By Michael J. Critelli | MakeUsWell Newsletter, 

“I am gluten sensitive.” “I cannot eat beans.” “Fruit does not agree with me.” These statements often reflect real experiences. Someone eats a food, feels uncomfortable, and understandably wants to prevent that discomfort from happening again. 

The problem begins when a useful observation becomes a complete explanation. Naming the food associated with symptoms does not necessarily identify what caused them, or establish that every form and quantity of that food will produce the same result. 

This tendency can also be reinforced by healthcare providers who, when confronted with symptoms that point to a condition like lactose intolerance, use one or more of the four U.S. ICD-10-CM diagnosis coding system E73 codes. This diagnosis may be correct, but it is often not sufficiently informative. 

We like simple diagnoses because they offer clarity and a course of action. Avoid the offending food, and the problem should disappear. But foods are complex combinations of proteins, carbohydrates, fats, and other substances. Our responses also depend on quantity, preparation, the rest of the meal, and our underlying health. A label can help us organize an investigation. It can also end that investigation prematurely, leaving us with restrictions broader than the evidence supports. It may also cause consumers to conclude incorrectly, without clinical validation, that they have other broad allergies or sensitivities. 

Consider gluten sensitivity. A person stops eating wheat bread and pasta, experiences less bloating, and concludes that gluten was responsible. Yet removing wheat also removes fructans, fermentable carbohydrates that can produce digestive symptoms in susceptible people. 

In a controlled study of 59 people with self-reported nonceliac gluten sensitivity, fructans produced more symptoms, while gluten did not differ from placebo. This does not mean gluten sensitivity is imaginary. It means that feeling better without wheat does not, by itself, identify gluten as the cause.

The distinction matters because different explanations lead to different choices. Someone reacting to wheat’s fructans may also experience discomfort from onions or garlic. Calling each reaction a separate food sensitivity could obscure a shared mechanism. 

Conversely, understanding the carbohydrate involved may allow a person to make more precise choices about portions and foods. The objective should be to identify the smallest necessary restriction, while preserving as much nutritional variety and enjoyment as possible.

Fruit provides another example. “I cannot tolerate fruit” treats an enormous category as though its members were interchangeable. They are not. The amount of fructose, its balance with glucose, and the presence of sugar alcohols such as sorbitol can influence digestive responses. A small serving may be comfortable while a larger serving causes symptoms. One fruit may be tolerated while another is troublesome. The relevant question is therefore more specific than whether fruit is good or bad for that individual.

Preparation can change the picture as well. Some people who experience an itchy mouth after eating raw apples have pollen-food allergy syndrome: their immune systems recognize food proteins resembling pollen proteins. They may tolerate cooked apples because heating changes those proteins. “Apple allergy” captures part of the experience but may omit an important distinction. This remains an allergic condition requiring appropriate assessment; the lesson is that the form of the food can matter alongside its name.

Sometimes the apparent precision comes from a test. Commercial food sensitivity panels may provide long lists of foods supposedly responsible for symptoms, creating an impression of scientific certainty. However, food-specific IgG testing has not been validated for diagnosing food sensitivity. 

IgG can reflect ordinary exposure or tolerance rather than a harmful reaction. A detailed report is not necessarily a reliable explanation. It can encourage people to eliminate nutritious foods they were eating comfortably before receiving the results.

None of this justifies dismissing symptoms. The discomfort is real even when its explanation remains uncertain. Nor should it encourage people with confirmed celiac disease or serious food allergies to experiment casually. Those conditions require specific precautions. The challenge is to respect the person’s experience while keeping the explanation open to examination. We can believe someone who says, “This meal made me feel ill,” without assuming we already know which ingredient or biological process was responsible.

A better investigation asks: What exactly was eaten? How much? How was it prepared? What else accompanied it? Which symptoms occurred, how quickly, and how consistently? With appropriate professional guidance, those questions can turn a broad prohibition into a more useful understanding.

The larger lesson extends beyond nutrition. Labels are valuable when they help us see patterns. They become limiting when they substitute for curiosity. In food intelligence, our goal should be to help people discover what works for their particular bodies and circumstances, then make informed choices with confidence. A diagnosis should advance that learning, not bring it to an early close.

By Michael J. Critelli | MakeUsWell Newsletter, 

My wife and I recently sorted through our medicine cabinet at our Darien, CT home, where we have lived since 1994. 

Most of us treat the medicine cabinet as a place for quick relief. But the bottles we reach for often also act as a diary, recording where our bodies kept struggling. They raise a question we rarely ask: Is something in my daily routine, starting with what and when I eat, driving the need for this?

