Nutrition

Posted on November 3, 2023 by Catherine Cheng, MD

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?

The Joyous Liberation of Radical Acceptance

Posted on September 9, 2023 by Catherine Cheng, MD

Happy Happy 50th Birthday to me!

I’ve been 50 for over two weeks now and could not be happier about it! Do I obsess about my age? Maybe. But whatever, I’m having a great time and it’s all because I’ve lived long enough to acquire some wisdom, and may yet live a while longer to exercise it all. What a privilege and a joy.
Middle age. Awesome.
I’m like a vintage car now. If I wanna keep driving smoothly, I’ gotta invest in the maintenance. My value continues to grow, and I can revel in some positive attention I get for being my real, colorful, sparkly, strong, BOOBS OUT, middle aged self.

Why is aging so difficult to accept? Why do we resist so fiercely?

Maybe we equate acceptance with resignation? Is it a conventional fallacy, like if we admit that we are ‘old’ then by definition we are decrepit and obsolete, that only young people have value in and contribute to society?

Maybe it’s how we define ‘old’? Is 50 old? Is 30? 80? Is it a number, a mindset, a set of abilities? Does it matter?

Patients often ask me what they should expect to be able to do and not–usually physical things–based on their age. It’s impossible to answer, as each person is unique; and it’s not just about chronological age. It’s about what’s worth doing for each of us. What are your goals, how important are they to you, and what trade-offs are you willing and not willing to make to achieve them? What factors would alter these calculations? What are you willing to risk? What will you regret if you don’t get what you want, or hurt yourself (and/or others) in the pursuit?

What do you need to get to peace with your age, and the state of your body, mind, relationships, and life expectancy? Where can/do you still act with energy and power, despite new and cumulative constraints? What’s great about the now, and how can you maximize that, amplify and spread it?

Resist. Deny. Reject. Oppose. Deflect. Energy spent on these diversions is counterproductive, wasted. It keeps us tethered to exactly the thing we refuse to acknowledge. Opposition and denial are unidimensional and static. When I fight against an unwanted reality, it’s all I see, my sole focus–even as I actively deny it–how hilariously and tragically ironic. I show up tense, defensive, in fight or flight survival mode–often without knowing, or in metadenial–denial of my denial. I get nowhere and I’m all uhnappy about it. We are funny, we humans.

When I accept the thing, I can put it down, let it be. Even if I disagree with and dislike it, even if it causes me pain. Unburdened from carrying it (even as I deny carrying it), I can loosen my neck and shoulders, look up, breathe deeply and ask, “Okay, what now? What next?”
And here is where the magic happens.

Acceptance is dynamic. It liberates. When I stop denying, rejecting, and opposing, then I’m free to question, explore, discover, choose, invent, experiment, connect, and move.
Acceptance is the birthplace of possibility.

Anger, jealousy, self-loathing, grief, sadness, conflict, uncertainty, other people’s inexplicable behavior, your aging body: Allow it. Embrace it all. Hold it lightly and loosely or put it down, or just nod respectfully and leave it. We can choose this: to suffer less by simply accepting first. We get to decide then, consciously, what orientation to any reality is most consistent with our values, goals, joy, fulfillment, and peace. We do this by seeking the best questions instead of the usual ones. Make them open ended and relevant to you, now, here, as well as to your future best self. Talk things through with people who love you for who you are, who don’t judge, who accept you, whom you trust, and who will also hold you accountable.
Self-acceptance is fundamental and essential for a life of peace, and no less vital are true belonging and deep, honest communion with others.

OH I finally get it, I think! For so many years I have grappled with this paradoxical and counterintuitive idea that acceptance is the foundation of peace and change, and today I think I reached a new overlook on the climb. Acceptance is not resignation or wallowing; it is not tacit endorsement of what I don’t want. It is simply being with what is, including how I feel about, dispelling my self-delusions about the current reality. It is also understanding that that reality can and likely will change, and though I may not have control, I have agency: I can absolutely influence the direction of that change. And I don’t have to be grumpy and adversarial while I act–I can choose to do it all joyfully. How exciting! I am ready, let me at it!

Revel Now to Fuel Your Future

Posted on August 22, 2023 by Catherine Cheng, MD

Photo by Brian Gelbach, Minnesota, August 2023

When you get a head cold, do you ever wish you had appreciated better when you could breathe through your nose?

What do you take for granted, that you’d miss and regret if it disappeared?

Our family had quite a rough patch from about 2018-2022, and this past year things really turned around. I still have a little post-stress reactivity (a second of dread whenever I get a text or call from the kids), but it’s much better.

Then last week I had another scare, an x-ray showing what looked like a hole in bone—a lucency, as it’s called. Despite opposite effort, I allowed myself to catastrophize. Osteosarcoma, I thought—an uncommon and aggressive bone cancer (it would not actually present this way, I realize now, but hey, I was hijacked). The thought cascade unfolded rapidly: urgent specialist referral and imaging, surgical biopsy, treatment—surgery, radiation, chemotherapy. Recurring appointments, treatment side effects, and physical, psychological, and relational pain. I’d have to cancel my vacation this week, find coverage at work (or take a leave again), maybe stop working on the book, and, gasp, stop going to the gym. Kids’ activities and future would be affected—would they have to move/stay close to home for college? And the absolute worst-case scenario—death—what would that be like? Interestingly, this semi-unintentional exercise actually helped me calm down. It reminded me of when Daughter had an anaphylactic food reaction with the babysitter. I had to meet them at the Emergency Department without killing myself in a car accident on the way, so to center myself I imagined the worst—her death. In a moment I realized that though it would be horrible, I would be okay—because I had to, for Son. I breathed deeply, drove mindfully, and arrived physically and psychologically intact. We simply do what we must do.

I have faced multiple life-threatening situations at home, in addition to witnessing all manner of death in my work. Maybe that’s how I can balance my emotional reactions with a more rational response? I have seen enough times how good can turn to bad on a dime, and it makes me cherish the good while it lasts—really revel in it.

Before I got confirmation that the x-ray last week was, in fact, normal, I had already come to a sense of peace about whatever may come. I thought to myself, ‘Well, good thing I really soaked up everything awesome about life until now, saturated myself with it and shared the joy as much as I could.’ I found myself with very few regrets, which empowered me to meet uncertainty with calm, confidence, and strength, and not denial or false optimism.

It’s not that I dread the future, expect serial crises, or harbor some kind of victim mentality. I just understand the unpredictable randomness of life and accept my total lack of control in most situations. Reveling in the good now protects me when any hard times do come later. I feel deep satisfaction and contentment to remember all that was good before, and that I knew it at the time, truly appreciated it. That warm, radiant energy feels stored like solid rocket fuel, stable and dense, ready to call forth for emotional and relational thrust when I need it.

What can you revel in now, that will replenish your existential fuel for the unknown future?

Below are some of my current revels. May you, readers and friends, feel your own daily delights emerge with light and coherence in these waning days of summer. May you immerse in the awesomeness and feel it buoy you through whatever life brings.

Shaneiaks meet in person!