Even for consumers who know better, highly processed and adulterated grain can be challenging to avoid. Cereal and milk is the number one breakfast served at many schools. LAUSD offers a range of breakfast choices each day, but cereal and milk remains the most popular option, with many kids skipping the milk and opting to eat the cereal as a snack. The same holds true for other school breakfast initiatives, such as Breakfast after the Bell.
Anne Ricci recently posted a list of 10 beliefs that she believes keep people from eating a healthy diet. Although the author highlights important subjects to address, her approach gives me pause. Some of us respond to a take no prisoners, tough love, or authoritarian approach to food, diet and lifestyle. However, I instinctively approach these same issues differently with my clients.
Here’s my stab at tackling the exact same client challenges. Check out both approaches and consider what support would work better for you.
Very little in our culture honors the time and energy to purchase, prepare, and eat food that contributes to good health. We have grown to expect to eat on the run: at the sink, at our desk, and in the car. In addition, convenient foods often deliver a hearty dose of highly processed, refined and adulterated ingredients that keep us less than healthy. Choosing to eat more nutrient dense foods means greater attention in the marketplace and in the kitchen.
REFRAME THE CHALLENGE: Determine if your health ranks high enough to change your ways. If yes, your greatest challenge will be to stay mindful. When you are ready and willing, make better decisions at the marketplace, allow more time and and energy into preparing food at home, choose carefully when eating away from home.
2. Nutrition is too complicated.
While nutrition science is complicated, eating better doesn’t have to be. Basically try to stick with a balance of whole foods. That means enough protein to feel satisfied, sufficient vegetables, fruit, beans or legumes to provide the energy you need, and adequate fat to feel content over time.
The trickier part is figuring out what balance of carbohyrate, protein and fat works for you. Do you need more animal protein to feel satisfied, or more plant foods? How much fat do you need to help you feel content over time? Remember that the balance of food that works better for you is not necessarily what works for your best friend or neighbor, and sometimes professional guidance can help.
REFRAME THE CHALLENGE: Eating better allows you an opportunity every day to feed yourself well.
3. Cooking is a chore.
Cooking takes time, energy and skill. However, preparing better food is also a statement. It says, “I care about my health and well being”. It says, “I like having the energy to accomplish the tasks and enjoy the activities in my day”. It also says, “I’m worth the time it takes to eat better.”
If you want to learn how to cook, try asking a friend or neighbor who does to teach you. Take a class or workshop–a great way to create community if you don’t have one in place. However, if you truly don’t like cooking, there are a myriad of resources to help.
REFRAME THE CHALLENGE: Taking time to purchase, order, and/or prepare better food shows how much I value my (my family’s) health and well being.
Quieting the sweet beast takes fortitude as well as readiness and willingness. It also helps to understand why we feel so addicted in the first place. In 2011 I wrote a guest blog for Appetite for Health to address how to navigate sweet’s slippery slope (which is no longer available on that site, but available on my website)
REFRAME THE CHALLENGE: Would you like to regain true control over when and how much you enjoy a sweet treat? Taming the tiger is tough, and only you can determine if the effort is worth it. However, the number one word my clients use after they successfully learn to manage sugar in their life is liberation. You can be liberated, too.
5. Eating healthy is too expensive.
Fruits, vegetables, protein rich foods and dairy are more expensive per calorie than bread, cereals, grain based snacks, and sweet treats. But how much is “too expensive” depends on each individual and their circumstances. Research from Harvard School of Public Health found “the healthiest diets cost about $1.50 more per day than the least healthy diets” (that’s $45 a month for one person, $550 per year, and $2,200 more for a family of four). The authors of the study consider the economic burden significant.
REFRAME THE CHALLENGE: Healthful eating is more about progress than perfection. Do what you can to allocate more dollars to healthier choices. After all, prevention costs much less than disease. It may be cheaper in the long run to pay the farmer instead of the doctor.
Eating healthy isn’t nearly as challenging as finding the willingness and readiness to change. Health scares can catapult people into eating better, but reaction is rarely as effective as pro-action. Ideally we eat well to give ourselves the best chance to navigate whatever comes our way.
If you don’t have a support system, or worse, if those who could support you actually sabotage you instead, you may want to cultivate a new team or join a different tribe of support. Multiple organizations are available, or you might find the support of your health care team and a nutrition professional to be more effective.
REFRAME THE CHALLENGE: You have an opportunity to cultivate a support team, whether a formal group, a team of professionals, or new friends with a like-minded goal. In the long run, you will need to be your own best advocate, but it always helps to build a reliable support network.