The answer varies by product. For some, food has a great deal to say. For others, it has little. Learning to tell them apart is the real skill. Here are five more common examples that could be in virtually any American’s medicine cabinet. 

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By Michael J. Critelli | MakeUsWell Newsletter, 

Practically every morning I am up early to drink a double espresso at the local Starbucks in either Darien, CT (between July and October), or Naples, FL (November through June). On school days, teenagers and college students show up between 6:45 a.m. and 7:15 a.m. to pick up a pre-ordered drink with highly concentrated caffeine.

I can relate to them to some extent because I was a heavy consumer of either Coca Cola or Pepsi, with a small cup of coffee at breakfast when I was in college. In law school, I substituted Tab, a sugar-free cola, for either Coca Cola or Pepsi. Today, I regularly consume no more than 300mg of caffeine per day, almost always before 9 a.m. 400 mg is considered the upper safe limit. My Dad was able to drink a big cup of coffee immediately before bedtime and my daughter seems to have inherited that attribute. I have trouble drinking coffee after noon.

Behaviors of young people are quite different today from what I did to get more energy. Caffeine is increasingly packaged and marketed as energy, focus, performance and endurance. It appears not only in coffee, but in energy drinks, energy shots, pre-workout products and highly caffeinated beverages that can deliver a large dose very quickly.

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By Michael J. Critelli | MakeUsWell Newsletter, 

On Tuesday, September 22, I spent several hours in the Emergency Department at Stamford Hospital after my wife fell on a New York City sidewalk. As on previous occasions, the care she received was exceptional. But when I went looking for lunch in the hospital, I encountered a puzzling contradiction: Why is it sometimes so difficult to find convenient, healthy food in a place dedicated to improving people's health?

Let me begin by emphasizing my admiration for Stamford Health. It is one of Connecticut's remaining independent healthcare systems, serving an extraordinarily diverse population. Its staff is consistently polite, professional, compassionate, and deeply committed to its mission.

I have written to its CEO, Kathleen Silard, more than once to commend the care my wife or I have received. When I experienced an episode of dizziness five years ago, I received the same exceptional treatment.

My experience this week reinforced that admiration. The clinical care was excellent. But it also raised questions about an aspect of healthcare that deserves more attention: the food available to employees, patients' families, and other visitors.

When Healthy Food Is Hard to Find

At approximately 2 p.m., 90 minutes after my wife had been admitted to the Emergency Department, I went looking for lunch.

The dining facilities I could locate had stopped serving lunch. The most convenient alternative I found was a Farmer's Fridge vending machine offering a selection of cold foods, including several salads that appeared to be nutritious.

I commend Stamford Health for making these options available. Unfortunately, the experience revealed several shortcomings.

The salad containers did not have labels adjacent to them that made it easy to match the physical products to the descriptions on the ordering screen. The screen provided ingredient information, which was helpful for people with allergies or food sensitivities. But the selection offered limited options for individuals with multiple dietary restrictions.

The utensil dispenser was broken. Nearby beverage machines offered numerous sugary drinks.

None of these problems was particularly serious in isolation. Collectively, however, they demonstrated how difficult it can be to make healthy food genuinely accessible.

Providing nutritious food is only the first step. People also need to identify it, understand its ingredients, find options compatible with their dietary needs, and obtain it conveniently.

That brings me to two larger questions.

1. Why should hospital employees and visitors have difficulty obtaining healthy meals outside conventional dining hours?

2. Why should foods and beverages that healthcare professionals routinely encourage people to limit remain prominent offerings in healthcare facilities?

The Special Responsibility of Healthcare Systems

Hospitals face legitimate challenges in providing food services.

Patients may require medically prescribed diets, fasting before certain procedures, or other restrictions. Hospitals must maintain rigorous food-safety and infection-prevention standards. They must also accommodate diverse nutritional requirements while managing staffing, procurement, and operating costs.

But employees and those accompanying patients for what are often several-hour diagnostic and treatment processes have different needs.

A nurse working a twelve-hour shift should not have to choose between a convenient meal and a nutritious one. A family member spending an unpredictable number of hours in an Emergency Department should have access to healthy food without leaving a loved one unattended.

In my case, I could have left the hospital and gone to a nearby restaurant. But that would have meant being away from my wife for an extended period when she might have needed me to help make a medical decision.

As it turned out, she did not. But there was no way to know that in advance.

Hospitals have a responsibility to consider the needs of these populations, particularly because they often have limited alternatives.  This requires healthcare leaders to think about food services differently.

Traditionally, hospital food services have been evaluated partly on their ability to control costs, generate revenue, and contribute to institutional overhead. Those considerations are important, but they should not define the entire value of the operation.

