Monthly Archives: November 2023

Nutrition

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Ok friends, now we get to talk about hard stuff: Food. GAAH, I JUST LOVE IT SO MUCH. My indiscriminately joyous palate and hedonist tendencies conspire to make me positively fat, and I have spent decades resisting that outcome. I feel an internal truce developing with age, though. I wrote my post on leading vs lagging indicators of health back in February, and share it regularly with patients. Each conversation reinforces my thesis: that numbers, be they body mass, body fat, glucose, or cholesterol, do not tell a remotely complete story about our overall health.

After reading Anti-Diet by Christy Harrison at the recommendation of a therapist friend, I can own my insidious internalization of our cultural obsession with thinness. I diverge mildly from some of the author’s opinions and assertions. I still greatly appreciate her understanding and validation of the complexity that is body weight, and the reality that we do not and cannot necessarily control it. Despite what many say, body mass does not simply equate to calories in minus calories out. Metabolism takes myriad inputs and outputs, both intrinsic and extrinsic, always in flux. Genetics play a large role, more for some than others, in body habitus changes over a lifetime. Sometimes acceptance is a healthier, more peaceful strategy than resistance.

Reconciling body mass and shape to health and well-being, especially for folks like me who are not naturally thin, costs loads of psychic energy. It can cause layers of stress and discomfort, much beyond moving around in a heavy body. I focus on weight/body mass and appearance in this post on nutrition becuase when my dietician colleagues and I talk to patients about food, a majority of the conversations are centered here. If American culture is obsessed with exercise, then we are brainwashed about thinness. I can think of few domains where both collective and individual judgment is more harsh and destructive. And when we judge weight, judgment of food and eating follows closely behind. Let’s see if we can shift this, shall we?

When I look at my eating habits today, I nod approvingly. Not because they are perfect or even admirable, but because they are so much healthier than in the past. This year especially, I’m able to practice mindful eating:  More often than before, I ask myself:  What’s driving my eating at this moment?  If it’s not truly hunger, will the calories be worth it?  What else do I need (water? sex? laughter? connection? movement?), and is food a good enough substitute?  I understand my non-hunger eating drivers (eg visual cues–never watch Big Bang Theory after dinner–and omg stress) and can anticipate them farther in advance. I can take precautions like not keeping ice cream in the house, and buying sweets in easily portioned units (thank you, Trader Joe’s frozen macaron varies!). I know my sleep requirement threshold below which mindless eating easily takes hold, and make strides to get to bed on time. My snacks are healthier–I pop blueberries as I write this–and I attune to my saiety much better with age–just ate my last blueberry of the writing session.

Here’s what I’m still working on, the mantra I have yet to integrate: “Enjoy every bite!” Whether it’s mac ‘n’ cheese or pecan pie, mashed potatoes or Haagen-Dazs, I am sure to indulge when offered. The visceral and limbic pleasures of flavor, texture, and sharing with friends act like jet fuel accelerating utensil to mouth oscillation speed. The greatest potential food joy quickly and easily devolves into an automatic race to consume, and it’s over before I realize. Not only have I then obliviated a peak plesaurable sensory experience, but I have also likely overeaten, and the sadness and guilt compound. “Enjoy every bite,” if I can remember and repeat, reminds me to slow down and attend to the full experience. Temperature, texture, flavor, aroma–just thinking of it all now relaxes and uplifts me. Good food, enjoyed mindfully in real time and especially in good company, connects and delights. I will continue to practice this not only for the most indulgent foods, but also the most mundane. The simplest foods can make me positively giddy: a poached egg, buttered toast, watermelon. Holy cow I just realized: If I truly enjoy every bite this way, how much more amazing could my sensory life be? Could I even stand it?

So what’s already good about American nutrition? Let me put down my cynic hat for a moment…
—The United States is self-sufficient in food: we can produce enough to feed our own population (though 17 million households were food insecure for some part of 2022).
–Many of us have access to non-local, non-seasonal food, which we often take for granted (though economic and ecological costs are high).
–Information about healthy eating (though not necessarily healthy food) is more and more easily accessible.. though misinformation and fads cost us millions of hard earned dollars every year.
–Oh here’s a good one: Reasonably healthy meal prep and delivery services are increasingly available for busy families…. who have the funds to outsource planning/shopping/cooking.

Okay let’s just skip to what could be better.. no holds barred here, full fantasy mode engaged:
–Portion options at restaurants, with coinciding pricing scale. This prompts diners to assess and decide more mindfully when ordering. Or offer to present takeout container when entrees are served, so diners may save leftovers at the beginning of the meal and eat mindlessly thereafter (I try to bring my own boxes)
–Elevate nutrient quality of meals served in schools
–Effectively incentivize purchase and consumption of locally produced plants and animals by both individuals and businesses
–4 day work week. This could actually solve, or at least improve, intersecting problems in all 5 reciprocal domains of health: sleep, exercise, nutrition, stress management, and relationships. See evidence for benefit from The World Economic Forum, the Wall Street Journal, and the UK/EU
–Cultivate a collective mindset of slow, selective activity and connection, both personal and professional, rather than the frenetic, competitive, have-and-do-it-all mentality that drives us all to the brink and over the edge of burnout and insanity

Huh. At a collective, cultural, societal level, turns out I feel pretty pessimistic about meaningful positive changes in nutrition patterns. So it’s basically up to us individuals and small groups/organizations to continue swimming upstream against forceful currents of hyperprocessed food supply, agribusiness, and thinness obsession despite all systems trying by default to make us fat and sick.

