, seafood, or poultry on it. Dedicate their own chopping boards and containers to these.
- I’ll cut you some slack if the items being chopped will be cooking with the meat or poultry.

Don’t Keep Cleaning Supplies by the Food

Cleaning chemicals and the bugs collected on rags and sponges can transfer to the food.
See my Tip of the Month about sponges and scrub brushes here.
Don’t reuse washcloths and tea towels used during meal prep after the meal. Put them in the wash.

Eeeeeewwwww - Fungi/Mold, Yeast, and Parasites - When to Toss the Food

Fungi/Mold: Throw out food with mold on it, although you can cut mold off of hard cheeses and still eat them if you cut it at least one inch from the mold.
Yeast: Some can cause food spoilage. Look for bubbles, an alcohol smell or taste, discoloration, or slime.
Parasites: They need a live host to survive. Freezing and heat will kill them.
When in doubt, throw it out.

Most Food-Borne Botulism is Caused by Canned Food

Botulism is a rare, but extremely serious illness caused by any one of three bacteria, most commonly Clostridium botulinum. The toxin it produces can grow in food, wounds, and the intestines of infants. It attacks the nerves and causes difficulty breathing, muscle paralysis, and even death without quick medical treatment.

Improperly made or stored home-canned foods are the most common source because the bacterium’s spores can grow in: (Read more on this CDC page).
- Low-oxygen or no oxygen (anaerobic) environment
- Low acid
- Low sugar
- Low salt
- A certain temperature range
- A certain amount of water
Throw out any food that looks discolored, moldy, or smells bad.
- Beware of store bought canned food with dents, bulges, swollen tops, or leaks.
- Throw out containers that don’t look right.
- Throw out any container that spurts liquid or foam when you open it.
Botulism doesn’t need oxygen to thrive, and heat kills it - see Cooking Temperatures below.

Wash Vegetables and Fruit

Veg and fruit that have firm exteriors or rinds should be washed with soap, water, and friction and well rinsed.
- Result: you will not transfer pathogens from the exterior onto the interior, e.g. when cutting citrus fruits or winter squash or peeling potatoes.
Rinse all other fruit and vegetables thoroughly with running water.

Refrigerated Storage

Store raw foods below cooked foods and fruits, vegetables, breads, etc. to prevent any juices dripping on them from above.

Options for Thawing Frozen Foods - All of Them

In the refrigerator, under 41ºF. Start a few days early for big things like roasts and turkeys!
- Count 24 hours for small birds/roasts, 3 days for a 15lb turkey, longer for bigger ones.
Under running cold water that is 70ºF or lower (not those big meats, though!)
Microwave, but only if you plan to cook it right away.
As part of the cooking process (e.g. frozen vegetables).
Never thaw meat, fish, or poultry at room temperature:
- The center will thaw more slowly than the exterior, and pathogens will grow at room temp. You can’t count on the cold of the interior to protect the exterior.
- People forget to put the food away or cook it timely = pathogens!

The Temperature Danger Zone for Bacteria to Grow

This is so important if you have a buffet that lasts for several hours!

Cold foods should be kept at 41ºF or below and hot foods kept at 135ºF or above to avoid bacterial growth before serving.
- Foods that contain water or are damp are more likely to grow bacteria.
Very alkaline (like crackers) and very acidic (like lemons) foods are not hospitable to bacterial growth.
Harmful bacteria grow rapidly when kept for more than a total of four hours between 41º and 135º.
- Reminder: Keep hot foods hot and cold foods cold.
Perishable food can be left out safely at room temperature for around 2 hours, but not longer. (Only 1 hour if the ambient temperature is 90º or above).

Minimum Safe Internal Temperature During Cooking

Raw chicken, turkey (not stuffed), and other poultry: 165º Test deep in the thickest part of the bird.
Stuffed turkey: stuffing - 165º; breast - 170º; thigh - 175º.
- Note: turkey may be removed from the oven if it has reached 160º-165º if you allow it to sit for 20-45 minutes. The internal temperature will continue to rise about 5º.
Eggs (not served immediately), chopped fish, ground meat/beef patties: 155º for at least 15 seconds.
Eggs (served immediately), fish, beef steak, pork chops, game animals raised commercially: 145º for at least 15 seconds.
Stuffed fish, stuffed meats, stuffed pasta, and all poultry: 165º for at least 15 seconds.
Vegetables, fruits (eaten immediately): 135º
Reheating food in the microwave: 165º, then allow to stand for 2 minutes before eating.

