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?
health
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.
salad
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.
garden
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.”

We’re bombarded with the words Eat Healthy, but what do they really mean?

Every day we’re bombarded with the words Eat Healthy, but what do they mean? Do any of us really know?

Watch TV news shows for a day and you’re bound to see a graphic that features some combination of the words healthy and eat, eating, or diet in a list of behaviors that can reduce your chances for contracting some chronic health condition – diabetes, heart disease, high blood pressure, arthritis, seasonal affective disorder, inflammation, irritable bowel syndrome, Crohn’s disease, chronic fatigue syndrome, fibromyalgia, migraines, and more.

If a healthy diet can help prevent us from contracting all of these horrible things, you’d think we would all jump on the bandwagon so we could avoid feeling bad, doctor visits, side-effects of medicine, higher insurance rates, and a shortened lifespan. It kinda seems like a no-brainer, and yet I’d wager that a high percentage of us really have no idea exactly what a healthy diet is.

The word diet has come to be automatically associated with low calorie or something you do to get skinnier. Since you can be both thin and unhealthy, let’s start by removing our association of diet with calories alone.
healthy meal
A healthy diet combines a good balance of water and nutrients. Nutrients are the components in foods that our bodies use to survive and grow. They include carbohydrates, fats, proteins, and vitamins. Also essential to human metabolism are some dietary minerals – salts, copper and iron.

In the broadest view, the best foods have the highest ratio of nutrients to the lowest amount of calories, but you do not have to limit yourself to these foods. You can eat in a healthy manner by maintaining a good balance across all food groups while managing portion size.

In order to know whether you are getting a good balance of nutrients, you must first know what’s in the food you consume. That doesn’t mean knowing what a TV commercial says about it, or what the large marketing terms on a package scream out. In fact, it’s best if you erase the food pyramid from your brain along with packaging that says DIET, no ADDED sugar, WHOLE grain, or low fat. These terms do not mean the food is healthy.

To know what’s in packaged food, you must read the ingredients and nutrition information on the label. To learn the composition of fresh foods, you can use one of the many tools available online.

It’s also good to have some general guidelines regarding how much of each nutrient your body requires. Because everyone’s metabolism is unique, there’s not a single, exact formula that applies, but you can begin with generalities and then observe and adjust to fit your body’s requirements. You may need less or more food than listed based on your age, height, health condition, and activity level.

Here are some general guidelines to healthy food consumption:

Allow the following in your diet each day:
75 – 100 grams of protein, plus additional if you eliminate complex carbohydrates (300 – 400 calories)
60 – 80 grams of carbohydrates, plus additional to meet calorie requirements. Most of the additional carbs should come from fresh vegetables, legumes, and fruit (240 – 320 calories minimum)
63 – 97 grams of fat (567 – 873 calories)
9 – 13 cups water minimum (0 calories)

If you find all of this confusing, just remember to focus on FLAVOR!

F resh food
L imit packaged, processed food and grain-based carbs
A nimal proteins with the least amount of fat and no additives
V egetable and fruit carbs in wide variety
O rganic when possible
R epeat each day

And now for more detail:
protein
Protein Minimum: 46 (women) – 56 (men & pregnant women) grams of protein per day.
Better: 25 grams per meal or about 75 grams per day.

Examples of high protein foods: beef, pork, lamb, bison, chicken, eggs, fish, seafood.
Other foods with protein: milk, greek yogurt, cottage cheese, eggs. nuts, beans, tofu, quinoa.

A 3 ounce portion of meat typically has 21 grams of protein and each gram of protein provides 4 calories of energy. Meat will also contain fat. In order to keep your fat intake reasonable, it is good to eat a variety of lean meats, poultry, and fish. You can also choose yogurt made with skim milk instead of whole milk, raw nuts instead of roasted nuts with oil, and you can cook beans with chicken stock rather than ham or salt pork.

Protein is made up of amino acids that your body uses to build healthy cells. If you do not get enough, you can suffer from fatigue, weakness, or muscle loss and your immune system may suffer.

veggie carbs
Carbohydrates 60 – 80 grams per day is sufficient.
If you have a calorie deficit after consuming the amount of protein and fats you need, then adding vegetables, legumes, or fruits for more energy is a healthy choice.

