Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen: On today’s episode, Dr. Nicole Farmer joins us to talk to us about her research on cooking frequency in non-Hispanic households and highlights the advantages of home cooking for better diet, quality, mental health, and prevention of chronic disease. Stay tuned.

Dr. Nicole Farmer is currently a staff scientist at the NIH Clinical Center and the Aging Section Chief of the Dietary Behaviors and Biophysiological Health section within the translational Behavioral and Health Disparities branch. In the intramural research position, Dr. Farmer is involved in both community-based and patient research exploring the role of cooking in chronic disease prevention and psychosocial health. Welcome, Dr. Farmer.

Dr. Farmer: Hi Shireen. Thank you for having me today.

Shireen: Such a pleasure having you on. So, Dr. Farmer diving right in. Tell us more about how has cooking been influential in your own life and then as a path into the research that you do.

Dr. Farmer: Sure. Yeah, so my research portfolio really starts with my own experience with cooking. Growing up cooking was always around. I come from a family that where the men cooked. So, I learned a lot of my cooking from my father and his father, who learned it from his mother, from South Carolina.

So cooking was just steeped in our weekend traditions. And then as I got older, I moved away from it like a lot of young adults do and moved towards a lot of convenience foods and fast foods. But then as I got married and my husband and I faced our own health challenges in order to really tackle them through food as medicine, I had to go back to cooking. And I had to go back to what I learned from my family in order to do that. So, through that journey, I really felt like if it worked for us then it has to work for others. So, I need to figure out how to build this into my practice and then eventually need to research.

Shireen: Absolutely love that. And I personally just love it connecting to your own journey and your own health journey, like you mentioned. Speaking of some of the research that you’ve done, you did a research study that showed that non-Hispanic blacks were more likely to live in households with lower dinner cooking frequency when compared to other racial groups in America. Now, what factors did you find played the most significant role in this conclusion?

Dr. Farmer: So, I’ll start with that the research work that I’ve done on that topic really builds off of what was put out a few years earlier by other groups. Who initially saw that when they looked at national surveys of when asking adults about frequency of cooking dinner, that there was this gap between what African Americans are reporting and non-Hispanic whites and Hispanic Americans and Asian Americans.

And those other papers left it at African Americans cook less. I really wanted to do just one paper just looking at those samples of African Americans, what might be the factors?

Why are they cooking less? Is it income related? Is it sub marker of perception of their diet quality? And then to the kind of answer, another question that sometimes I would run into is people would say, well, if African Americans were to cook, then their diet wouldn’t be healthy anyway. So, I wanted to counter that stereotype through research.

So that paper really looked at what are the factors that might be contributing to a lower reporting of cooking frequency, but then also looked at if African American adults are cooking at home, what’s their diet like? So, I’ll start with the first part. And so some of the factors that we found are important is that, that question is just a bad question.

That question wasn’t getting at the way that people cook and how people are defining cooking. So, if people do batch cooking where they cook over the weekends and they’re eating off of that cooked food throughout the week, then actually that question about how many times you cook dinner doesn’t really capture the role of cooking in their diet or their exposure to potentially healthier foods.

Other things that we found is that it really was income. So, we saw in the whole U.S., the higher your income, the more your cooking frequency, the more your diet quality. When we looked just at African Americans, we found that only rang true for middle income households. Lower income households and even the upper end income households, income wasn’t related to cooking frequency.

And so, then that leaves in kind of the work that I’m doing now to ask more of those questions about if you have people that are on two different bookends of income, why are there consumer behaviors around food? Not following that income trend. So that’s some of the work that we’re doing now.

And then to look at the role of diet quality. So yes, the more that African Americans in that sample cook in their household, the better their diet. And we specifically saw that their diet improved in terms of vegetable intake, green leafy vegetable intake, and a reduction of sugar sweetened beverages. So, I felt it was important to put that research out into the literatures to help to dismay some stereotypes that people have about what African Americans eat or what actually a cooking intervention could lead to.

Shireen: Speaking of which, so in the same study you concluded that the promotion of higher cooking frequency among higher income non-Hispanic blacks may be related to promoting cooking as a viable option within their daily living schedules, as opposed to focusing on food access options. Can you elaborate a little bit more on this?

Dr. Farmer: Yeah, yeah. I can elaborate a little bit more. So, I think a group that we oftentimes don’t think about or don’t think about recruiting the studies are higher income African American households and families. And thinking about the fact that we see across income levels there’s an increased risk for chronic disease amongst African Americans.

