How To Painlessly Pass A Primary Care Dietary Screening with Flying Colors...

 

Every year when I go in for my annual primary care visit – they give me the 2-item test for fruit and vegetable consumption.  It asks for an estimate of how many servings of fruit and vegetable are consumed every day. I can’t recall the break points my health plan uses but the scale runs from zero servings per day up to ≥ 5.  If you research these screenings, some studies will use half measures (like 2.5 servings if consumption varies between 2 or 3).  Other studies will get very specific about what constitutes a serving.  That can vary from “one small apple” to “one cup of apples” to “a baseball sized portion.”.  My goal with this post is to illustrate how you can pass this screen by eating one complicated but easy to make salad a day.  I will also illustrate how to record recipes easily using a system invented by an engineer.

I have to add the usual disclaimers that I am not advising you to make and eat this salad like I do – only showing what is possible for educational purposes. If you are a vegetarian for example, I expect that you would easily exceed the upper end of the scale.  There are two additional advantages to the salad I eat almost every day – first it is designed to be palatable for people like me who generally do not like the taste of vegetables.  Second, it minimizes spoilage. The only ingredient susceptible is tri-color slaw and carrots and they are usually consumed by the expiration date on the bag.  The other ingredients are either frozen (berries) or have a long shelf life (apples). 

I stopped trying to use lettuce of any type because it often spoiled before the expiration date.  The paternal side of the family were cabbage (and potato) eaters from central Europe.  It took me a while to figure out why – but then it dawned on me – they could preserve barrels of cabbage as sauerkraut and not need any refrigeration.  Cabbage also has endogenous antioxidants and that is also probably why it lasts longer than lettuce.   Sauerkraut also fundamentally changes the state of cabbage, leading me to think that many of these relatives may have had the same aversion to vegetables that I do.  As an example, I remember my father eating overcooked boiled potatoes as his main vegetable staple while the rest of us were supposed to be eating a broader selection.

There is a taste receptor specific and non-specific genetic component to taste and it has been studied for both vegetables and food-linking or food fussiness.  Cabbage makes the list in several categories.

 

