Archive for ‘Dietary Compliance’

September 26, 2017

Food or Feud

In my family, it can be food or feud. The simple solution is for us to eat on time. But what happens when things aren’t simple?food or fuedI am sitting in 3000 square feet of emptiness looking up at the ducts on the ceiling 22′ above me. My head is hurting. I planned to be here until 1pm. Now the heat & air installers say it may be 4pm. I am hungry for more than the cheese and crackers I brought to tide me over until 1. It may be fall, but it is hot!

Hot, hungry, and tired with a headache that won’t quit can be a recipe for a family feud or at least a lot of misunderstanding! When someone in my family starts to become easily annoyed, we immediately look for food. We know that we’re grumpy when we’re hungry. Because of this, we’re pretty good planners and we always have a snack handy, but the unexpected can still sometimes catch us unprepared.

If you’re one of those folks who can go all day without a meal, you’ll have no idea why this is significant. If, on the other hand, you begin to feel shaky, confused, sweaty, and sick if you don’t eat on time, you’ll understand why I’m writing this.It’s hard to count the number of times I’ve told a travel companion that I’m hungry only to have them stall me for 3 or 4 hours. Long before that time is up, I feel like I’m going to throw up my guts. I physically hurt. I cannot think straight enough to tell you what I want to eat.

What I’m describing has happened to me all of my life. It also happens to my son. It probably happened to my grandfather who could not tolerate sugar. He never ate cake, pie, cobbler, or cereal with added sugar. He would occasionally eat chocolate covered cherries. I don’t remember, but I’m guessing he ate those after a meal when they would have less effect.
I say this because that’s my experience with sugar. I can tolerate some after a meal, but feed me pancakes with syrup or a glazed doughnut for breakfast and I will be puking them up in 5 minutes. I will feel a horrible sinking sensation, then wretchedly nauseous.

My grandfather and his sisters who shared this sugar sensitivity were never diagnosed with a condition or disease. I have had blood work done just after two of these episodes. It is always in the normal range. My body may struggle to break down sugars because of celiac disease, but no one has been able to tell me that with any certainty.

That’s the thing sometimes. You know how you’re feeling isn’t normal, but whatever you have isn’t showing up, isn’t being tested for, or falls in the “normal” range. That can feel really frustrating. But life goes on. You learn to recognize when you’re approaching critical and do your best to stay ahead of the problem.

But when a plan suddenly changes, things run late, or there is an unexpected problem, what I most need is for you to believe me when I say I need to eat. I may say it matter-of-factly and without drama, but I need for you to understand that it will soon be more than I can do to remain calm if you ignore repeated requests to stop at the next place we come to.

I know that you may be trying to get to a better restaurant 10 miles down the road, but what I need for you to get is that once I hit a certain point, I do not care whether the food will taste good, I just need it in my tummy. Telling me to hang on because there’s a great restaurant in the next town is like telling me you’re going to break my arm. If I respond as though that’s what you’ve said, it is because that is how it feels to me.

When I am using my energy to stay calm, ask politely, and try not to puke or cry, it is overwhelming to ask me to choose a restaurant, name what I want, or really to communicate at all. Keep in mind that I will have attempted to address the oncoming problem I am sensing before I get to this point. If you did not recognize that those attempts were important, you may not recognize that I want to cooperate, but am feeling as though my situation is dire. Boom! Argument, misunderstanding, or meltdown may be imminent.

While I may get into a situation in which grabbing a handful of crackers from the table is tempting, since becoming gluten-free I have never made that choice. And that adds a second layer of distress when communication becomes difficult.
Today, when I began to feel vague hunger pangs, I ate some cheese and crackers. An hour later, I was getting seriously hungry. About that time, I received the news that my stay would be extended several hours past what I had planned for. I recognized that it was important to either stop the crew and go get food, or find a way to get some brought to me.

I did not wait until I could no longer think straight. I made a short list of people who could help, decided what I would request they do, and proceeded to call the list. Before the next hour was up, I had eaten lunch and no longer had a headache.
plate
Today, things worked out well. Other times, they have not. Most often those have been times that I was accommodating a group or an individual with little insight or empathy. Occasionally it has been at times that I was forced to deal with a person who simply can’t be reasoned with or does not value how I feel.

