The Expectant Parent’s Guerrilla Guide to Preeclampsia

c-sectionTrust me on this one: You do not want to first learn about preeclampsia the night your wife is diagnosed with a severe case of it, resulting in an emergency Caesarian delivery of your child.

I learned this lesson the hard way. Here’s what happened. In January, my wife and I learned that she was pregnant. This was something of a surprise, because we had been unable to get pregnant for years. What I think happened is that my wife’s fibroid embolization procedure in 2012 cleared a blockage (perhaps of the fallopian tubes), eventually allowing the pregnancy. We signed up at Mountain Midwifery near Denver, went to classes there, and planned on a normal delivery around August 15.

That’s not how things turned out. We went in to the Midwifery on July 10, and attendants there got high blood pressure readings for my wife of 163/96. This was a surprise, as my wife had not previously had trouble with high blood pressure. I didn’t know what was going on, and I had no idea how to gauge the seriousness of the reading. An attendant also tested my wife’s urine, and it showed high protein counts—an indication of possible kidney problems.

The Midwifery sent us to Swedish Hospital. The Midwifery’s relationship with Swedish to handle emergencies is a major reason why we chose the Midwifery. The thinking is that, for most cases of child delivery, you don’t need the intensive medical intervention of a hospital setting, but, in a small fraction of cases, you really do want access to all the technology and expertise that Western medicine offers. We turned out to be in the minority.

We saw a doctor at Swedish, and she confirmed that my wife had high blood pressure. She ordered an ultrasound to check the health of the fetus; thankfully, he was fine. She also rechecked my wife’s urine, and again found elevated protein.

My wife had preeclampsia. At the time, I had no idea what that meant. One thing I soon learned is that there are mild and severe forms of it. At first it was not clear where we were on that spectrum. At first, the doctors thought they might be able to send us home with some medications and deliver in a couple weeks. But, after my wife’s blood pressure did not respond well to medication, we heard the diagnosis of severe preeclampsia. That narrowed our options to inducing delivery right away or going in for a C-section. We started the induction process, but then, when a doctor found the fetus was breech (head up), we started prepping for a C-section.

One thing I appreciate about the staff at Swedish is that they gave us the information and the space to make an informed decision. Going in for a C-section was not an easy option to face, especially given that my wife had read extensively on traditional vaginal birth and was committed to that path. When I asked the staff to give us a few minutes to absorb the information and discuss our options, they gave us the space we needed.

The decision came down to two main facts. First, my wife’s preeclampsia was not going to improve, and was likely to get worse, until she delivered the baby. Second, the baby was breech, meaning that a vaginal birth was unlikely anyway. Everyone at Swedish was on board with the C-section, and so was our primary care doctor (with whom I was able to speak by phone). That wasn’t the path we had planned or thought much about, but, we soon realized, it was the medically optimal path for us given the circumstances. We both felt that we were making an informed decision and that we remained actively in control of our health. I will always be grateful to the staff at Swedish for giving us the information and time we needed to reach the conclusion on our own, rather than trying to push us into the procedure before we understood the relevant issues and had the time to absorb the emotional shock.

We went in for the C-section around two in the morning of July 11. My wife remained awake, and I could observe both sides of the sheet: my wife’s face and the doctors at work. Watching the C-section was another shock for me. What I had imagined is a doctor gently slicing open the belly, then reaching in with fingertips and gently pulling the baby out. But “gentle” is just not a word that applies to a C-section. I tried hard to conceal my shock so my wife couldn’t see it on my face.

The process was much more—shall we say active—than I had imagined. The main surgeon and her assistant forcefully cut through the belly, then the uterus, then pulled out the baby a limb at a time. At one point, it seemed that the surgeon’s whole arms disappeared into my wife’s belly. I thought for sure the baby would end up with broken bones (of course he didn’t, although he did have some bruising). I vividly remember my baby with his entire body out of the womb except for his head, which remained stuck inside. It was quite a process just to get the head out. Of course, during this process tubes sucked away the blood and amniotic fluid.

Child Birth Swedish HospitalFinally, baby delivered, the doctors stitched back together my wife’s uterus—as it sat atop her belly. “Is that normal?” I asked; I was assured it is. I even saw a couple of fibroids left from the embolization procedure. One larger fibroid was on the bottom of the uterus, which might have made a normal vaginal birth difficult or impossible, even had my wife not had preeclampsia.

I’ll pause here to praise the lead surgeon, Susan Peck. Her work during the surgery, as well as her interactions with us before and after the surgery, were outstanding. I’m convinced she shaved several weeks off my wife’s recovery time with her skillful work. “Beautiful” is sort of an odd word to refer to a surgical scar, but it is in fact beautiful as a mark of excellent work, and several staff members at Swedish used the term in that context, as did I.

My son owes his life largely to two doctors: Brooke Spencer, who performed the embolization procedure and thereby made his conception possible, and Susan Peck, who performed the C-section and thereby made his delivery possible.

The delivery finally over, my wife went to recovery while my son went to the NICU (Neonatal Intensive Care Unit). I spent the rest of the night wandering between my wife’s room and the baby’s room.

So what is preeclampsia? Please note that I am not a doctor or health professional of any kind, so nothing I discuss here is intended as medical advice. As far as I can tell, no one really knows what causes preeclampsia. They do know how to treat it, thankfully.

“Eclampsia” refers to seizures during pregnancy. So a preeclamptic woman is one at risk of suffering seizures or stroke. Here’s a summary from the Preeclampsia Foundation:

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms. . . .

Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.

Notably, my wife showed no external symptoms of the disease. But for the blood pressure test and subsequent tests for her kidneys and liver, we would not have known she was preeclamptic. That’s horrifying in retrospect, because I don’t know how long my wife had the problem (her previous blood pressure check was three weeks prior), and I imagine what might have happened had we not caught the disease when we did.

As Mayo points out, the precise causes of preeclampsia are unclear. One theory I heard is that the genetics of the placenta (and possibly the fetus) somehow trigger an autoimmune response (or something similar) in the woman.

