Monday, September 27, 2010

An Apple A Day

I could see the glimmer in my mother's eyes when I started taking nutrition prereq a few years ago. I enjoyed the dreaded organic chemistry and biochemistry classes and I knew what she was thinking - hoping what every cliche tells us a Jewish mother wishes for her child - that I would become a doctor. I told her and anyone else who suggested it that I would not become a doctor. I need my sleep, I faint every time I give blood and though I do not seem to be in a hurry to finish school, I was not about to embark on the long, demanding road to medical school. Nutrition would suffice. As though I were settling. In fact it was a very calculated decision - perhaps the most reasonable and rational one I've made to date. I wanted to change the face of public health and quality of life in the easiest, most basic way possible through an understanding of how the body works in order to address the root problem of most preventable illness while still allowed to maintain my own health and sanity. Well, most of the time. I figured that if everybody eats there would always be a need for health care providers to guide those eating decisions.

No, mom I will not be a doctor. I have not studied anatomy and physiology in the same detail, I have not focused as much time and attention on pathologies and diagnoses (though sometimes watching House I pretend). But I do know a good deal about food, cooking and nutrition and according to a recent article in The New York Times, most doctors cannot say the same. Though there is increasing recognition in the medical community that diet is linked to health, few doctors are equipped to discuss this with patients. This is where dietitians and nutritionists should be acknowledged as filling in the crucial missing link in preventative medicine and chronic disease management.

Ask most doctors why "an apple a day keeps the doctor away" and I wonder what they might say. Ask a nutrition expert and they'll tell you that apples are low in calories, a great source of fiber and they are naturally rich in phytochemicals like quercetin, one of the current darlings of the dietary supplement world. Eating apples can keep you healthy and hopefully out of the doctor's office. I wouldn't go so far as to suggest that the AMA removed a focus on nutrition from med school curricula to keep patients sick and business booming (though a more cynical conspiracy theorist might make that argument). I imagine there is only so much time and over the years the emphasis has shifted to treating conditions rather than root causes. I think that doctors today are overworked and stuck in administrative and financial battles with insurance companies and have less and less time to spend with patients. And I think that they might appreciate a future nutritionist like me easing their patient load with little bits of advice like this: it's apple season (in WA and NY!) so do yourself a favor and go apple picking, make a salad or dip your apples in some honey or caramel and have a sweet year ahead!

Wednesday, September 22, 2010

Tweets and Sweets, Fat and Friends

In college I loved sociology classes. Sociology of mass communication and pop culture, the American Jewish community, movies, religious fundamentalism. I took so many that I graduated with an obsessively critical mind and minor in sociology. If I were in college today I imagine I'd be registered for a course this fall on the sociology of social networking.

Social networking just barely existed when I was an undergraduate ten years ago. I first registered for Facebook as a graduate student at NYU when I learned that my sister Leigh's friend had posted pictures from Leigh's wedding on the site. I wanted to see them and I still had a .edu email address so I created an account. For the first six months I had about 5 friends, all college-age younger siblings of my real life friends. Then something changed. Maybe the right people had signed up and made it desirable and acceptable for skeptics and cynics to join or maybe it was when the site allowed non-students to sign up, but Facebook hit a tipping point. The initial excitement (I found my kindergarten crush! That guy who sat behind me in Spanish class! My friends from study abroad!) soon turned to public outcry (My mother joined Facebook! My boss, my teacher, my students!) The ongoing battle began - to secure privacy policies and allow access to a select few (hundred) people so that your potential employers did not come across your spring break photos from Cancun, 2003. The culture of Friendster, MySpace, Facebook, of Twitter has changed the way we live and the way we relate. It's not surprising then, that it has also affected our health.

This week an article in The New York Times addressed the use of social networks to tackle public health problems. do we extract information from existing social networks to improve public health?

One method is to identify social connectors, people who spend time with more friends than average — and are thus exposed to more germs and are more likely to be among the first to contract contagious diseases like the flu. If health officials could find and track those social butterflies, they could tap into an early-detection system for epidemics and figure out whom to vaccinate first in order to slow the spread of disease.

This suggests a way to use social networks for control of infectious disease. But what about other health conditions? Last year The New York Times magazine featured an article, "Are Your Friends Making You Fat?" The answer, they found, was not only are your friends making you fat, but so are your friends' friends. The Framingham Study, conducted by the National Heart Institute, began in 1948 and over the years ithas become an important longitudinal study of heart disease by assessing biometrics, risk factors and other confounding factors. It was noted that healthy participants influenced one another in a way that benefited weight and overall health. It turns out that obesity, smoking, happiness can all be contagious. And no system lends itself to social contagion quite like the internet, where information can go viral. So does that mean it's time to go through your 537 Facebook friends and unfriend the fat ones? Perhaps if they update their status every day with messages like: Blankety McSo-and-So had the most decadent and rich slow-churn homemade ice cream sundae and can still taste the hot fudge on my lips. Go to your freezer and indulge too!" or "Lazy Johnsondecided that staying home and a seven hour Glee marathon was a far better idea than getting any sort of physical activity. Singing along on the couch is exercise too, right?" If reading these posts will influence your own behavior, then maybe unfriending (or at least hiding them in your feed) is a good solution. Or try the diet that encourages participants to broadcast every calorie and morsel they ingest. It worked for these people. (For those not interested in disclosing their food habits publicly there is a calorie-counting iPhone app to track food intake.)