What’s the best plan in those instances?

Recognize that not everyone you come into contact with has your best interest at heart. If there are people in your life who are routinely difficult and make it hard to take care of yourself, avoid situations that make you dependent on dealing with them. Take a separate car. Choose a different work group. Volunteer for a different committee. Say no if you have to.
Know that you will never be able to make an unreasonable person be reasonable. They must come to a point where they choose to see their contribution to a situation that distresses you before you can reach them. How you feel can be communicated and cooperation can be requested, but it is helpful to know that you cannot force understanding.

You will never be able to make crazy behavior make sense. It is not necessarily important to understand why someone does something. If they exhibit a pattern of behavior that is detrimental to you, it is enough to know they do it and that it is not acceptable to you.

Once you determine that, you have many choices for what to do next:
Set and enforce better boundaries.
Minimize your exposure.
Leave behind friendships, romantic relationships, jobs, or distant relatives that hurt you.
Become realistic about your contribution to any friction in a relationship and apologize for your part in a misunderstanding.
Refuse to be lured into apologizing for taking care of yourself so long as you have managed to remain calm and kind and have tried your best not to inconvenience anyone else. You cannot control every circumstance.
pork roast
On the flip side, you also have choices about how you view another’s actions:
Extend the benefit of the doubt. Some people mean you no harm, but will inadvertently hurt you anyway.
Be present. We are all less likely to hurt each other when we are fully aware of the effect we’re having in the moment.
Allow yourself to see and feel the discomfort of someone else’s distress. Being attuned to subtle signs will change how you respond. Isn’t this what we want from others?

I wish for a partner who understands my physical limitation to the extent that in a pinch he is willing to voluntarily bring me something to eat that doesn’t take much energy to digest – a banana, a glass of milk, or some Greek yogurt. It sounds so simple. I’m sure any man who has failed to do so would read this and say, “I would do that.”

Of course you would if it seemed important at the time. But what if you got distracted by a work call or the kids throwing a fit or trying to figure out how we’re going to pay for replacing a heat & air system we haven’t budgeted for? What if you felt annoyed when I repeated a request for food when you’re planning to EVENTUALLY honor that request? What if you were in the mood for a really good meal and thought I’d be ruining my appetite by eating before our 9pm reservation? What if your mother believes I am trying to avoid eating the meal that’s taking extra time to prepare because she’s making it gluten-free for me? What if you simply don’t believe how sick I feel because you’ve never experienced it and my test results are normal?

We all like to see ourselves as reflected only by our best moments. In real life, we’re experienced by those around us as a sum of our level of presence, our tolerance for vulnerability, our priority in the moment, our insight, our ability to empathize, our reliability, our helpfulness, kindness, and thoughtfulness, our flexibility, stability, and mindfulness, our willingness to entertain different points of view, our truthfulness, genuineness, respect for others, and our courage to make the difficult choice. Other’s experience of us may not match up with what we believe about ourselves.

So what?

We are surrounded by evidence that many of us have difficulty taking care of ourselves. If we were consistently receiving the message that we matter, we are important, we are valued, others wish us well, and our loved ones are willing to help us, would we have a rapidly increasing number of pervasive, preventable, chronic health problems? Would we ignore simple lifestyle changes that can give us the ability to live longer, more productive, more comfortable, and more joyous lives? I don’t think so. I think part of the struggle to eat in a manner that maximizes our health comes from the messages we receive on a daily basis.

Why does that matter?

Only you know how significant, painful, overwhelming, exhausting, or stressful something is to you. You may communicate that clearly and still find yourself without assistance. That does not mean there is something wrong with you, that you should not take care of yourself, or that you do not deserve help. It could mean you need a better communication strategy, or it could mean that you are surrounded by relationships that need to be reexamined.

For my family, it’s food or feud, so there are repeated opportunities to observe, examine, and improve our interactions. Most of us accept each other’s limitations and work together to take care of each other. We also accept that some family members will choose to make things more difficult and that we have many options for dealing with this. Those options may not be easy choices and may require some self-sacrifice to maintain a relationship. We accept that at some point a relationship could become be too harmful to continue. At that point, we can choose to let it go.

