Podcast Ep. 6: How We Can Use Food as Medicine With Lexi Hall, RDN

Justin: To be honest, I haven't got along with every dietitian I've worked with. I've found some to be closer to rigid accountants rather than experts in love with food. Well, this is certainly not the case with our guest today, Lexi Hall, a registered dietitian whom we first met when she was working at Children's Hospital of Orange County.

She immediately struck us as the real deal, not only an expert in Clinical Nutrition but a real passionate defender of delicious food as medicine. Lexi describes herself as an integrative and functionally minded registered dietitian whose passions lie in treating food allergies and IBS IBD. She has witnessed how nutrition therapy has improved the lives of her own family, as well as patient-centered practice and this motivates her to share a food-centered health message with the world.

Lexi acquired her BS in Dietetics with a minor in Biology at Sacramento State University and served a year internship at UC Davis Medical Center. Following a move to Southern California, she was invited to put her skills to use in the Food Allergy Lipid in Cancer Survivorship clinics at Children's Hospital of Orange County, where we first met her. She developed and continues to lead the culinary medicine program at CHOC.

She also collaborates in private practice and co-founded a personal chef and dietitian services operating under the name of Kitchen Curative serving clients in South Orange County, Lexi holds an additional certification in Food Allergy Management and is pursuing her Integrative and Functional Nutrition Credentialed Practitioner certification expected in May of 2021. Last but not least, Lexi has served as the Culinary Medicine Dietitian for MaxLove Project and is the lead dietitian for The Family Thrive. Without further ado, here's our interview with Lexi Hall.

Lexi: So I just love this kind of atmosphere that we have today because that, it's such a collaborative thing and it's so approachable. I think when I'm sitting there with a patient at CHOC or in my private practice, I really want to be the type of person that people can reach out to, that people can, I think that I'm working with them and I'm on the same level of them versus me talking at them. And so I just love the atmosphere that you guys have provided today so that we can get that done.

Audra: Thank you so much, Lexi. This is going to be so fun and I wanted to tell our listeners a little bit about how we met and how we are fortunate to start working with you from my perspective, let's put it that way. So Lexi, we met, gosh was it four years ago now?

Lexi: Four years ago, yes.

Audra: It's crazy to think for me to think of that. When you were connected to us, through Children's Hospital of Orange County, through a burgeoning culinary medicine program, MaxLove project, had given a culinary medicine cart to Children's Hospital Orange County with a supplemental bit of funds for dietitians to start working on tailoring curriculum. And in that process, in the process of excitement, I think the dietitians who were originally assigned were, there was a lot going on clinically, and you were brought on board at the hospital to really take on the culinary medicine project as one of your many projects at Children's Hospital of Orange County. It ended up being one of three of your assignments there?

Lexi: Four or five, something like that.

Audra: So you, you wear many, many hats as a registered dietitian at Children's Hospital of Orange County. But we met through this, in this particular way. And Lexi, I have to say I was so inspired from meeting you the very first moment because not only are you a functional dietitian, somebody is like really, really looking at digging deeper and trying to understand how food can be used as medicine.

And this is all inspired by your experience as a mom, seeking support for your daughter. And of course, I identified with that innately, I feel like we're soul sisters. We were immediately connected. And then you're the kindest, most generous person. You are thrilled to be working on this because it's your life's passion. It's your passion project and that uplifts me every single time that I get to work with you or even talk with you. So would you be willing to tell us more about how you became a dietitian and got into healing through nutrition?

Lexi: Thank you for your kind words. That really touches me because I feel so much the same way that you do, about working with you because you have such a passion for food and you have such a passion for people, and that healing just comes into play.

When I think about where I started as a dietitian, I had always fervently believed in the magic of food, the magic of food to be able to sit people down in the same room over shared experiences and just be in community and love with each other. I remember as a kid we used to live next to our Hispanic neighbors and she would make these homemade tortillas. And I mean kids would come running. You could just smell it and it was amazing and she'd make this chorizo. And it was so special. And then in my own household with my mom whose, her parents were from Italy and how that revolves around food and how people are just so proud of making and gifting this gift of food to their families. It was magical to me.

But then I had a, my youngest daughter had some health issues, and seeing what the right food did for her health in a positive or a negative way just absolutely blew me away and made me... I was already enthralled with the magic of food and the magic of how it made me feel, but then to see how it could heal was another one that just knocked me off my chair and I was like I have to do this. This is, this is what I see myself doing.

And so I saw that in you as well. And you too, Justin, that, that both the science and the magic of it, I'm hooked. I mean, I can't imagine myself doing anything else, so. I took a class, one of my early classes in my dietetics program where the professor said as a dietitian, you can go in 30 different directions with this. And I see that so much with all of my colleagues. We have some dietitians that work nitty-gritty in the numbers in the ICU, and then we have some dietitians that work directly with food and every different level in between, and so it's great to be able to be a dietitian. You can work with absolutely whole real food.

Justin: So talking about, like the science and the magic, I think that's what we try to go for with this concept of Fierce Foods, right? Like we wanted to get this idea of food as, as this scientific chemical healing modality, so there's a lot of science behind it, but at the same time, food means so much more.

Food has had these emotional qualities, cultural qualities, social, like it means so much more than just like biochemical makeup, and so that's what we're going for with this idea of Fierce Foods. And so we developed Fierce Foods with you with MaxLove Project, but we're bringing this idea into The Family Thrive as well. So can you tell us a little bit about what Fierce Foods are? What does it mean?

Lexi: I liken it to something that we told my daughter way back in the beginning, which was, she was scared to death to get a vaccine and the vaccine was necessary. And so the doctor told her that the vaccine was just little ninjas coming into her bloodstream to do battle with the bad guys.

And she was like, “Oh yeah, well, I definitely want one of those.” You know what I mean? So I think about that with Fierce Foods. I think that, when we eat nutrient-dense foods that it comes into our body and does amazing magical superhero-type things. It does battle with the bad guys. It gives us all the nutrients that we need to be our strongest, our most powerful being.

That's what I think of, I think of, there's a simple term that's a called Aggregate Nutrient Density Index and I think it's a scoring system where it scores food on a number scale and so it gives like a nutrient-poor thing like an Oreo or a cookie like a number three. But it gives a kale or a collard green or Brussels sprouts in the 900s, and so if you think if I had a fistful of that or a fistful of the other, what's going to go in there and do battle for me when I need it, make me powerful and strong? That's what I think of in terms of Fierce Foods.

Audra: You know, Lexi, and it occurs to me hearing you talk about this, that, that this approach to food or understanding food in this way as being empowering, not just like neutral needed to sustain life, but empowering to the body and beyond, is something that we're really learning, aren't we? I think back to my parents' generation, back to when we were growing up, this didn't occur to us. I really think the connection between food and health and well-being were not there really. It was just food as sustenance.

Thinking about that ties in with an experience that I remember you telling me about with your daughter's GI doctor, and... OK, you're seeing a GI doctor, and to me it seems so natural that with gastrointestinal you would be, you know, thinking about food, but these clinicians were not trained to consider food in that way, and so it was not a part of the process. Were you just shocked when you were told, it’s like really not of consequence, that food doesn't matter?

Lexi: I was. I was frothing at the mouth to see this lady. She was a dermatologist. She was a GI specialist. She was Stanford-trained. She had a pedigree that was a mile long and I had to wait four months to see her and I walked into her office with a, you know, file folder full. I couldn't wait to see her and get her opinion and I got like 30 seconds of what I was trying to say out of my mouth and she actually held up her hand and said, “Stop. This is where you stop, mom and this is where I take over” and without saying anything else she wrote me seven different prescriptions. And I was so sad with that whole experience.

But I also think about something that you just said made me think about how we market food and how we change the interpretation of food. I mean, back when my parents were just starting out, the marketing was, is that eating this frozen TV dinner is going to give you power. It's going to give you, you don't have to spend hours in the kitchen. You can just throw this in the microwave and there you go. And the way we market food, the way we identified with food was that it was there for us to use as a tool, but not in the ways we're thinking now.

You know, that's one of our biggest challenges is the way we have to change that phrasing of food as whole, real natural food is empowering. It doesn't have to be special. It doesn't have to have all these bells and whistles to it, it just has to be natural, whole, real, fresh food, because that is perfectly designed to give us everything we need. And we've gotta, we gotta phrase it in that way, and it's a top-down mentality.

We give a lot of respect to our doctors and I think that more so now that, and anytime I've been practicing, is that this idea of culinary medicine is taking hold from a top-down from our doctors through our nurses through our nurse practitioners. And that's one of the things that I really want to focus on, is that message all the way through the healthcare paradigm.

Audra: It's a huge paradigm shift, isn't it? And you see this day in and day out. You can see why it is overwhelming to parents because the standard American lifestyle from the advertising to what's the inside of the perimeter of that store to food access, things like food apartheid in our communities. You understand why it's overwhelming to families to have access to real whole foods.

If a parent could only make one Fierce Food change in their family’s diet this week, only one, what would you suggest? What would give them the most bang for their buck in this overwhelming, you know, paradigm shift, that moving from the standard American lifestyle into more of a Fierce Foods approach?

Lexi: I think literally of vegetables every time somebody asked me that question, because we have all of these huge epidemiological studies that show we get enough protein and we get a lot of different proteins, a big variety of them, but less than 10% of our population gets vegetables.

And so if we could change one single thing, it is to invite a new vegetable into your life this week, just one. And that's where it starts. And I think of you know conversations that I have with people where they might only have iceberg lettuce, and that's the only thing they have, and they might only have a carrot. And I try to get them excited about dark green leafy vegetables because dark green leafy vegetables have, gram for gram, have so much more to offer than anything there.

So I work with families a lot that have kids that really don't wanna try any new vegetables. So I try to come up with exciting ways to make it fun, you know, and that it involves, you know, things like a trip to the grocery store where it's Green Day, pick three things that are green and usually the grocers in the grocery store will get excited with you and let you take little samples of things and come home and try it. Try it raw, try it cooked. And so if there's one thing that we could try, it's a new dark green leafy vegetable this week. That would be my say so.

Justin: Oh, yeah, I just have a real quick, just a real quick thought here. So I'm a parent and I'm, let's just say, I'm a part of this mass of people who are only getting, what did you say 10% of their calories from vegetables. Going straight to dark leafy greens kind of scares me, like I'm feeling like oh man, I'm going to bring that home and no matter how I cook it I know there's going to be a backlash. So do you have some baby steps? Like if I'm not really having a ton of veggies from my family but I'm like on board to try more, what is a baby step vegetable that I can start to work with?

Lexi: I think of spinach. I think of spinach because it's such a mild taste and I love the ideas that you guys have incorporated into a lot of your messaging and that is the 50/50 Rule. So if you're, the only thing you've ever eaten is an iceberg lettuce salad, chop up a little spinach and throw that in and make it half and half, because that's an easy way where it's a mild taste, it's not a strong taste and you're still getting the usual taste that you like.

We, in formal words, when I work with my feeding therapist at work, we call it a bridging technique, so it takes something you know and like and use that to bridge into something that's new and different. You may not be a person that's going to go from an iceberg lettuce salad to steamed chard and kale greens, you know, with olive oil and garlic, and that would just be a humongous step. But if you can start little and small and make those little swaps out, that's something that's going to get you started along that road.

And it is a journey. It's not today I eat this way tomorrow I eat that way. It is, it is a lifelong journey. I know that where I am now is different from where I started and I still have different improvements that I need to make in my own diet. And so I'm, I feel like I'm always on a journey for it and that's it, that's a great question because you can do it with a salad. You can do it with like, broccoli. Broccoli is a pretty mild form. It's easy to steam and so most kids, if I ask them, they'll tell me that that is the only dark green leafy vegetable they like. 'Cause it is a little bit sweet. But some kids may not even like that, so again, using their favorite foods as bridging techniques, but also dips.

So if they, if they're into the you know cheese dip or they’re into barbecue sauce or something like that, that they could use some of these dips to help you know if there's normally get French fries for dinner, serve half the size of French fries and put a little broccoli on there and you know, incorporate that as a way... Start to shred a little bit of cauliflower and get that into the rice. That is another way to start making those changes slowly. With things that aren't going to shock the taste buds but get you there.

Audra: I love that, Lexi, I couldn't agree more. I think the baby steps really matter and when I look back on our journey as well, I mean, we started in a very like typical, typical family working full time, struggling to like come home, you know, put food on the table and even as somebody trained in culinary arts and having the experience I had, I didn't know anything about nutrition really and, and so.