I'm thinking about this today as two old friends from New York arrive for a weekend visit. Last time they visited they were afraid that I would force them to eat kale. As we spent time together cooking and eating they were realized that I enjoyed food that tastes good. This time around they know the drill. One is excited to go hiking again, the other is eager to walk around the lake. "I think I lost weight when I came to you last time," one offered. The other recalls tasting quinoa for the first time, and loving it. As for me, I'm looking forward to taking time to talk and laugh with old friends...cuz laughter is contagious too.

Tuesday, September 21, 2010

The "V" Word

Several months ago when I first started blogging a friend had suggested I read Jonathan Safran Foer's latest book, Eating Animals. At the time I was buried in schoolwork and could not fathom picking up a book for pleasure (is that what one might call a book about factory farming?) but earlier this month, with news of the author's impending visit to the Emerald City I decided it was time to use one of my Barnes and Noble giftcards to see what all the hype was about. When the cashier rang up my purchase she couldn't help but share her two cents. "I loved this book! After reading it I became a vegetarian. It made Natalie Portman vegetarian too. So you might want to go enjoy your last burger before you start reading it."

My last burger. I remember my last burger. It was ten years ago, eaten at a beach bbq in Southern California. At the time I was a counselor for a summer teen tour of the West Coast and there had been a major snafu with the kosher food for the trip. For six weeks I ate cereal and granola bars and pasta and by the end I was feeling sick and tired. At the end of the trip we arrived in Los Angeles where there were more kosher food options and the cook bought enough kosher meat to bbq for the group of 100. The only complication was that I was a vegetarian. I'd sworn off red meat years prior and so it had been nearly five years since my last burger. But here I was at this bbq with no vegetarian options, and I made the choice to eat a burger. Feeling guilty at first, I decided that this would be a one time deal, so I ate a burger and as I sank my teeth in I enjoyed it. Afterward I thought, am I no longer a vegetarian? Was this akin to breaking my fast on Yom Kippur? Was it all over? That all or nothing approach to eating animals is precisely the problem with using the word "vegetarian" and one of the reasons Jonathan Safran Foer deliberately avoided using it whenever possible during his reading and conversation last night at Town Hall. The "v" word (my term) creates a dichotomy (his term) of all or nothing, black and white that points to our obsession with hypocrisy. In light of his book, of learning of the evils and perils of the unsustainable and detrimental factory farming system, eating less meat is still a legitimate response, a way to engage with the issue.

I agree with every argument in the book - it's hard not to. In fact, Safran Foer has said that during his book tour around the country he anticipated a lot of disagreement and opposition but has not found any because nothing he writes about is controversial. It is very clear that factory farming is harming our health, the animals and the environment on an unbelievably massive scale. And yet, reading Eating Animals did not make me a full blown "vegetarian." It did make me think a lot more seriously about where my food comes from, how I spend my money, what I value and how to engage in conversations about food.

Perhaps the most refreshing thing about Eating Animals is that it is not a manifesto. Safran Foer has no agenda for the reader, just as he did not preach to the audience last night. He does not tell people how they should eat but simply presents his personal journey in a compelling and intelligent prose, encouraging readers and eaters everywhere to consider what is on their plates and what it is worth. He doesn't talk politics or policy and admits that he doesn't know much about legislation and current issues. He is a writer not a journalist, a father concerned with what to feed his children. After years of research and reflection he reluctantly calls himself a vegetarian. And this is perhaps why so many people have been affected by the book: because it's about examining one's values and recognizing that sometimes personal compromise means losing one's self in the process. And that's not worth a 50 cent burger.

Monday, September 20, 2010


Despite a month-long blogging hiatus, I've never really stopped reading and thinking about food news, articles, ideas and politics. In fact, in some ways I've been more engaged than ever. Instead of sitting down to reflect and opine upon the latest trends, I dove deep into a reservoir of food-related information that continues to shock, impress, confound and inspire me.

So in case you've been busy with your summer reading (Girl With the Dragon Tattoo, anyone?), one of the big stories I've been following, aside from the daily recalls of every food under the sun: Kids, advertising and junk food.

For years food corporations have targeted kids with their marketing campaigns. My own childhood memories are peppered with favorite cereals, eaten while watching cartoons that featured ads for those very same brands. Years later, it's not uncommon for me to sit around with a group of my friends and reminisce about the cereal ads of yore and then watch the old ads on Youtube. ("Gotta have my pops." "Brings out the tiger in you "Kid tested, mother approved." Google your personal favorites.)