HA! I’ll think more about this. I’m not hopeless or sad, more just fascinated. How are you feeling about it?

Exercise

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“There are two kinds of people: those who exercise regularly because it’s who they are and they can’t help it, and those who do it because they know they should.”

When my teacher in medical school said this, I took it as truth. I now see it as partial truth. It reminds me of what little I know of Ayurvedic doshas, an eastern medicine idea of inborn constitutions; the first kind of people above are vata dominant, always active, high energy. The second kind are the rest of us. That said, these ‘constitutions’ are not cut and dry; they exist along a multidimensional spectrum. I don’t know what Ayurvedic medicine says about maleability of constitution, but the older I get the more I think we are all a living paradox: We are who we are from a very young age (before we are even born, in my opinion), and we are constantly changing and evolving throughout our lifetimes.

“You’re an athlete, Cathy.” Wut? My trainer Melissa stated it with a tone of irrefutable certainty. We had worked together maybe four months in 2014; she had observed me try and fail at many new movements, and also make noticeable progress along the way. Before that day I would have identified more as ‘mathlete’. In high school, classes were easy. Volleyball was hard. I participated fully in practice and drills, gave full effort in the weight room, all to be an okay player on the team. I did no other sports. But I kept playing at open gyms, college and med school intramurals, anywhere and anytime I could. To this day, I can still hold my own on a volleyball court. That sunny summer day running through her neighborhood, Melissa assigned me a new distinction, one I may never have considered. I have now proudly claimed it, and today my fitness program is firmly established and thriving. Since Melissa met my Ethos coaches six months ago, I have resumed learning, practicing, and training new movements, awakening dormant muscles and integrating them with what’s already strong and stable. My weight is unchanged, yet my clothes fit better. I’m stronger. I feel better about myself.

Consistency. Results. Progress. Tribe. My exercise pattern today is the best I’ve ever experienced. I wonder what it will look and feel like with another six months of training and beyond? After tearing my ACL in 2017, I know to appreciate any session that doesn’t end in injury. So how could my fitness be better? I must stay on the path, no matter how it winds and climbs. Surgery and changes at work disrupted my personal training schedule. So I rehab’d on my own at home. COVID prevented me from joining Ethos in 2020. So sibs and I did HIIT workouts at home over Zoom for three years. I can work out by myself; I know now that I do it exponentially better and have ‘way more fun with others. So that’s the plan–stick with the group that teaches me and holds me up. If I can do that, I’ll live to be STRONG OLD LADY, not frail old lady.

How would we describe American fitness? What is our exercise identity? ‘Bipolar’ and ‘ironic’ come to mind. On one hand we positively obsess over it all. If you live in any urban or suburban setting, you can practically fall out your front door and land in a gym of some kind. Sports apparel’s new fashion (genre?), Athleisure, now accounts for nearly 20% of online clothing sales. So you can at least look like an athlete when you walk around outside of the gym. On the other hand, according to the CDC, “60 percent of US adults do not engage in the recommended of activity,” and “approximately 25 percent of Americans are not active at all.” Well duh. Let’s take a look at just two correlates:

Infrastructure. American geographic sprawl necessitates transportation in the static sitting position, in cars, trains, and buses. Neither roadways nor transit culture make cycling or other self-powered locomotion appealing or feasible to anyone but the most determined, avid, and resourced. Most of us barely walk anywhere anymore, to the point of having to track daily step counts to goad us into getting up and moving at all.

Work culture. “Moreover, more than 80% of American jobs involve mostly sedentary activities,” statistics reported in 2021. This worsened for many with the pandemic, as remote work tied to a fixed computer video screen eliminated incidental movement within and between office spaces and in transit (walking to the train station or parking lot is still walking), reducing workday steps to the distance between bedroom, bathroom, and kitchen.

How can we make this better? Some simple, though not easy, ideas:

Stairs. Build them beautifully and out in the open, as centerpieces of our public spaces instead of last resort, emergency egress. Make it normal and the default to take the stairs instead of the elevator.

“5 of the best office staircase design ideas” –www.robinpowered.com

Get off camera. Do you really need that Zoom meeting? Do you need to meet at all? Whatever can be converted to a (concise!) email or voice call, do it. Hold folks accountable for preparation and brevity so all time spent meeting is valuable and productive. Then give them the time back so they can get away from their desks, accompish more tasks both personal and professional, and get more sleep, so they can be more motivated for the workouts they can now fit into their days.

Sit to stand desks. Make them standard in offices and reimburse workers to get them at home.

Give people balance boards and mini steppers as remote work onboarding gifts.

How else can we modify our systems and structures to lower the threshhold to get off our butts? What do you see around you that’s working already?