Cooling Food

Reduce the size of the food product by cutting or dividing.
Consider placing it in containers and then put the containers in ice water baths. Stir to mix cooling food into still warm spots until cool enough to place in fridge or freezer.
Use loose or no covers while cooling to prevent trapping heat.
Cool from 135º to 70º in less than two hours, then 70º to 41º in less than four hours.
Do not place still hot foods directly in the freezer or refrigerator. Allow them to cool first, stir them so that warm spots will even into cool ones, and then store in fridge or freezer. Otherwise bacteria can grow in the still warm parts of the food and contaminate the whole thing.

Leftovers

Good for 3 days if kept properly cooled, stored, and refrigerated.
- If you’re not going to follow the three day boundary (and so many of us don’t ), then reread the section on When to Toss Food.
Remember the rules about rewarming described above.
Good for 4-6 months if frozen (generally).

Tip of the Month

This newsletter was full of tips already!

My tip this month, then, is to suggest you find ways to connect. Remember that no one is perfect. It’s ok to have different opinions - when you hit them, consciously find commonalities instead. Stuff goes wrong, and that’s ok. Seek out hugs. Play games. Take walks. When you need a break, take it. Ask for help. Join in creating a healing community. Love fully from the heart.

Blessings on you and your family by blood and your family by choice, now and always.

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Volume 106: Fasting - Is It Right for You?

11/9/2023

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My work focuses on mental health, gut health, and metabolic health. You already know from reading this newsletter that each one of these influences the others. Not surprisingly, there are lots of nutritional and integrative interventions that can support healing these systems. I address one of them in this newsletter thanks to a reader’s question: fasting.

You can’t swing a short stick without hitting a podcast or news article about fasting. The data is pretty compelling - but is it right for everyone? I dig into pros and cons, and also provide viewpoints on fasting that often get left out.

Reader's Question:

“I would love to know more about fasting. It is promoted strongly by some of my favorite podcast sources, and I appreciate the idea of more "metabolic rest" especially for menopausal women, but I find fasting to be stressful, headache inducing, and maybe not worth the benefits.”

Fasting is one of the darlings of the nutrition world.

The evidence promises health improvements across the body via a very straightforward, free-to-use route: simply don’t eat periodically for an extended period of time. The research literature supports this intervention.

Certain models of intentional fasting have demonstrated routinely improved: blood glucose levels, insulin sensitivity, use of fat for energy, weight management, mitochondrial health/energy production, brain health, and mood; and a decrease in inflammation, cancer cell proliferation, oxidative stress, cardiovascular disease, and mental illness.

So much to like, right?

I would be remiss in not pointing out that some form of fasting is an ancient ritual in each of the world’s five major religions. Those who participate report a remarkable feeling of lightness and being closer to their higher power. Often this is a water fast, limited food over a day(s), or a dawn to dusk fast, as in Ramadan, and typically it is in combination with prayer and other religious practices.

How is fasting done?

Just so you are in on the lingo, in the medical and nutrition worlds “fasting” means a period of time of not eating. “Fed” or “feeding” indicates times of consuming food and the post-consumption metabolism of it. So in research, they distinguish between a “fasted state” and a “fed state” for a subject. A “feeding window” indicates how many hours a day are designated as available for food consumption.

At the American Nutrition Association summit in October, I heard a compelling presentation by Sebastian Brandhorst, PhD of the Longevity Institute on the role of fasting in healthy aging. Spoiler alert: fasting supports longevity. He defined the primary forms of intentional fasting this way:

Calorie Restriction (CR): reduction of total caloric intake of the standard diet by 15-40% for a limited feeding window. This is the form most weight loss diets take.
Time Restricted Feeding (TRF): short feeding window of between 4 to 12 hours without calorie restriction. This, I think, is what most of us think of as Intermittent Fasting, and the terms are often used interchangeably.
Intermittent Fasting (IF): alternate 24 hours fasting/24 hours feeding, using the standard diet without calorie restriction.
Periodic Fasting (PF): 1-2 days fasting followed by 6-5 days feeding, using the standard diet without calorie restriction.
Fasting Mimicking Diet (FMD): reduced caloric intake to ~30% of energy needs for 5 days with a specifically defined, nutritionally supportive diet that reduces protein intake as well as calories, then a post-FMD return to the standard diet. There is no feeding window. Performed from once a year to quarterly to monthly.
Water Fast: Consuming only water for anywhere from 24 hours to 3 days.

Dr. Brandhorst highlighted Time Restricted Feeding (TRF), Intermittent Fasting (IF), and Periodic Fasting (PF) as the most effective, sustainable fasting techniques, with TRF as the most accessible. Most people, even nutrition professionals, think of TRF as interchangeable with IF as a term. I use TRF here since it is the most accurate to what most people follow.