The cure for preeclampsia is to give birth. However, as I learned, the “cure” can take some time to take hold. Doctors put my wife on a twenty-four hour magnesium drip soon after delivery to protect her from stroke and seizure. With the drip and with blood pressure medications, finally they got my wife’s blood pressure under control. However, once she went off the drip, we had another scary night with high blood pressure readings, so doctors put her back on the drip and increased the dosages of her other meds.

In all, we spent eight days in the hospital, a grueling slog that felt like it would never end. (Note to hospital equipment designers: Please stop making every single last piece of equipment beep unnecessarily and incessantly.)  Apparently, such severe residual preeclamptic symptoms are fairly rare in patients, so our doctors struggled a bit to get the meds right.

My wife continued to take blood pressure medication for another three weeks at home, until finally her readings returned to normal.

While my wife recovered from preeclampsia, my son developed in the NICU. The nurses there are excellent, and they helped train me to feed and care for my son.

We were delighted to learn that, thanks to the Mother’s Milk Bank, our son would be able to drink donated breast milk until my wife’s milk came in. This was a huge relief, as I was slightly horrified the last time I read the ingredients list of formula. I was so grateful that our son could have the best available nutrition.

At 35 weeks, our son was a premie but a relatively developed one. Some babies in the unit were far younger. Our son needed a feeding tube at first, in addition to pressurized air to help him breath. He also got the “hot box” and the jaundice light for a few days.

Our son spent ten days in the NICU, two days longer than my wife spent in the hospital. We were thankful to get everyone home, yet I was also grateful that we could stay at the hospital when we needed to. In general, we were extremely happy with Swedish from the moment we walked in the door until, finally, we drove away.

I had spent all my time planning for a “normal” vaginal birth in mid-August, so an emergency Caesarian delivery in early July was a difficult thing to adjust to. The time in the hospital was extremely stressful and exhausting. And we were in the middle of some major home projects—I thought I still had five more weeks—so coming home was not the restful and serene experience I had envisioned. But we made it through fine, and the results are excellent. We didn’t take quite the path we had planned, but we arrived at the same destination; ours is a success story.

So what are some of the take-home lessons for other expectant parents?

1. Learn the basics about preeclampsia early in pregnancy, so you are better equipped to handle it if it happens to you.

2. Plan for a “normal” delivery—I highly recommend the Mountain Midwifery if you’re in the Denver area—but have a contingency plan in case something goes wrong. The Midwifery’s contingency plan is to send patients with complications to Swedish, and, for us, that worked spectacularly well.

3. If you’re pregnant, consider buying a home blood pressure kit and taking your pressure every day or two. One doctor advised us to sit still for five minutes and have your arm level with your heart to take a pressure reading. If I had it to do over again, I’d take regular home readings to supplement doctors’ readings. That way, I’d have a better ability to notice sudden changes and promptly seek professional guidance if needed.

4. If you do end up with severe preeclampsia, take heart that modern doctors know how to handle it. You want to take the disease seriously, but there’s no need to worry excessively about it, given the technologies and expertise of modern medicine.

5. Be prepared for contingencies. Get your “to go” bag ready early on. Include earplugs and eye shades, as sleeping in a hospital can be challenging. Get your house in order early if you can. Line up someone to watch your house and your pets if necessary.

6. Prep yourself for the potential stresses of a hospital visit. During the first night at the hospital, I did not sleep a wink, so I started the process utterly exhausted. It was a very busy and stressful time.

7. Be an advocate for yourself or your patient while respecting the time and expertise of hospital staff. Generally, we had very positive interactions with everyone at Swedish—something made easier because Swedish is an excellent hospital. However, I had a couple of unnecessarily testy exchanges with doctors, largely because I was tired and stressed; I later apologized to those doctors and we resumed a good working relationship.

8. Do what you can to get mother with baby, but recognize the limitations of the hospital setting. At first, I did not understand why baby could not be in the same room as mother. Then it became apparent to me: The NICU is very specialized, as is the Labor and Delivery ward, so sometimes it’s not feasible to keep mother and baby together. That said, do try to facilitate meetings of mom and baby until they can get into the same room or come home.

To me, preeclampsia was terrifying. But largely that’s because I didn’t know what it is or how doctors treat it. If you’re an expectant parent, do yourself a favor and spend a bit of time reading about the disease and preparing for the possibility of going through it. Then you can take comfort in the knowledge that most pregnant women don’t get preeclampsia, and, if a pregnant woman does get it, doctors are in a great position to effectively treat it. Preeclampsia is a problem for some women, but a manageable one with modern medicine.


William Coley’s Immune-Provoking Cancer Treatments

Image: Wikimedia Commons
Image: Wikimedia Commons

William Coley, a doctor in the late 1800s and early 1900s, noticed that some people who got infections beat their cancer. As I understand his work, he theorized that an infection boosts the body’s immune system, which then also (sometimes) fights off cancer. Coley developed some bacterial vaccines and gave them to patients, not to vaccinate against a particular illness, but to basically trick the immune system into going into high gear.

Today Coley is not well-respected by other cancer researchers, and his vaccines are illegal in the United States. But Monica Hughes thinks Coley vaccines are a very good ways to treat some cancers, and her husband has taken them (in conjunction with other treatments) to treat a brain tumor. Apparently the treatments have met with at least some success. I’m not sure what to think of Coley’s work, but I do find it interesting, regardless of whether ultimately there’s anything substantive to it.

In June, Hughes presented her views at a Liberty On the Rocks event in Broomfield. Please observe the disclaimer posted with the video: “The speaker is not a medical doctor or health care practitioner. The ideas in this video are not intended as a substitute for the advice of a trained health professional. All matters regarding your health require medical supervision. Consult your physician and/or health care professional before adopting any nutritional, exercise, or medical protocol, as well as about any condition that may require diagnosis or medical attention. In addition, statements regarding certain products and services represent the views of the speaker alone and do not constitute a recommendation or endorsement or any product or service.”

My Wife’s Experiences with Uterine Fibroid Embolization

I never heard of fibroids until I learned early last year that my wife Jennifer had them. (Her mother had them as well, as did an aunt and a grandmother, so I think they’re at least partly genetic.) Fibroids of the uterus are what they sound like: Fibrous masses—noncancerous tumors—growing in the uterus. My wife had a lot of them, some of them quite large (up to six centimeters across).