I mean, we definitely struggled in changing our lifestyle and getting, getting our kids on board and I mean we're talking almost 10 years in it now and we are, it's still a daily practice. And when you brought up bridging that, that is the word that I thought when I started thinking about Justin's question was like just building this bridge. Like our daughter, she eats a little bit more typically than Max does. She has some more freedoms 'cause her needs are different and that's the way that we frame it. We all have different needs but give her a chance to eat an entire cucumber, an entire raw pepper like it's an apple, an entire flat of strawberries. She will totally do it.

Justin: Or a shallot.

Audra: Or a raw shallot. But last night we had a salad and she loves bell peppers, it had orange bell peppers on it and so she ate the orange, but I think she ate the salad 'cause the orange bell peppers. You know the shallot that was on it was like it was its own bridge because she will readily eat these things and when I'm cooking I try to have my setup, my mise en place of these things out. She'll be really hungry and come in and snack on the veggies that are sitting around, 'cause like, she's so hungry.

So that's one of the things too, is just like the 50/50 feed them when they're hungry. Provide that stuff out before dinner and be like, yeah, why don't you just take a snack on that? And, and you know, maybe dip that broccoli or don't be afraid to cook broccoli, like, cooked broccoli is amazing. You know, I know you hear a lot of myths going around like cooked broccoli is not as good as raw broccoli. What kid likes raw broccoli? You know?

Lexi: You know what? It all works. So like if they're having steamed broccoli, it's got nutrients to it that you know, are OK and way better than no broccoli at all.

Audra: At all, right, and no fiber at all, right? You know, like I'm completely sold on frozen vegetables now. Lexi, I'm down. Like we stock up with so many frozen vegetables now and it makes not only life easier, it's more economical and it's easy to add in and doctor ‘em up. I'm like all about it, like my parents were in the ‘80s. I'm right back there.

Lexi: Wholeheartedly agree, wholeheartedly, agree. There's so much technology out there with food these days. I mean, they have the ability to freeze fish right on a ship so that you are getting the freshest product even more fresh than if it was, you know, brought in after a couple days and sold at the fish market. Same thing with vegetables. They have the capacity right there at the farm to get you the most nutrient-dense product right away. So if we think about fresh sitting there for a couple of weeks on the shelf or frozen. Lock in that nutrient density into place. Let's do it absolutely.

Audra: Lexi, I wanna get into the systemic stuff again. Like let's step back over to help us understand why eating a healthy Fierce Foods diet or in that way is so hard to get into in today’s environment and I want to preface this by saying this, I hear in the conversation around, especially in the health food, space and the health and wellness space, that it is not hard to eat this, it is not hard to eat healthy.

You know, I hear a kind of like, a counter-narrative and I have a hard time with people saying that things aren't hard for people who they don't have their lived experience, they don't know. And I think, when I think of the standard American lifestyle, I think of the Fierce Foods approach and hold one up right next to the other and look at these.

I think how the odds are stacked against us with the overwhelmingly oppressive systemic aspects of the standard American lifestyle. So can you share some of your thoughts on that, on why it is, why it can be really, really hard to eat in a Fierce Foods manner today?

Lexi: Absolutely, absolutely. I think of, there was this one study that was done that said part of it is the, how much nutrient-poor food is available at every turn. Available in food deserts available when you go to Bed, Bath and Beyond, when you go to Target, when you go to the pharmacy. I mean right there at every check stand they have candy bars and just really nutrient-poor pretzels and chips and all these other things. And it's, it's cheap, cheap, cheap for these manufacturers to sell and they make a lot of money doing it.

But there's food scientists and food behavioralists at play that say if this person has to make a decision every time she goes up to a counter to buy something, to not buy that thing after four or five presentations she's going to say, oh just forget it. I'm just going to take that candy bar. And we actually use the reverse of that when we're talking to a child who is not accepting foods, 'cause we're saying it takes five or six times of trying before you get a kid to like something.

Audra: Oh yeah, so.

Lexi: Maybe even 15 times of trying something, And so the unbelievable availability of nutrient-poor foods is one of the biggest problems. And then we start thinking of it from political terms, we think about the lobbyists and we think about the subsidizations of the corn in the soy products, which are the cheapest, most nutrient-poor foods that we can put out there. And it is the basis of all of the junk food that's out there.

If you look at the food products that are coming home right now in the middle of COVID to all of our kids and read the ingredients label and it's sugar and corn and soy: first, second, and third ingredients in. And, and so that's what are, are, we’re eating and when we eat food our taste buds, especially as children, get used to the flavors that we give it. And then when you try to convert that over into something else, it's strong and it's different and you need to give it several times before you gain acceptance.

That's hard on budgets, especially for families that can't afford to be throwing food away, but it's also systemic, like you said, because it's food deserts. If you don't have a grocery store within 10 miles, and you don't have a car, and all you have is the 7-11 down on the corner, and there is no fresh food there, or there are some moldy apples sitting in a box. You know, what are you going to choose?

And it's the way we market food like I was saying before, if we put Tony the Tiger on a box of Frosted Flakes and make you think you're powerful and it's great or Flaming Hot Cheetos. This, this marketing effort that they have to have whole populations think that what they're putting in their bodies is going to make them strong and important. It's that marketing message, that lobbying message. It's that, that, that cheapness of nutrient-poor food.

The CEO of PepsiCo got up on one of the podcasts that I listen to. And somebody said, “Why do you keep putting high fructose corn syrup in your drinks when you know it has such a bad result in terms of health?” And he said, “How can I not? I'm being paid by the subsidization of these food products?” He said, “I can't answer to my board, my shareholders if I don't put this in my product.”

Audra: Wow.

Lexi: And, I mean, that's such a sad statement. And so I think all of these things converge to make it really, really difficult for our families to stand up against.

Audra: It feels overwhelming...

Lexi: It is overwhelming.

Audra: ...to be the mom or the dad who was going to say, you know, because you have it coming at you systemically, right? Access-wise, what you're being advertised to, what your kids are being advertised to like, think of that. Have you seen that Kraft Mac and Cheese commercial? I mean, it is just it, it makes me so mad, Lexi, because you got this mom who puts down broccoli on the table and the kids are like “Mrrrr... I'm so mad.” And then she comes through with the bowl of just mac and cheese, not half Mac and cheese and half broccoli, but it's just Mac and cheese and everybody's happy. And the tagline is for the win-win.

Lexi: So your mom's winning, kid’s winning, manufacturer’s winning.

Justin: They should serve the kid whiskey on the rocks too.

Audra: Dad’s winning too.

Justin: No, the kids!

Audra: Yeah, yeah. So you know that we've got those odds and then you actually do have kids sitting at the table. You've worked a long day. Do you really want to come home and put, put, work hard then to put food on the table that is only going to bring complaints and sadness? I think it feels oppressive, right?

And, and the thing that really strikes me from our personal experience, is it's a practice. It's a daily, daily practice. It is easier to do when they're young. I think it's something that we need to learn how to like help parents do from the time that kids are really young and then you just have to be relentless with it and always offering and I think it took us a good two years of offering Max broccoli almost every single day for him to get to the point of like “I love broccoli, I love it.” You know he would, he would grin and bear it. You know we, we bribe, we do all the things to like because just like you said, like if I could get them to have this like 10 times or maybe even 20 times, like maybe it'll become…

Justin: Let's go, let's go even more updated than that. Last night he ate the salad-

Audra: He ate the salad.

Justin: Without a word of complaint.

Audra: Ate the salad.

Justin: Years and years of putting salad…

Audra: Years of putting salad down and getting that complaint and all of that.

Justin: And I'll just say what happened last night was you made a salad, you didn't say anything about it, just was a part of the meal. Put it down and then he ate it. There was no issues about it and it was, it was done.

Lexi: Love it.  

Audra: Yeah.

Justin: That was years in the making.

Audra: Yeah, we're talking nine-and-a-half years in the making, you know. So how do we, I mean, that just feels enormous to me. I mean, it feels like climbing, you know, pushing water up a hill.

Justin: And I also want to recognize that there's a lot of families that wasting food or like having their kids not eat things is not like a financial option. I want to recognize that this is, you know that there's a certain amount of privilege that we have in, in having this trial and error…

Audra: And being able to practice. In fact, one of the reasons why we started MaxLove Project, one of the reasons why we're like, in this work, we’re like we have the privilege to experiment, we have, I have training. We have privilege to experiment with our resources. Let's help other families start 10 steps ahead of where we are.

You know, let's try. I mean, this is something that we can use our privilege for, and the same goes for The Family Thrive. Like we don't want families to have to struggle and waste food and all of that. So I think that comes back to our, our mission with The Family Thrive is that this is, this is a platform where we want to be able to help families accumulate those wins without the tremendous psychological burden, the sadness, the cost, the emotional pain, the cost, you know. How can we strategize around cost savings?

I think that's one thing that's really so powerful about things like our 50/50 approach, Lexi, is that I mean sneaking in cauliflower rice, half rice, half cauliflower rice, we have it in our Family Thrive E-Zine and, and folks are going to have access to that on the platform and more tips like that is a really, really easy way to sneak in fiber, vegetables. I don't have problems with sneaking stuff in, do you?

Lexi: Not at all. Not at all. I talk about it all the time. I talk about the fact with my kids present. I say your taste buds get used to the taste you give it. So if you only ever give it soda and Cheetos, it gets used to that. And so when you get a piece of broccoli, it's going to taste weird because that's what your taste buds are used to. But you could do this continuing on what you said, you know and your taste buds are gonna get there. I promise you type of thing.

And if you're talking to kids, you're talking about instant benefit. You're not going to say oh, it's going to help your heart 10 years down the road you're saying you're gonna have great skin. You're going to be strong, you're going to run down that soccer field. That's what they respond to. Whereas the parents are more like thinking 10 years down the road.

But I want to also piggyback on something you said a second ago, which was the benefit of that frozen food. If I get a couple heads of broccoli and it all goes waste, that's gonna bum me out. But if I've got cut up florets broccoli in a frozen container, I can bring out that half a cup every day and, and make it like that and spend $1.50 on two weeks worth of trials. So that, that frozen comes into play there as well.  

Justin: Great idea.

Audra: I think that's an amazing insight, Lexi. And these frozen foods are now widely available at Walmart, Sam's Club, Target. And other, I'm not sure about Food for Less, but I bet you can get cauliflower rice now frozen at Food for Less.

Lexi: I’m sure.

Audra: Something I'd like to bring up. It brings us into Justin's one of his favorite food topics of all time is food myths. Food myth-busting and one of those things is organic. This is, this is a very, very hot button I feel like, partially because I buy, me buying organic food is an identifier, you know, kind of as a mom of like I would have a hard time in, you know, among a group of friends being like I, I don't always buy organic food. I don't care, you know, I do care. I do want to lay it on the safe side.

I do think organic farming practices are, are good, but from MaxLove Project, our perspective has always been, start wherever you can and a whole food is better than a processed food regardless of the organic nature of it, right? So it's better to have a whole food that's not organic than a processed food.

Lexi: Absolutely. Environmental Working Group [puts] out a list every year of The Clean 15 in The Dirty Dozen. But if you have the money to spend on organic food, great. But if you don't, then you want to use these lists of, of where to budget, where to not budget. But if you don't have the budget to pay attention to it at all, hands down 100% what you said in terms of clean, unprocessed food is such a much better way to go.

And that leads back to our other decision that we were talking about how it's cheaper for a thing of Cheetos than it is for a head of broccoli, which is not people's fault, but buying that frozen bag of broccoli is hands down 1,000 times better, whether it's organic or not, then the bag of Flaming Hot Cheetos. And, and I'm not here to bash people's food choices and make them feel bad about it. I just, that's kind of like my life song, is nutrient-dense foods. You know what I mean, so that's where I'm going with it when I talk about the difference between Cheetos and broccoli.

Justin: There's also a pay now or pay later type of thing.

Audra: Yeah, that's really important. Really, really important.

Justin: You can look at these foods or these food choices as investments, right? Like I'm investing in my child absolutely resting in my health, and that we're going to see better lab results later on down the road, or you'll see fewer….

Audra: Fewer health care or lower health care costs issues, yeah? I mean, that's one thing that we looked at when Max was first diagnosed. I remember the food budget like radically changed we’re like OK this is a health care cost and this is a part of the process for us.