But what are the behaviors within specific income groups? And so when we look at higher income African Americans they tend to live in more mixed race or not as segregated neighborhoods. So therefore, they would, in theory, have better access to food. So then why is that not translating into more cooking frequency?

And it could be that their family schedules are busier, or it could be that their work schedules are busier. And so, these I think are some of the questions that still need to be answered.

Shireen: That’s so fascinating. What dietary needs typically are lacking in non-Hispanic black’s diets?

Dr. Farmer: Well, going back to the national surveys that we have to formulate our research off of we generally see a reduction in consumption of vegetables nuts and seeds and fish and seafood. But I’ll just kind of caveat that to say that the most recent U.S. dietary guideline research that came out showed that only about 20% of all Americans are actually meeting their dietary goals when it comes to fruits and vegetables.

And when we look at the more recent data across all racial and ethnic groups, it’s really only Asian Americans that are close to hitting the benchmark in terms of fruit and vegetable consumption. Our overall diet quality has really just dwindled in the last 10 years.

Shireen: And you know, I’m still trying to figure out that correlation with low income and high-income individuals and what is perhaps a common thread there? So, you mentioned a couple of things was not having the time. And then I also think even if you’re in the middle-income bracket, you wouldn’t quite…So I’m kind of struggling to figure out what that thread could possibly be. But yeah, I would love some initial thoughts from you on what some of those things could be.

Dr. Farmer: Yeah. Some initial thoughts that I have are that if you are higher income, there’s just more choices available. And if you’re lower income, there’s less choices available. So, I think it’s like, and in those less or higher choices, people tend towards what’s around, so that what’s around could be a Whole Foods or that what’s around could actually be a McDonald’s.

And then in terms of middle income, one of the things that we were not able to do in this analysis because the data was limited. I really wanted to look at, if there was more health risks. So, was it just that people that were in the middle-income range were the ones that actually had been told that they have high blood pressure or the ones that actually had been told that they have obesity or some risk factor. And that their behavior was really generated by wanting to change their health was another potential theory that I had.

Shireen: Interesting. And that really resonates with me. The first point of which you said is that, if the higher income individuals are not cooking, they’re surrounded by healthier options versus the McDonald’s for the lower income. And I want to now talk about just cooking and how we sort of view cooking.

Now cooking can be considered to be both a labor of love and a time-consuming task. How do you advise sustainable, healthy, home cooked meals when you don’t have much time to spend on cooking? What do you tell someone?

Dr. Farmer: Yeah, so I used to tell, talk to patients about this all the time. And one of the biggest things is that if cooking is new to you, you should definitely cook and add it into your family schedule as opposed to change your family schedule in order to cook. So, if to give a classic example we do a lot of afterschool activities. So, for me, cooking a nice meal from scratch in the evening is not. A feasible thing but to cook to my family’s schedule, then I do a lot of morning cooking or weekend cooking.

And then having things ready to go as we move throughout the week. I think also cooking is oftentimes viewed in a lot of households as one person’s job. And really starting to expand that beyond one person, to multiple people involved in cooking and that can be very task-oriented thing.

So, if you have children, allow them to take the salad bag out, mix the salad, put the vegetables in the salad. Just getting people involved in the process of cooking actually cuts down the time and it cuts out our perception of the effort that’s involved too.

Shireen:  And I love that also for another reason, and that it also gets them involved. So that then as the kids grow up and then have families of their own, they’re already sort of they’re already trained, if you will, or they’re already in the habit of sort of building that, that relationship with food.

Dr. Farmer: And to that, there was a longitudinal study that I just love to tell students about. That looked at children whose parents taught them to cook, and then the researchers followed them 10 years later. And they found a better diet quality for the kids whose parents involve them in cooking versus the ones who were just kind of bystanders. So, it’s really important to involve them even in the smallest thing.

Shireen: I love that. So, make it a family affair. Help yourself and your family as a result. Love it. Now let’s talk about the cost of food. Especially in this economy, foods can definitely get expensive eating out or cooking at home, especially for large families. What advice would you give to families that want to create healthy indigenous, just meals for their families with a strict budget that also meets recommended nutritional value?

Dr. Farmer: So, this is really important, as you mentioned, especially in this economy. This year we actually saw grocery store food prices increase more than food prices of prepackaged or foods that we can get out. And so, it definitely is a struggle to convince people now that to invest in produce because the price is so much more than what you might be able to pay for a dinner out.