Most of the time we don’t need to eat the perfect diet to enjoy good health. A healthy diet allows some indulgence, an occasional sweet or treat. Moving beyond black and white thinking, the kind of thinking that tells us we are bad if we eat chocolate and virtuous if we stick with a piece of fruit, presents the toughest challenge.
Ironically perfectionism often backfires, allowing anyone the perfect excuse for abandoning themselves and their health goals. The inevitable splurge is called “what the hell effect.”
REFRAME THE CHALLENGE: Learn what it takes for you to enjoy good health. If you have perfectionistic tendencies, learn to tolerate a good enough effort without beating yourself up. Adequate attention to what you eat in the moment will take care of the outcome. (see #7 above re; self regulation and resilience)
9. I love my high-calorie comfort foods too much.
Comfort foods gain their reputation for a reason. They are often tasty and satisfying on many levels, regardless of the number of calories involved. They may also remind you of home, grandma’s cooking, or some other nurturing experience.
REFRAME THE CHALLENGE: Food in its rightful place is both nourishing and nurturing. Allow yourself the full experience of that pleasure when you are hungry. Try to honor how much is enough, especially since most of us will have another opportunity to eat tomorrow. Ideally we cultivate many ways to nurture ourselves when we aren’t hungry, as well.
You don’t need to exercise to improve your metabolic health, but you do need to move. Physical activity allows the body to burn both fat and glucose better or fuel, the very foundation of metabolic health. Thankfully, physical activity takes many different forms–all good. From neighborhood walks to exploring the wilderness, from gardening to dancing in the living room, from biking to work to cycling for a personal best.
REFRAME THE CHALLENGE: Take an inventory or explore ways that you enjoy movement. Know what you don’t enjoy. The gym is not for everyone, so allow yourself to move when it works for you. Ideally the physical activity you choose also feeds your soul, takes care of a few errands, avoids the traffic, or any other reinforcing benefit.
COMPARE AND CONTRAST
Do you respond better to an authoritarian approach or an opportunity to cultivate an approach based on what works for you? After reviewing both approaches, let me know what you think.
I was diagnosed with ovarian cancer last fall, but my medical adventures started a month earlier while on vacation in August. During a tour of Stonehenge, I noticed a blood blister in my mouth and bright red pin pricks on my leg. I desperately tried not to hyperventilate, but knew in my heart that I was dealing with a second bout of ITP – an immune driven platelet disorder.
The discovery found us in a National Health Service emergency room in London the following day. After my diagnosis, we adjusted our plans and I continued care in Holland while we visited family. By the time we returned home my platelets were recovering, but I was not. I was suffering.
A DIFFERENT DIAGNOSIS
At first I didn’t know what caused the gas and bloating. Could it be the large doses of prednisone, an 80 mg metabolic wallop designed to suppress my overactive immune system? In a vain attempt to calm my symptoms, I tried drinking ginger tea, experimented with my diet, and tapped into acupuncture, yoga, exercise, and every other resource to no avail. The discomfort, gas, and bloating only worsened over time. When the pain topped out at 8-9, I found myself thinking, “I don’t know if I can keep this up.” I didn’t have to.
By mid September I asked my doctor to run tests that would rule out ovarian cancer. I can imagine that she probably rolled her eyes. With over 30 years of working with me, she either tolerates or is resigned to having me direct much of my health care. Soon Dr. Bhai called me with the results. She wasn’t able to rule out ovarian cancer, and I scheduled a biopsy the following week. In quick succession I saw a medical oncologist, then Dr. Vasilev, my gynecological oncologist, and we planned a course of treatment.
MORE INSIGHT, MORE LEARNING
My world spun crazily around me, my husband aged 20 years in two weeks, and I instinctively stepped up for the challenge ahead.
I often wonder why I seamlessly shift into this mode, a bizarrely calm and battle ready stance, navigating what must be done, but I do. Mostly I wasn’t all that surprised by the diagnosis. I’ve always known I was a high risk for ovarian cancer. However, as I step away from this stage of the journey, I want to share what I understand, and what I’ve learned.
ALL LIFE FORMS ARE INTERCONNECTED
We all grow cancer cells. Problems occur when the immune system is unable to shut those cells down, and they start replicating without restraint. Ideally the human body is able to manage this dance, but we are living in complicated times. In my case, heavy doses of prednisone could have primed the pump for tumor promotion. Or cancer cells can run amok from any number of environmental triggers.
