Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?
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It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.
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But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.
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Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

steam trayI’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

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

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

A Second Opinion

The local newspaper recently featured an article entitled, “Excluding gluten”.(1) It was a basic exposition about the abundance of choices now available in a gluten-free version. This article, like many I’ve read lately, leaned toward proclaiming the gluten-free diet as necessary for a few, but mostly a fad made popular by Hollywood.

Today, I received a newsletter from Isabel De Los Rios of Beyond Diet.(2) In an article describing how to eliminate inflammation, she states:
“If I had to choose just 1 thing to do right now to help reduce your inflammation it would be to greatly reduce your wheat and gluten intake.”

Eliminating wheat from your diet can have an astounding impact on how you look and feel. 

Wheat wasn’t always so harmful like it is today. In the past, we had many different strains of wheat, but in modern times, in order to increase production, agricultural scientists created two hybrid strains. Right now more than 99% of the wheat grown worldwide comes from those two hybrid crops.

Genetically modified foods in any form can have an extremely negative impact on our health and weight.  Dr. William Davis, a Wisconsin based cardiologist, points out that the hybrid wheat strain shows only 95% of the same proteins as its parent wheat strains: the other 5% are completely unique. This unique 5% of proteins is responsible for so many people’s wheat sensitivities.  It’s becoming a huge epidemic and most everyone is allergic or sensitive to wheat in some form.

Which article is more accurate?

The rapid increase in the incidence of Celiac Disease, Autism Spectrum Disorder, and ADHD over the past 50 years seems to lend weight to the theory that we have a huge epidemic on our hands. Whether that’s because of a change in the amount of wheat we consume or in the wheat itself is not as critical to our health as is the recognition that for many of us, the need for a gluten-free diet is far from a fad.

It is interesting to note that the dietician quoted by our local newspaper predicts that “except for those who must absolutely maintain a GF regimen, the diet will come and go because ‘it’s really a hard diet’.” The different positions taken by this dietitian and Isabel De Los Rios (also a licensed dietitian) are striking, and common, making it difficult for some to discern whether or not sticking to a gluten-free regimen is truly important.

If you have had a physician or dietitian tell you that maintaining a gluten-free diet is hard, I hope you will take a moment to reflect on the fact that this is not a medical opinion. It is a personal belief held by the person who is telling you. Since it’s a personal opinion, there is no need to defer to it as the truth and dismiss the gluten-free diet as too difficult before you even try it. Chances are that if you are having this conversation with a health professional, the medical evidence points to a need for the diet.

Gluten may be the culprit when you have the following symptoms:
Fatigue or malaise – feeling tired and exhausted much of the time
Vague abdominal discomfort or significant abdominal pain
Upset stomach
Bloating
Flatulence
Recurring diarrhea or constipation, or one followed by the other
Steatorrhea – presence of excess fat in feces that may cause stools to have an oily appearance and float
Bacterial overgrowth of the small intestine
Gastric reflux – heartburn
Growth delay or failure to thrive
Unhappy with your weight
Eating problems – anorexia
Run-down
Weakness or lack of energy
Chronic fatigue
Joint pain
Poor coordination – unexplained falling
Peripheral neuropathy – tingling or burning in arms & legs, loss of sensation, or inability to control muscles
Coughing after every meal
Runny nose and sinus problems
Anemia – chronic iron deficiency
Osteoporosis or growing pains
Dermatitis, eczema, itchy or bad skin
Chronic dry eye
Nose bleeds or easy bruising
Alopecia – baldness or diffuse hair loss
Runny nose and sinus problems
Headaches or migraine
Depression, moodiness, behavioral changes
Can’t think clearly
Poor sleep
Hyperactive or cranky
Down syndrome
Short stature
Failure to thrive
Attention Deficit Hyperactivity Disorder (ADHD)
Autism
Mental health problems
Seizures
Hypoglycemia

If you can eliminate these symptoms simply by avoiding wheat, rye, barley, malt, and oats (other than certified GF oats), isn’t it worth a try even if it were hard? If you can eliminate these symptoms, feel better than you’ve ever felt, and enjoy a more full and joyous life with your loved ones, isn’t it worth the small investment of time and energy it takes to change old habits?

With the myriad gluten-free choices now available from restaurants, grocery stores, drug stores, and online, living the lifestyle becomes easier every day whether or not you choose to cook. All it takes is a bit of education, support and commitment. When you need additional encouragement and support, Cooking2Thrive® is here to help.

Conflicting opinions may abound regarding the difficulty of complying with a gluten-free diet, but the preponderance of evidence suggests that this lifestyle is not a fad, but an increasing medical necessity. With this in mind, we hope you’ll trust your body’s signals, seek a second opinion, and be willing to invest in your own healing.

Feeling fantastic and loving every minute of it!
Cheri

 

(1) Wolfe, Ron. “Excluding gluten.” Arkansas Democrat Gazette [Little Rock] 12 June 2012, Daily ed., Style sec.: 1E+.

(2) http://www.beyonddiet.com/BD