But for families who are focused on a super-strict and very limited food budget like so many American families, and especially now with unemployment in COVID, I think it's a really important and relevant topic. And Lexi, one thing that I wanted to just tap into here is there is a thought that if I, if I can't go all in and do all the things then it's not worth it even do anything. And our perspective is always been like, change a, change one thing or one meal a week even makes a huge difference. What are your thoughts on that?

Lexi: Absolutely accumulative effect. Just to illustrate a story, I had an 18-year-old kid come to me the other day, a guy, and he was told by his doctor that his growth plates closed and so there was no way he was going to grow any bigger and he said, “Why should I care about, you know, eating in a healthy way, it's not going to ever change the fact that I'm never going to be taller than 5’2” or whatever he was. He was bummed about it and I said, “Did you know that you have the greatest amount of bone growth between the ages of 18 and 24 and calcium and vitamin D and all of these different things that are going to make your bone growth different is gonna make a gigantic difference for you in 10 years?”

Justin: I mean, would you rather be a, a cut and ripped 5’2” or not right?

Lexi: Or a healthy one that's not going to colds and flu season has great skin that has great care and all of that. So that, that's just a story that illustrates for help to illustrate for him, you know that it made a difference, and so it always matters. Food always matters.

Audra: So how did that impact him, Lexi? How did that impact him to think about it that way?

Lexi: He actually verbalized that it did make sense to him to keep on trying to eat healthy, even though it didn't get his only objective, that there, he could broaden his ideas of the fact that there were other objectives out there that were worth fighting for that were worth making that effort, and that, that change for. Yeah.

Justin: So we talked about this institutional environment and you know the economics of this and then the taste and all these, all these different things, but there's the informational environment as well and I know so many parents who say, you know, like it doesn't matter because one day, coffee is good and one day, coffee is bad according to the scientist.

And not only that, you know on social media we’ll see the latest fad this or that, and so there's all these food myths, as Audra alluded to, circulating around, and we see a lot of these working with MaxLove Project, our childhood cancer nonprofit. So we'll have new parents come in and their child will have been recently diagnosed and they'll say “I'm doing so bad because we're trying to go vegan and cut out all meat. And we know that vegan is the healthiest.” But it’s like…  Oh, no. Actually, that's not the case. That is not what the science shows.

So could you pop a few food myths for us, the first one being that eating vegan is just far and away the healthiest choice hands down and we don't need to say any more about it.

Lexi: It, it is the most popular question I get, actually.

Audra: Oh wow. Really?

Lexi: That there, there's so many different diets out there and everybody wants an edge and they want a fix for whatever the thing is come up. And I've had vegans come to me, and all they eat is French fries. And they put alternative cheese dip on everything and they eat no vegetables at all. And I've had Paleo people come to me, and Modified Atkins people come to me and they are only eating pork rinds. And it's that's the only thing that they eat and they eat no vegetables at all and I think that any diet that's not well planned, well thought out has a variety to it, includes at least five servings of vegetables and fruit, is a diet that needs to be improved upon.

And so these labels don't help us. They don't—they make you feel as though you're achieving health because you are aspiring to a certain lifestyle. But if the diet is not well planned then… And it also makes it difficult if you put these restrictions on yourself to only be vegan, you run the risk of being deficient. As students, dietitian students, we’re taught that you really need to look out for calcium, vitamin D, zinc, riboflavin, and B12. You absolutely have to supplement with a non-plant-based source of B12 in order to get enough. And the same thing if you only restrict in other different areas, you have to get your nutrients from a different way.

But if we just make it simple and if we just do whole real fresh food, if we try to get in protein sources a couple times a day. If we try to aspire to that five servings of fruits and veggies a day, if we get some of those dark, gorgeous, beautiful colors in terms of the reds, the blues, the yellows, the greens, we are going to achieve incredible health without having to worry about it and counting numbers and all of those different things.

Justin: So meat won't kill us?

Lexi: Meat absolutely won't kill us. No.

Audra: This brings up a really great topic in terms of trying to, like really elucidate the Fierce Foods approach, Lexi, which is evidence-based, so I'd like to know. I mean from you and Justin there is nutrition science behind the Fierce Foods approach and that is a well-balanced approach that incorporates animal protein, tons of veggies, and fruits. So, so tell us why. Why, what are these nutritional building blocks that are really important too, for, in a general way for most people, for cellular health and beyond?

Lexi: If you think about carbohydrates, carbohydrates are there to provide your body with energy. But there are carbohydrates that are going to do that that are going to bring you so much more nutrient density, like fruits and vegetables. Fruits and anything that grows in the ground is a carbohydrate, so whether it's a fruit, vegetable, a grain, or sugar cane, those are all carbohydrates.

But if you look at that group and you look at, I want to get a fruit and a vegetable because it's going to give me so much more. All of these different vitamins and nutrients than sugar cane. If you think about protein, protein is there to make strong muscles, but it's also there to make parts of the immune system. If I'm looking at that protein group, how much do I need? Generally three servings about the size of your fist a day. If you think about fats, you're thinking about the fat that your brain is made up of 80% fat and that fat is the basis of all your hormones, which are the chemical messengers that communicate to all your body systems what you need to do.

We think about, in this country, that we have a problem where we eat too much corn oil which is omega-6 type fats rather than omega-3 type fat which is from grass-fed beef, from fish, from olive oil, and nuts and seeds, and those types of fats. If we pick the choice that's gonna give us that nutrient density, that Fierce Food aspect, we're going to leap miles ahead in terms of giving our body all the tools it needs to be as strong as we can.

Justin: OK, so food, food myth number two that we hear when parents come in fresh, fresh off the street and they'll say, “So I really need to get my child's body alkaline, right? So I need the alkaline diet and so can you tell me how to do the alkaline diet?” Can you bust that myth for us?

Lexi: The absolutely most important thing there to know is that we cannot change the pH of the blood by even millimeters because we absolutely have to keep the pH of the blood within two percentage points away from each other in order to sustain life. And your body has all kinds of buffer systems in play to make sure that the pH of your blood stays in this perfect range.

We can change the pH of the saliva in our mouth and we can change the pH of our urine by eating in a certain way. If people have an extreme disease, for example, if you had prostate cancer or if you had some kind of cancer of the bladder, you might want to tweak the urine a little bit in order to facilitate health and healing in that department, especially if you had radiation, but it's hard to do, number one: because there are so many buffer systems in the body.

If you ate the way we're talking about what the Fierce Foods philosophy is, you automatically are going to get the right pH in the saliva, which is going to, you know, make gingivitis not be an issue and in the urine which is going to be helpful for that particular instance that I just brought up. But as far as changing the blood pH is the only way you could do that is if you were, were in a serious disease state that caused it, you can't change it with your diet.

Justin: So just focus on Fierce Foods, yeah?

Audra: I mean yeah, Doctor Andrew Weil made the same exact point. You know, he said our bodies work so hard to balance that pH. That's not something that you want to try to mess with. Just eat whole foods.

Lexi: You can't change it, you can't change it, number one because you would die.

Audra: Yeah, so the confusion comes around Lexi, especially you might hear this in survivorship clinic with cancer patients, comes around a misunderstanding of the pH of the I guess the intracellular space in cancer cells that is uniquely more acidic, and so they're trying to change that because cancer cells thrive in the environment they thrive in.

But you can't change that anyway, and you can't change that with diet anyway. That being said, I think that a lot of people do feel better going on an alkaline diet because they end up eating Fierce Foods more often than not, they just end up eating, you know better whole foods from what they're eating before.

One thing I did read, I just wanted to add this because we will have listeners who are in this conversation with us. I did read a study, I think it was actually two studies, on the use of alkalinized water and disrupting the mouth biota, I think, and disrupting digestion. And so basically we're like really negatively affecting, 'cause you're affecting that pH in your mouth and then disrupting the biome in that and disrupting digestion. The same thing with digestion in your gut. So I feel like that's a little bit of a warning. Don't drink only alkalinize water or water that has sodium bicarbonate in it. You're just at that point, lowering the acidity in your gut, right? I mean, in your, in your stomach.

Lexi: I actually did a lot of research on this particular topic because my father has had prostate cancer and then he got radiation to the prostate and then he got interstitial cystitis, which is a problem that happens with the bladder where the walls of the bladder get too thin and problematic. And so I was told to help him do a little bit more of an alkaline diet in order to help this urine issue to help the other issue.

And I looked hard at alkaline water, and the problem is, is that the oxygen, H2O molecules from water combined with the O2 molecules from the air, and so as you are gulping the water with oxygen from the air, you're buffering it so your, your water is no longer alkaline.

So honestly, going back to what we were saying before, eating in a Fierce Foods way and eating dark green leafy vegetables is going to give that alkalinity to the mouth just as well as any alkalinize water is. And so all of the research data that I looked at, alkaline water did not hold up. I mean, there could be things that I don't know, obviously you know in, in regard to that, but maybe if you drink it through a straw and close your mouth, so there could be no oxygen in it. But there's oxygen in our body and so that automatically buffers that alkaline water and brings it to a neutral pH, so it's hard to get that all the way through to an inner, intracellular way that stays without oxygen. I mean, our, all of our cells burn oxygen in order to respirate. So I mean, I don't know how we could change that pH.

Audra: Yeah, Lexi, you know what it really, it really makes me think I was talking to someone we're actually going to have on this, with this podcast in the next few weeks about honoring how are our bodies have been created to heal and for balance. And like we are, we were not built faulty and I think biohacking this sort of sense of like OK I can tweak, tweak, tweak, tweak, tweak, you know to...think through corrective action in my body does it disservice and doesn't honor the fact that we're built for this balance. You know, I think honoring that inherent strength instead of looking us, looking at ourselves as being faulty and needing some sort of correction that we can think of, our bodies are built to do this.

Lexi: Yeah, yeah. When we get an insult such as a disease state, there are things we can do and we're finding out more all the time. The alkaline water one, as far as I know, is debunked, but things surprised me a lot. So when I did that research for my dad and they were saying don't do cranberry juice before bed basically. Because that would fill up the bladder with a more acidic substance, worsening his problem.

So I mean, I think you can make some little tweaks here and there that can exacerbate or help. Just like we're talking about with whole real food versus junk food. You know what I mean? You can, you can make a slight difference in some of those...but the body’s a beautiful thing. Like that pH buffer that comes in every day to keep the blood in that tight range, we're not going to affect.

Justin: Last myth that I wanted you to puncture here is the idea that I need to drink eight glasses of water a day and that is the healthiest thing that I can do.

Lexi: Everybody is an individual. Listen to your body without a doubt. As dietitians, we’re trained, we have this complicated mathematical algorithm that takes into account your age, your gender, your body weight, this and that, and we come up with a number, especially if you're in a coma in the ICU and we need to feed you through a vein. We come up with a number, but then we watch it over the next couple days, and we say, “Oh, you know, my mathematical number was not perfect, he didn't respond.”

Justin: As a regular person walking around? Do I need to measure out how much water I consume?

Lexi: This is my favorite thing. If you hold up your hand and you pinch your skin. If your skin stays up in a pinched form, you need more water. If it flattens out perfectly, you don't need as much. If you look at your pee and your pee in the toilet is like the color of pale lemonade, you're hydrated. If it's dark amber yellow, you need a little bit more water.

Audra: What if it’s clear?

Lexi: If it's cleared, you got a lot of water on board. You know what I mean?

Justin: So basically drink when you're thirsty?

Lexi: Drink when you're thirsty. There is, especially as you get older, some miscommunication between your hunger and your thirst signals in your body where you might get confused and think that you are hungry when you're actually thirsty. There is a documented, documented phenomenon.

So the same thing could be that, this is going to lead us all kind of into the rabbit trails here, but there's a great saying that when we have young children, the parents should decide what food goes on the table and when it is served. And the kid gets to decide if they're gonna eat it and how much. If we massively manipulate that, a child starts to have a problem recognizing their own satiety and hunger.

And so we do have that issue a little bit, so sometimes what you're talking about is, you know, recognizing when you're thirsty and not thirsty. Sometimes we don't recognize it as well as we should. And in those situations, we can use those you know, pinch the skin thing and look at the color of your urine to help us. If we have dry cracks on the sides of her mouth, we have dry, thin skin. That's also another good indication, but just because you need eight ounces eight times a day doesn't mean that I do, and maybe I get by with six or maybe I get by with 10 and so I can't make it quite as simple as that, but I think that we should always have fresh clean water available for somebody to drink.