Fibroids can do a variety of nasty things, such as interfere with pregnancy and cause heavy bleeding. My wife had severe anemia (for which she took iron pills), and she ended up in the emergency room once due to bleeding, which prompted us to get more serious about solving the problem.

The first OBGYN we visited (before the ER visit) wanted to cut out my wife’s uterus—do a hysterectomy—which struck me as an absurdly disproportionate “solution” relative to the problem. A hysterectomy would have required a six-week recovery, and obviously it would have made pregnancy impossible.

The second doctor my wife visited is an endocrinologist. He wanted to cut out the fibroids laparoscopically, through small slits in the abdomen. This was a considerably less-horrible alternative, but the problems were two-fold: a long recovery time and a high probability of regrown fibroids within a few years.

There is a lesson here: Don’t necessarily act on the first “expert” advice you hear from a doctor (or anyone else). The first doctor my wife saw gave her terrible advice. I chalk this up to the “hammer and nail” phenomenon: The first doctor happened to do hysterectomies, so that’s what she thought my wife needed. The second doctor happened to do laparoscopic surgery, so that’s what he thought my wife needed. In fact, she needed neither of those procedures.

Thankfully, we kept digging, and we learned about embolization. The idea is that a doctor runs a tube up through the main artery in your leg up to the uterus. Then the doctor strategically releases silicon particles to block or restrict the blood flow to the fibroids. Assuming this goes well, the fibroids shrink and are absorbed by or discharged from the body.

Jennifer learned that RIA Endovascular performs uterine fibroid embolization (UFE) in Denver. Checking around, we heard that RIA’s Dr. Brooke Spencer was excellent in the field. And she is.

After a consultation and a preliminary MRI, Jennifer had the UFE procedure done by Spencer on September 6 of last year. At the six month mark she got a second MRI, and the results are very good, with some fibroids completely gone and most others significantly smaller. (The remaining fibroids are expected to continue to shrink.) Her monthly bleeding and cramping is radically less now than it was before, and her anemia is gone.

We were extremely happy with Spencer’s work and with her willingness to answer our questions in minute detail. Indeed, we were very happy with the service provided by everyone associated with RIA. Likewise, we were happy with the service provided at Littleton Medical Center, where the procedure and recovery took place.

We did have a slight hitch in the recovery. The hospital staff put Jennifer on a morphine-class drug (I believe synthetic) immediately after surgery, but the next day when they took her off of that drug and switched her nausea medication she experienced some abdominal pain and some violent vomiting. They put her back on the morphine-class drug, changed her nausea medication, and kept her a second night. So UFE is definitely not an out-patient procedure, but Jennifer was back to work five days later.

Obviously neither Jennifer nor I are doctors, so anyone reading this should consult with a qualified medical expert regarding any medical issue. That said, in our case, we’re extremely glad we pursued UFE, particularly through RIA. So thank you Dr. Spencer and team!

July 7, 2016 Update: Last year my wife gave birth! It is my belief, although not a certainty, that the fibroid embolization allowed her to get pregnant. The procedure did not seem to interfere with the pregnancy. She did deliver early due to severe preeclampsia. Because she had a c-section, I actually saw her uterus. She still had some remaining fibroids, including one that might have interfered with baby positioning and delivery; but we still regard the embolization as an overwhelming success.

Good Times, Mixed Ingredients

I prefer Fat Head to Super Size Me. I don’t think much of anti-fast food hysteria. I regard forcing restaurants to post calories as both foolish and tyrannical. I oppose the Nanny Statist campaigns against fast food and Ronald McDonald.

Yet I also believe that ultimately consumers drive production, and smart consumers demand full disclosure from producers. (The government rightly steps in to punish fraud.) Consumers should spend their money wisely and insist on quality goods.

Therefore, after I drank a yucky strawberry-banana shake from Good Times Burgers, I contacted the company to lodge a complaint and figure out what was wrong with it. Christi Pennington, an “executive assistant” with the company, helpfully provided me with full nutritional details.

Generally I like Good Times. I have regarded the best burger for the money in the Denver area is a bacon “bambino” burger (at $1.39 last time I checked), times two (and throw away the top buns). And generally I like the custard there.

A quick look at the ingredients indicates why the custard is pretty good whereas the shake was pretty bad. Here are the ingredients for the “custard base:” “All-Natural: Milk, Cream, Sugar, & Egg Yolks & Grade A Milk Powder.” (The ingredients come from a document dated September of 2010.) Relatively wholesome (though of course a lot of sugar is bad for you, and most Americans eat way too much of it).

Contrast those ingredients with the ones found in “strawberry syrup:” “High Fructose Corn Syrup, Strawberry Puree, Artificial Flavors, Citric Acid, Sodium Benzoate (preservative), Cellulose Gum & Artificial Colors (red 40 & blue).”

So, in other words, my “strawberry”-banana shake was actually a corn shake with several added chemicals, and a bit of strawberry. Gross.

Good Times lists the meat as “Meyer All Natural, All Angus,” which is good. However, I got nervous when I saw a listing for soybean oil immediately beneath the listing for meat. So I asked about this. Thankfully, Pennington replied, “No we do not cook the meat in oil at all.” That’s good, because as a rule I regard all vegetable fat as suspect.

Unfortunately, Good Times continues to add hydrogenated fat to a number of its products. Everyone agrees that’s horrible for you. You can get all sorts of conflicting dietary advice, but one of the well-documented and universally accepted claims is that hydrogenated fat is bad.

And yet Good Times serves up hydrogenated fat in all of the following products, according to the ingredients lists Pennington sent me: bambino bun, chicken dunkers, crispy chicken filet, onion rings, mushrooms in sauce, onion tanglers, cake cone, cheesecake (a custard flavor), cherry hearts, cookie dough, graham cracker, Heath English toffee, hot fudge, Oreo cookies, polar chips, pound cake, waffle cone, and whipped topping.