Eating on time may not be a feuding issue for your family. Your point of contention could center around eating gluten-free or vegetarian It could be that a battle breaks out every time you try to convince your sister that your diabetic mother doesn’t need carbs. It could that no one but you lives near Grandma, but the rest of the family condemns you for wanting to put her in long-term care.

The specific issue may vary. The importance of expressions of empathy, kindness, helpfulness, thoughtfulness, care and concern, and acceptance for ourselves and each other cannot be overstated. These expressions are critical to our health, our families, our communities, and our nation. They make a difference. They can make THE difference, especially when things don’t go according to plan.

https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

http://www.webmd.com/diabetes/tc/hypoglycemia-low-blood-sugar-in-people-without-diabetes-topic-overview#1

September 20, 2017

Can Food Win a War?

save France“Food Will Win the War” was the slogan of the US Food Administration in 1917; can food win a war? I’ve been cleaning out a storage building and a house. I’ve sorted through bags and bags of mail from 1987 to now, disposed of boxes of paper scraps, broken toys, and canned food so old that the cans are leaking. Hidden amid the mountain of junk, I’ve also rescued two baby books, a 1910 teaching contract, antique maps, and a copy of “Food Saving and Sharing” – the 1918 textbook prepared under the direction of The United States Food Administration.

This 102 page book, which was distributed to teachers in schools across the US, provides basic information about food and its function, interweaves cultural myths, and promotes conserving food, cleaning your plate (that probably sounds familiar), and helping the nation and its allies through personal sacrifice. For me, reading this now at a different point in history provides much food for thought.

Food Administration

Established in 1917, the US Food Administration was the agency responsible for the administration of U.S. Army overseas and Allies’ food reserves. The Food Administration’s goals were to provide food for its own troops and those of its Allies in war-torn Europe as well as to feed the American and Allied populations. Although the name sounds similar, this agency was not related to the Food and Drug Administration which was instituted in 1938 to enforce the Federal Food, Drug, and Cosmetic Act.

Herbert Hoover was tapped by President Woodrow Wilson to lead the organization. As head of the agency, Hoover was quoted as saying, “Our conception of the problem in the United States is that we should assemble the voluntary effort of the people…We propose to mobilize the spirit of self-denial and self-sacrifice in this country.”

“Food Will Win the War” became the slogan featured on widely disseminated posters, articles, and educational material. Concepts such as “Meatless Mondays” and “Wheatless Wednesdays” were implemented to encourage US citizens to voluntarily conserve food so that more commodities would be available to send to the Allies.

The campaign was successful, resulting in a 15% reduction in domestic food consumption without rationing. In a 12-month period from 1918 to 1919 the US furnished 18,500,000 tons of food to the Allies.

Food Education

About half of the book “Food Saving and Sharing” is food education. I was struck by the accuracy of the information included. With more sophisticated lab technology, years of additional research, and multiple media outlets for disseminating information, it seems that we should have
significantly greater knowledge and be more accurately informed regarding nutrition now than we were 100 years ago. Instead, we have a wealth of confusing, conflicting, misleading information to sort through. It’s tough for most of us to know what to believe.

I recently watched a national TV morning news segment in which an MD stated that yogurt was not a good breakfast food because of all the sugar it contains. She did not qualify that statement in any way and it’s simply not true. Plain yogurt contains no sugar other than lactose from milk. If made at home and processed for 24 hours, even the lactose breaks down.

If milk is a good breakfast food, then yogurt is just as good. Well, actually better for most of us so long as the yogurt contains live bacteria. What’s not so good are yogurts that have sugars, sweeteners, gums, and flavors added. The distinction is important. If that distinction isn’t made, the public is being misinformed. And not just misinformed by misleading advertising (which is constant and bad enough), but misinformed by an authority figure with a national platform presenting the information as fact.

My experience of frequent frustration with current presentation of food and nutrition information, advertising, disinformation, and inaccurately reported research stands in contrast to the simple, clear message delivered a century ago. Reading this book it was interesting to see the food knowledge of 1918.