And water is the best thing you can drink. I think if we could throw out all the soda, if we could throw out all the juice, you know milk is great, but at the same time, too much milk is not a good thing, type of thing and so if we could always have fresh clean water and, and get ourselves to like that 'cause so many of my kids come to me and say, “I don't like water, it just doesn't have enough taste. I'd rather have juice, I'd rather have soda.” It's like, well put a squeeze a lime, put it, squeeze the lemon, but water is your body needs it in its fresh form without all the sugar in it. You know what I mean?

Audra: Nothing more refreshing, it's so good.

Lexi: Sorry, I know I went off in ten different areas.

Audra: No, I love it. If water only had a commercial where it's being poured into an icy glass and the ice rocks are going around and like the dripping down like soda gets, right. If only we had...

Justin: I thought Stephen Curry had that.

Audra:  Oh did he? Cause the athlete, there was an athlete who you, I think admire, who said he would never sell soda, only sell water.

Justin: Steph Curry, I think.

Audra: Steph Curry.

Lexi: Steph Curry is my new hero. Yes, his wife is a big nutrition promoter too. I did not know that about him. 'Cause what's his name? LeBron? He always has that Sprite and it drives me crazy, 'cause that's what we need… And you know he doesn't drink it, you know? He's so...

Audra: You know he doesn't drink it.

Justin: Actually. Actually, his big thing is wine, like he…

Audra: Tell me more.

Justin: Yeah, he actually drinks a lot of wine.

Audra: LeBron does?

Lexi: Not before he's working out though.

Justin: No.

Audra: While he's working out does he have a nice Pinot?

Justin: Yeah, I don't know if he does anymore, 'cause as he gets older I just think there's no way you can drink that much. But he was like having wine after games and stuff, but…

Audra: What? OK, that's that's a...

Justin: Anyways.

Audra: So, Lexi I really do, I wanna follow this rabbit hole just a little bit further because you brought something up that I think would be the super relevant topic for The Family Thrive. So you brought up the fact that parents like, the rule of thumb is that you decide what to serve, when to serve it, put it on the table, kids get to decide how much of it they're going to eat, if they're going to eat it, and how much they're going to eat, right? Which is…

Lexi: It is a line attributed to Dr. Ellyn Satter. I should say that's not mine.

Audra: OK, really, I mean I think this is such an amazing topic because as a parent, and I know Justin has feelings around this too, from day one, my first concern with my babies is their feeding and it is so deeply ingrained. And we see it in the childhood cancer community, whether the biggest concerns that comes up is, is around feeding. And you know, as a mom, you get that innate and you know, as a mom, you know, having health issues related to food as well or affected by food, but that you get that innate like pain of like the baby, the child, the person needs to eat. I mean this is life-sustaining. It is one of the most important things possible.

So how do you balance your own? How do you walk yourself back as a parent in that situation when you want to control and you want to be like, join the “Clean Plate Club,” as my grandmother would say, you have to finish everything you have to before you get anything and you're not going to get anything else like what, how do you navigate this?

Lexi: We have and are born with, like you said, this physiology makeup that drives your need for hunger and thirst, so if that's allowed to manifest naturally, it will naturally be what it's supposed to be. You will naturally intake what you need to grow.

There are things that come along that knock you off your game. You know what I mean, that not kids off their game that you know? Maybe it's a chemotherapy or radiation that has driven down some of those hunger hormones, and so there's fixes for those but when you don't have something strong like that influencing the outcome, we don't always want to eat every time we sit down to eat. But we as adults, and as kids, if there's nothing else going on, you get what you need, and so if you sat down for breakfast and two eggs were on that plate and some blueberries were on that plate and you decided you didn't want to eat it all at that particular moment, if you did not eat anything else between now and the next time a meal was served, you’d probably have a little bit more hunger at the next time and you would be fine.

And I think you're absolutely right as a parent, especially when that kid, his first born. That's your most important basic biological need and you are bound and determined that you're going to fill it. You know what I mean? And so you're counting every ounce on that scale for that newborn baby, you're looking at the number of wet diapers you're monitoring that, and then you know you have your second child, your third child or child, and you're like, alright? They're gonna figure it out. They, they got this. You know what I mean?

But if they under, barring any other disease, you have a natural desire for food, and so you're going to meet it. So if you didn't make it at breakfast, then next meal’s at lunch, and we're going to lay out healthy foods, and you can choose whether or not you're going to eat it. If it goes days without eating, then there's a problem there that we need to identify what the cause is.

Audra: So, typical mom is listening to this and thinking we've got two young kids. I want to figure out how to develop a healthy relationship around food and help my kids develop this empowerment where they can navigate these things for themselves. It's almost like learning how to self-soothe and go to sleep on your own, right? Like it's an essential life skill. I want them to learn how to do this.

So you would say around day three or four they're not eating, go to your primary care or you know, figure it out. Try to see if it's, it's a virus or they have something else going on, 'cause I know a lot of parents would be like two meals into it and be like where's the mac and cheese?

Lexi: If it's, I, I would probably get concerned before three or four days. I probably get concerned about like day two. You know what I mean? But if you follow those presets, if you follow the idea that meals are scheduled, everybody sits down for the dinner table at breakfast, lunch, and dinner. And then there are two snacks in between is OK for a young child as well. Not that much necessary as you get older, but you know this is we're always going to have some form of protein.

We're always going to have some sort of fruit or vegetable at each one of those meals, and we're always going to have water available. And you let the kid take it from there. If by day two, they're not eating, then you're probably gonna wanna think something’s up with that. But a child's natural hunger drive is going to, it's going to take over.

Audra: And those hunger drives vary?

Lexi: Yes they do, and naturally yeah bring it too. Is that people are always shocked when I tell them a two-year-old serving size is a tablespoon and so they're thinking about it in terms of, you know, a serving size of protein for a two-year-old is two to three tablespoons at a time, but it's hard to translate that into your kid who's 10 or your husband, you know what I mean? When they're eating a cup and a half of protein or something like that.

Growth matters. You want to make sure that they're maintaining their growth curves on the food that they are on and you want to make sure that you provide good healthy food at a regular schedule that the kids can depend on and you want to make sure that you're letting their own hunger cues take play and they're not getting a bunch of junk in between because that leads back to our very beginning discussion in that you can eat a ton of nutrient-poor food and it will fill up space in your stomach and make you not hunger for good, healthy food. So if you're getting Cheez-Its and Goldfish and all the other junk that's out there to feed kids in between, you're gonna mess with the kids' hunger hormones so that when meal time comes, they're not hungry.

Audra: Yeah, so it sounds like the balance there too is when the kids like no, I'm listening to my body. I'm not hungry and I do not want that broccoli that you put down, 'cause I, so you put it down, respect it, that I don't want to eat it right now. And then they wanna head over and get the goldfish. That's not an option.

Lexi: No, we go back to that simple rule. Mom decides what goes on that table. Mom and Dad decide what goes on the table and kids get to decide if they want to eat it and how much. And so if, if you laid goldfish out there and they decide they want to eat all the goldfish, I mean that there in is the problem.

Audra: Yeah, right, right, right? OK, I think that's a really good topic, Lexi. Thank you for going down that rabbit hole with me.

We have an interesting question for you, for you next and this is going to be our last regular question. For you, what is the most interesting thing happening in the food product or nutrition science space today—and not like today-today—but currently, what in the, I guess, maybe like the nutrition science, innovation, or food product innovation space?

Lexi: I was thrilled, absolutely thrilled to see one of the most prominent researchers at Stanford step up and say that we have to, in this country, make healthy food sound sexy. And I thought, oh, that's awesome. That is really awesome.

And we demonstrated as a governing body that we could do it. We did it with tobacco and we did it with, we did a fantastic job. We stopped putting billboards next to schools. And we drastically reduced the number of cigarette smokers in this country with those marketing efforts. We have a problem in this country where we have made it OK, I think the last statistic I had, I heard was that something like 30% of our food stamps are spent on soda. We have the ability to change that. We can change it with legislation. I get arguments from my more conservative colleagues that you're taking away people's right to choose. Well, if we took away the ability to buy, I guess it is like a parent. You know in terms of that, you're providing whole real fresh food.

But I do believe that were damaging an entire segment of our population with higher rates of diabetes and everything else because it's not on the no-fly list. You know what I mean? And that we shouldn't be subsidizing Pepsi Cola to make a cheaper product. We shouldn't be subsidizing it with our food stamps or with our high fructose corn syrup that's basically free to use as an ingredient.

Audra: Absolutely. What if we were subsidizing whole foods, we were subsidizing you, know, health-supporting, promoting things…

Lexi: Exactly. I just read Obama’s, Michelle Obama's “Becoming,” her autobiography, and she talked about all the effort she made in the school food systems. I love what Jamie Oliver's done with the school foods and how many blocks they run into on a national level where a lot of their initiatives get watered down so much and changed and not the original intent.

That's something beautiful that I see is that we're getting more and more and more providers that are standing up for these changes that we so desperately need. Starting with that guy at Stanford. Starting with, you know, First Ladies, starting with these food activists, and we are, we are seeing grassroots of these things everywhere.

We have an initiative in California for food as medicine. The initial one started in Pennsylvania probably 10 years ago and it spawned one in just about every state. And so people are rallying to that cry that food is medicine, and we're getting more and more and more support, more support in the hospital. And it's a slow process. It's trickling down slow, but I see food as medicine as a, is a hugely growing for lack of a better word, wave of effort coming through.

Audra: So awesome to hear, Lexi.

Justin: Yeah that, yeah that, that does that does put a little spring in my step.

Lexi: Yeah, good.

Justin: Alright, so we have our weekly three questions that we ask every single guest on the podcast, and we're going to throw ‘em at you. So the first one is if you could put a big post-it note on every parent's fridge tomorrow morning. What would that post-it note say?

Lexi: You're worth it. Eat a veggie.

Justin: You're worth it, yeah.

Lexi: You’re worth it.

Audra: You know what's really great point about that too? Is that parents need that post-it note and need that too. And this is a rabbit hole for us to go down on a later basis, Lexi, but it's really hard to ask your kids to eat that green veggie when you won't.

Lexi: Oh my gosh, that is a whole fantastic, 'cause that's. I mean, every single thing we do, every single thing we do as a, as a young child is copied behavior. Everything, language, emotions, facial expressions, everything. What we eat is absolutely right up there.

Audra: So what is the last quote that changed the way you think or feel?

Lexi: I loved it. It was posted on my Facebook. I, there's a, help me with this name 'cause I always pronounce it wrong, but it's, I didn't know that I needed an umbrella because I didn't know I was all wet, and so it has to do with racism. It just, when I read that I was like especially—

Audra: From Dr. Ibram Kendi.

Lexi: Doctor, yeah yeah it is.

Audra: Yeah it's beautiful. He, he talked about it, up in a podcast with Brene Brown as well. I mean. Did you hear it? Did you hear that? Yeah, oh so powerful.

Lexi: I heard it on Brene Brown’s and then I went to go explore him further and got his book because I was like when I heard so many of the things that he raised. I did not and I can because I translate everything back to food. I think of that in terms of people. I, especially my diabetics that, 'cause they can go so long without having any idea what their blood sugar is. And then they know what their blood sugar is. And it motivates them like crazy to do the things they need to do to have a good relationship with food and everything. But if they kind of put their head in the sand and don't have any idea, they don't make a change, they don't have to, there's no incentive there. There's no reason to. And so when I heard that from Dr. Kendi, it was, it was really, really powerful for me.

Audra: Thank you for sharing that. OK, last one, what's your favorite thing about kids?

Lexi: My favorite thing about kids is the fact that they're so resilient and they're so hopeful they have so much hope. I think as adults we start to get sullied by running up against a brick wall a lot that we lose a little bit of faith in people or faith in a process. And kids don't have that. They have hope and they have resilience that is just magical, just magical.

Audra: Oh, I love that.

Justin: Hope and resilience. Let’s just plant that in our hearts as we move on today.

Audra: Thank you, Lexi. This was so beautiful and you know this is going to be recurring because I have a million things to talk with you about on here.

Justin: We’ll try to talk about that parent one.

Audra: I mean, we've got a lot of topics in with The Family Thrive that are going to be coming up on a regular basis as well. So this is just the first of many conversations.

Lexi: Woohoo! Alright, this was fun. I can't wait.

Audra: I can't wait to do it again.

Lexi: Well guys have a fantastic day. It was great to hang out with you.

Audra: You too, thank you so much, Lexi. We’ll be talking soon.

Lexi: Alright bye guys.