So I won’t be buying any of those items from Good Times! I mean, come on: you can make regular buns without hydrogenated fat but not bambino buns? How about you just get rid of the crappy vegetable oil altogether?

While we’re on that topic, I was relieved to read that AMC pops its popcorn in coconut fat, not vegetable fat. (The coconut, along with the avocado and the olive, is a fruit. My general view is “fruit fat good, vegetable fat bad.” Notably, you can find the former, but not the latter, in nature.) I think those calling for vegetable fat as a replacement for coconut fat are simply idiots who don’t know what they’re talking about. Thanks, AMC, for not subjecting your customers to unhealthy vegetable fat! (That said, popcorn is not inherently a health food! But that doesn’t mean moderate consumption is especially bad for you.)

When I make a strawberry banana milkshake, here are the ingredients I use: frozen strawberries, bananas, cream, and milk. (Sometimes I add commercial but quality ice cream, though I’ve decided to stop buying that.) When I make popcorn, I use popcorn, butter, and a little salt.

Perhaps a representative for Good Times would care to leave a comment here when the restaurant has decided to at least phase out hydrogenated fat.

So be a smart consumer, take responsibility for your choices, and don’t go crying to government to do your thinking for you. Because once you authorize politicians and bureaucrats to micromanage your life, there will be no stopping them. And that is the single most pressing threat to your health and safety.


Anonymous commented June 24, 2012 at 8:18 PM
just drank a yucky banana shake from GoodTimes. Though they might actually JUST add a banana to their custard… no such luck. Not because I looked up the ingredients -found your blog. but because that taste was obviously NOT just a banana added to custard. darn. I told my kids, let’s stop eating chemicals! ok. we are going to see how that goes. No chemicals for tomorrow. thanks for your blog. I am not going to try to find what the heck makes banana flavor besides a good old banana…. chemicals, I’m sure.

Fast, Cheap, Healthy Eating

For some time I’ve wanted to discuss “fast, cheap, healthy eating” in more detail, and finally I just decided to do it in a fast and cheap blog post. I should state that I am neither a doctor nor a nutritionist. I’m inspired by “paleo” type eating, associated with lower carbs and nutrient-rich meats and vegetables. Much of my thinking on budget eating was inspired by my “food stamp diets” in 2009 and 2007.

Good Time for Economy

Unemployment remains high throughout much of the country; it hit 9.3 percent in Colorado as of the last measurement. It seems very much as though the federal government’s inflationary monetary policies are starting to show up in food prices (see a first, second, and third article on the matter.)

So many people’s budgets are strained now more than ever. But we gotta eat. Thankfully, some easy, common-sense steps can help make one’s grocery budget stretch further while still providing great nutrition. That’s what this post is about.

My Dietary Pilgrimage

Once in college a fast food joint put burgers on sale, so I ate there every day until, one day, I nearly vomited. Then I stopped eating there. But the funny thing was, I wasn’t really saving any money by purchasing the “sale” food. Soon after college I stuffed my freezer with frozen dinners, again from a sale. But then I discovered that these dinners were full of salt and other junk, plus they just didn’t taste very good (at least after about the third one). Nor did they save me any money.

Now I’m still not much of a chef, but I’ve learned to prepare tasty, economical, fast, and nutritious meals. My wife and I eat things like curry chicken and saag, roasts with sweet potatoes and onions, quiche, and spaghetti squash with meat sauce. We eat very well, but we don’t spend a lot of time or money on our food. I thought others might benefit from my experiences.

The Great Myths: Eating Well Costs a Lot and Consumes Time

We hear constantly that nutritious eating is costly and time-consuming. It’s not. Some of the least nutritious food in the grocery stores, food full of sugar and processed grains, is also relatively expensive. Some of the least expensive food overflows with life-giving nutrition. Often preparing and packing a meal takes less time than going to a restaurant.

It is a myth that nutritious eating has to cost a lot. It is a myth that nutritious eating takes a lot of time. This entire post is about exploding those myths, but I thought it worth mentioning them explicitly at the outset.

Eating Out: The Great Budget Killer

I enjoy eating out at restaurants, just like most people do. But it’s important to understand just how much that costs. A nice restaurant meal easily can cost a person fifty bucks — enough for more than a week’s worth of groceries.

If you figure there are around 260 weekdays in a year, eating an $8 lunch for every one of those days costs over $2,000 for the year. If you buy a $4 coffee for each of those days, that’s another thousand.

Sure, if you’re bringing down a large salary, you’re very busy, and you enjoy eating out, spending that much or more might be worth it to you. But if you’re on a tight budget, or you’d rather spend that money on other things, preparing food and taking it to work is relatively easy.

Consider an Entertainment Budget

You probably don’t need to give up eating out, but you might want to eat out less often.

For a long time my wife and I bickered about spending money on entertainment. We’d spend money to eat out, then feel guilty about blowing our money on nonessentials. We’d argue about what entertainment pursuits were worth it.

We’ve solved those problems by adopting an entertainment budget. The idea was inspired by Diana Hsieh, though my wife and I adapted it to our own purposes. The basic idea is that you give yourself a certain amount each month for entertainment, to spend however you want without feeling guilty about it. Obviously the amount must make sense given your overall budget. If you spend less one month, you can carry the balance to the next.

We also decided to put a third of all extra income (beyond our regular take-home) into our entertainment budget (split evenly between us). We figure that gives us a third for fun, a third for taxes, and a third for investment.

Obviously the details of an entertainment budget can be adapted for the particular needs of an individual, couple, or family. But, having tried it, I really like the general strategy.

Forget List Shopping

It seems like every pretender who addresses the matter of budget shopping suggests that you shop only from an established list. Such advice is horrible. You cannot possibly maximize your grocery budget if you shop only from your preordained list. Indeed, while I do make lists for the essentials, often I shop without any list at all.

The grain of truth to the “shop by list” mantra is that it’s stupid to make impulse purchases of unnecessary items. Certainly I am not advocating that!

What I am advocating is that you take advantage of sales, the most important of which are never announced. I’m talking about mark-downs. You will never include mark-downs on your shopping list, because you cannot possibly know which items a store will mark down on a given day.