But I still like to stress to people the ability to have control over your ingredients is extremely important and important for your health. So, for instance, when you’re eating out, you have no control over the sodium. Amount that has been put in that meal. Even when we’re purchasing something that is pre-made or pre-marinated from the grocery store, we have no control over that sodium.

And when you turn around and look and actually see how much sodium is in a serving and that you actually have a small amount of your food per serving. You start to realize, okay, I’m going to have an overexposure salt for the day I’m eating this. Whereas if I even if you take half of a meal and have half of pre-prepared and half that you control, you’re still lowering your sodium.

So, I like to tell people control your meat. So, you want to purchase a pre-made rice peel or some veggies from a salad bar do that. Control the shrimp, control the salmon, control that salt exposure that can come from that.

Shireen: Indeed. Great, tips here. And my biggest thing at this point is don’t be swayed by what you see on the nutrition like on the front of the box of any kind of processed food that you’re buying. Do not be swayed by that. It is not controlled by the FDA. No one’s looking at that. They can say whatever they want to. The true story is the back where the nutrition label is. PSA there about how–

Dr. Farmer: Yes, absolutely.

Shireen: How some of these things can really…. Absolutely, yeah. They can sneak into the packaged foods when you’re making food choices outside of the home as well. And my next question for you, Dr. Farmer, is really around, when we’re talking about cooking at home, it doesn’t necessarily also equate to eating healthy. Can you talk about how we can end up with good intent, make poor nutrition choices for ourselves?

Dr. Farmer: Yeah. So, I can actually go back to the paper that we started talking about. The initial papers that looked at all U.S. adults as well as our paper who looked us at African American adults, all the papers found that cooking frequency did not change sodium intake. We were able to… the more people cooked at home, it was associated with more vegetable and take more food.

Sodium stayed the same. So, I think one of the things that we can really think about is most of our sodium exposure occurs from pre-packaged foods. But a lot of people use pre-packaged foods only when they cook at home. And so how much of the dinner meal are you cooking fresh? And how much of that are you cooking that’s pre-prepared? It can do a lot to make sure that what you’re preparing, you absolutely have control over and it positively affects your health.

Shireen: But this also does not mean that we have to create everything from scratch either. We just have to be smarter.

Dr. Farmer: Yeah. We just have to be smart. I mean, that gets back to the time, you know, factor like everything cannot be from scratch. Otherwise, we would be crazy. You know, and totally stressed. It has to really be knowing, going through the aisles, like planning the meal and saying, oh. Sometimes we do pasta dishes in my house, so my kids know that I make tomato sauce from like, no salt canned tomatoes. So, like that’s how I choose to control, but I’m not making it only pasta, you know?

Shireen: And what, what other recommendations would you provide to an individual so that they know that they’re looking out for their family’s wellbeing and really creating nutritional, well-balanced meals?

Dr. Farmer: I think this is when cooking really becomes essential, and that’s learning how to make vegetables flavorable and adding them to your dish. so that your family enjoys them. I think learning basic cooking techniques like roasting certain vegetables, especially like starch splash or cruciferous vegetables like broccoli. How to do like light sauté of a cauliflower. I think these are the things that really– this is how I see cooking as an essential dietary strategy for people to really use food for their health and use food as medicine. I hope that answered your question.

Shireen: It really does. And if I had to, like for all our listeners out there, if they had to look at their meal and just like audit it, right? To say, I think I’m eating healthy, what are symptoms they should look for? What differentiates a high nutrient dense meal versus one that isn’t nutrient dense?

Dr. Farmer: So, I like to have the strategy of, and this can be a breakfast, a lunch, or a dinner kind of strategy. Half of the plate or half of the bowl is some component of fruits and vegetables. So oftentimes after breakfast, we don’t think about vegetables for breakfast, but that can be you can accomplish that by adding spinach and mushrooms to your eggs and then having a piece of fruit.

So, I think having that strategy first is really important. And then crowding out your plate also and thinking about where’s the fiber. So, the fiber will come from your vegetables and fruit. You get a point for that. But then also thinking about, well, do I have whole grains here? So, do I have steel cut oatmeal versus the pre-processed oatmeal? We’re looking at breakfast.

If we’re looking at lunch, am I having brown rice at the base of my bowl versus white rice? And then for dinner, am I using the whole grain type of pasta? So, I think those two key things can do so much for how we control our food and how we control exposures to foods that are unhealthy.

Shireen: I do want to switch real quickly to talk about mental health. Now, Dr. Farmer, you spent extensive time researching the benefits of cooking and mental health. We’re living in a post-COVID world now. Where people really are eating out more than ever. That’s what’s really the best way to get people to want to start cooking again?