Audra: Bye.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.  

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Justin: To be honest, I haven't got along with every dietitian I've worked with. I've found some to be closer to rigid accountants rather than experts in love with food. Well, this is certainly not the case with our guest today, Lexi Hall, a registered dietitian whom we first met when she was working at Children's Hospital of Orange County.

She immediately struck us as the real deal, not only an expert in Clinical Nutrition but a real passionate defender of delicious food as medicine. Lexi describes herself as an integrative and functionally minded registered dietitian whose passions lie in treating food allergies and IBS IBD. She has witnessed how nutrition therapy has improved the lives of her own family, as well as patient-centered practice and this motivates her to share a food-centered health message with the world.

Lexi acquired her BS in Dietetics with a minor in Biology at Sacramento State University and served a year internship at UC Davis Medical Center. Following a move to Southern California, she was invited to put her skills to use in the Food Allergy Lipid in Cancer Survivorship clinics at Children's Hospital of Orange County, where we first met her. She developed and continues to lead the culinary medicine program at CHOC.

She also collaborates in private practice and co-founded a personal chef and dietitian services operating under the name of Kitchen Curative serving clients in South Orange County, Lexi holds an additional certification in Food Allergy Management and is pursuing her Integrative and Functional Nutrition Credentialed Practitioner certification expected in May of 2021. Last but not least, Lexi has served as the Culinary Medicine Dietitian for MaxLove Project and is the lead dietitian for The Family Thrive. Without further ado, here's our interview with Lexi Hall.

Lexi: So I just love this kind of atmosphere that we have today because that, it's such a collaborative thing and it's so approachable. I think when I'm sitting there with a patient at CHOC or in my private practice, I really want to be the type of person that people can reach out to, that people can, I think that I'm working with them and I'm on the same level of them versus me talking at them. And so I just love the atmosphere that you guys have provided today so that we can get that done.

Audra: Thank you so much, Lexi. This is going to be so fun and I wanted to tell our listeners a little bit about how we met and how we are fortunate to start working with you from my perspective, let's put it that way. So Lexi, we met, gosh was it four years ago now?

Lexi: Four years ago, yes.

Audra: It's crazy to think for me to think of that. When you were connected to us, through Children's Hospital of Orange County, through a burgeoning culinary medicine program, MaxLove project, had given a culinary medicine cart to Children's Hospital Orange County with a supplemental bit of funds for dietitians to start working on tailoring curriculum. And in that process, in the process of excitement, I think the dietitians who were originally assigned were, there was a lot going on clinically, and you were brought on board at the hospital to really take on the culinary medicine project as one of your many projects at Children's Hospital of Orange County. It ended up being one of three of your assignments there?

Lexi: Four or five, something like that.

Audra: So you, you wear many, many hats as a registered dietitian at Children's Hospital of Orange County. But we met through this, in this particular way. And Lexi, I have to say I was so inspired from meeting you the very first moment because not only are you a functional dietitian, somebody is like really, really looking at digging deeper and trying to understand how food can be used as medicine.

And this is all inspired by your experience as a mom, seeking support for your daughter. And of course, I identified with that innately, I feel like we're soul sisters. We were immediately connected. And then you're the kindest, most generous person. You are thrilled to be working on this because it's your life's passion. It's your passion project and that uplifts me every single time that I get to work with you or even talk with you. So would you be willing to tell us more about how you became a dietitian and got into healing through nutrition?

Lexi: Thank you for your kind words. That really touches me because I feel so much the same way that you do, about working with you because you have such a passion for food and you have such a passion for people, and that healing just comes into play.

When I think about where I started as a dietitian, I had always fervently believed in the magic of food, the magic of food to be able to sit people down in the same room over shared experiences and just be in community and love with each other. I remember as a kid we used to live next to our Hispanic neighbors and she would make these homemade tortillas. And I mean kids would come running. You could just smell it and it was amazing and she'd make this chorizo. And it was so special. And then in my own household with my mom whose, her parents were from Italy and how that revolves around food and how people are just so proud of making and gifting this gift of food to their families. It was magical to me.

But then I had a, my youngest daughter had some health issues, and seeing what the right food did for her health in a positive or a negative way just absolutely blew me away and made me... I was already enthralled with the magic of food and the magic of how it made me feel, but then to see how it could heal was another one that just knocked me off my chair and I was like I have to do this. This is, this is what I see myself doing.

And so I saw that in you as well. And you too, Justin, that, that both the science and the magic of it, I'm hooked. I mean, I can't imagine myself doing anything else, so. I took a class, one of my early classes in my dietetics program where the professor said as a dietitian, you can go in 30 different directions with this. And I see that so much with all of my colleagues. We have some dietitians that work nitty-gritty in the numbers in the ICU, and then we have some dietitians that work directly with food and every different level in between, and so it's great to be able to be a dietitian. You can work with absolutely whole real food.

Justin: So talking about, like the science and the magic, I think that's what we try to go for with this concept of Fierce Foods, right? Like we wanted to get this idea of food as, as this scientific chemical healing modality, so there's a lot of science behind it, but at the same time, food means so much more.

Food has had these emotional qualities, cultural qualities, social, like it means so much more than just like biochemical makeup, and so that's what we're going for with this idea of Fierce Foods. And so we developed Fierce Foods with you with MaxLove Project, but we're bringing this idea into The Family Thrive as well. So can you tell us a little bit about what Fierce Foods are? What does it mean?

Lexi: I liken it to something that we told my daughter way back in the beginning, which was, she was scared to death to get a vaccine and the vaccine was necessary. And so the doctor told her that the vaccine was just little ninjas coming into her bloodstream to do battle with the bad guys.

And she was like, “Oh yeah, well, I definitely want one of those.” You know what I mean? So I think about that with Fierce Foods. I think that, when we eat nutrient-dense foods that it comes into our body and does amazing magical superhero-type things. It does battle with the bad guys. It gives us all the nutrients that we need to be our strongest, our most powerful being.

That's what I think of, I think of, there's a simple term that's a called Aggregate Nutrient Density Index and I think it's a scoring system where it scores food on a number scale and so it gives like a nutrient-poor thing like an Oreo or a cookie like a number three. But it gives a kale or a collard green or Brussels sprouts in the 900s, and so if you think if I had a fistful of that or a fistful of the other, what's going to go in there and do battle for me when I need it, make me powerful and strong? That's what I think of in terms of Fierce Foods.

Audra: You know, Lexi, and it occurs to me hearing you talk about this, that, that this approach to food or understanding food in this way as being empowering, not just like neutral needed to sustain life, but empowering to the body and beyond, is something that we're really learning, aren't we? I think back to my parents' generation, back to when we were growing up, this didn't occur to us. I really think the connection between food and health and well-being were not there really. It was just food as sustenance.

Thinking about that ties in with an experience that I remember you telling me about with your daughter's GI doctor, and... OK, you're seeing a GI doctor, and to me it seems so natural that with gastrointestinal you would be, you know, thinking about food, but these clinicians were not trained to consider food in that way, and so it was not a part of the process. Were you just shocked when you were told, it’s like really not of consequence, that food doesn't matter?

Lexi: I was. I was frothing at the mouth to see this lady. She was a dermatologist. She was a GI specialist. She was Stanford-trained. She had a pedigree that was a mile long and I had to wait four months to see her and I walked into her office with a, you know, file folder full. I couldn't wait to see her and get her opinion and I got like 30 seconds of what I was trying to say out of my mouth and she actually held up her hand and said, “Stop. This is where you stop, mom and this is where I take over” and without saying anything else she wrote me seven different prescriptions. And I was so sad with that whole experience.

But I also think about something that you just said made me think about how we market food and how we change the interpretation of food. I mean, back when my parents were just starting out, the marketing was, is that eating this frozen TV dinner is going to give you power. It's going to give you, you don't have to spend hours in the kitchen. You can just throw this in the microwave and there you go. And the way we market food, the way we identified with food was that it was there for us to use as a tool, but not in the ways we're thinking now.

You know, that's one of our biggest challenges is the way we have to change that phrasing of food as whole, real natural food is empowering. It doesn't have to be special. It doesn't have to have all these bells and whistles to it, it just has to be natural, whole, real, fresh food, because that is perfectly designed to give us everything we need. And we've gotta, we gotta phrase it in that way, and it's a top-down mentality.

We give a lot of respect to our doctors and I think that more so now that, and anytime I've been practicing, is that this idea of culinary medicine is taking hold from a top-down from our doctors through our nurses through our nurse practitioners. And that's one of the things that I really want to focus on, is that message all the way through the healthcare paradigm.

Audra: It's a huge paradigm shift, isn't it? And you see this day in and day out. You can see why it is overwhelming to parents because the standard American lifestyle from the advertising to what's the inside of the perimeter of that store to food access, things like food apartheid in our communities. You understand why it's overwhelming to families to have access to real whole foods.

If a parent could only make one Fierce Food change in their family’s diet this week, only one, what would you suggest? What would give them the most bang for their buck in this overwhelming, you know, paradigm shift, that moving from the standard American lifestyle into more of a Fierce Foods approach?

Lexi: I think literally of vegetables every time somebody asked me that question, because we have all of these huge epidemiological studies that show we get enough protein and we get a lot of different proteins, a big variety of them, but less than 10% of our population gets vegetables.

And so if we could change one single thing, it is to invite a new vegetable into your life this week, just one. And that's where it starts. And I think of you know conversations that I have with people where they might only have iceberg lettuce, and that's the only thing they have, and they might only have a carrot. And I try to get them excited about dark green leafy vegetables because dark green leafy vegetables have, gram for gram, have so much more to offer than anything there.

So I work with families a lot that have kids that really don't wanna try any new vegetables. So I try to come up with exciting ways to make it fun, you know, and that it involves, you know, things like a trip to the grocery store where it's Green Day, pick three things that are green and usually the grocers in the grocery store will get excited with you and let you take little samples of things and come home and try it. Try it raw, try it cooked. And so if there's one thing that we could try, it's a new dark green leafy vegetable this week. That would be my say so.

Justin: Oh, yeah, I just have a real quick, just a real quick thought here. So I'm a parent and I'm, let's just say, I'm a part of this mass of people who are only getting, what did you say 10% of their calories from vegetables. Going straight to dark leafy greens kind of scares me, like I'm feeling like oh man, I'm going to bring that home and no matter how I cook it I know there's going to be a backlash. So do you have some baby steps? Like if I'm not really having a ton of veggies from my family but I'm like on board to try more, what is a baby step vegetable that I can start to work with?

Lexi: I think of spinach. I think of spinach because it's such a mild taste and I love the ideas that you guys have incorporated into a lot of your messaging and that is the 50/50 Rule. So if you're, the only thing you've ever eaten is an iceberg lettuce salad, chop up a little spinach and throw that in and make it half and half, because that's an easy way where it's a mild taste, it's not a strong taste and you're still getting the usual taste that you like.

We, in formal words, when I work with my feeding therapist at work, we call it a bridging technique, so it takes something you know and like and use that to bridge into something that's new and different. You may not be a person that's going to go from an iceberg lettuce salad to steamed chard and kale greens, you know, with olive oil and garlic, and that would just be a humongous step. But if you can start little and small and make those little swaps out, that's something that's going to get you started along that road.

And it is a journey. It's not today I eat this way tomorrow I eat that way. It is, it is a lifelong journey. I know that where I am now is different from where I started and I still have different improvements that I need to make in my own diet. And so I'm, I feel like I'm always on a journey for it and that's it, that's a great question because you can do it with a salad. You can do it with like, broccoli. Broccoli is a pretty mild form. It's easy to steam and so most kids, if I ask them, they'll tell me that that is the only dark green leafy vegetable they like. 'Cause it is a little bit sweet. But some kids may not even like that, so again, using their favorite foods as bridging techniques, but also dips.

So if they, if they're into the you know cheese dip or they’re into barbecue sauce or something like that, that they could use some of these dips to help you know if there's normally get French fries for dinner, serve half the size of French fries and put a little broccoli on there and you know, incorporate that as a way... Start to shred a little bit of cauliflower and get that into the rice. That is another way to start making those changes slowly. With things that aren't going to shock the taste buds but get you there.

Audra: I love that, Lexi, I couldn't agree more. I think the baby steps really matter and when I look back on our journey as well, I mean, we started in a very like typical, typical family working full time, struggling to like come home, you know, put food on the table and even as somebody trained in culinary arts and having the experience I had, I didn't know anything about nutrition really and, and so.