Gene / variant	What it detects	Functional effect	Consequence for vegetables / diet
TAS2R38 — PAV ("taster")	Glucosinolates/isothiocyanates in Brassica (broccoli, sprouts, cabbage, kale); PROP/PTC	High bitter sensitivity; more PAV mRNA expressed in taste cells correlates with stronger perceived bitterness	Greater bitterness → vegetable avoidance; may shift toward sweeter/fattier foods; "tasters" decreased vegetable intake under minimal dietary counseling
TAS2R38 — AVI ("non-taster")	Same compounds	Low/absent bitter perception	Less aversion; largest increases in vegetable intake with intervention
TAS2R38 — heterozygote (PAV/AVI)	Same compounds	Intermediate sensitivity, widest perceptual range	Variable acceptance; intermediate vegetable intake response
TAS2R16	Bitter β-glucosides (broad glycoside ligands)	Two-faced binding pocket giving high specificity across diverse glycosides	Modulates perception of bitter plant glycosides, contributing to bitter-food preference
TAS2R19	Bitter glycosides (e.g., in grapefruit, other plant foods)	Clusters genetically with bitter-food liking traits	Associated with liking of bitter vegetables/foods
Multiple TAS2R loci (GWAS)	Various bitter compounds	Polygenic influence on bitter-taste pathways	Collectively shape bitter-food preferences and metabolic/sensory pathways
Food-fussiness / food-liking heritability	Not receptor-specific	~50% heritable; genetic correlation ~−0.65 between fussiness and vegetable liking	Some children genetically predisposed to reject vegetables independent of a single gene
1:  A Review of the Associations Between Single Nucleotide Polymorphisms in Taste Receptors, Eating Behaviors, and Health. Critical Reviews in Food Science and Nutrition. 2018. https://pubmed.ncbi.nlm.nih.gov/27247080 2:  Bitter Taste of Brassica Vegetables: The Role of Genetic Factors, Receptors, Isothiocyanates, Glucosinolates, and Flavor Context. Critical Reviews in Food Science and Nutrition. 2017. https://pubmed.ncbi.nlm.nih.gov/28718657   3:  Human Bitter Perception Correlates With Bitter Receptor Messenger RNA Expression in Taste Cells.        The American Journal of Clinical Nutrition. 2013. https://pubmed.ncbi.nlm.nih.gov/24025627 4:  TAS2R38 Predisposition to Bitter Taste Associated With Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3. 2018. https://pubmed.ncbi.nlm.nih.gov/29686110 5:  A Review of the Associations Between Single Nucleotide Polymorphisms in Taste Receptors, Eating Behaviors, and Health. Critical Reviews in Food Science and Nutrition. 2018. https://pubmed.ncbi.nlm.nih.gov/27247080 6:  Human Bitter Perception Correlates With Bitter Receptor Messenger RNA Expression in Taste Cells. The American Journal of Clinical Nutrition. 2013. https://pubmed.ncbi.nlm.nih.gov/24025627 7:  TAS2R38 Predisposition to Bitter Taste Associated With Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3. 2018. https://pubmed.ncbi.nlm.nih.gov/29686110 8:  Human Bitter Perception Correlates With Bitter Receptor Messenger RNA Expression in Taste Cells. The American Journal of Clinical Nutrition. 2013. https://pubmed.ncbi.nlm.nih.gov/24025627 9:  TAS2R38 Predisposition to Bitter Taste Associated With Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3. 2018. https://pubmed.ncbi.nlm.nih.gov/29686110 10: The Bitter Taste Receptor TAS2R16 Achieves High Specificity and Accommodates Diverse Glycoside Ligands by using a Two-faced Binding Pocket. Scientific Reports. 2017. https://doi.org/10.1038/s41598-017-07256-y 11: Genome-Wide Association Analyses of Bitter Food Preferences Link Genetic Loci to Sensory and Metabolic Pathways. The Journal of Nutrition. 2026. https://pubmed.ncbi.nlm.nih.gov/42632617 12: A biologically informed framework for instrument selection in dietary Mendelian randomization using chemosensory genetics. BMC Medicine. 2026. https://doi.org/10.1186/s12916-026-04966-x 13: Genome-Wide Association Analyses of Bitter Food Preferences Link Genetic Loci to Sensory and Metabolic Pathways. The Journal of Nutrition. 2026. https://pubmed.ncbi.nlm.nih.gov/42632617 14:  A biologically informed framework for instrument selection in dietary Mendelian randomization using chemosensory genetics. BMC Medicine. 2026. https://doi.org/10.1186/s12916-026-04966-x 15:  Common Genetic Architecture Underlying Young Children's Food Fussiness and Liking for Vegetables and Fruit. The American Journal of Clinical Nutrition. 2016. https://pubmed.ncbi.nlm.nih.gov/26864359 16:  Large-scale GWAS of food liking reveals genetic determinants and genetic correlations with distinct neurophysiological traits. Nature Communications. 2022. https://doi.org/10.1038/s41467-022-30187-w

   

The implications of the above table seem fairly clear.  If you are one of these folks who prefers fats and sugars to vegetables it seems logical that disguising that taste would make these foods more palatable.  Salt, pepper, sugar and other condiments are commonly used as well as butter.  Just a few years ago, I had my first salad with blueberries and that was an eye opener.  I typically use salad dressing to disguise the vegetable taste, but blueberries worked very well.  That is one of the driving forces for the salad I will reveal below.