Human activity spews over 10,000 chemicals into the environment every year and we only track about 200 of them. Many are known endocrine disruptors, including pesticides, herbicides, insecticides and other agents used in agriculture. These agents compromise our metabolism, our health and our lives. They compromise all life forms because all life is interconnected.
CANCER AND THE FOOD WE EAT, THE PRODUCTS WE USE
I know I can’t control all the chemicals that contribute to my body burden, but I can limit exposure to endocrine disruptors associated with living my life. Our landscaping and herb garden are managed organically. I purposefully limit exposure to endocrine disruptors in my household, using soap, vinegar and baking soda as the primary cleaning agents. I purchase organic and bio-dynamic food, grass fed, pastured, and beyond.
At the initial meeting with my oncologist, board certified in functional and integrative medicine, he asked about my diet. I laid it all out as he nodded in appreciation and told me, “Keep doing all of that.” I choose to eat whole foods grown as responsibly and sustainably as possible, mostly because I understand that I am voting with my dollars for my health, and the health of the planet.
I’m a healthy cancer patient, as strange as that sounds, and basically blew away the medical staff with my body’s capacity to navigate chemotherapy. My body is strong, well nourished in the best possible sense, and capable of fighting the good fight. In fact, the powerful lesson I learned over the past 10 months is that despite my diagnosis, my body was ideally prepared for the battle ahead.
Eating close to the earth, cooking from scratch, lots of physical movement, plenty of sleep, some wine with dinner, good times with friends and family. So many ways I live my life contribute to my health, and yet none of it prevented me from developing disease. Everything I do helps me survive.
EATING WELL TO PREPARE FOR WHATEVER LIFE BRINGS
I didn’t get tripped up with the “Why me?” but others do. During treatment I heard other cancer patients lament that they had done everything ‘right’. I realized they bought into a promise promoted by too many in the medical world–a promise that can’t be delivered. I knew I needed to change how I talk about food, health, and risk of disease.
I no longer encourage clients to eat, exercise, or whatever to reduce risk. What a set up! I now tell clients that eating well and taking care of ourselves serves a larger purpose: preparation for whatever we may encounter. Whatever challenge, whatever hardship, whatever opportunity. My journey was easier because I was already on board.
There is no guarantee that how we live our lives will eliminate risk of disease. However, eating well and living well reinforces all of our resources. I never second guessed what I could have done differently because I was already doing what I could. Without regret and other distractions, I was free to focus on the task at hand.
Today I’m inspired to continue my work, writing, speaking, and counseling as I help others learn to how to enhance, support or restore their metabolic health. I’m just starting to rebuild my practice, and I am looking for opportunities. I’m open to speaking at local events and educational venues, open to new private clients, and happy to work in the community. Contact me if you have specific ideas or opportunities to share. Call me if you would like to figure out an approach to food that works for you.
The FDA rolled out the “new and improved” version of the iconic Nutrition Facts label this month, exposing a dark underbelly of nutrition policy. Conveying nutrition information for the public at large is difficult, and the science isn’t settled– even when The USDA Dietary Guidelines tells us it is. So what can consumers learn from the new label?
- There is less concern about fat intake and risk of disease, so the label no longer details the number of Calories from fat. Total fat, saturated fat, and trans fat grams are still listed.
- The new label calls out added sources of refined sugar in a food in addition to total sugars.
- The label includes data for potassium which is helpful for some consumers on special diets (sodium data is already on the label)
- Serving sizes reflect real portions. For example a 20 ounce soda that is consumed in a single sitting will no longer be considered to contain more than one serving.
- The labels contain too much detail and most consumers pay little attention to much of the information. While it may be meaningful to note a specific food is a good source of calcium, I can’t imagine too many people calculating their diets based on food labels to make sure they are getting enough.
- Some labels will include a second column of data to let consumers know the damage when they end upeating the entire package, as if they couldn’t do the math by themselves.
- Fruit juice is not considered an added sugar, despite being mostly sugar. Will food manufacturers exploit the provision by reformulating products with juice or agave “nectar”?
- Specific nutrients, Vitamin A and C are no longer tracked on the food label. Vitamin D is now listed despite food being a rather poor source of Vitamin D. A waste of space– I don’t know anyone tracking nutrient intake based on the Nutrition Facts label. (Besides, ten minutes of sunshine at the right angle of the sun helps our body convert all the Vitamin D we need. Unfortunately, we don’t all live at the equator, so many of us need to supplement Vitamin D six months out of the year anyways. Food sources? Not good enough.)