What if hospitals evaluated their food services by how much they contributed to employee health, patient experience, family wellbeing, and the institution's broader mission?

That would change the questions healthcare leaders ask and the solutions they pursue.

Healthy Food Can Be Good Business

Several healthcare systems have already demonstrated that nutritious food and financially sustainable food services are compatible.

One system which owns healthcare systems in both New York and Connecticut, Northwell Health, has undertaken a major transformation of its dining operations under the culinary leadership of Bruno Tison, a Michelin-starred chef.

Its initiatives have included replacing heavily processed prepared foods with freshly prepared meals, eliminating deep-fat fryers, substantially reducing sugary beverages, and creating restaurant-quality dishes using healthier ingredients and cooking techniques.

Northwell has also introduced teaching kitchens that bring chefs and dietitians together to help employees, patients, and visitors develop healthier eating habits.

These initiatives demonstrate that hospital food can be nutritious, appealing, and an important component of the healthcare experience.

The Partnership for a Healthier America's Hospital Healthier Food Initiative provides additional evidence.

The initiative encouraged participating hospitals to improve the nutritional quality of patient meals, cafeteria offerings, vending-machine products, and food marketing.

In reporting results from an earlier phase of the initiative, the Partnership noted that Henry Ford Health System experienced increases in cafeteria sales ranging from 2% to 10% across its locations after adopting healthier nutrition standards.

That is important because it challenges the assumption that improving nutritional quality necessarily comes at the expense of financial performance.

The opportunity is not simply to replace unhealthy foods with healthier alternatives. It is to rethink the entire food-service experience.

Could hospitals make nutritious meals available throughout the hours when employees and visitors need them? Could they provide better ingredient and allergen information, accommodate more dietary restrictions, and make healthy choices more convenient and affordable?

Could food services become an integral part of an institution's commitment to employee wellbeing?

These are management and leadership questions, not simply cafeteria operating decisions.

Making Healthy Eating Part of the Healthcare Mission

In 1986, after my wife underwent a Cesarean section at New York Hospital, the nursing staff gave us menus from local restaurants that would deliver meals directly to our hospital room.

It was wonderfully convenient and provided an enormous range of choices. Of course, unrestricted restaurant deliveries into patient-care areas could create infection-control and security risks that hospitals must manage carefully today.

But the underlying idea was valuable: make it easy for patients' families to obtain the food they need without leaving their loved ones.

With today's technology, hospital leaders should be able to develop even better solutions, including designated delivery locations, mobile ordering, and convenient access to freshly prepared meals.

The broader opportunity is to recognize that the hospital food environment is part of the healthcare environment.

We typically think of hospitals as places where professionals diagnose diseases, perform procedures, administer medications, and help patients recover.

But hospitals are also workplaces and gathering places for families. The foods and beverages available there influence the everyday choices of thousands of people.

If a healthcare system encourages patients to eat nutritious foods, reduce added sugar, manage chronic conditions, and improve their long-term health, shouldn't it make those choices easier within its own facilities?

A healthcare system that makes healthy food readily available to its employees demonstrates that it values their long-term wellbeing, not merely their ability to deliver care.

A healthcare system that makes nutritious meals conveniently available to families recognizes that supporting loved ones and caregivers is part of supporting patients.

I would never want my experience looking for lunch to overshadow the exceptional medical care my wife received at Stamford Health. On the contrary, I believe the institution's commitment to excellence creates an opportunity to extend that same standard to other aspects of the healthcare experience.

A hospital that delivers exceptional medical care should aspire to deliver an equally exceptional environment for healthy living.

Healthy food should not be a special accommodation or an afterthought. It should be readily available, affordable, appealing, and convenient.

Given what we know about the relationship between nutrition and long-term health, healthcare institutions should be setting the standard for making healthy eating the easy choice.

That commitment should extend all the way to the cafeteria and beyond.

By Michael J. Critelli | MakeUsWell Newsletter, 

This summer, many parts of the world have experienced extreme heat, including places poorly equipped to deal with it. Americans have air-conditioned a high percentage of homes, offices, stores and public buildings. That is far less common in many other countries.

These heat waves raise an interesting question: How have societies that have lived for centuries in climates we find intolerable adapted to them?

One answer can be found at the dinner table:

For millennia, climate has helped shape human cuisine. It determines what crops can grow, how quickly food spoils, how much water is available, how long food must be stored, and how much energy people need. Along the way, humans also discovered foods and spices that affect our perception of heat, cold and comfort.

The result is that regional cuisines are, in part, records of human adaptation to the environment.

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