The other driving force is also genetics.  Several years ago, I learned that I have a risk genotype for pancreatic cancer as well as being in the 100^th percentile for polygenic risk for amyotrophic lateral sclerosis (ALS).  I would like to try to avoid both of those illnesses if possible.  How and whether or not either of those genotypes get expressed is still a research question.  The answer can only be approximated by epidemiological studies and the results are conflicting.  In terms of exercise, it probably reduces cancer risk but the ALS risk is an open question.  Contact sports and in some cases high exertion athletics can increase risk.  In other cases, non-contact exercise at any level does not seem to have an impact.  Dietary effects on cancer and cardiovascular are more well known and the source of recommendations for non-processed fruits and vegetables.  In terms of ALS – higher premorbid intake of fat, trans fat, and cholesterol were higher is a group who developed ALS. Fruit and vegetable intakes reduce the risk by 34%.  In a Mendelian randomization study (genotype based) oily fish, fresh fruit, coffee intake reduced the risk.  There is no definitive prevention path suggested by the studies done so far only the recommendation for larger intervention-based studies.  With current genotyping methods those studies can be done on a pool of subjects with concentrated ALS risk.

At any rate, general dietary guidelines suggest that fruits and vegetables are a critical component of the diet with certain other common components (high added sugar, high saturated fat, trans fat, cholesterol, alcohol) - red flagged.   The dietary landscape has been more confused than ever over the past 2 years based on political misinformation. Against that backdrop I present my personal solution (again not a recommendation to you or medical advice) that allows me to both pass my primary care physician’s fruit and vegetable screening and reassure myself that I can ingest a palatable meal that is probably good for my health.  The salad is also designed to be cost effective since one of the main concerns with fresh produce is how long it will last before it is discarded.

The blueberry salad that started all of this was mixed salad greens, blueberries, and a vinaigrette dressing.  I have not had much luck with mixed greens or even lettuce in my refrigerator.  They generally deteriorate well before the best by date and rapidly discolor.  I decided to substitute mixed slaw (red cabbage, green cabbage, carrots).  Apples last longer and I decided to add that to the mix.   The recipe is presented in graphic form below.  As you can see this is a combination of 3 vegetables and 4 fruits for a total of 7 per day – all in one bowl. 

 

 

That is my salad that I eat most days of the week. The cumulative number of fruits and vegetables at the end of the year is impressive and any spoilage is minimal.  A summary of the possible nutritional benefits is listed in the table below.   