“Food Saving and Sharing” explains the functions of food and four basic food groups using the imagery of a child shopping for food in an imaginary market. The book explains each food group and why it should be included in the child’s basket. At that time, milk spanned the spectrum of each food group and was considered important for children because of its protein and “lime” (calcium) content.

Here’s what we can learn from the book:

The Functions of Food
1)Fuel to keep us warm and give us energy for work.
2)To build and repair the body.
3)To keep the machinery of the body in good running order.

Food Groups
The first group is fruits and vegetables. (Notice that it was not grains.)
The book states that we need the mineral matter supplied by fruit, vegetables and milk to make teeth and bones. We also need them for vitamins that make us grow. Not much was known about the amount of vitamins needed at that time, but it was known they are important to health.

We also learn that fruits and vegetables contain a lot of water which we also need. Water comprises 60 lbs of every 90 pounds of weight in an adult. (As you can see, this is very close to the 64% water we now estimate the human body to be.) 

While the term fiber is never used in the book, there are repeated references to the “bulk” and “things that are not readily digested” that help move food through the digestive tract.

The second group is proteins.
The word protein means “of the first importance”. Protein is important because it is needed for growth and repair. Children who don’t get enough protein become stunted.

Proteins included in this group are milk, cheese, eggs, nuts, seeds, fish, seafood, legumes, and meat. Meat is not necessary if we use the right foods in its place. According to this text, if we rely on beans and peas we need some milk, eggs, or meat as well.

The book also encourages us to get over our prejudice about fish stating, “It is foolish and narrow-minded to be afraid to try new kinds.” (I don’t know much about the origin of this fish prejudice, but my father had it and my sister still does.)

The third food group is cereals (grains).
Cereals are presented as the cheapest source of energy. All cereal grains are good producers of starch. They are easy to cook, but must be cooked for a long time, so prepared cereals have been put on the market. For instance, rolled oats are oats steamed, then crushed between heavy rollers.

Wisely, we’re informed that if we eat more peas and beans, we will not need so much bread, and when there’s a shortage of grains, we can eat potatoes instead.

Fourth is the group called sugars and sweets. 
The consumption of sugars is not highly encouraged. While it is asserted that sugar provides quick energy for emergency rations, it is also recognized that: “Sugar is so agreeable that we are often inclined to eat it in too large quantities or at the wrong time.” It will spoil your appetite because it makes you feel as if you don’t care for anything more even though your body may be in need of food.

Further noted are the facts that you can get sugar from fruits and vegetables and that potatoes or bread will provide quick energy as well. 

The rest of the book sings the praises of our troops and allies and encourages us to conserve so we can support those who live in war-torn areas. While the reasons for conservation may now differ, it is still a timely message.

Can Food Win a War Now?

In spite of a long growing season and an agricultural history, my state reports a food insecurity rate of over 25%. Somehow that seems unfathomable when according to the Environmental Protection Agency, wasted food is the single biggest occupant in American landfills.

Across the nation, the US throws away 60 million tons (or $160 billion) worth of produce annually. We waste between 30 & 40 percent of our food supply while 12.3% of our households (15.6 million) are uncertain of having, or are unable to acquire, at some time during the year, enough food to meet the needs of all their members because of insufficient money or other resources.

Surely we can find a way to win the war on hunger here at home!

Food propaganda? 

“Food Saving and Sharing” seems to only promote the positive aspects of a particular course of action rather than presenting the pros and cons of multiple options. It uses familiar cultural myths to encourage compliance with the course of action it promotes. That sounds like propaganda to 
me. 

Yet oddly, the presentation of the message feels so much more informative, unifying, and positive than the majority of messages bombarding my screens every day, I find myself longing for this kind of straightforward promotion and the message that the US is us.  

The US is us!

With or without this book’s existence, I choose to believe the general premise that each of us makes a difference. Our choices determine whether that difference pulls our families, friends, communities, and institutions forward or leaves someone else with a greater burden. 

Individually, we can choose to leave our fears, recognize our value, and work each day to learn more about nutrition, waste less, face poverty, practice compassion, and make a positive difference. Collectively, we can choose to meet seemingly insurmountable goals.