- The Nutrition Facts label overemphasizes Calorie data. Researchers, clinicians, and public health advocates are still mired in the belief that weight management is basically a math problem. The wishful thinking leads to pretending that counting calories leads to improved metabolic health and weight loss.
I’ve belabored this issue before, so click here if you are looking for additional details. In reality, quality of our food intake more profoundly impacts hunger, satiety, and metabolic health than the number of calories we eat.
- FDA makes a baffling decision continue a preoccupation with cholesterol and naturally occurring saturated fat in food. This, despite the recent USDA position that cholesterol is “no longer a nutrient of concern”. While the FDA stays consistent with dietary guidelines to limit saturated fat intake, most current research indicates that naturally occurring saturated fats from meat and dairy products–especially from animals eating their natural diet– is not only not harmful, but in all likelihood enhances satiety and contributes to better metabolic health.
- Food labels continue to be based on a 2000 Calorie diet, despite the fact that most men, adolescents, and active women may need more than 2000 Calories a day, and others need less. Calorie counting will continue to be mired in controversy for three reasons. 1) Major flaws exist in how science determines the energy value of foods 2) the Nutrition Facts labels allow a 20% margin of error in either direction. 3) Noted scientists acknowledge that the calorie balance equation is dead. Energy metabolism is more biology, less math.
- Percentage of nutrient consumed refers to percent of amount recommended, not a percentage of nutrient in the food. I’ve already witnessed the confusion. People think 20% next to the 10 grams of added sugar in the sample label above means that the food is 20% sugar–NOT.The 20% refers to 20 % of “recommended” sugar intake. The dietary guidelines currently recommend limiting added sugar to no more than 10% of total calories. In a 2000 calorie diet that means 200 calories (2000 x .10). At four calories per gram, that equals 50 grams of added sugar a day: 10g/50g = 20%.I’m thinking it would have been simpler to say: Limit added sugar to less than 50 gm a day–and maybe not every day.
CONSUMERS DESERVE BETTER
The ever optimistic First Lady would like to believe it won’t require a nutrition degree to decipher the new label, but I’m not so sure. If food labeling could help Americans eat better we would have already measured the benefit.
Indeed, in a recent Politico piece the Economist who proclaimed 20 years ago that the food label would lead to better health outcomes realizes his mistake. Today Americans suffer more conditions linked to diet and poor metabolic health.
Maybe what is really needed is a wholesale change in the way both public health and medicine approach food, nutrition and metabolic health. We need disruption.
No more assuming there is one right way to eat. No more prescriptive diets for the public at large or even for a specific diagnosis. Personalized nutrition should be the norm.
Maybe the nutrition facts label should just inform and stop trying to direct food choices and shape everyone’s overall diet. Keep the ingredient list and identify the serving size and number of servings per container. Document the total grams of energy nutrients (carbohydrate, protein and fat).
A colored pie chart might work ever better. It’s pretty clear this mythical food’s calories mostly come from carbohydrate with some fat. Very little protein.
Break out the grams of fiber, sugar and added sugar. Identify grams of trans fats. Specify the milligrams of sodium and potassium, and leave the rest alone. We’ll still need to teach consumers how to use the information, but at least I won’t have to explain detail that doesn’t apply to most of us. More critically, I won’t have to explain why we shouldn’t pay attention to government guidelines that tell us what to eat.
This week we learned that the Food and Drug Administration’s (FDA) nutrition guidelines considers Frosted Flakes healthy, but not avocados and nuts. This is nuts, but FDA’s PR nightmare mostly underscores why no one should be labeling individual foods “healthy”.
A DEBACLE DEFINING HEALTHY
Over 20 years ago bad science figured low fat was healthy, and now the hubris of yesteryear has come back to haunt us. Today we understand excessive trans fat is not healthy, however a fiery debate rages regarding the healthfulness of naturally occurring saturated fats and polyunsaturated oils. What a mess.
And despite the dispute, the FDA is trying to determine how to define “Healthy”, supposedly so that clueless consumers can figure out what to buy at the supermarket. I don’t buy it.
WHAT’S FOOD LABELING GOOD FOR ANYWAY?
- Whole grain cereals that are little more than highly processed foam with added sugar.
- Juices that are little more than sugar water with vitamin C.
- Hundred calorie packs of highly refined sugar and starch parading as a great way to limit eating too much
- Better for you snacks that don’t always seem better. There’s plenty of highly refined organic junk food stacked on every shelf.