Each gram of carbohydrate provides about 4 calories of energy. Carbohydrates can be broken into two categories – simple and complex. Simple carbs from fresh fruits and vegetables are the healthiest form of carbohydrates. They provide many essential vitamins, minerals, water, and fiber. Legumes, which can be either simple or complex, are also a source of protein.

Examples of high carbohydrate foods: fruits, vegetables, grains, legumes. Less healthy carbohydrates often combined with fats are bread, rolls, wraps, tortillas, cornbread, crackers, cakes, pies, brownies, candy, muffins, pancakes, waffles, donuts, pastries, toaster pastries, breakfast bars, breakfast cereal, many protein bars, cookies, french fries, ice cream, ice cream bars, pasta, rice, corn, and oats. Other high carbohydrate foods that should be consumed in limited amounts: sugar, soft drinks, energy drinks, ketchup, maple syrup, cane syrup, high fructose corn syrup, agave nectar, honey, jellies, jams, and candy.

Simple carbohydrates are single and double-chained sugars and usually end in the letters ose – glucose, fructose, lactose, maltose, and sucrose. These simple carbs are usually devoid of nutrition in spite of the calories they add. If you get these sugars from fruits or dairy, the fruit itself or the dairy product will contain nutrients. If simple sugars are added to processed food, they provide temporary energy, but no significant nutrition making them empty calories.

Complex carbohydrates are made from many chains of simple sugars joined together. Complex carbohydrates include starch and fiber. Foods containing complex carbs include wheat, corn, rice, oats, barley, hops, some beans, potatoes and other vegetables, breads, wraps, cakes, muffins, pancakes, waffles, donuts, pastries, breakfast cereal, breakfast bars, many protein bars, toaster pastries, chips, and pasta.

Your body will process simple sugars faster than it processes complex carbohydrates. Because we have a cultural habit of eating 3 meals per day spaced 5-6 hours apart, many people have become accustomed to using complex carbs as a way to feel full for a longer period of time. You can eliminate complex carbohydrates and eat more often and still be eating a healthy diet that will give you continual energy. If you eat too little protein, it may be even more tempting to fill up with starchy complex carbs in order to feel satisfied.

Bread, rolls, cakes, muffins, pasta, rice, corn, and oats are less expensive to purchase than proteins. For that reason, restaurants, fast food outlets, and the increasingly popular fast casual restaurants have menus filled with an overabundance of carbohydrates and fats combined with small portions of protein. Fresh vegetables and fruits are offered in limited selection because they have a short shelf life and are relatively expensive.

Since many grain based products are fortified with vitamins and minerals, they appear to have more nutrients than the raw grains offer. There’s nothing wrong with added nutrients unless they are accompanied by a high amount of fat, simple sugars, and chemical additives. This is often the case with packaged, convenience foods.

As the public has demanded lower fat food choices, many packaged foods have replaced fats with sugars to enhance flavor. If you read any nutrition label, you may notice that the percentage of the recommended daily allowance of sugar is never listed. The carbohydrates will be listed in grams, but never the percentage of RDA. This is a clever omission to make it more difficult to recognize how much sugar you are consuming in each serving.

Filling up with high carbohydrate packaged foods on a daily basis is not healthy.

(This is perhaps the most debated food group and rarely do medical professionals take a stand other than in relation to diabetes. There are some physicians who believe no carbohydrates are essential, but many vegetables and fruits are good sources of essential vitamins and minerals so most will concede that some carbohydrate consumption can be healthy. A larger group warns against highly processed, high fat, sugary complex carbohydrates. The seemingly largest, and most vocal, group of medical professionals and nutritionists encourage the consumption of whole grain breads, cereals, and pastas so that you will get proper nutrients and enough dietary fiber. Often overlooked in their recommendations is the fact that most breads, cereals, and pastas purchased at the market must be fortified with added vitamins and minerals in order to offer you the nutrients of which they speak. Additional oversights seem to be: 1)Breads purchased in a package will often contain a significant amount of sodium even though they do not taste salty. 2)Fruits, vegetables and nuts contain a large amount of fiber making it possible to get enough fiber without consuming complex carbohydrates.)

fat
Fats Women should allow consumption of 63 – 73 fat grams per day, and men from 77 – 97 depending on age and overall calorie requirements.

Examples of foods that contain fat: meat, some fish and seafood, poultry, eggs, bacon, cheese, salad dressing, lard, shortening, nuts, nut butters like peanut butter, avocados, whole milk, butter, cod liver oil, coconut oil, olive oil, sunflower oil, and other vegetable oils. Muffins, cookies, crackers, cakes, chips, fried chicken, french fries, other fried foods, breads, candy bars, and protein bars.