Food can win this war! We can decide to feed our food insecure. We just need to again mobilize a spirit of self-denial and self-sacrifice in this country. We need to embrace the truth that the US is us…ALL of us and we can make a difference!

https://en.wikipedia.org/wiki/Federal_Food,_Drug,_and_Cosmetic_Act

https://www.archives.gov/fort-worth/finding-aids/rg004-food-administration.html

http://exhibits.mannlib.cornell.edu/meatlesswheatless/meatless-wheatless.php?content=two

https://en.wikipedia.org/wiki/United_States_Food_Administration

https://www.archives.gov/education/lessons/sow-seeds

https://www.usda.gov/oce/foodwaste/faqs.htm

https://www.theatlantic.com/business/archive/2016/07/american-food-waste/491513/

http://www.foodwastemovie.com/

http://www.cooking2thrive.com/blog/get-know-food/

August 21, 2017

Sandwich in Some Healthy Habits

Today when the moon gets sandwiched between the earth and the sun seems like the perfect opportunity to sandwich in some healthy habits. I’m sure you’ve seen a million warnings in the past two weeks about protecting your eyes during today’s eclipse. You probably prepared by purchasing some special viewing glasses or creating a pinhole viewer. That tiny bit of preparation will protect your eyes as you view something spectacular.

eclipse

Eclipse


Making tiny changes in preparation for better health as you age can be just as easy and have a big impact over time. If you look at everything you think you should be doing to live a perfectly healthy lifestyle, it may so overwhelming that you don’t ever get started. Statistics indicate that the majority of us fall in this group. The CDC reports that only 20% of Americans meet physical activity recommendations and a 2016 study indicates only 3% of us live a healthy lifestyle.

It is important to note that you can improve your health by making small changes over time. A study published July 13, 2017, in the New England Journal of Medicine found that “Improved diet quality over 12 years was consistently associated with a decreased risk of death. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17%….” In other words, it didn’t take 100% improvement in diet to result in a significant reduction in mortality. And mortality is the extreme. Just imagine how much small changes can improve your everyday energy level, stamina, strength, flexibility, mental acuity, mood, and comfort level.

So often we look at eating well and working out as all or nothing propositions. When all seems like more than we can handle, we go for nothing. Knowing that even small changes can make a difference seems to indicate we should look at healthy habits more like a savings or investment account with benefits that grow slowly, but surely.

What do small changes look like?

Drink water 95% of the time rather than soda, diet soda, energy drinks, sweetened coffee drinks, lemonade, sweet tea, hot chocolate, or any other sweetened drink.
Eat an orange for breakfast rather than drinking orange juice.
Eat plain, unsweetened yogurt topped with fresh fruit rather than flavored yogurt.
Choose eggs and whole grain toast for breakfast rather than cereal and milk.
Snack on raw, unsalted nuts rather than the salted, roasted version.
Choose black beans over pinto beans.
Order a side of mixed vegetables rather than a choice of potato most of the time.
Reserve dessert for special occasions.
Snack on fruit rather than candy.
Pop your own popcorn using a tiny bit of olive oil spray.
Get salad dressing on the side and limit to 1 tbsp.
Buy frozen vegetables rather than canned when you can’t get fresh.
Cook with olive oil.
Take leftovers for lunch rather than eating fast food.
Substitute baked fish for one serving of red meat each week.
Eat less prepared meat.

Sandwich in some activity

Even if you don’t have an hour to spend in the gym, you can increase physical activity during your daily routine.

Stretch every morning.
Walk to lunch.
Walk a few flights of stairs before catching the elevator.
Do stair stretches before you head upstairs to shower.
Regularly park on the far side of the parking lot.
Do some yoga breathing at your desk.
Carry your own boxes.
Wear ankle weights on Saturday.
Do tricep curls with your cast iron skillet before cooking.
Find a video workout you can do at home when there’s no time to go to the gym.
Combine lifting light weights with warrior poses and lunges.

Make sure to rest

Get the electronic lights out of the bedroom.
Allow plenty of time for sleep.
Plan some down time each week.
Do something fun each week.
Don’t skip vacations.