Ingredient	Antioxidant capacity	Flavonoids	Dietary fiber	Characteristic phytochemicals
Blackberry	Very high (among highest cellular antioxidant activity of common fruits)	Rich in anthocyanins; flavonols (quercetin)	High (berries ~5–8 g/cup)	Anthocyanins, ellagitannins, hydroxycinnamic acids
Raspberry	Very high; anthocyanin-rich fruits show highest TEAC/FRAP/ORAC	Anthocyanins; quercetin	~8.0 g per cup	Anthocyanins (cyanidin), ellagitannins
Blueberry	Very high cellular antioxidant activity	Anthocyanins; notable seasonal variation in flavonoid content	High (berries)	Anthocyanins (delphinidin, malvidin, petunidin), chlorogenic acid
Red cabbage	Highest among cabbages/vegetables; highest TEAC of the vegetables tested	Highest cabbage flavonoid content (~108 mg catechin eq/100 g); cyanidin predominates	Moderate (cabbage, fermentable)	Anthocyanins (cyanidin), glucosinolates, kaempferol, quercetin
Yellow/green cabbage	Lower than red cabbage but still notable (flavonol-rich)	Kaempferol, quercetin, apigenin predominate (lower total than red)	Moderate (fermentable)	Glucosinolates/isothiocyanates, flavonols
Carrot	Lower than berries/red cabbage	Low flavonol content	~2.8 g/100 g (skin); 4.8 g/cup cooked	Carotenoids (β-carotene), galactose-rich pectin
Apple (with skin)	Lower (hydroxycinnamate-rich fruits lowest antioxidant activity), but a major dietary phenolic contributor	Lowest flavonol content among fruits tested (~460 mg/kg dry); quercetin concentrated in skin	~2.4 g/100 g; 4.4 g per medium apple	Chlorogenic acid, quercetin glycosides, procyanidins
1:  Cellular Antioxidant Activity of Common Fruits. Journal of Agricultural and Food Chemistry. 2008. https://pubmed.ncbi.nlm.nih.gov/187594502:  2:  Synergistic, Additive, and Antagonistic Effects of Food Mixtures on Total Antioxidant Capacities. Journal of Agricultural and Food Chemistry. 2011. https://pubmed.ncbi.nlm.nih.gov/21222468 3:  Flavonoid Content of U.S. Fruits, Vegetables, and Nuts. Journal of Agricultural and Food Chemistry. 2006. https://pubmed.ncbi.nlm.nih.gov/17177529 4:  Flavonoid Content of U.S. Fruits, Vegetables, and Nuts. Journal of Agricultural and Food Chemistry. 2006. https://pubmed.ncbi.nlm.nih.gov/17177529 5:  The Antioxidant Activity of Regularly Consumed Fruit and Vegetables Reflects Their Phenolic and Vitamin C Composition. Free Radical Research. 2002. https://pubmed.ncbi.nlm.nih.gov/11999391 6:  Chronic Constipation in Adults. American Family Physician. 2022. https://www.aafp.org/afp/2022/0900/chronic-constipation-adults 7:  Cellular Antioxidant Activity of Common Fruits. Journal of Agricultural and Food Chemistry. 2008. https://pubmed.ncbi.nlm.nih.gov/18759450 8:  Flavonoid Content of U.S. Fruits, Vegetables, and Nuts. Journal of Agricultural and Food Chemistry. 2006. https://pubmed.ncbi.nlm.nih.gov/17177529 9:  The Antioxidant Activity of Regularly Consumed Fruit and Vegetables Reflects Their Phenolic and Vitamin C Composition. Free Radical Research. 2002. https://pubmed.ncbi.nlm.nih.gov/11999391 10: Antioxidant Properties of Raw and Processed Cabbages. International Journal of Food Sciences and Nutrition. 2004. https://pubmed.ncbi.nlm.nih.gov/15223595 11: Fibre: The Forgotten Carbohydrate in Sports Nutrition Recommendations. Sports Medicine. 2025. https://doi.org/10.1007/s40279-024-02167-1 12: The Antioxidant Activity of Regularly Consumed Fruit and Vegetables Reflects Their Phenolic and Vitamin C Composition. Free Radical Research. 2002. https://pubmed.ncbi.nlm.nih.gov/11999391 13: Antioxidant Properties of Raw and Processed Cabbages. International Journal of Food Sciences and Nutrition. 2004. https://pubmed.ncbi.nlm.nih.gov/15223595 14: Glucosinolates From Cruciferous Vegetables and Their Potential Role in Chronic Disease: Investigating the Preclinical and Clinical Evidence. Frontiers in Pharmacology. 2021. https://pubmed.ncbi.nlm.nih.gov/34764875 15: Chronic Constipation in Adults. American Family Physician. 2022. https://www.aafp.org/afp/2022/0900/chronic-constipation-adults 16: Does Vegetable Colour Matter? A Comparative Assessment of Bioactive Composition and Biological Properties. Food Chemistry. 2026. https://pubmed.ncbi.nlm.nih.gov/42566904 17: Dichotomous effect of dietary fiber in pediatrics: a narrative review of the health benefits and tolerance of fiber. European Journal of Clinical Nutrition. 2024. https://doi.org/10.1038/s41430-024-01429-5   18: The Antioxidant Activity of Regularly Consumed Fruit and Vegetables Reflects Their Phenolic and Vitamin C Composition. Free Radical Research. 2002. https://pubmed.ncbi.nlm.nih.gov/11999391 19: Dichotomous effect of dietary fiber in pediatrics: a narrative review of the health benefits and tolerance of fiber. European Journal of Clinical Nutrition. 2024. https://doi.org/10.1038/s41430-024-01429-5 20: Flavonols (Kaempeferol, Quercetin, Myricetin) Contents of Selected Fruits, Vegetables and Medicinal Plants. Food Chemistry. 2008. https://pubmed.ncbi.nlm.nih.gov/26065748 21: Panche AN, Diwan AD, Chandra SR. Flavonoids: an overview. J Nutr Sci. 2016 Dec 29;5:e47. doi: 10.1017/jns.2016.41. Erratum in: J Nutr Sci. 2025 Jan 29;14:e11. doi: 10.1017/jns.2024.73. https://pmc.ncbi.nlm.nih.gov/articles/PMC5465813/