Now, not every store features mark-downs, but most grocery stores I’ve seen do. The idea is that stores will put items about to go out of date on steep discount.

My local grocery store — and this is similar to many other stores I’ve seen — features a regular “discount” section with breads, canned goods, etc. Most of these “sale” items are worthless: discounted junk carbs are still junk carbs. You’re not getting a “deal” by buying nutritionally worthless food. Sometimes, though, I have found spectacular deals in the discount sections.

Often, rather than place mark-downs in a special location, stores will leave them in their regular place. For example, once at Target I bought something like eighty 100-percent chocolate bars at a steep discount.

Other times, stores will create a special place for mark-down meats and dairy. So get to know your store. And get to know your foods: I regularly use eggs well after their stated expiration date. (Obviously eating spoiled foods can be dangerous, so you have to pay attention.)

Obviously my shopping strategy depends on my living in an urban and suburban environment, where I am constantly walking or driving past stores. Because my rented mail box is near my local grocery store, I’ll quickly pop into the store most days of the week. (Plus I just enjoy walking through stores.) This enables me to hunt for mark-downs. But if you live out in the country, you’ll probably be able to visit stores infrequently, so you’ll be less able to take advantage of unannounced sales.

The key to mark-downs is to figure out what you need that’s a good deal (sometimes mark-down sales aren’t a very good deal), then buy a lot of it. Often I’ll unexpectedly pick up 20, 30, even 60 pounds of produce or meat, because it’s on a spectacular sale. By shopping only by list, you close your eyes to the best deals out there.

Eat What’s On Sale

Don’t schedule your meals far in advance; cook the ingredients that are the most economical at the time. If you find chicken on a great mark-down, eat chicken, not hamburger. If squash is fifty cents a pound, eat squash, not a pricey salad. Hamburger and lettuce will be on sale another day.

Shop the Good Aisles

I don’t even look at most of the aisles in my grocery store. Boxed cereals? Forget it. Soda? Nope. In my world, there are really only three main sections of the store: dairy and eggs, meat, and produce. (Add to these the minor sections of spices and chocolate.) If you’re shopping anywhere else, chances are excellent you’re wasting money.

Use Your Freezer

If you live in a normal American house, you have a freezer conjoined to your refrigerator. Use it! Practically every meat freezes well. Practically every fruit freezes well, including bananas. (Frozen fruit works great for smoothies.)

The freezer is what enables you to buy mark-downs in huge quantities and preserve the food for several months.

Particularly fruits are subject to large seasonal variations in price. So buy when the prices are low!

I also bought a half-sized stand-alone freezer for the garage. That lets me really stock up on meat and frozen fruit. (I also freeze sprouted bread.) Be aware that the freezer costs some money, as does the electricity to run it, but for some people an extra freezer can save money overall. An extra freezer also allows you consider options like buying a side of beef.

Even if you don’t have an extra freezer, your standard one can still hold a great amount of frozen food.

Consider a Dehydrator

I also own a food dehydrator, which is great for drying fruits like peaches, apricots, cherries, and strawberries. (I tend to cut my fruit into thin slices for faster drying.) I’ve even dried banana slices soaked in orange juice, and they were delicious but exceptionally messy. (I’ve also tried canning before, which may interest you, but I don’t do it any more. I much prefer drying.)

Think About Gardening

This year my wife and I are putting in two long planters with soaker hoses. The goal is to grow food is that is relatively easy to raise in our region and more expensive at the store, like tomatoes. I probably won’t grow hard squash, because usually it goes on sale every year for about fifty cents a pound (which likely will inflate upwards over the coming years). I want to try yams, too, and perhaps even some type of berry if I can find a region-friendly one.

Minimize Coupons

I use coupons, just not very often. Usually coupons apply to overpriced items that you’d do best to avoid altogether. Getting a discount on overpriced, highly processed, nutritionally worthless food is still a bad deal.

Remember, there is no coupon for a mark-down, the best deal out there.

Often a coupon is a just a way to dupe the mathematically challenged into spending more money on unnecessary products.

Sometimes people trap themselves in a false choice with a coupon. They think, “Would I rather have Product X at its normal price, or at the discounted price?” The discount wins! But the third option is to buy some other product altogether, or to buy nothing. For example, a coupon for boxed cereal will rarely save you money over a box of uncooked oatmeal or a breakfast of scrambled eggs.

Very often, coupons are for suckers.

Watch Weekly Ads

Sometimes a grocery store will offer some spectacular deals announced in their weekly ads. Usually these ads are mailed to every household and are also available online.

A “loss leader” is a sale product that a store doesn’t expect to make any money from, and may even lose money on, in the hopes that the item will bring people into the store to buy other stuff. The loss leader is your friend. Just note any restrictions on quantity.

Sometimes stores offer steep discounts on products like eggs, some item of produce, tea, or a particular meat. Watch for these!

A couple of my local stores recognize “double ad day” every Wednesday, when the store honors ads from two weeks.

Consider Costco

Perhaps surprisingly, Costco (to which my wife and I have a membership) often offers worse prices on staple grocery items. I buy neither eggs nor yoghurt at Costco, though I did recently start buying milk there. One issue is that often Costco offers only a big-brand item, while a local grocery store may offer its own brand or a less-expensive third-party brand.

But some things I regularly buy at Costco: roasted almonds, large bags of fresh spinach, ice cream, and yams. But on many items Target or the local grocer beats the hell out of Costco’s prices. So don’t assume that “membership store” equals lower prices; very often it does not.

Use Math

Don’t assume a coupon will save you money. Don’t assume a “sale” will save you money. Don’t even assume a mark-down will save you money. Don’t assume the larger package will save you money. Don’t assume a generic brand will save you money. Don’t assume a membership store will save you money.

In short, don’t shop like a sucker.

Only two things matter: the quality of the food, and the price per weight.

If a grocer can sell you a generic brand on “sale” for more than a regular brand, he will gladly do so. If a grocer can sell you a larger package for more per weight than the smaller package, again he will gladly do so.

Thankfully, many stores now provide the price per weight, so that can help. If not, figure it out yourself. Put the fruit on the scales. Put that fourth-grade education to work and do a little division. Bring a calculator with you if you must.