As you can see, nothing on these lists sounds like a big deal. Everything is easily doable. In fact, it’s hard to believe that these changes can make any significant difference in your health. The great thing is, they can. Simple changes like these when made for an extended period of time can have many positive effects. Why not sandwich a few into your day?

https://www.cdc.gov/media/releases/2013/p0502-physical-activity.html

http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract

http://www.nejm.org/doi/full/10.1056/NEJMoa1613502

August 15, 2017

Travel Tip #18 Push the Limits?

Travel Tip #18 Push the Limits is written with you in mind if you suffer from IBS, IBD, Crohn’s Disease, Celiac Disease or other conditions that may lead to a sudden need for bathroom facilities. I just got back from LA. During Sunday brunch I had a sudden reminder of how uncomfortable it can be to travel with a gastrointestinal condition. This travel tip deals with a subject that’s difficult to discuss in public.
cypress
If your guts are constantly in a knot and you can’t predict when diarrhea, gas, or pain may suddenly hit, it can be hard to imagine taking a long trip on an airplane or even in a car full of people. A fear of embarrassment or discomfort can lead to a gradual withdrawal from family outings and vacations.

Reluctance to disclose the real reason for resistance to certain situations often leads family and friends to misinterpret what’s happening. I mean who really wants to say, “I just can’t face the chance that I’ll poop myself during a 3-hour plane ride?” I don’t. It really doesn’t matter how close we are, I just don’t want to discuss that with you.

So, what should I do?

Pretend to be too busy, too sick, or too angry with Aunt Jane to attend?
Insist on a different trip that no one else is excited about?
Wear adult diapers?

Sometimes saying no may be the best choice. If your only motive is to take care of yourself, you’ve explored all the options that might make the journey enjoyable for you, and you still can’t find a way to make peace with attending, then say no. It’s only when you have an ulterior motive or when continual refusals begin to limit your access to a full life that saying no becomes detrimental.

Say yes within limits. If it’s hard for you to take care of yourself, establishing certain parameters in advance can make it easier to decide in the moment when presented with an invitation. For instance, you may want to have a rule that you only agree to car trips in areas with ample facilities. You may want to limit flights to 1 hour at certain times of the day. You could have a rule that you will not stay at friends’ houses so that you have the privacy of your own space. Along those lines, you can have a rule that you don’t share hotel rooms. If you know you usually have fewer problems an hour after eating, join the family after the meal rather than for the meal.
breakfast
Make sure you eat properly and/or take your medication on time. When you’re willing to say yes, there’s no reason to tempt fate. Adhering to the regimen that works best for you while varying your activity can make all the difference. Investing a little time in research and advance planning can make it possible for you to have plenty of medication on hand even when you miss a connection.
It can also mean that you have plenty of tummy friendly snacks on hand when meal times or restaurant options unexpectedly change.
orange tree
Focus on the good stuff. A beautiful view, a warm hug from your favorite cousin, or the smile on your grandson’s face when he meets LeBron James can all mitigate a little discomfort. After all, you may not feel perfectly well at home. If you can feel equally good and add some great memories, it may be worth risking possible inconvenience or embarrassment. If things turn out badly, you can make a different choice next time. If you always stop yourself before you start, you’ll miss out on a lot of good stuff.

Bring the party to you. If you need to be in your own space to be comfortable, make your home the place everyone gathers. Let the travel be someone else’s problem. Instead of missing out on memories and contact with people you enjoy, develop your hosting skills.

That doesn’t mean you have to do a lot of work and throw a party. Just establish that you’d like to see everyone at a certain time and invite, invite, invite. When someone visits, relax and enjoy them. It may take some time to develop momentum, but eventually word will spread that your place is the place to be. Making your guests feel welcome is all it really takes to be a great host.

If you suffer from IBS, IBD, Crohn’s Disease, or Celiac Disease, should you push the limits and travel or should you stay home? There’s no right or wrong answer. What’s right for today may not be right for tomorrow.

The important thing is to always, always take very good care of yourself. For some of us that is in and of itself pushing the limits.