 

The table illustrates this this salad adds fruit and vegetable components that are not generally available form other sources. It is complementary rather than complete nutrition because it lacks protein, several vitamins (B-6, B-12, D, E), minerals (Ca, I Zn, Fe, Se), fats and omega-3 FFA, and caloric density.  Some of these deficiencies can be made up by the additional components of the salad (olive oil in vinaigrette, additional nuts, etc). and additional food groups.  This salad is a niche player in the overall diet – but an important one in supplying necessary antioxidants, fiber, and phytochemicals that are not available elsewhere.  It is designed to avoid processed foods and food wasting.        

 

George Dawson, MD, DFAPA

 

Supplementary 1:   The graphic recipe display as two sources.  The first is the engineer Michael Chu's blog "Cooking for Engineers" who came up with the idea in the first place.  The second is the online site Recipe Tables where I was able to convert my recipe to graphic form.  The software named it Wyman’s Berry Salad based on the name of the frozen berries that I use. Any brand will do but I found these were the best prepared and do not require any additional preparation other than defrosting.  I typically use the defrost cycle in my microwave for 2-3 minutes depending on portion size.     

Supplementary 2:  While I am meteing out dietary advice I thought I would also include a place where you can get expert advice including advice that is designed to counter the popular misinformation from the US Government.  

Dr. Jessica Knurick https://www.jessicaknurick.com/ An extremely articulate doctorate level nutritionist with both written and visual channels.  She has not only expert dietary advice that sems rare these days but also has very good opinions about professional boundaries like the roles of physicians and dieticians and how our current healthcare system is respecting nether profession.    

References:

1:  Goutman, S.A., Savelieff, M.G., Jang, DG. et al. The amyotrophic lateral sclerosis exposome: recent advances and future directions. Nat Rev Neurol 19, 617–634 (2023). https://doi.org/10.1038/s41582-023-00867-2

2:  Huisman MHB, Seelen M, van Doormaal PTC, et al. Effect of Presymptomatic Body Mass Index and Consumption of Fat and Alcohol on Amyotrophic Lateral Sclerosis. JAMA Neurol. 2015;72(10):1155–1162. doi:10.1001/jamaneurol.2015.1584

3:  Nieves JW, Gennings C, Factor-Litvak P, et al. Association Between Dietary Intake and Function in Amyotrophic Lateral Sclerosis. JAMA Neurol. 2016;73(12):1425–1432. doi:10.1001/jamaneurol.2016.3401

4:  Jing Z, Qi X, Teng J. Dietary factors and risk for amyotrophic lateral sclerosis: A two sample mendelian randomization study. Medicine (Baltimore). 2024 Jun 21;103(25):e38473. doi: 10.1097/MD.0000000000038473. PMID: 38905382; PMCID: PMC11191971.

5:  Chapman L, Cooper-Knock J, Shaw PJ. Physical activity as an exogenous risk factor for amyotrophic lateral sclerosis: a review of the evidence. Brain. 2023 May 2;146(5):1745-1757. doi: 10.1093/brain/awac470. PMID: 36918362; PMCID: PMC10151186.

6:  Westeneng HJ, van Veenhuijzen K, van der Spek RA, Peters S, Visser AE, van Rheenen W, Veldink JH, van den Berg LH. Associations between lifestyle and amyotrophic lateral sclerosis stratified by C9orf72 genotype: a longitudinal, population-based, case-control study. Lancet Neurol. 2021 May;20(5):373-384. doi: 10.1016/S1474-4422(21)00042-9. PMID: 33894192.