Cook a Lot at Once

Some dishes (scrambled eggs) are so quick and easy that it makes little sense to prepare large quantities.

Very often, though, it’s a good idea to cook a lot, then keep the spare in the refrigerator or freezer for later. This is the primary way to save time on food preparation.

Don’t cook two chicken breasts; cook six. Don’t bake one flan; bake two.

You only have to cook major dishes two or three times a week if you cook a lot each time.

The Pan: Types

Now I’ll get into cooking proper. I’ll start with an essential item for any cook: the pan.

I’ve gone round and round with pans. I started with a nonstick pan, but it started getting scratched. I bought expensive stainless steal pans, but they’re hard to use without food sticking. I tried cast iron, which are theoretically very cool but are difficult to use without food sticking and even more difficult to keep clean without ruining the surface. So now I’m back to a nonstick pan.

Are nonstick pans safe? Consumer Reports states, “Some perfluorinated compounds have been found to be accumulating in human blood, but our past tests suggest nonstick cookware is not likely to be a significant source of exposure.”

The keys to safely using a nonstick pan are to use it only on low to medium heat and toss it once it starts to scratch or flake. (I suggest a soft silicone spatula.)

The best feature of nonstick pans is that they are cheap. I’ve seen small ones for as little as a dollar, and regular ones for ten to twenty dollars.

The Pan: Dishes

Pans are great for cooking bacon, sausage, scrambled eggs, toast, and so on. Try an “egg in the basket:” a piece of bread with a hole cut in it (say, with a glass), cooked with an egg in the hole.

Often I cook a generic dish starting with an onion. Peel the onion, cut it in half, and slice it in wedges and then in small pieces. Place the chopped onion, perhaps with some chopped cloves of garlic, in your pan with some butter, olive oil, or coconut oil. Cook on low to medium heat until translucent. Then you can add practically any combination of vegetables, meats, and spices for a quick, nutritious meal (plus leftovers).

Are you in the mood for something spicy? Try some tomatoes, hamburger, and chili powder. Have some summer squash sitting around? Dice it up and toss it in with the onion, perhaps with some diced chicken or turkey.

I also use my pan for things like cooked cabbage.

The Crockpot

You can pick up a decent crockpot (with a removable bowl) for around twenty bucks. Do it! Nothing cooks food faster or easier.

Consider some possibilities:
* Throw a roast in the crockpot with some diced yams and onions.
* Combine a can of coconut milk, some curry powder, and a half dozen chicken breasts.
* For an easy, spicy dish, cook a half dozen chicken breasts in the crockpot with a jar of salsa.
* Throw in some ground hamburger for Mom’s chili recipe (or a recipe from the internet).

I love my crockpot.

The Oven

You can also bake chicken breasts, fish fillets, and dishes of vegetables in the oven. I really like ceramic dishes with glass lids.

We eat baked “fry”-style yams fairly often. Just slice up a yam or potato into strips, coat them lightly with olive oil and salt, and bake them at 350 degrees for about half an hour, stirring after fifteen minutes. Or I’ll cook a sliced onion the same way.

My wife is the master of oven-prepared desserts; for instance, she makes a spectacular cheesecake but uses only a quarter cup of sugar for the recipe. I make a great flan but cut the sugar way down.

The Knife

You don’t need a bunch of knives. You need only one knife. But make it a good one.

If I could have only one knife, I would choose the Wusthof paring knife. It’s great for cutting up all kinds of vegetables, and it can handle meats well enough.

I also use a larger Wusthof knife for bigger jobs, but I use the paring knife much more often.

If you eat a lot of bread — we do not — you might also want a bread slicer.

The Plates

Once I saw my sister drop a whole stack of Corelle plates, and not one of them broke. I love my Corelle plates. They’re inexpensive and sturdy, and they stack well.

But if you’re really on a budget, check out the local thrift store.

Don’t Forget the Simplest Dishes!

Some of the best dishes are the simplest.

What’s easier than throwing a couple of salmon steaks in the oven? Or tossing some chicken in the crockpot?

Salads can make wonderful meals or sides, and they are trivially easy to prepare. Top any combination of greens with any combination of vegetables, and perhaps some chunk tuna or chicken.

For a snack, I like something I call “Chocolate Uncovered Raisins.” Mix chocolate chips (I buy 60 percent Ghirardelli from Target, where I get the best price for that item) with some raisins (from Costco) and perhaps some roasted almonds (also from Costco).

Or for dessert I’ll mix a little ice cream (Costco) with shredded coconut (Sunflower), fresh walnuts (also Sunflower, from the bulk aisle), and chocolate chips.

If you’re not worried about your carb load, you can make silly stuff like popcorn or a microwaved Mug Cake.


I do take a multivitamin, along with Vitamin D3 and fish oil (all from Costco). We try to eat wild salmon (frozen) once a week, as I think that’s better than fish oil for getting DHA Omega 3. Salmon is easily the most expensive food I buy, which is why we limit our intake of it and supplement with fish oil.

Good Fat

I have severe misgivings about vegetable fats. Yes, it’s low in saturated fat, but it’s high in Omega 6 fat, and it’s just not something people ate as they developed. So, while a giant vat of vegetable fat is cheap, I go with butter, olive oil, and coconut fat. They’re a bit more expensive but still reasonable.

Invite Guests

My grandparents played cards, a lot. When I got older I realized why: they didn’t have cable, and they didn’t have money for restaurants and such. So the family would get together for dinner and cards. And people had a delightful time. The same simple, cheap forms of entertainment are open to us today.

Stay In Touch

For updates about my articles, blog posts, and videos, please “Like” myFacebook Page.

And please check out my book, Values of Harry Potter: Lessons for Muggles.