Back in 2005, the Food and Nutrition Board and the Institute of Medicine conducted a report and published the findings in Food Marketing to children and Youth, a book that can be downloaded for free from their website. The report found that:
Children's dietary and related health patterns are shaped by the interplay of many factors their biologic affinities, their culture and values, their economic status, their physical and social environments, and their commercial media environments all of which, apart from their genetic predispositions, have undergone significant transformations during the past three decades. Among these environments, none have more rapidly assumed central socializing roles among children and youth than the media.
And yet, this report did little to galvanize legislators to introduce any industry marketing standards to protect kids. Fast forward to June of this year - a friend of mine posted this piece on Facebook. It cites recent research concluding that kids will choose food options that feature cartoon characters over foods that do not. Since I have yet to see a carrot or apple donning a recognizable Disney character, this bodes poorly for children's health. Then in late July, the New York Times reported that long overdue government intervention into the establishment of uniform health standards for children is being stalled due to - imagine this! - industry opposition. For years the FTC has "encouraged" the voluntary use of discretion when advertising to kids, but in April of this year it launched Admongo, a site designed to "ad-ucate" tweens in media literacy. As for the younger set, well, they're left to their own devices in order to decode the heavily researched marketing messages that ad agencies have carefully and calculatingly crafted to influence their consumer desires.

If you have any doubt about the power of advertising, spend a minute playing this alphabet game that I was introduced to this past week at the Washington State Food and Nutrition Council's annual conference. Can you name the product that each letter represents?


I hope sometime in the future there will come a day when the ABC's will represent Apples, Bananas and Carrots, rather than All, Bubblicious and Campbell's. I would even settle for "ABC" simply conjuring up a good Jackson 5 song.

Sunday, September 19, 2010

The Morning After

Yesterday was Yom Kippur, the Day of Atonement, the day when Jews come out of the woodwork, flock to synagogue in droves, bang their chests to confess their sins and pray for the year ahead, all the while forgoing any and all food and beverage for a 25 hour fast. But why fast? Often in Jewish tradition, fasting is demanded at times of heightened spiritual reflection. The idea is to deny - or perhaps more accurately, transcend - one's physical needs and turn inward to recognize what is really important. The prophet Isaiah eloquently expresses the purpose of the fast in the portion read on Yom Kippur (58:5-7):
Is such the fast I desire,
A day for men to starve their bodies?
Is it bowing the head like a bulrush
And lying in sackcloth and ashes?
Do you call that a fast,
A day when the Lord is favorable?
No, this is the fast I desire:
To unlock the fetters of wickedness,
And untie the cords of the yoke
To let the oppressed go free;
To break off every yoke.
It is to share your bread with the hungry,
And to take the wretched poor into your home;
When you see the naked, to clothe him,
And not to ignore your own kin.

Fasting, then is intended to encourage social justice, to arouse one to free the oppressed, to feed the hungry, to house the homeless. But from my own experience and that of others I've spoken to, this lesson of Yom Kippur is often obscured as we sit in services with dry mouths and rumbling stomachs. My goal is often to simply make it through the day, since I am unaccustomed to skipping a meal. In fact, you could say that I am fastidious about eating healthful, well balanced meals at fairly regular intervals. And while I find that fasting gets easier as I get older, I find it harder and harder to recover from long periods of hunger. Studying nutrition has taught me that biochemically there are major shifts in metabolism that occur over periods of time without food. Fasting has taught me that psychologically there are major shifts as well.

Last night as Yom Kippur ended, a sense of relief washed over everyone who had made it through the day. Where I was attending services, rather than race for food, many of us sang and danced and wished each other a happy new year. We then proceeded to drink some water and eat a modest break fast meal.

Then I woke up this morning. I can't quite describe my level of hunger - it was not quite ravenous but certainly insatiable. Instead of my usual oatmeal I dug out leftover quinoa with lentils, carrots, apples, and almond butter. I drank cup after cup of tea and, feeling full, left the house for an hour. When I returned I was again drawn to the kitchen - not from hunger, but from some other need to eat, to know that I had food, to feel the sensation of chewing, of swallowing, of being full and satiated and nourished, even if it was overly so. This was not a physical need but a psychological one. I had experienced only one day without eating and drinking and this had triggered survival mode food hoarding behavior. It gave me just the tiniest insight into what it means to really be hungry, to think about food in this way, without even regard for taste or satiety but as a more base desire and basic human need.

Last week I watched Ellen Gustafson's TED Talk linking obesity and hunger and was struck by one of her leading statements: "...when I'm hungry I'm really pissed off and I'm assuming that the rest of the world is too." I have certainly felt this way - my family will tell you that I'm not the most pleasant person when I haven't eaten - but more than that, when I'm hungry I think about food in an entirely different way. So while Gustafson takes a macro approach and links hunger and obesity to problems with global agricultural policies (which is true), I think there is also a more micro level relationship at play. I know, for example, that when I shop hungry I buy far more food than I need. I eat far more than I need. More broadly, skipping meals or eating irregularly triggers an altered relationship with food, leads to binges, to overeating, to obesity.

Yom Kippur may have ended last night, and traditionally that means that the heavenly gates have closed and my fate and the world's have been sealed for the coming year. But the lesson of Yom Kippur, of what it means to really fast, did not kick in until today. I may have eaten and bathed, but the food did not satiate my hunger, the shower did not wash away the empathy Yom Kippur generated for those who do not know what, when and where their next meal will be.