I mean, we definitely struggled in changing our lifestyle and getting, getting our kids on board and I mean we're talking almost 10 years in it now and we are, it's still a daily practice. And when you brought up bridging that, that is the word that I thought when I started thinking about Justin's question was like just building this bridge. Like our daughter, she eats a little bit more typically than Max does. She has some more freedoms 'cause her needs are different and that's the way that we frame it. We all have different needs but give her a chance to eat an entire cucumber, an entire raw pepper like it's an apple, an entire flat of strawberries. She will totally do it.

Justin: Or a shallot.

Audra: Or a raw shallot. But last night we had a salad and she loves bell peppers, it had orange bell peppers on it and so she ate the orange, but I think she ate the salad 'cause the orange bell peppers. You know the shallot that was on it was like it was its own bridge because she will readily eat these things and when I'm cooking I try to have my setup, my mise en place of these things out. She'll be really hungry and come in and snack on the veggies that are sitting around, 'cause like, she's so hungry.

So that's one of the things too, is just like the 50/50 feed them when they're hungry. Provide that stuff out before dinner and be like, yeah, why don't you just take a snack on that? And, and you know, maybe dip that broccoli or don't be afraid to cook broccoli, like, cooked broccoli is amazing. You know, I know you hear a lot of myths going around like cooked broccoli is not as good as raw broccoli. What kid likes raw broccoli? You know?

Lexi: You know what? It all works. So like if they're having steamed broccoli, it's got nutrients to it that you know, are OK and way better than no broccoli at all.

Audra: At all, right, and no fiber at all, right? You know, like I'm completely sold on frozen vegetables now. Lexi, I'm down. Like we stock up with so many frozen vegetables now and it makes not only life easier, it's more economical and it's easy to add in and doctor ‘em up. I'm like all about it, like my parents were in the ‘80s. I'm right back there.

Lexi: Wholeheartedly agree, wholeheartedly, agree. There's so much technology out there with food these days. I mean, they have the ability to freeze fish right on a ship so that you are getting the freshest product even more fresh than if it was, you know, brought in after a couple days and sold at the fish market. Same thing with vegetables. They have the capacity right there at the farm to get you the most nutrient-dense product right away. So if we think about fresh sitting there for a couple of weeks on the shelf or frozen. Lock in that nutrient density into place. Let's do it absolutely.

Audra: Lexi, I wanna get into the systemic stuff again. Like let's step back over to help us understand why eating a healthy Fierce Foods diet or in that way is so hard to get into in today’s environment and I want to preface this by saying this, I hear in the conversation around, especially in the health food, space and the health and wellness space, that it is not hard to eat this, it is not hard to eat healthy.

You know, I hear a kind of like, a counter-narrative and I have a hard time with people saying that things aren't hard for people who they don't have their lived experience, they don't know. And I think, when I think of the standard American lifestyle, I think of the Fierce Foods approach and hold one up right next to the other and look at these.

I think how the odds are stacked against us with the overwhelmingly oppressive systemic aspects of the standard American lifestyle. So can you share some of your thoughts on that, on why it is, why it can be really, really hard to eat in a Fierce Foods manner today?

Lexi: Absolutely, absolutely. I think of, there was this one study that was done that said part of it is the, how much nutrient-poor food is available at every turn. Available in food deserts available when you go to Bed, Bath and Beyond, when you go to Target, when you go to the pharmacy. I mean right there at every check stand they have candy bars and just really nutrient-poor pretzels and chips and all these other things. And it's, it's cheap, cheap, cheap for these manufacturers to sell and they make a lot of money doing it.

But there's food scientists and food behavioralists at play that say if this person has to make a decision every time she goes up to a counter to buy something, to not buy that thing after four or five presentations she's going to say, oh just forget it. I'm just going to take that candy bar. And we actually use the reverse of that when we're talking to a child who is not accepting foods, 'cause we're saying it takes five or six times of trying before you get a kid to like something.

Audra: Oh yeah, so.

Lexi: Maybe even 15 times of trying something, And so the unbelievable availability of nutrient-poor foods is one of the biggest problems. And then we start thinking of it from political terms, we think about the lobbyists and we think about the subsidizations of the corn in the soy products, which are the cheapest, most nutrient-poor foods that we can put out there. And it is the basis of all of the junk food that's out there.

If you look at the food products that are coming home right now in the middle of COVID to all of our kids and read the ingredients label and it's sugar and corn and soy: first, second, and third ingredients in. And, and so that's what are, are, we’re eating and when we eat food our taste buds, especially as children, get used to the flavors that we give it. And then when you try to convert that over into something else, it's strong and it's different and you need to give it several times before you gain acceptance.

That's hard on budgets, especially for families that can't afford to be throwing food away, but it's also systemic, like you said, because it's food deserts. If you don't have a grocery store within 10 miles, and you don't have a car, and all you have is the 7-11 down on the corner, and there is no fresh food there, or there are some moldy apples sitting in a box. You know, what are you going to choose?

And it's the way we market food like I was saying before, if we put Tony the Tiger on a box of Frosted Flakes and make you think you're powerful and it's great or Flaming Hot Cheetos. This, this marketing effort that they have to have whole populations think that what they're putting in their bodies is going to make them strong and important. It's that marketing message, that lobbying message. It's that, that, that cheapness of nutrient-poor food.

The CEO of PepsiCo got up on one of the podcasts that I listen to. And somebody said, “Why do you keep putting high fructose corn syrup in your drinks when you know it has such a bad result in terms of health?” And he said, “How can I not? I'm being paid by the subsidization of these food products?” He said, “I can't answer to my board, my shareholders if I don't put this in my product.”

Audra: Wow.

Lexi: And, I mean, that's such a sad statement. And so I think all of these things converge to make it really, really difficult for our families to stand up against.

Audra: It feels overwhelming...

Lexi: It is overwhelming.

Audra: ...to be the mom or the dad who was going to say, you know, because you have it coming at you systemically, right? Access-wise, what you're being advertised to, what your kids are being advertised to like, think of that. Have you seen that Kraft Mac and Cheese commercial? I mean, it is just it, it makes me so mad, Lexi, because you got this mom who puts down broccoli on the table and the kids are like “Mrrrr... I'm so mad.” And then she comes through with the bowl of just mac and cheese, not half Mac and cheese and half broccoli, but it's just Mac and cheese and everybody's happy. And the tagline is for the win-win.

Lexi: So your mom's winning, kid’s winning, manufacturer’s winning.

Justin: They should serve the kid whiskey on the rocks too.

Audra: Dad’s winning too.

Justin: No, the kids!

Audra: Yeah, yeah. So you know that we've got those odds and then you actually do have kids sitting at the table. You've worked a long day. Do you really want to come home and put, put, work hard then to put food on the table that is only going to bring complaints and sadness? I think it feels oppressive, right?

And, and the thing that really strikes me from our personal experience, is it's a practice. It's a daily, daily practice. It is easier to do when they're young. I think it's something that we need to learn how to like help parents do from the time that kids are really young and then you just have to be relentless with it and always offering and I think it took us a good two years of offering Max broccoli almost every single day for him to get to the point of like “I love broccoli, I love it.” You know he would, he would grin and bear it. You know we, we bribe, we do all the things to like because just like you said, like if I could get them to have this like 10 times or maybe even 20 times, like maybe it'll become…

Justin: Let's go, let's go even more updated than that. Last night he ate the salad-

Audra: He ate the salad.

Justin: Without a word of complaint.

Audra: Ate the salad.

Justin: Years and years of putting salad…

Audra: Years of putting salad down and getting that complaint and all of that.

Justin: And I'll just say what happened last night was you made a salad, you didn't say anything about it, just was a part of the meal. Put it down and then he ate it. There was no issues about it and it was, it was done.

Lexi: Love it.  

Audra: Yeah.

Justin: That was years in the making.

Audra: Yeah, we're talking nine-and-a-half years in the making, you know. So how do we, I mean, that just feels enormous to me. I mean, it feels like climbing, you know, pushing water up a hill.

Justin: And I also want to recognize that there's a lot of families that wasting food or like having their kids not eat things is not like a financial option. I want to recognize that this is, you know that there's a certain amount of privilege that we have in, in having this trial and error…

Audra: And being able to practice. In fact, one of the reasons why we started MaxLove Project, one of the reasons why we're like, in this work, we’re like we have the privilege to experiment, we have, I have training. We have privilege to experiment with our resources. Let's help other families start 10 steps ahead of where we are.

You know, let's try. I mean, this is something that we can use our privilege for, and the same goes for The Family Thrive. Like we don't want families to have to struggle and waste food and all of that. So I think that comes back to our, our mission with The Family Thrive is that this is, this is a platform where we want to be able to help families accumulate those wins without the tremendous psychological burden, the sadness, the cost, the emotional pain, the cost, you know. How can we strategize around cost savings?

I think that's one thing that's really so powerful about things like our 50/50 approach, Lexi, is that I mean sneaking in cauliflower rice, half rice, half cauliflower rice, we have it in our Family Thrive E-Zine and, and folks are going to have access to that on the platform and more tips like that is a really, really easy way to sneak in fiber, vegetables. I don't have problems with sneaking stuff in, do you?

Lexi: Not at all. Not at all. I talk about it all the time. I talk about the fact with my kids present. I say your taste buds get used to the taste you give it. So if you only ever give it soda and Cheetos, it gets used to that. And so when you get a piece of broccoli, it's going to taste weird because that's what your taste buds are used to. But you could do this continuing on what you said, you know and your taste buds are gonna get there. I promise you type of thing.

And if you're talking to kids, you're talking about instant benefit. You're not going to say oh, it's going to help your heart 10 years down the road you're saying you're gonna have great skin. You're going to be strong, you're going to run down that soccer field. That's what they respond to. Whereas the parents are more like thinking 10 years down the road.

But I want to also piggyback on something you said a second ago, which was the benefit of that frozen food. If I get a couple heads of broccoli and it all goes waste, that's gonna bum me out. But if I've got cut up florets broccoli in a frozen container, I can bring out that half a cup every day and, and make it like that and spend $1.50 on two weeks worth of trials. So that, that frozen comes into play there as well.  

Justin: Great idea.

Audra: I think that's an amazing insight, Lexi. And these frozen foods are now widely available at Walmart, Sam's Club, Target. And other, I'm not sure about Food for Less, but I bet you can get cauliflower rice now frozen at Food for Less.

Lexi: I’m sure.

Audra: Something I'd like to bring up. It brings us into Justin's one of his favorite food topics of all time is food myths. Food myth-busting and one of those things is organic. This is, this is a very, very hot button I feel like, partially because I buy, me buying organic food is an identifier, you know, kind of as a mom of like I would have a hard time in, you know, among a group of friends being like I, I don't always buy organic food. I don't care, you know, I do care. I do want to lay it on the safe side.

I do think organic farming practices are, are good, but from MaxLove Project, our perspective has always been, start wherever you can and a whole food is better than a processed food regardless of the organic nature of it, right? So it's better to have a whole food that's not organic than a processed food.

Lexi: Absolutely. Environmental Working Group [puts] out a list every year of The Clean 15 in The Dirty Dozen. But if you have the money to spend on organic food, great. But if you don't, then you want to use these lists of, of where to budget, where to not budget. But if you don't have the budget to pay attention to it at all, hands down 100% what you said in terms of clean, unprocessed food is such a much better way to go.

And that leads back to our other decision that we were talking about how it's cheaper for a thing of Cheetos than it is for a head of broccoli, which is not people's fault, but buying that frozen bag of broccoli is hands down 1,000 times better, whether it's organic or not, then the bag of Flaming Hot Cheetos. And, and I'm not here to bash people's food choices and make them feel bad about it. I just, that's kind of like my life song, is nutrient-dense foods. You know what I mean, so that's where I'm going with it when I talk about the difference between Cheetos and broccoli.

Justin: There's also a pay now or pay later type of thing.

Audra: Yeah, that's really important. Really, really important.

Justin: You can look at these foods or these food choices as investments, right? Like I'm investing in my child absolutely resting in my health, and that we're going to see better lab results later on down the road, or you'll see fewer….

Audra: Fewer health care or lower health care costs issues, yeah? I mean, that's one thing that we looked at when Max was first diagnosed. I remember the food budget like radically changed we’re like OK this is a health care cost and this is a part of the process for us.