Evil Red Scandi commented April 1, 2011 at 3:25 PM
You recommended a knife. Culinary flame war time! :-)

Seriously, though, if you have one knife it will have to be steel, because there are a few things ceramic knives can’t do – namely, cut through bone and other hard materials, and they can only be used on soft surfaces (wood, plastic, or bamboo cutting boards – no stone, metal, or ceramic). However, we’ve got plenty of very good knives and the knives we use 95% of the time are our Kyocera Ceramic knives. The reasons are simple:

1) They hold an extremely fine, sharp edge in a way that makes the best metal knives seem downright pathetic. Our “daily use” ceramic knives need sharpening about every two years. The big downside of this is that you have to send them back to the manufacturer for sharpening. This takes about two weeks (including shipping time), but they only charge shipping and handling (about $15 or so for the first knife, each additional knife for a few bucks more).

2) They don’t impart any flavor or increase the oxidation rate of your food. You’re probably reading this and immediately dismissing me as a brain-dead hippie who believes any stupid thing they read on the Internet. No, I’m serious – I noticed this myself before I started reading up on it. You actually can taste the difference – especially in acidic fruits – and see the difference in things like sliced apples (they go brown much more slowly). Really strange and not something we expected when we bought them, but I’m always willing to take yes for an answer.

3) They don’t stain or rust, and nothing sticks terribly well to them.

We had some very nice Henckels steel knives, and we were given a three piece set of Kyocera ceramics as a gift. We’ve expanded our collection of cermaic cutlery quite a bit since then. Aside from the steak knives (have to use metal on plates), the Henckels mostly gather dust these days. Our preference is so strong that we bought “backup” ceramic knives for the rare occasions when our main ones are out being sharpened.

Carol commented April 5, 2011 at 8:36 PM
I very much like the idea of cooking a lot and storing it for later as it would definitely save time on food preparations. I do have concerns though, how long do you keep it in the freezer before preheating it after- can it stay for say a week? We have tried it before but when I preheat it in the microwave- which is probably a bad idea as the food was still a bit cold even if it was already in the microwave for 20 minutes. Is it a better idea to heat it in a pan? Thanks

Walter in Denver commented April 6, 2011 at 1:32 PM
I enjoy cooking, although I’d never say I’m particularly good at it. But I cook all the time, and I have probably far too many pots, pans, knives, etc.

Things I find indispensable or at least extremely handy:

A dutch oven. If you are pressed for space you can forgo the slow cooker, any crock pot recipe can be made as well or better in a dutch oven. The only drawback versus a slow cooker is if you want to leave it cooking unattended, which may not be a good idea.

At least three knives – a paring knife, a chef’s knife for chopping and a boning knife, especially if you cook wild game.

A steaming insert for a large kettle.

A pressure cooker.

A smoker.

Over the long term having multiple cooking vessels for a variety of cooking methods makes cooking at home more interesting, and I will be less likely to eat out if I know I can cook just about anything myself.

Ari commented April 6, 2011 at 1:48 PM
Carol, How long food will keep in the fridge or freezer very much depends on the dish. But generally if you freeze something it will remain in the same state for much longer than a week. Whether you want to microwave or stove-heat a dish — with or without refrigerator thawing — again depends on the dish and the portion size. In my experience, microwaving smaller amounts, and stirring frequently, works better. (Don’t use plastics!)

Walter, Thanks for the tips. I never use a knife to cut bones, just because I tend to throw stuff in the crockpot, which nicely removes any remaining meat. I’ve found no need for a pressure cooker or a smoker, though I do have a nice steamer pan. -Ari

Quiche Bowls and Microwaves

My purpose here is two-fold: to briefly discuss the alleged harms of microwave cooking, and to mention oven-baked quiche bowls.

After writing about microwave egg bowls, several people claimed that cooking by microwave is unhealthy because of the way it modifies foods. While I remain open to evidence demonstrating some harm of microwave cooking, to date I have seen not a shred of evidence to suggest that microwaves are in any way unhealthy.

Note that evidence does NOT consist of parroting some other web page on the matter which itself relies on overblown and unsubstantiated claims.

Also recall that Franz Mesmer made some superficially plausible-sounding claims regarding magnetic health treatments — claims that turned out to be complete crap. (That hasn’t stopped various companies from continuing to sell magnetic underwear and such, which is comparable to snake oil.)

I have also read that cooking itself harms food and is therefore unhealthy; see the “raw food” movement. I do not doubt that microwaves alter foods, as does any sort of cooking; what I doubt is that microwave cooking alters foods in ways significantly differently than the ways that regular cooking does, and that cooking itself is harmful. (Obviously certain types of cooking, such as charring meat over an open, smokey fire can introduce carcinogens.) Rather, I am persuaded that cooking actually makes many foods more healthy for human consumption, and that humans evolved while cooking with fire.

Readers are welcome to point to actual evidence testing claims about microwave healthiness. However, I will not publish comments that merely cite other unsubstantiated claims.

Nevertheless, obviously there are many ways to cook foods other than by microwave, and different techniques provide better results for different dishes.

This morning, I cooked quiche bowls for my wife and me in the oven:


My bowl consisted of two eggs, some milk, a quarter of a diced red pepper, some sausage (which my wife skipped), and a slice of swiss cheese. The bowls cooked to perfection in 30 minutes at 350 degrees Fahrenheit. We used our regular, oven-safe ceramic bowls.

There are several advantages to cooking a bowl of eggs in the oven rather than in the microwave. I like the texture better. One can cook several bowls at the same time. There is no need to stir the contents during cooking, as is necessary with a microwave. I like bowls rather than one large quiche because they cook faster, and different eaters can add different ingredients. And the clean-up is trivial. We ate our breakfast straight from the bowls resting on coasters; the bowls would be too hot for children.

I will probably start cooking eggs more often this way, because they are healthy, good, and easy. So there are definitely reasons to choose some cooking methods over others for different dishes. Overblown, unscientific fear mongering is not among those reasons.

Freezers, Crockpots, and Microwave Egg Bowls

Since adopting a more “paleo” type of diet (real food, plenty of meat and eggs, fewer carbs, very little grain), I’ve found three machines particularly useful: my freezer, my crockpot, and my microwave.

I bought a five cubic-foot freezer at Sears for around $130. It’s a half-size top-loader. This enabled my wife and me to purchase half of a grass-fed cow for just over five dollars per pound. I’ve also purchased bacon, fruit, and other meats on sale, then frozen them. The cost savings for food far surpasses the cost of the freezer and the electricity to run it.