Dr. Farmer: So, I’ll start with the fact that some of the research that we’ve done, but also research in fields like anthropology and evolutionary psychology, show that cooking, really the intention of cooking in human lives was to be a social practice. And so going back to the idea that it shouldn’t just be one person’s job and that it actually should require multiple people coming together.

What I found with patients at the clinical center, as well as patients in my private practice before, is that people who didn’t want to cook alone, are willing to cook together. There is a social cohesion that happens. There is a joint attention. So, attention and focus to one thing, to a shared goal. That I have seen cause what I can only describe as activation of joy.

But a lot of the work that I’ll start to do is looking at how that activation of joy may turn on some neurobiological or some anti-stress markers within the body. And actually, explain what we’ve known through anthropology and psychology that cooking is a beneficial social practice. And then lastly, loneliness has in the last 10 years been found to be more of a risk factor for chronic disease and ill health than obesity and blood pressure. So, thinking about how cooking can be a vehicle for people to come into being in groups and being socialized and prevent loneliness is one of the key areas where I see my research moving.

Shireen: Absolutely love that. And that you sort of create the social atmosphere and by creating that, you’re really helping yourself. What other things can we do to change the way we view cooking and what kind of influences can it have on our health?

Dr. Farmer: Yeah. So, I’ll start with the last part. So, influences on our health. So, we talked about the dietary influence but there’s also significant literature that shows that as people engage in cooking, they also start to have a different sense of self.

And so, we term it self-confidence. If we apply it towards a task, it’s self-efficacy. Self-efficacy is a hallmark of emotional wellbeing. And then also in the last 10 years, we know that when we have emotional wellbeing, that’s actually a pathway to physical health, to chronic disease prevention.

And some of those pathways are that we don’t require as much cortisol to function through the day. Cortisol is our stress hormone that raises our blood sugar. We don’t require as much adrenaline to function through the day. And adrenaline is a hormone that raises our blood pressure. So that’s how I think we can start to think about cooking as a behavior for emotional wellbeing.

Shireen: Absolutely. Love that, that deep connection there and how it relates back to our wellbeing. I have to ask you this just because you focus so much of your work in this, but what is the importance of home cooking role in chronic disease prevention?

Dr. Farmer: There have been I think now more than a dozen studies that have shown that when we have people go through a series of cooking classes in the research book, we call it an intervention, but it’s essentially about six to 12 cooking classes consecutively. And then we follow them for three to six months later.

Studies show that we can see reduction in blood pressure. A reduction in weight. And then surprisingly also an unintended increase in physical activity, even though physical activity may not have been the main outcome. As well as in increase in someone’s perception about how mindful they are about their lives through the day.

So, I think that’s where we can see like, okay, chronic disease prevention. We can think about cooking not only just because of the diet, but also, we can see risk factor of prevention that can happen. Risk factor reduction.

Shireen: I love that because it’s so multi-layered. It’s like, oh, if I’m thinking about my food, then I naturally now think about my physical activity and it sort of starts the seed, it plants the seed for that.

And now you’re looking at all of these other avenues. So it’s really about, and I think what I’m hearing you say here is it’s really about connecting back with yourself, understanding what’s important, taking out time for that. And then of course trying to cook and get the help you need to cook as well.

Right. So, I love how multi-layered that this journey is to go through. I feel like you and I can continue this conversation for like another 30 minutes Dr. Farmer. But this time we will wrap up the episode here. Can you tell us how can our listeners connect with you and just learn more about your work?

Dr. Farmer: Sure. And you can reach out to me at Nicole.Farmer@NIH.gov. And then also all of my work is on the NIH, National Institute of Health Clinical Center in main homepage. And you can search for me under Nicole Farmer.

Shireen: Thank you so very much Dr. Farmer, for your time. And to all of our listeners help us sort of spread the word for this podcast.

Head over to your Facebook, your Instagram, share the post for this podcast in your network, but also comment below to tell us what’s your favorite go-to home cooked meal that you make? So, in the spirit of this episode, head over to our Facebook, our Instagram, find this podcast episode and comment below to say, what is your favorite go-to home Cooked meal that you love to make?

That is also nutritionally dense, because remember what we’re talking about here. So , absolutely. So, with that, we will see you on our Facebook, Instagram. We’ll continue the conversation there. Dr. Farmer, thank you so very much for your time.

Dr. Farmer: Thank you.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.

You can also visit our website, Yumlish.com for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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