- Products in every department of the grocery store labeled “High Protein!”–until you consider the amount of carbohydrate.
KNOWLEDGE IS NOT THE SAME AS BEHAVIOR
All this information hasn’t seem to improve how Americans eat, with people purchasing more sweets and highly processed food than 20 years ago.
The Food and Drug Administration’s (FDA) effort to guide consumers to better food choices confuses too many. My experience tells me that most regular folk looking at a Nutrition Facts panel and ingredient list require coaching. Even I need to check my references to remember exactly what “low calorie”, “reduced fat” or “low sodium” means.
When I taught basic nutrition at Santa Monica College and UCLA, too many students couldn’t calculate a percentage of calories from carbohydrate, protein or fat. Confusion reigned as I tried to explain why a percentage of the Recommended Dietary Intake (RDI) actually means. Too often claims on the front of the food packages hinge on the flimsiest of data, and end up encouraging people to buy products dressed up as healthful, but just as likely contribute to a poor diet overall.
FEEDING OURSELVES WELL
Feeding ourselves is the most complicated behavior we humans endeavor. The time, energy and skill to do it well overwhelms most, especially since we pretend the shopping, cooking and eating is supposed to just happen. The plethora of prepared foods at grocery stores coupled with an increasing number of food prep and food delivery companies, in addition to all the taking out and eating out tells me all I need to know.
When it comes to food labeling, we need to stop pretending that any one food is healthful. Likewise, no one food ruins your whole diet. Rather than preoccupation with any one food or nutrient, we need to help consumers figure out an approach to food that works so that they enjoy good health. Therein lies the dilemma.
AN APPROACH TO FOOD THAT WORKS
There is no single right way to eat, however there are plenty of ideas out there telling you how to eat, including food rules that focus on counting calories, writing down what you eat, and all those other absolutes that usually backfire. I prefer to share guidelines that stick with the basics and help people develop adequate self regulation and resilience to eat well as a lifestyle. Here’s a few of my favorites:
- Try to eat when you are hungry and stop when you feel satisfied. Sometimes that will mean slowing down so you can determine how much is enough. Over hungry usually results in over eating.
- Eat a balance of protein rich foods with enough fruits and vegetables, modest starch (if at all) and adequate fat to feel satisfied over time. But remember that the balance that works for one person may not work for someone else.
- Choose mostly whole foods, meaning foods that are minimally processed and retain most of their natural goodness. Ideally the cook starts with fresh foods and prepares them with care. Too often large companies preparing food skimp on the ingredients and use cheap fillers or substitutes to maximize their profit margin.
- Enjoy every bite. Food’s rightful place embraces both social context and cultural roots.
- How we grow food matters. As you can, purchase food that is grown with minimal harm to humans and the environment. That translates to paying more for organic or sustainably grown plant foods and more grass fed, pastured and cage free animal products. We can pay the farmer now, or pay the doctor later.
Since data tells us people continue to spend more on sweets and processed foods, there is plenty more to do to help consumers, but I’m not sure having the FDA define what is “healthy” is going to help. What do you think would?
A few vegan proponents crossed a line this week as some issued death threats to the owners of Cafe Gratitude. For people claiming to value all sentient animals, the alleged threats expose a lapse in critical thinking. The controversy also exposes a frank hypocrisy cloaked in the increasingly shrill rhetoric regarding plant based diets.
Plant based eating originally aimed to increase intake of fruits and vegetables, a laudable goal considering the national average holds steady at just over one serving a day for vegetables (and that’s including potatoes), and just less than one serving a day for fruit.
However, more recently proponents promote plant based eating with a not so hidden agenda. Too often “plant based” is merely code for a vegetarian or a vegan diet.
PLANT BASED EATING HIJACKED BY VEGETARIANS
Plant based eating advocates cite everything from personal health to the environment and climate change to elevate their cause. Evangelical vegans lean into the medical community for validation, and they get it.
The Physician’s Committee for Responsible Medicine states that “The vegetarian diet is the optimal way to meet your nutritional needs”, and offer a 21 day vegan kick start support.
The more studied and thoughtful Health Care Without Harm also presses for more plant based foods, more vegetarian food options, and eating a lot less meat though their Healthy Food in Health Care Program. They anchor their position by quoting the UN Food and Agriculture Organization report that claims 20% of global greenhouse gas emissions are directly linked to beef and dairy production.
