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From the Townsend Letter
October 2014

Optimizing Metabolism
A Field Guide for Brown-Bag Lunches
by Ingrid Kohlstadt MD, MPH
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Introduction: It's Time for Some Brown-Bag Bragging
Change when possible, accept when necessary, and wisely distinguish between the two. Sometimes called the Serenity Prayer, this advice seems equally apt to the practice of nutritional medicine. The good news is that savvy practitioners who have wisely placed lunch in the "accept when necessary" category may now find that change is finally possible. This Townsend Letter column highlights practical resources for packing a healthful lunch.

Brown Paper Bag Rescues
"These aren't just for hyperventilating patients," I explain to colleagues as I pull a handful of brown paper bags out of the mountain survival kit. "Rebreathing can normalize blood chemistry in a mountain rescue scenario. Using these bags for refueling also saves lives."
My medical fieldwork has reinforced the importance of meticulous packing. Preparation was a watchword during my sojourn as an Antarctic station physician, humanitarian efforts in Sudan, and immunization efforts in the South America, where we traveled from village to village by canoe.
Everyday expeditions to school and to work benefit from smart packing, too. Unfortunately, many of us work in "accept when necessary" workplaces and attend "accept when necessary" schools. We really are going on an expedition. Without planning ahead for a healthful lunch, people find themselves in that uncomfortable dilemma: skip the meal or eat junk.
The medical effects of skipping lunch are significant. The most noticeable effects are difficulty in work performance, especially cognitive function. A drop in blood sugar relative to insulin is now considered the leading food (or lack of food) trigger for migraine headaches. The same physiologic effect sparks unrelenting food cravings leading to compulsive eating and resulting self-discouragement. Nor is eating junk worth the collateral damage.

PickNICRefueling Instructions PickNIC: A Rescue for Everyday Expeditions
Here's my field guide for the brown paper bag refueling rescue. It's called PickNIC 2014 and is freely accessible at
The e-book is free because of tremendous support for the project through our crowd-funding effort. Thank you to Townsend Letter for the shared vision. I'd be telling a lot of people "Thanks. I owe you lunch." So it's a good thing that we had lunch "in the bag."
PickNIC stands for Pick Nutritious Ingredients Cost-effectively. It's a list of 100 best-for-you brown-bag lunch ideas.
The 100 nutritious and cost-effective ingredients include something more – diversity. Lunch is an opportunity to be adventurous and take gastronomic expedition. In a celebration of multiculturalism, PickNIC gives every continent a bit of brown-bag bragging. Happy globetrotting!

Dollars and Sense
I am empathetic to the sometimes extra expense that healthful choices can incur, and that is why PickNIC has suggestions for low pricing and economic sense. That said, if you circulate PickNIC and receive some resistance about cost, you may want to probe for other reasons that people are resistant to change. Here are some recent examples.

  • Packing a lunch is usually less expensive than buying one on the spot. It just takes more initiative.
  • From my perspective as a mom, regional public schools have made tremendous strides in food service based on federal mandates, while local well-heeled private schools have voiced their reticence and have chosen not to revamp lunch.
  • An only-pizza meal remains the most common way to fulfill an advertisement for a free lunch lecture at a premier US school of public health and school of medicine. Were the school leadership to change the policy to be consistent with overwhelming health evidence, the favorable publicity (or avoidance of negative publicity) would be of greater value than the increased cost of the lunches.

John La Puma, MD: Get to the Real Reasons and Incentivize
If it's not time and cost, what creates barriers to change? The reasons are many, but it may be more effective to reframe the question. Whatever the reasons for resistance, what can encourage my patient to healthful lunch-time food selection here and now?
Friend and New York Times best-selling author Dr. John La Puma provides an outstanding answer in his recent book Men Don't Diet, Men Refuel. Aimed at incentivizing men in positive health behaviors, he promises and delivers a plan to shed fat, boost testosterone, and pump up strength and stamina. Here's an important take-away, recapped in my words: Want a six-pack? Pack lunch.
He preps readers towards a plan of action:

  • Place lunch items in your [desk] drawers at work for a whole week, and replenish the next week.
  • Bribe your spouse into packing lunch for you.
  • What do you do when the boss wants to split a pizza? Say, "I'm going to try this carpaccio and get a bowl of minestrone soup, but the pizza looks good." Still stuck? Say that having food high in protein makes you a better employee: "I'm more productive and have a lot more energy." Smile when you see him or her yawning during your 2:00 meeting.

Jennifer Salos, MS, CNC: Send Your Patients 'Packing' Before They Come to See You
Practitioners may be appropriately concerned that talking with patients about their food selection may detract from equally important topics in a short clinic visit. My friend and colleague Jennifer Salos flips it around. She literally sends them packing before they come to see her. Instead of waiting until the clinic visit, her office staff provides nutrition-themed messaging as a form of office promotion, and uses healthful brown-bag stuffers as giveaways for those who take health actions before visits. More than selecting nutrition-aware patients, Jennifer is shaping them. Visit for examples of the newsletter, which keeps her clinic at the forefront of her patients' "to do" list.

We'll be back packing in November 2014 for PickNIC 2015. Meanwhile, please send your favorite brown-bag stuffer suggestions. Because longevity is something that we can often influence through healthful choices, I conclude this column as it began, with a folk saying. "An [Irish] toast to your coffin: May it be made of 100-year old oak and let's plant the tree tomorrow." 

For healthful lunches that are tasty, trendy and not too spendy, visit

If you are interested in participating in PickNIC 2015, you may wish to view the PickNIC 2014 crowd-funding campaign at

Ingrid Kohlstadt, MD, MPH, FACPM, FACN
Faculty Associate
Johns Hopkins Bloomberg School of Public Health
Executive Director, NutriBee National Nutrition Competition Inc.
Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)

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