Nutrition

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 Only Diet That Works

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Hello Friends!!  Oh my gosh, it feels so good to be writing again, like sinking into my favorite squishy armchair, at the campus coffeehouse where I have met my friends since college, to sip, gab, bond, and plot to save the world.

New phase of life, woo hooooooo!  And eekgadds.  I have long thought of balance as a dynamic state, like that octopus ride at the amusement park.  I am the ride, spinning around, raising and lowering each aspect of life in controlled coordination, attending to each car so nobody flies out and gets hurt.  With the added responsibility I have taken on at work this year, it feels like I have just agreed to accept a massively overweight rider in that car, and my whole frame now strains to keep everything moving smoothly.  At first everything looks normal.  But the continuous strain of gravity, mass, and cumulative sheer forces create microfractures in my arms over time.  And suddenly one day, something (or everything) may come crashing to the ground.  People get hurt.  The ride is broken, in need of major repairs, possibly never the same again.

 

So better to slow the RPMs now, decrease the amplitude of vertical oscillations.  And, increase frequency and intensity of maintenance: inspection, lubrication, computer upgrade, parts replacement.  All of this is to say that 2018 is my year of graduate study in life-octopus ride maintenance.  Curriculum so far includes a lot of Thomas Rhett songs (“Drink a Little Beer”), communion with close friends, and a resurrection of my spiritual life.  I’ got this. [fist bump emoji]

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Okay so, this is a post I have thought about for weeks and I can finally sit down to write it today/tonight.

Since December, two people have told me, essentially, “Medicine has failed at nutrition.”  One person was a good friend, the other a new acquaintance.  Both were athletes, well-educated professionals, and thoughtful men.  I respect both of them and was intrigued by their assertions (and, honestly, just a little defensive).  They pointed to the myriad books, fads, products, news articles, and programs around the country in the last decade or so, all claiming to have the one method for lifelong healthy eating.

Their expressions went something like this:  “What’s the deal with gluten?  I’ve read Wheat Belly and Grain Brain and now I feel conflicted every time I want to have some bread, even though I feel fine, and I like bread.  …Is saturated fat bad or good?  On Atkins I can have as much steak and liver as I want, and my cholesterol is supposed to get better.  And Bulletproof says I should be drinking butter and coconut oil in my coffee.  But my doctors all tell me to minimize red meat and oil in general.  …The Inuit people live off of whale blubber, and they have a fraction of the heart disease we have.  I used to think I knew how to eat healthy and now I’m not so sure.  I’m so confused.”

I was taken aback somewhat by both of these conversations, as I don’t feel confused at all about nutrition and eating.  I feel personally tempted, frustrated, vacillating, under-motivated, and/or fat, depending on the day.  But professionally I feel informed, confident, and reassured that I can counsel my patients solidly toward optimal health.  So wherein lies the disconnect?

In my practice, our approach to nutrition starts with the patient interview.  What is your current eating pattern?  How does weekend or travel eating differ from regular workdays?  How does this pattern either promote or hinder your health and well-being?  What are you doing that’s already healthy and where is there room for improvement?  What needs to happen in order for you to make small, sustainable behavior changes for optimal health?  How important is it to you to do so?  The conversations focus on my patients’ own physical, mental, and emotional experiences around food.  They have a chance to relate their eating habits to personal and professional goals, and a vision for their best selves.

I have learned that my advice needs to be concrete, specific, and relevant at a granular level.  I can roll with Paleo, Atkins, Whole 30, gluten-free, vegetarian, ovo-lacto, oil-less vegan, pescatarian, Mediterranean*, or other diets.  There is some good evidence for all of them.  But is any one of them the sole antidote to all of our eating poisons?  My left brow rises every time I hear someone make this claim.  Here’s the key:  None of these diets tell us to eat pizza, burgers, chips, cheesy fries, dinner rolls, diet soda, craft beer, loaded nachos, fettucine alfredo, cookies, cake, ice cream, and candy the way most of us do.  So what are the underlying origins of my night-time corn chip-cream cheese binges?  What strategies can we brainstorm to cut back on my birthday cake consumption between birthdays?  Questions like these and the conversations that follow serve my patients far better than my recommending the blood type diet (which I do not).

Furthermore, leading proponents of each of these diets also emphasize the importance of concurrent self-care in the other realms of health: Exercise, Sleep, Stress Management, and Relationships.  Diet and nutrition are vitally important for health, but they do not occur in a vacuum.  All of our health behaviors need to be assessed in their combined context, and recommendations are best made with circumstances, preferences, logistics, and access in mind.

If you’re an elite athlete whose diet is already 99% cleaner than the rest of us, yes, maybe there is a subtle difference between medical diets that will affect your performance and sports longevity.  Then again, maybe not.  And you are also likely attending to your needs for training, rest, recovery, and stress management.  So you’re probably good either way.

For us regular people, the only diet that works is the one we can stick to, that doesn’t cost us inordinate amounts of psychic energy to maintain, and that actually makes us healthier.  How can we tell we’re healthier?  We may feel: lighter on our feet, increased energy, more regular bowel movements, clearer skin.  When we see our doctors (as we all should, ahem) they may find we have lower blood pressure, lower body fat, smaller waist circumference, lower fasting and overall glucose, lower LDL and triglycerides, and an overall brighter aura and vibe.

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So maybe keep Michael Pollan’s words in mind as a general guideline: “Eat food.  Not too much.  Mostly plants.”  I would add:  Eat foods as close to how they occur in nature as possible.  If you can tell what leaf/seed/grain it is by looking at it, it’s probably better than if you cannot.  Harvest/kill it, cook it (or not), eat it.  The fewer steps the better.  Eat often and slowly with people you love.  Help each other moderate the junk.  Enjoy your food.  Life is short.  Strive for an eating life that adds joy and delight to your whole being, both immediately and in the long term.

Onward, my friends.

 

*I have no financial, philosophical, or other interests in any of these or other diet programs, products, centers, providers, etc.