Nicolette Hahn Niman, a former environmental lawyer, rancher, vegetarian, and author of Defending Beef, challenges this figure, and currently the United Nations Environment Program pegs greenhouse gas emissions at 13% for all of agriculture.
HOW WE GROW FOOD MATTERS
I’m mostly encouraged by the Healthy Food in Health Care effort. I appreciate the push for more locally sourced foods and stepping outside the conventional food supply to offer more organic produce as well as grass fed, pastured and cage free animals products. The report spares no one and pinpoints the great metabolic and environmental harm from chemically intensive agriculture and the industrialized food supply.
However, the program encourages participating hospitals to use a variety of methods to serve less meat, as well as no meat, as if even grass fed meat inherently contributes to environmental and metabolic harm. The lead authors hold positions with the San Francisco Bay Area Physicians for Social Responsibility, a advocacy group pressing for greater emphasis on plant foods and more vegetarian options in hospitals.
A 2013 evaluation of participating hospitals in California outlines key parameters of the program and reports the following:
- Offer at least one protein-balanced vegetarian or vegan menu option at each meal for patients and in cafeteria (24/33)
- Cafeteria menu is meat-free one day per week (9/33)
- Patient menu is meat-free one day per week (6/33)
- Reduce portion sizes of meat and poultry offered in patient and cafeteria meals (12/33)
- 50% or more of daily meals served are vegetarian or vegan (3/33)
THE COWS WILL SAVE US
From this report, you would never know that eating meat does not necessarily negatively impact health. You would not appreciate that some individuals actually need more protein to achieve metabolic health. You also wouldn’t suspect that vegans showed higher incidence of cancer, allergies and poor mental health in a study matching vegetarians with meat eaters who also eat plenty of fruits and vegetables.
You would never imagine that effectively managed grazing animals actually help sequester carbon and improve soil ecology. Grazing animals enhance water retention and flow, protect against drought, and reverse desertification. Proponents of holistic management tell us that returning animals to the grasslands instead of fattening them in confined agricultural feeding operations (CAFOs) can reverse climate change.
GROWING ALL THAT GENETICALLY MODIFIED SOY HARMS THE PLANET
Conversely, agriculture ranks as one of the most environmentally damaging activities on the planet, especially mono-crop agriculture subsidized by the USDA. Corn, soy, and wheat feed omnivores, vegetarians and vegans alike.
All that plant food, especially genetically modified soy used extensively in pseudo meat products, presents unique challenges for vegetarians. Glyphosate, the most pervasively used herbicide in America, holds a patent as an antimicrobial agent and kills off the very microbial and fungal networks in soil responsible for carbon sequestration.
To make matters worse, the FDA and USDA conveniently decided not to measure glyphosate residue in food during the last 10 years, so we know little about it’s impact on our own gut microbes. During this time the EPA has allowed glyphosate to be sprayed directly onto crops as a “harvest aid”.
COWS OR CROPS: WHAT CAUSES MORE HARM?
Vegans often focus on the welfare of cows. However, many wonder if they ever consider all the other animals killed in the process of growing crops used to produce their food. Matthew Englehart, a former vegan/vegetarian and owner of Cafe Gratitude, learned the the hard way when establishing his own organic farm. In the LAist article linked above he states, “Agriculture is most violent destructive force on the planet. It has caused the extinction of more species then any other activity.”
Maybe vegans and especially organizations leveraging science based principles should rethink their strategy. Is it really a good idea to press for less meat or a meatless diet for all?
Regenerative agriculture honors how nature really works. All living things– microbes, plants and animals– dynamically recycle nutrients. Nature gets the science right.
Ultimately, we need the animals whether we eat them or not. Consumers eating better meat and dairy ensure grazing animals will save the planet. Vegans can do other good works.
A recent Washington Post article suggests that American’s junk food diet starts in toddlerhood. The journalist details a recent study by Victor Fulgoni analyzing data from the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2012 for 4,406 children under the age of 2.
Diving into the data, he reveals even at one year of age, infants are eating their fair share of highly refined and processed foods. While the article goes into a bit of mind numbing detail, I consider the piece a decent start to the conversation, however the most critical issues aren’t revealed in the government data. In truth, there is much more to the story.
PREGNANCY INCUBATES BABIES IN A POTENT METABOLIC STEW
A children metabolic problems may stem from mom’s food choices and metabolic health even before she conceived. What and how she eats throughout pregnancy, and how she responds to the dynamic metabolic shifts during pregnancy influence everything. Babies born to mothers who gain weight quickly during pregnancy, gain excessive weight or too little weight during pregnancy may confer great risk of poor metabolic health on their children.