Sleep

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Photo by Vickie Barrett, July 7, 2023

NaBloPoMo 2023, here we goooooo!  What’s already good and what could be better?  

How do you sleep?  Has it always been the way it is now?  What affects it?  What do you know about sleep in general?  What questions do you have about it?  

Personally

I am a great sleeper.  I fall asleep easily and sleep through the night, and am also easily aroused and quickly lucid.  I do best with 8 hours, and can function highly with much less, at least for a while, given ready access to caffeine.  I love sleeping, look forward to it every night, climbing into bed, burrowing under the covers, closing my eyes, letting my thoughts and fantasies drift where they may.  If my mind is full, the relief from dumping it all into a journal is almost euphoric for me.  I use fun colored pens and observe my handwriting, which often correlates with my mood, energy, and general state of being at the time.  

I just don’t spend enough hours in bed.  Night time is when I get my best writing done, so too often I stay up too late. In past years NaBloPoMo has severely exacerbated this tendency.  I know that when I don’t sleep enough, not only do I have more food cravings, but they are for unhealthy foods and I have essentially no impulse control, so sleep deprivation poses a cascade of downstream risks for me.  If I just hit 7 hours a few nights in a row, I literally feel viscerally better.

So, NO MORE (for now)!

Adding “Lights out 11:30” to my habit tracker last month, I documented goal achievement four times.  I think I do better.  It starts with realistic expectations of what I can accomplish each day: see patients, work out, write, read, cook, etc.  I can anticipate on Sundays and find times and tasks that can flex if needed. I should probably make a list of things I will put down or scale back during this month of daily blogging… Or multitask–pair attentive with mindless activities, like phone calls with friends instead of video, so I can also fold laundry.  I’ got this. Form a plan, experiment, evaluate, adjust, repeat. 

OH and social media, ya. Jeez, gotta manage that time sink better. I’m getting there—more on that November 12!

Societally

How do we sleep as a society?  Wow, so much data at our fingertips!  Here’s what’s already good:  According to sleepfoundation.org, a majority of Americans get 7 hours of sleep or more, yay!  Is that you?  I think maybe half of my patients report this.   Also good is that only a small minority of people report chronic insomnia, about 10-15%.  Does that seem like an underestimate to you?  In my skewed perspective, most people don’t feel satisfied with their sleep.  Maybe I’m thinking of all the other sleep disruptors: apnea, hot flashes, young children, night time peeing, anxiety, depression.  Aging can be a huge factor, what with menopause, enlarged prostates, and effects of aging on circadian rhythm.  

Collectively, sleep awareness is at an all time high, I think. I credit this in large part to Matthew Walker and his remarkable book, Why We Sleep, which I highly recommend. Walker presents the science clearly and accessibly, and while dense, the book clarifies mysteries of sleep that can inform our habits in practical ways. It’s humorous and clever, and well worth a read or listen.

SleepFoundation.org

Age, menopause, and prostate symptoms are individual factors that we each must manage ourselves.  My night owl habit challenge is mine to solve.  How could we modify our systems to facilitate better sleep for everybody?

Arenas where solutions may lurk:

Media streaming guardrails.  I have timer settings on Spotify, Audible, and Scribd (soon to be Everand), but not Netflix or Prime.  We’d probably disengage from leisure media sooner and more easily, especially late at night, if the apps’ defaults were to ask us when to stop at the time we start, rather than making us do it proactively.  And how many collective hours–which I think could be measured in lifetimes–do internet browsing algorithms cost us?  All of this is unlikely to change, I know.  

Alcohol. When do the costs outweigh the benefits for individuals, and yet how often do folks drink more than they want, becauase it’s ‘what you do’? Peer pressure is no less real at fifty than at fifteen. How likely is it that our culture can depend less on ethanol to lubricate social and business gatherings? I’m gratified to see mocktails and the like increasing in popularity and acceptance. Let’s see where this goes…

Synchronous global video meetings.  Meetings in general.  I understand the importance of face to face connections.  How can we make them maximally efficient and effective, and give some time back to people?

Remote work in general.  The average American work commute time is about 30 minutes.  That’s 5 hours per week.  Cutting commute time, as happened for so many during COVID lockdown, not only gives people time back, but decreases overall stress and anxiety.  We are happier when we’re not rushing around every day; we can get more life tasks done.  We may then get to bed earlier and in a better mood.

Later school start times for adolescents.  This is ideal for growing brains, and also a bear to execute when parents must coordinate drop off with morning commute or international Zoom calls.  We can see here how some solutions collide and some others coincide–yikes.

There are many ways to move more and differently when we’re awake. Food choice, volume, and timing can also be flexible. But we can only sleep when we are sleeping. This is why I list it first among the 5 reciprocal domains of health, the last two being stress management and relationships.

I should have worn my blue blocking glasses tonight, come to think of it.  With 29 more days of increased screen time, what else can I put in place to protect my sleep?  I’ll sign off now to rest my thinking brain, give my subconscious a chance to mull it over.  Maybe in those unfocused minutes of first waking, I’ll have a stroke of insight.  Good night!