Time Restricted Feeding

A TRF feeding window can be as narrow as 4 hours to as long as 12. TRF follows circadian light/dark rhythms - eating during the day and not overnight. The last meal is no later than early in the evening, and the next meal is taken sometime after waking the next day. This provides the body time to focus on tending to itself: sweeping out metabolic trash, repairing, rejuvenating, and building, which is what it does during the quiet hours of night and sleep.

A second longevity expert, Dr. Kara Fitzgerald, whose life work researches healthy aging using food and lifestyle, points out that the benefits of TRF can be reached with a mere 12 hour stretch of not eating between dinner and breakfast. Finish dinner at 7:00pm, and eat again as early as 7:00am. Voilá! You have done time restricted feeding.

Some choose TRF daily, and others insert limited feeding windows a few times a week. It’s a flexible method that can be individualized. Dr. Brandhorst described that there are many benefits to TRF. One is that humans are social, and social factors influence when we eat. TRF days and timing can be chosen by the individual and so can be socially adapted. A key point is that TRF does not restrict calories. The health benefits echo the ones described in my first paragraph, with the bonus elements of an improved quality of life, higher energy, more restful sleep, and lower hunger at bedtime. In short, TRF enhances both lifespan and healthspan.

What could go wrong?

Going to my reader’s question, TRF, especially with a longer fasting window, can be a trigger for those who have low blood sugar or suffer from migraines. Those who suffer from chronic stress, including the stress and energetic drain of poor sleep, also may feel worse trying TRF. During these times, the body requires more support nutritionally and regular energy inputs. Remember that lengthy periods of fasting or highly calorie restrictive diets can deplete nutrients, even with refeeding. Too short a feeding window can prevent consuming the amount of food/nutrients (both macro- and micronutrients) that our bodies need. If you are already consuming the minimal amount of calories your body needs to function well (a form of mild CR), adding TRF may tip into damaging instead of health promoting.

TRF can undermine our health if we don’t start with a foundational food plan that is nutritionally rich. A body that already experiences nutritional deficits will suffer rather than improve, especially as a fasting window is widened. On top of that, most who feel deprived on a fast (especially CR) are more likely to react with a binge - either because their body is desperate for easy energy or because they feel psychologically isolated from the pleasure of food - or both. Pregnant and nursing people should not participate in TRF - or any fasting - due to the need for regular energy and nutrient intake.

If you want to try TRF, choose the least limited fasting window of 12 hours and see how it goes. Widen the fasting window gradually (or don’t!) to find your own sweet spot. Remember that TRF does not need to be daily or even weekly, and you don’t need to choose it at all.

What else should I know about fasting?

There’s one concern I always have about any program that restricts food in any form: could it trigger health issues, a disordered relationship with food, or an eating disorder?

The fewest health benefits and the biggest risk comes from extreme calorie restriction (CR). Dr. Brandhorst explained that it does not provide lasting benefits for weight loss or cardiovascular disease. In fact, he rather dryly pointed out that starving animals live longer - unless it’s overdone and they die.

Too many commercial weight loss diets involve a form of CR fasting that ultimately results in muscle wasting and nutrient depletions. They are unsustainable and eventually fail those who try them, often triggering new health problems, disordered eating, body distrust, and eating disorders. I suspect this topic is of interest to many, so I will happily explore it more deeply in another newsletter.

From my viewpoint, any fasting program has the opportunity to lure the participant into ever more extreme versions of itself, especially with promises of weight loss or the new shiny object - living long past 100. This is a significant disordered eating/eating disorder risk factor especially for tweens, young adults, and - surprise! - middle aged women.

Take-Home Message

Well managed Time Restricted Feeding can be an incredible way to shape our health for the better.

12 hours of fasting overnight provides all the health benefits.
It is typically safe, easy, and effective to increase the fasting window up to 14 hours, if desired.
Feel free to extend the fasting period longer if you feel good doing it, but it’s not necessary.
Be sure to include adequate calories and nutrition during your daily feeding window.
Do not restrict calories.
Aim for mostly nutrient dense meals, and remember that we eat for pleasure as well as physical nourishment. Include fun foods and celebratory foods.
Those who suffer hypoglycemia, headache/migraine, or other health issues may not be good candidates.
Pregnant and nursing women should not fast in any form.

If you become rigid and rules-based about what you are eating and when, and if not following those rules upsets you, you feel that you need to restrict and/or compensate for breaking your rules, and/or you find yourself routinely eating until overfull or binging (especially common later in the day/evening), it’s critical that you work with a nutritionist and therapist who are disordered eating/eating disorder informed practitioners.

A key point of any eating plan is tuning in to how it makes your body feel. If it’s not working, become aware of what’s not right for you so that you can make choices that help you feel most well.

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Volume 107: Thanksgiving Food Safety and Storage: A Comprehensive Guide to a Healthy Holiday

Volume 106: Fasting - Is It Right for You?

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