Mothers who develop gestational diabetes and or are already diabetic when they conceive pass on even greater risk. Babies born to mom with gestational diabetes are 8 times more likely to become diabetic themselves. The metabolic footprint is in place.
BREASTFEEDING: TOO MANY MOMS BAIL AFTER A FEW MONTHS
Next, too few mothers who intend to breastfeed aren’t breastfeeding a few months after birth. Too many workplaces, retail environments, and a distorted sense of privacy compromise a mother’s ability and ease to breastfeed.
It doesn’t help that the health care community has yet to offer adequate education and support. Too few hospitals engage in best practices to encourage breastfeeding. Under the auspices of the Affordable Care Act, The Office of Disease Prevention outlines specific recommendations to for hospitals to support breastfeeding education and support and insurance companies to cover costs. With most moms leaving the hospital after a day or two, that isn’t enough.
Most women need ongoing to support and resources through the critical first six weeks as baby and mother learn how to breastfeed and mom’s milk supply gets established. Breastfeeding may be natural, but it’s not instinctual nor automatic.
FIRST FOODS MATTER
Too often a baby’s first food is a highly processed, high glycemic refined starch. Infant cereal made with refined flour remains the overwhelming most popular first food. Too many new parents preferentially feed their baby infant cereals, usually following a health care provider’s advice or at least the advice from a free informational pamphlet offered by an infant food company.
Around the world parents feed babies a wide variety of mashed up whole foods, including sources of more fat and protein tham Americans consider feeding their infants. From avocado and nut butters, to eggs and all matter of animal protein, as well as whole grain gruel and porridge, an array of cultural food patterns around the globe encourage babies to eat better.
SNACK AND MEAL TIME IN AMERICA
By 8 months of age an infant’s affinity for all things starchy and sweet grows. Babies are offered a wide range of finger foods from Cheerios to pretzels, crackers, biscuits, goldfish, as well as the sweets, treats, juice and sweetened beverages. Too many busy parents and care givers forget that in between meal snacks provide an important opportunity contribute nutrient dense foods in the diet. This is no time to fill kids up with easy, portable and starchy snacks and sugary drinks to keep them quiet.
Mealtime often translates to kids filling up with pasta, rice and bread, with parents and other care givers often caving to what a child will eat instead of what they need. A mix of food choices should include adequate protein, produce and fat to balance the popular starches. Many parents benefit from honoring, Ellen Satter’s division of responsibility. The parent determines when and what to eat; the child determines how much.
EATING AWAY FROM HOME
Eating out presents its own challenges. Meals away from home stir just enough emotions to drive parents to capitulate. The stakes are raised and most parents and caregivers cave to their crying infants demands to minimize the glaring stares of other patrons.
Unfortunately most restaurants make this easy as they fill us up with too many carbs, even before the meal is served. Bread, tortilla chips, crackers or bread sticks appear on the table enticing hungry children and seducing parents yearning for a quieter dinner.
Interestingly, the more affordable Kids’ Meals may help, or may constitute a dietary disaster. Why don’t more restaurants offer smaller portions of more balanced meals available on the adults menu?
IT TAKES A VILLAGE
Lastly, most parents can’t tackle this alone. We live with abundance, and we feed babies and children as if they will always get away with eating whatever they want. Current health statistics tell most of us don’t.
Children are fed by a web of family and care providers, as well as an army of adults. In a culture of indulgence too many friends of the family, neighbors, and adults in the business community bribe and seduce children with a treat just to be nice or create a bond. What a set up.
As a parents, caregivers, and responsible members of the community we need to answer a hard question: Why feed children a diet that will predictably lead to insulin resistance, poor metabolic health and increase risk of every inflammatory disease at some point in their life?
Patients suffering a severe type of heart attack are younger, more obese, and more likely to smoke according to a study presented at the 65th American College of Cardiology conference last month. With Americans suffering more from preventable “lifestyle” diseases like diabetes and high blood pressure, the lead author, a cardiologist at Cleveland Clinic, uses his platform to admonish others. “The primary care physicians and the patient need to take ownership of this problem.”
Well, yes and no. Primary care physicians and patients probably do need to more effectively address and engage in prevention, however barriers to change stem from a wide range challenges, including what we consider prevention.
WHAT PASSES AS PREVENTION?