But for families who are focused on a super-strict and very limited food budget like so many American families, and especially now with unemployment in COVID, I think it's a really important and relevant topic. And Lexi, one thing that I wanted to just tap into here is there is a thought that if I, if I can't go all in and do all the things then it's not worth it even do anything. And our perspective is always been like, change a, change one thing or one meal a week even makes a huge difference. What are your thoughts on that?

Lexi: Absolutely accumulative effect. Just to illustrate a story, I had an 18-year-old kid come to me the other day, a guy, and he was told by his doctor that his growth plates closed and so there was no way he was going to grow any bigger and he said, “Why should I care about, you know, eating in a healthy way, it's not going to ever change the fact that I'm never going to be taller than 5’2” or whatever he was. He was bummed about it and I said, “Did you know that you have the greatest amount of bone growth between the ages of 18 and 24 and calcium and vitamin D and all of these different things that are going to make your bone growth different is gonna make a gigantic difference for you in 10 years?”

Justin: I mean, would you rather be a, a cut and ripped 5’2” or not right?

Lexi: Or a healthy one that's not going to colds and flu season has great skin that has great care and all of that. So that, that's just a story that illustrates for help to illustrate for him, you know that it made a difference, and so it always matters. Food always matters.

Audra: So how did that impact him, Lexi? How did that impact him to think about it that way?

Lexi: He actually verbalized that it did make sense to him to keep on trying to eat healthy, even though it didn't get his only objective, that there, he could broaden his ideas of the fact that there were other objectives out there that were worth fighting for that were worth making that effort, and that, that change for. Yeah.

Justin: So we talked about this institutional environment and you know the economics of this and then the taste and all these, all these different things, but there's the informational environment as well and I know so many parents who say, you know, like it doesn't matter because one day, coffee is good and one day, coffee is bad according to the scientist.

And not only that, you know on social media we’ll see the latest fad this or that, and so there's all these food myths, as Audra alluded to, circulating around, and we see a lot of these working with MaxLove Project, our childhood cancer nonprofit. So we'll have new parents come in and their child will have been recently diagnosed and they'll say “I'm doing so bad because we're trying to go vegan and cut out all meat. And we know that vegan is the healthiest.” But it’s like…  Oh, no. Actually, that's not the case. That is not what the science shows.

So could you pop a few food myths for us, the first one being that eating vegan is just far and away the healthiest choice hands down and we don't need to say any more about it.

Lexi: It, it is the most popular question I get, actually.

Audra: Oh wow. Really?

Lexi: That there, there's so many different diets out there and everybody wants an edge and they want a fix for whatever the thing is come up. And I've had vegans come to me, and all they eat is French fries. And they put alternative cheese dip on everything and they eat no vegetables at all. And I've had Paleo people come to me, and Modified Atkins people come to me and they are only eating pork rinds. And it's that's the only thing that they eat and they eat no vegetables at all and I think that any diet that's not well planned, well thought out has a variety to it, includes at least five servings of vegetables and fruit, is a diet that needs to be improved upon.

And so these labels don't help us. They don't—they make you feel as though you're achieving health because you are aspiring to a certain lifestyle. But if the diet is not well planned then… And it also makes it difficult if you put these restrictions on yourself to only be vegan, you run the risk of being deficient. As students, dietitian students, we’re taught that you really need to look out for calcium, vitamin D, zinc, riboflavin, and B12. You absolutely have to supplement with a non-plant-based source of B12 in order to get enough. And the same thing if you only restrict in other different areas, you have to get your nutrients from a different way.

But if we just make it simple and if we just do whole real fresh food, if we try to get in protein sources a couple times a day. If we try to aspire to that five servings of fruits and veggies a day, if we get some of those dark, gorgeous, beautiful colors in terms of the reds, the blues, the yellows, the greens, we are going to achieve incredible health without having to worry about it and counting numbers and all of those different things.

Justin: So meat won't kill us?

Lexi: Meat absolutely won't kill us. No.

Audra: This brings up a really great topic in terms of trying to, like really elucidate the Fierce Foods approach, Lexi, which is evidence-based, so I'd like to know. I mean from you and Justin there is nutrition science behind the Fierce Foods approach and that is a well-balanced approach that incorporates animal protein, tons of veggies, and fruits. So, so tell us why. Why, what are these nutritional building blocks that are really important too, for, in a general way for most people, for cellular health and beyond?

Lexi: If you think about carbohydrates, carbohydrates are there to provide your body with energy. But there are carbohydrates that are going to do that that are going to bring you so much more nutrient density, like fruits and vegetables. Fruits and anything that grows in the ground is a carbohydrate, so whether it's a fruit, vegetable, a grain, or sugar cane, those are all carbohydrates.

But if you look at that group and you look at, I want to get a fruit and a vegetable because it's going to give me so much more. All of these different vitamins and nutrients than sugar cane. If you think about protein, protein is there to make strong muscles, but it's also there to make parts of the immune system. If I'm looking at that protein group, how much do I need? Generally three servings about the size of your fist a day. If you think about fats, you're thinking about the fat that your brain is made up of 80% fat and that fat is the basis of all your hormones, which are the chemical messengers that communicate to all your body systems what you need to do.

We think about, in this country, that we have a problem where we eat too much corn oil which is omega-6 type fats rather than omega-3 type fat which is from grass-fed beef, from fish, from olive oil, and nuts and seeds, and those types of fats. If we pick the choice that's gonna give us that nutrient density, that Fierce Food aspect, we're going to leap miles ahead in terms of giving our body all the tools it needs to be as strong as we can.

Justin: OK, so food, food myth number two that we hear when parents come in fresh, fresh off the street and they'll say, “So I really need to get my child's body alkaline, right? So I need the alkaline diet and so can you tell me how to do the alkaline diet?” Can you bust that myth for us?

Lexi: The absolutely most important thing there to know is that we cannot change the pH of the blood by even millimeters because we absolutely have to keep the pH of the blood within two percentage points away from each other in order to sustain life. And your body has all kinds of buffer systems in play to make sure that the pH of your blood stays in this perfect range.

We can change the pH of the saliva in our mouth and we can change the pH of our urine by eating in a certain way. If people have an extreme disease, for example, if you had prostate cancer or if you had some kind of cancer of the bladder, you might want to tweak the urine a little bit in order to facilitate health and healing in that department, especially if you had radiation, but it's hard to do, number one: because there are so many buffer systems in the body.

If you ate the way we're talking about what the Fierce Foods philosophy is, you automatically are going to get the right pH in the saliva, which is going to, you know, make gingivitis not be an issue and in the urine which is going to be helpful for that particular instance that I just brought up. But as far as changing the blood pH is the only way you could do that is if you were, were in a serious disease state that caused it, you can't change it with your diet.

Justin: So just focus on Fierce Foods, yeah?

Audra: I mean yeah, Doctor Andrew Weil made the same exact point. You know, he said our bodies work so hard to balance that pH. That's not something that you want to try to mess with. Just eat whole foods.

Lexi: You can't change it, you can't change it, number one because you would die.

Audra: Yeah, so the confusion comes around Lexi, especially you might hear this in survivorship clinic with cancer patients, comes around a misunderstanding of the pH of the I guess the intracellular space in cancer cells that is uniquely more acidic, and so they're trying to change that because cancer cells thrive in the environment they thrive in.

But you can't change that anyway, and you can't change that with diet anyway. That being said, I think that a lot of people do feel better going on an alkaline diet because they end up eating Fierce Foods more often than not, they just end up eating, you know better whole foods from what they're eating before.

One thing I did read, I just wanted to add this because we will have listeners who are in this conversation with us. I did read a study, I think it was actually two studies, on the use of alkalinized water and disrupting the mouth biota, I think, and disrupting digestion. And so basically we're like really negatively affecting, 'cause you're affecting that pH in your mouth and then disrupting the biome in that and disrupting digestion. The same thing with digestion in your gut. So I feel like that's a little bit of a warning. Don't drink only alkalinize water or water that has sodium bicarbonate in it. You're just at that point, lowering the acidity in your gut, right? I mean, in your, in your stomach.

Lexi: I actually did a lot of research on this particular topic because my father has had prostate cancer and then he got radiation to the prostate and then he got interstitial cystitis, which is a problem that happens with the bladder where the walls of the bladder get too thin and problematic. And so I was told to help him do a little bit more of an alkaline diet in order to help this urine issue to help the other issue.

And I looked hard at alkaline water, and the problem is, is that the oxygen, H2O molecules from water combined with the O2 molecules from the air, and so as you are gulping the water with oxygen from the air, you're buffering it so your, your water is no longer alkaline.

So honestly, going back to what we were saying before, eating in a Fierce Foods way and eating dark green leafy vegetables is going to give that alkalinity to the mouth just as well as any alkalinize water is. And so all of the research data that I looked at, alkaline water did not hold up. I mean, there could be things that I don't know, obviously you know in, in regard to that, but maybe if you drink it through a straw and close your mouth, so there could be no oxygen in it. But there's oxygen in our body and so that automatically buffers that alkaline water and brings it to a neutral pH, so it's hard to get that all the way through to an inner, intracellular way that stays without oxygen. I mean, our, all of our cells burn oxygen in order to respirate. So I mean, I don't know how we could change that pH.

Audra: Yeah, Lexi, you know what it really, it really makes me think I was talking to someone we're actually going to have on this, with this podcast in the next few weeks about honoring how are our bodies have been created to heal and for balance. And like we are, we were not built faulty and I think biohacking this sort of sense of like OK I can tweak, tweak, tweak, tweak, tweak, you know to...think through corrective action in my body does it disservice and doesn't honor the fact that we're built for this balance. You know, I think honoring that inherent strength instead of looking us, looking at ourselves as being faulty and needing some sort of correction that we can think of, our bodies are built to do this.

Lexi: Yeah, yeah. When we get an insult such as a disease state, there are things we can do and we're finding out more all the time. The alkaline water one, as far as I know, is debunked, but things surprised me a lot. So when I did that research for my dad and they were saying don't do cranberry juice before bed basically. Because that would fill up the bladder with a more acidic substance, worsening his problem.

So I mean, I think you can make some little tweaks here and there that can exacerbate or help. Just like we're talking about with whole real food versus junk food. You know what I mean? You can, you can make a slight difference in some of those...but the body’s a beautiful thing. Like that pH buffer that comes in every day to keep the blood in that tight range, we're not going to affect.

Justin: Last myth that I wanted you to puncture here is the idea that I need to drink eight glasses of water a day and that is the healthiest thing that I can do.

Lexi: Everybody is an individual. Listen to your body without a doubt. As dietitians, we’re trained, we have this complicated mathematical algorithm that takes into account your age, your gender, your body weight, this and that, and we come up with a number, especially if you're in a coma in the ICU and we need to feed you through a vein. We come up with a number, but then we watch it over the next couple days, and we say, “Oh, you know, my mathematical number was not perfect, he didn't respond.”

Justin: As a regular person walking around? Do I need to measure out how much water I consume?

Lexi: This is my favorite thing. If you hold up your hand and you pinch your skin. If your skin stays up in a pinched form, you need more water. If it flattens out perfectly, you don't need as much. If you look at your pee and your pee in the toilet is like the color of pale lemonade, you're hydrated. If it's dark amber yellow, you need a little bit more water.

Audra: What if it’s clear?

Lexi: If it's cleared, you got a lot of water on board. You know what I mean?

Justin: So basically drink when you're thirsty?

Lexi: Drink when you're thirsty. There is, especially as you get older, some miscommunication between your hunger and your thirst signals in your body where you might get confused and think that you are hungry when you're actually thirsty. There is a documented, documented phenomenon.

So the same thing could be that, this is going to lead us all kind of into the rabbit trails here, but there's a great saying that when we have young children, the parents should decide what food goes on the table and when it is served. And the kid gets to decide if they're gonna eat it and how much. If we massively manipulate that, a child starts to have a problem recognizing their own satiety and hunger.

And so we do have that issue a little bit, so sometimes what you're talking about is, you know, recognizing when you're thirsty and not thirsty. Sometimes we don't recognize it as well as we should. And in those situations, we can use those you know, pinch the skin thing and look at the color of your urine to help us. If we have dry cracks on the sides of her mouth, we have dry, thin skin. That's also another good indication, but just because you need eight ounces eight times a day doesn't mean that I do, and maybe I get by with six or maybe I get by with 10 and so I can't make it quite as simple as that, but I think that we should always have fresh clean water available for somebody to drink.