Each gram of fat contains 9 calories which is more than twice as many calories as contained in a gram of protein or carbohydrate. That’s about 120 calories per tablespoon.

The body requires fats that it cannot manufacture. These fats help proteins do their jobs. They help the body stockpile nutrients like vitamins A, D, E, and K, and they begin chemical reactions used in growth, immune function, and reproduction. Naturally occurring fats may be saturated or unsaturated. Saturated fats are typically solid at room temperature while unsaturated are not.

There’s a category of fats called trans fats that is produced in the gut of some animals. Small amounts of trans fats then appear in foods made from these animals. There are other artificial trans fatty acids created by an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. These trans fats will be listed on labels as partially hydrogenated oil which is no longer considered generally safe in human food and should be avoided.

Minerals and Vitamins There are recommended daily allowances for many vitamins and minerals and upper allowances for some. Minerals and vitamins are contained in most of the foods listed above.

Vitamins and minerals are important for bone health, electrolyte balance, thyroid function, and many other body functions like blood clotting and heart rhythm.

Examples of minerals that you need: Calcium, copper, sodium, iron, potassium, magnesium, selenium, zinc, and iodine.

Examples of vitamins that you need: A, B6, B12, Niacin, Riboflavin, Thiamin, C, E, K, and folate.

In order to get all of these vitamins and minerals, you will need to consume a wide variety of foods. If you have been advised to limit your salt intake, it is important to recognize that many packaged foods contain a significant amount of sodium even though they don’t taste salty.

Water Average adequate intake per day for a woman living in a temperate climate is 9 cups.
Average adequate intake per day for a man living in a temperate climate is 13 cups.

Water needs are affected by weight, age, temperature, electrolyte balance, intake of caffeine, intake of sugar, physical activity, your surrounding environment, health conditions, and pregnancy or breast-feeding so you may need more water than the amount listed here. You will also get water from fruits and vegetables, liquids like tea and coffee, juice, milk, and flavored drinks. Most flavored drinks also contain a large amount of added sugar or chemical sweeteners and should be limited or avoided altogether.

Water makes up about 60 percent of your body weight and contributes to the function of every body system. Lack of water can lead to dehydration that can drain your energy, give you a headache, cause weakness, dizziness, palpitations, confusion, fainting, sluggishness, and inability to sweat. Severe dehydration over a period of time will cause body systems to shut down leading to life-threatening conditions.

Now that you know the guidelines – we’ve said it before, but perhaps it bears repeating, the easiest way to know what’s in your food it to prepare it from fresh ingredients. Even when cooking from scratch you’ll make the healthiest choices by reading labels. This will help you avoid added sodium or preservatives that are often injected into meat or poultry. If you notice that a label contains lots of tough to pronounce chemicals, then it is probably best avoided or at least limited.

Again, if you don’t have time to study every little item you consume, then you can always just focus on FLAVOR as your guide:

F resh food
L imit packaged, processed food and grain-based carbs
A nimal proteins with the least amount of fat and no additives
V egetable and fruit carbs in wide variety
O rganic when possible
R epeat each day

There’s nothing more tasty than a perfectly ripe sweet cherry, peach, or tomato. You don’t have to cook them. They are rich in nutrients. They are just three of the hundreds of healthy, fresh foods that you can include in your diet and they prove that healthy can be both simple and delicious. Now get out there and Eat Healthy!

Want to know more? Check out these links:

http://www.webmd.com/diet/healthy-kitchen-11/how-much-protein

http://www.webmd.com/a-to-z-guides/dehydration-adults

http://www.doctoroz.com/article/protein-fact-sheet

http://fnic.nal.usda.gov/dietary-guidance

http://www.doctoroz.com/article/good-carbs-vs-bad-carbs?page=1

http://www.cdc.gov/nutrition/everyone/basics/carbs.html

http://www.hsph.harvard.edu/nutritionsource/pyramid-full-story/

http://www.drperlmutter.com/learn/faq/how-much-carbohydrate-do-we-absolutely-require-in-the-diet/

http://www.pennmedicine.org/health_info/nutrition/not_same.html

http://www.sciencedaily.com/releases/2013/04/130423102127.htm

http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/vitamins-minerals-how-much-should-you-take?page=2

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.”