The Affordable Care Act attempts to shift the medicine towards more prevention with the notion of decreasing more expensive care down the line. The current systems favors medications and procedures, with the toxic impact of burdening our economy while delivering worse health outcomes than other industrialized nations.
Prevention embraces the notion that we can live our lives in a way that decreases risk of disease. Preventative efforts target lifestyle factors including what we eat, how we move, and what we do to manage our lives. Ideally efforts to prevent illness promote services and programs that meaningfully impact these key lifestyle behaviors. However, a closer look at what passes as prevention hints at the challenges ahead.
I witness the efforts at Kaiser Permanente with both professional and personal curiosity, and appreciate that the Kaiser model works well, often trumping other health care plans. Still, I find myself scratching my head every time a press release crows about Kaiser’s #1 status.
I understand the public health implications, but honestly all the talking doesn’t feel like prevention to me. It feels like someone checking off a list, with others collecting the data. Mostly I started wondering how prevention is being measured in the first place.
WHAT GETS MEASURED AS PREVENTION
I spent a little time perusing the website for the Office of Disease Prevention and Health Promotion and found an outline of prevention efforts targeting adults, women, and children. As I tallied the initiatives, it became obvious that prevention may as well be code for screening. Here’s what I found.
ADULTS – 14/15 resources for adults involved screening while the other resource allows for no-cost vaccines. Screening measures include counseling to address alcohol addiction, support smoking cessation and treating obesity. NOTE: the recommendations included on the website outline what patients should do but doesn’t provide any guidance to obtain services or get them reimbursed. The dismal statistics regarding obesity counseling covered under Medicare services reveals just how a good idea gets sidetracked.
WOMEN – 20/22 services involve screening, while two preventative measures involve free access (birth control resources and folic acid supplements for women intending to get pregnant). Preventative measures include counseling for five conditions, including domestic violence, smoking cessation for pregnant women, sexually transmitted diseases, chemo-prevention, and breastfeeding support.
CHILDREN – 22/26 services for children involve screening. Children are screened for elevated BMI levels and obesity, as well as lipid disorders (think elevated cholesterol, triglycerides or low HDL-cholesterol levels). Free counseling supposedly includes counseling to address obesity, but that seems more treatment than prevention. Why are we waiting for a child to be diagnosed as obese to offer support?
WHY IS PREVENTION MORE SCREENING THAN SUPPORT?
Health screenings allows doctors to learn more about their patients, which is a good thing. However, what good does it do to identify risks linked with poor metabolic health if patients enjoy little access to effective nutrition education and medical nutrition therapy?
When I looked closer at the NIH directives for prevention, programs that offer counseling and support tend to focus on domestic violence, substance abuse, sexually transmitted diseases and other concerns that sit at the crossroads of public health and medicine. What’s missing is meaningful support to help consumers improve their metabolic health with concerted in-the-trenches education and counseling that works with consumers as they learn to eat better and navigate the complex and often overwhelming world we live in.
In the meantime, Kaiser continues to send out letters to patients to address nutrition concerns, such as this one directing a member to “follow a low cholesterol diet”, maybe attend a cholesterol class, and check back with the doctor in 6 months. In essence the medical world continues to believe one dietary approach will work for all patients with the same diagnosis, and no one has figured out that knowledge is not the same thing as behavior.
LITTLE ACCESS TO MEANINGFUL SUPPORT
Those of us in the trenches already know that real change requires more than information. Patients and consumers alike benefit when meaningful support targets core behaviors and beliefs including one’s ability, willingness, and readiness to change.
Meaningful intervention involves face time, but most patients enjoy little access to sophisticated nutrition counseling by a registered dietitian even to treat disease. Too often a soundbite to lose weight or eat better from a doctor or nurse with too much to do and not enough time suffices as “diet counseling”. Why do we tolerate not-so-benign neglect of nutrition in health care?
Even if the medical world did a better job referring patient to dietitians, most dietitians in private practice I’ve spoken to don’t accept insurance reimbursement for two primary reasons. First, an obscene amount of time taken to navigate the reimbursement process. Second, abysmal reimbursement rates when limits services are covered. The billions we spend on medical care for ever more sophisticated treatment can’t make up for basically ignoring prevention.
At the end of the day sophisticated nutrition support remains most available for consumers with an ability to pay for service. Everyone else is treated to a one-size-fits-all approach to food that increasingly is linked to the very diseases the guidelines are supposed to address. That’s not good enough to stem the rising tide of metabolic disease and obesity in the US population. The answer lies in prevention, not more aggressive treatment.