And water is the best thing you can drink. I think if we could throw out all the soda, if we could throw out all the juice, you know milk is great, but at the same time, too much milk is not a good thing, type of thing and so if we could always have fresh clean water and, and get ourselves to like that 'cause so many of my kids come to me and say, “I don't like water, it just doesn't have enough taste. I'd rather have juice, I'd rather have soda.” It's like, well put a squeeze a lime, put it, squeeze the lemon, but water is your body needs it in its fresh form without all the sugar in it. You know what I mean?

Audra: Nothing more refreshing, it's so good.

Lexi: Sorry, I know I went off in ten different areas.

Audra: No, I love it. If water only had a commercial where it's being poured into an icy glass and the ice rocks are going around and like the dripping down like soda gets, right. If only we had...

Justin: I thought Stephen Curry had that.

Audra:  Oh did he? Cause the athlete, there was an athlete who you, I think admire, who said he would never sell soda, only sell water.

Justin: Steph Curry, I think.

Audra: Steph Curry.

Lexi: Steph Curry is my new hero. Yes, his wife is a big nutrition promoter too. I did not know that about him. 'Cause what's his name? LeBron? He always has that Sprite and it drives me crazy, 'cause that's what we need… And you know he doesn't drink it, you know? He's so...

Audra: You know he doesn't drink it.

Justin: Actually. Actually, his big thing is wine, like he…

Audra: Tell me more.

Justin: Yeah, he actually drinks a lot of wine.

Audra: LeBron does?

Lexi: Not before he's working out though.

Justin: No.

Audra: While he's working out does he have a nice Pinot?

Justin: Yeah, I don't know if he does anymore, 'cause as he gets older I just think there's no way you can drink that much. But he was like having wine after games and stuff, but…

Audra: What? OK, that's that's a...

Justin: Anyways.

Audra: So, Lexi I really do, I wanna follow this rabbit hole just a little bit further because you brought something up that I think would be the super relevant topic for The Family Thrive. So you brought up the fact that parents like, the rule of thumb is that you decide what to serve, when to serve it, put it on the table, kids get to decide how much of it they're going to eat, if they're going to eat it, and how much they're going to eat, right? Which is…

Lexi: It is a line attributed to Dr. Ellyn Satter. I should say that's not mine.

Audra: OK, really, I mean I think this is such an amazing topic because as a parent, and I know Justin has feelings around this too, from day one, my first concern with my babies is their feeding and it is so deeply ingrained. And we see it in the childhood cancer community, whether the biggest concerns that comes up is, is around feeding. And you know, as a mom, you get that innate and you know, as a mom, you know, having health issues related to food as well or affected by food, but that you get that innate like pain of like the baby, the child, the person needs to eat. I mean this is life-sustaining. It is one of the most important things possible.

So how do you balance your own? How do you walk yourself back as a parent in that situation when you want to control and you want to be like, join the “Clean Plate Club,” as my grandmother would say, you have to finish everything you have to before you get anything and you're not going to get anything else like what, how do you navigate this?

Lexi: We have and are born with, like you said, this physiology makeup that drives your need for hunger and thirst, so if that's allowed to manifest naturally, it will naturally be what it's supposed to be. You will naturally intake what you need to grow.

There are things that come along that knock you off your game. You know what I mean, that not kids off their game that you know? Maybe it's a chemotherapy or radiation that has driven down some of those hunger hormones, and so there's fixes for those but when you don't have something strong like that influencing the outcome, we don't always want to eat every time we sit down to eat. But we as adults, and as kids, if there's nothing else going on, you get what you need, and so if you sat down for breakfast and two eggs were on that plate and some blueberries were on that plate and you decided you didn't want to eat it all at that particular moment, if you did not eat anything else between now and the next time a meal was served, you’d probably have a little bit more hunger at the next time and you would be fine.

And I think you're absolutely right as a parent, especially when that kid, his first born. That's your most important basic biological need and you are bound and determined that you're going to fill it. You know what I mean? And so you're counting every ounce on that scale for that newborn baby, you're looking at the number of wet diapers you're monitoring that, and then you know you have your second child, your third child or child, and you're like, alright? They're gonna figure it out. They, they got this. You know what I mean?

But if they under, barring any other disease, you have a natural desire for food, and so you're going to meet it. So if you didn't make it at breakfast, then next meal’s at lunch, and we're going to lay out healthy foods, and you can choose whether or not you're going to eat it. If it goes days without eating, then there's a problem there that we need to identify what the cause is.

Audra: So, typical mom is listening to this and thinking we've got two young kids. I want to figure out how to develop a healthy relationship around food and help my kids develop this empowerment where they can navigate these things for themselves. It's almost like learning how to self-soothe and go to sleep on your own, right? Like it's an essential life skill. I want them to learn how to do this.

So you would say around day three or four they're not eating, go to your primary care or you know, figure it out. Try to see if it's, it's a virus or they have something else going on, 'cause I know a lot of parents would be like two meals into it and be like where's the mac and cheese?

Lexi: If it's, I, I would probably get concerned before three or four days. I probably get concerned about like day two. You know what I mean? But if you follow those presets, if you follow the idea that meals are scheduled, everybody sits down for the dinner table at breakfast, lunch, and dinner. And then there are two snacks in between is OK for a young child as well. Not that much necessary as you get older, but you know this is we're always going to have some form of protein.

We're always going to have some sort of fruit or vegetable at each one of those meals, and we're always going to have water available. And you let the kid take it from there. If by day two, they're not eating, then you're probably gonna wanna think something’s up with that. But a child's natural hunger drive is going to, it's going to take over.

Audra: And those hunger drives vary?

Lexi: Yes they do, and naturally yeah bring it too. Is that people are always shocked when I tell them a two-year-old serving size is a tablespoon and so they're thinking about it in terms of, you know, a serving size of protein for a two-year-old is two to three tablespoons at a time, but it's hard to translate that into your kid who's 10 or your husband, you know what I mean? When they're eating a cup and a half of protein or something like that.

Growth matters. You want to make sure that they're maintaining their growth curves on the food that they are on and you want to make sure that you provide good healthy food at a regular schedule that the kids can depend on and you want to make sure that you're letting their own hunger cues take play and they're not getting a bunch of junk in between because that leads back to our very beginning discussion in that you can eat a ton of nutrient-poor food and it will fill up space in your stomach and make you not hunger for good, healthy food. So if you're getting Cheez-Its and Goldfish and all the other junk that's out there to feed kids in between, you're gonna mess with the kids' hunger hormones so that when meal time comes, they're not hungry.

Audra: Yeah, so it sounds like the balance there too is when the kids like no, I'm listening to my body. I'm not hungry and I do not want that broccoli that you put down, 'cause I, so you put it down, respect it, that I don't want to eat it right now. And then they wanna head over and get the goldfish. That's not an option.

Lexi: No, we go back to that simple rule. Mom decides what goes on that table. Mom and Dad decide what goes on the table and kids get to decide if they want to eat it and how much. And so if, if you laid goldfish out there and they decide they want to eat all the goldfish, I mean that there in is the problem.

Audra: Yeah, right, right, right? OK, I think that's a really good topic, Lexi. Thank you for going down that rabbit hole with me.

We have an interesting question for you, for you next and this is going to be our last regular question. For you, what is the most interesting thing happening in the food product or nutrition science space today—and not like today-today—but currently, what in the, I guess, maybe like the nutrition science, innovation, or food product innovation space?

Lexi: I was thrilled, absolutely thrilled to see one of the most prominent researchers at Stanford step up and say that we have to, in this country, make healthy food sound sexy. And I thought, oh, that's awesome. That is really awesome.

And we demonstrated as a governing body that we could do it. We did it with tobacco and we did it with, we did a fantastic job. We stopped putting billboards next to schools. And we drastically reduced the number of cigarette smokers in this country with those marketing efforts. We have a problem in this country where we have made it OK, I think the last statistic I had, I heard was that something like 30% of our food stamps are spent on soda. We have the ability to change that. We can change it with legislation. I get arguments from my more conservative colleagues that you're taking away people's right to choose. Well, if we took away the ability to buy, I guess it is like a parent. You know in terms of that, you're providing whole real fresh food.

But I do believe that were damaging an entire segment of our population with higher rates of diabetes and everything else because it's not on the no-fly list. You know what I mean? And that we shouldn't be subsidizing Pepsi Cola to make a cheaper product. We shouldn't be subsidizing it with our food stamps or with our high fructose corn syrup that's basically free to use as an ingredient.

Audra: Absolutely. What if we were subsidizing whole foods, we were subsidizing you, know, health-supporting, promoting things…

Lexi: Exactly. I just read Obama’s, Michelle Obama's “Becoming,” her autobiography, and she talked about all the effort she made in the school food systems. I love what Jamie Oliver's done with the school foods and how many blocks they run into on a national level where a lot of their initiatives get watered down so much and changed and not the original intent.

That's something beautiful that I see is that we're getting more and more and more providers that are standing up for these changes that we so desperately need. Starting with that guy at Stanford. Starting with, you know, First Ladies, starting with these food activists, and we are, we are seeing grassroots of these things everywhere.

We have an initiative in California for food as medicine. The initial one started in Pennsylvania probably 10 years ago and it spawned one in just about every state. And so people are rallying to that cry that food is medicine, and we're getting more and more and more support, more support in the hospital. And it's a slow process. It's trickling down slow, but I see food as medicine as a, is a hugely growing for lack of a better word, wave of effort coming through.

Audra: So awesome to hear, Lexi.

Justin: Yeah that, yeah that, that does that does put a little spring in my step.

Lexi: Yeah, good.

Justin: Alright, so we have our weekly three questions that we ask every single guest on the podcast, and we're going to throw ‘em at you. So the first one is if you could put a big post-it note on every parent's fridge tomorrow morning. What would that post-it note say?

Lexi: You're worth it. Eat a veggie.

Justin: You're worth it, yeah.

Lexi: You’re worth it.

Audra: You know what's really great point about that too? Is that parents need that post-it note and need that too. And this is a rabbit hole for us to go down on a later basis, Lexi, but it's really hard to ask your kids to eat that green veggie when you won't.

Lexi: Oh my gosh, that is a whole fantastic, 'cause that's. I mean, every single thing we do, every single thing we do as a, as a young child is copied behavior. Everything, language, emotions, facial expressions, everything. What we eat is absolutely right up there.

Audra: So what is the last quote that changed the way you think or feel?

Lexi: I loved it. It was posted on my Facebook. I, there's a, help me with this name 'cause I always pronounce it wrong, but it's, I didn't know that I needed an umbrella because I didn't know I was all wet, and so it has to do with racism. It just, when I read that I was like especially—

Audra: From Dr. Ibram Kendi.

Lexi: Doctor, yeah yeah it is.

Audra: Yeah it's beautiful. He, he talked about it, up in a podcast with Brene Brown as well. I mean. Did you hear it? Did you hear that? Yeah, oh so powerful.

Lexi: I heard it on Brene Brown’s and then I went to go explore him further and got his book because I was like when I heard so many of the things that he raised. I did not and I can because I translate everything back to food. I think of that in terms of people. I, especially my diabetics that, 'cause they can go so long without having any idea what their blood sugar is. And then they know what their blood sugar is. And it motivates them like crazy to do the things they need to do to have a good relationship with food and everything. But if they kind of put their head in the sand and don't have any idea, they don't make a change, they don't have to, there's no incentive there. There's no reason to. And so when I heard that from Dr. Kendi, it was, it was really, really powerful for me.

Audra: Thank you for sharing that. OK, last one, what's your favorite thing about kids?

Lexi: My favorite thing about kids is the fact that they're so resilient and they're so hopeful they have so much hope. I think as adults we start to get sullied by running up against a brick wall a lot that we lose a little bit of faith in people or faith in a process. And kids don't have that. They have hope and they have resilience that is just magical, just magical.

Audra: Oh, I love that.

Justin: Hope and resilience. Let’s just plant that in our hearts as we move on today.

Audra: Thank you, Lexi. This was so beautiful and you know this is going to be recurring because I have a million things to talk with you about on here.

Justin: We’ll try to talk about that parent one.

Audra: I mean, we've got a lot of topics in with The Family Thrive that are going to be coming up on a regular basis as well. So this is just the first of many conversations.

Lexi: Woohoo! Alright, this was fun. I can't wait.

Audra: I can't wait to do it again.

Lexi: Well guys have a fantastic day. It was great to hang out with you.

Audra: You too, thank you so much, Lexi. We’ll be talking soon.

Lexi: Alright bye guys.

Audra: Bye.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends, and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.  

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