We bought a crockpot at Sears for about twenty bucks. I was unsure whether I’d really use it much, but I use it often and love it. Here is a photograph of ($2 per pound) chicken breasts cooked in the pot with a jar of salsa, then shredded:


Last night we oven-baked a sliced onion with olive oil and salt, which went great with the chicken. Tonight we’ll probably eat it with guacamole and sour cream.

I’ve also used the crockpot to cook several pounds of bacon pieces, beans (not very “paleo” but at least very well soaked), whole chickens, and soup. The removable ceramic bowl is very easy to clean, and I love the fact that I can just plop the food in and leave it for hours at a time.

The third machine is more widely used by Americans: the microwave. I use it often to cook eggs (as I’ve mentioned). A single egg in a ceramic bowl cooks to perfection in about 45 seconds. More often I make “egg bowls.” Typically I microwave a couple of frozen one-inch cubes ofvegetable puree (usually cauliflower with spinach or broccoli) for a minute by themselves. Then I add precooked sausage (or bacon or whatever) and two eggs, then microwave at short intervals (30 seconds to a minute), stirring in between, until it’s done. Add cheese if you want. Not only do I love the results, but the egg bowls are extremely easy to make and clean up. Here are a couple of pictures:



To me, freezing good food, then cooking food in modern appliances, represents the perfect marriage of wisdom from the ancient past with modern technological sophistication.

With Paleo Diet Blood Counts Look Great

Largely due to the influence of Diana Hsieh, who recently started the Modern Paleo blog, and the book Good Calories, Bad Calories by Gary Taubes, my wife and I have switched to a largely “paleo” type of diet. The results, as indicated by our recent blood work, are positive.

Basically the diet means that we have cut out most grains, sugars, and vegetable fats. Largely the diet consists of trading off carbs for healthier fats. We’re not as strict in our diet as some are; I still eat an occasional slice of sprouted bread or a bowl of beans. However, most days I don’t eat any grains, and my intake of processed sugar is low. I have a soda or glass of juice maybe once a month. I buy chocolate of between 60 and 100 percent purity (which contains much less or no sugar).

I just bought a freezer full of grass-fed beef from Lasater Ranch, and we enjoy other kinds of meats. We eat plenty of vegetables, eggs, and nuts. Unlike stricter “paleo” eaters, we drink (whole) milk, and we eat moderate amounts of fresh, frozen, and dried fruit. So we are getting considerably more carbohydrates than are stricter “paleo” eaters, though our carb intake is dramatically lower than seen in the typical American diet, and our carbs are a lot healthier.

Earlier this week I paid the King Soopers pharmacy $20 to test the cholesterol levels in my blood. (Because I pay for my health expenses out of a Health Savings Account, I tend to seek good value for my money, unlike the case with most American health consumers.) My triglycerides are comfortably low at 51 (milligrams per deciliter), and my high-density lipoprotein (HDL) count is nice and high at 65.

My wife has seen a dramatic improvement in her blood counts with the diet. Four years ago her triglycerides were nearly 300; today they were 127. Her HDL count is even better than mine at 81.

Eating real food works.

April 12 Update: I neglected to mention the fact that Jennifer and I are also taking fish-oil supplements for Omega 3 fat. Dr. Eades points to a study indicating the benefits of Omega 3 supplementation for triglyceride and cholesterol counts.



Monica April 9, 2010 at 5:48 PM

“Eating real food works. ”

It sure does. Fantastic, and congratulations. My bloodwork is similar. I wish I’d gotten it done before going paleo-ish so I’d know how much I improved!

Microwaved Eggs

It occurred to me that often only the complicated dishes make it into published recipes. But I usually eat very simple meals that require no recipe. A standard dish for me is vegetables, meat, and spices sauteed in coconut, olive, or stock fat. I don’t mind cooking, but it is by no means a passion of mine, and usually I focus on quick and easy dishes.

Like fried or scrambled eggs.

Only now I usually make them in the microwave rather than in a skillet. This is faster and it generates fewer dishes. There are two basic ways to microwave eggs. You can microwave a single egg in a bowl for around 40 seconds. If you don’t break the yoke, the egg hardly sticks to the bowl.


Or you can microwave more than one egg, with or without additions. For example, yesterday I microwaved two eggs, sausage, and two cubes of cauliflower puree. First I microwaved the puree for around a minute to dethaw it. Then I stirred in the eggs and sausage. The edges tend to cook faster, so you have to stir it about every half a minute for a few minutes. This sticks more than does a single egg with an unbroken yoke. But it’s still easy, fast, and good.


No-Sugar Cheesecake

For New Year’s, Jennifer made a great cheese cake without sugar or any added sweetener. We topped it with blueberries or apples sauteed in butter and cinnamon, so of course that added the fruits’ sugar. The texture of the cake was fantastic.

We used a low-carb cheesecake recipe, except we didn’t put in the “artificial sweetener” (because, yuck). While I like it fine without any sweetener, we discussed putting somewhere between a quarter cup and a half cup of sugar in future attempts if we want a sweeter dessert.

One thing we got out of this recipe that will be useful for other things is the almond meal crust. We’ll probably make this for quiche and mousse pies.

To make the crust, mix a cup of almond meal and two tablespoons of melted butter (Jennifer just used a fork for the mixing). We thought we’d increase the quantities by half next time. Press the mixture into the bottom of a pie plate, then bake for 8 to 10 minutes, until slightly browned.


To make the filling, mix in the following ingredients, one at a time in order, with a hand mixer, scraping the bowl with a spatula between each ingredient:

* 3 packages (1.5 pounds) cream cheese (room temperature)
* 4 eggs (preferably room temperature)
* 1.5 teaspoons vanilla
* 1.5 teaspoons lemon juice
* sweetener (if desired)
* 0.25 cup sour cream

After you add the last ingredient, beat the mixture for an additional minute.

We used a water bath to bake the cake. Ours worked great for an hour at 350 degrees Fahrenheit. It puffed up a bit and then settled back down as it cooled.

Here’s the finished cake in the water bath:


Cooled, sliced, and topped: