You probably don’t need protein powder

Just like a name brand shoe that didn’t seem to exist before, and then appears on feet everywhere, it feels like everyone is using protein powder these days. There is certainly a big push for it by so-called influencers on social media (spoiler alert: they are paid money to hawk items) and ultra-processed food companies (yes, protein powder is an ultra-processed product) make a ton of money off of them (protein powders are usually made from waste products of industrial production of other processed foods and then marked up heavily at every stop on the supply chain).

Rule of thumb: where people can make lots of money in the food and supplement industry, expect to find products heavily promoted, especially products we don’t really need. As a wise person once told me—no one has to advertise the stuff you actually need.

So, here are some reasons why you probably can save yourself the $30 a bag—hopefully you haven’t been paying more than that.

  1. Protein powder isn’t likely to help you build more muscle—Americans are not protein deficient. We get lots of it and certainly enough of it to build muscle. You can absolutely build muscle eating a normal diet and even a vegetarian or vegan one. How do you think cows build their muscle in the first place? If you are an elite athlete or body builder and have reached your chicken, egg, bean, and peanut butter limit, your body might need more protein. If you are not an elite athlete or gym rat, save your money on protein supplements.
  2. Protein powder isn’t likely to help you lose weight—it might even make you gain weight. Protein has 4 calories per gram. If you are adding it to your regular diet, you are adding extra calories. Now, that isn’t a bad thing if you are trying to gain weight for some reason, but if you are trying to lose it, protein powder isn’t likely to help. While there is some evidence that protein can fill us up, when food components are taken out of their natural food homes and become more easily digested, they can do unexpected things. Like most ultra-processed foods, just what those things are, are usually discovered years later.
  3. Protein powder contains a bunch of additives you definitely don’t need and that aren’t all that healthy. On the ingredient list of almost every one I looked at there were sugar substitutes (which the WHO recently put out a warning on), maltodextrin (linked to inflammatory bowel disease/colitis and metabolic issues), and all kinds of gums (linked to colitis and irritable bowel syndrome). While there are some brands that don’t have these fillers, they tend to be more expensive and harder to find. But if you just must have protein powder in your life, try to find one of them.
  4. Real food contains…wait for it…protein and is actually healthy! Anything protein powder can do, real food can do better. If you are just looking for a quick breakfast, try using additive-free Greek yogurt and your favorite nut butter in a smoothie in the morning. Or hard boil some eggs to keep in the fridge to grab and go on busy days. Chia puddings, that take a couple of minutes to put together are also a great protein-rich way to start the day.

Basically, when you see an ad for protein powder, buyer beware. Save your money to buy those expensive sneakers that seem to be everywhere instead.

Don’t give up–we can get ultra-processed foods out of our diets!

The word is out–ultra-processed foods are leading to declining life expectancies in the US, poor gut health, more dementia, rising rates of diabetes, and many other health issues. We don’t have to take this lying down. Let’s start to get these foods out of our diets. Here’s how to do it.

First, let’s talk about what an ultra-processed food is and isn’t. It isn’t simply a “processed food” although a lot of times these terms are used interchangeably. People have been processing food for thousands of years. When food is dried, canned, milled, or fermented, it is being processed and that’s not a bad thing. Processing food has helped humans survive and thrive by making it last a bit longer and stabilizing our food supply.

On the other hand, ultra-processing food is a modern creation, that until very recently, we didn’t realize was doing as much harm as it is. Ultra-processing food started to really take off in the mid-1900s with the addition of all kinds of substances that were added to traditionally processed food to make it last longer—perhaps years longer. As more thickeners, stabilizers, and emulsifiers were discovered, they were added to myriad foods to the point that now ultra-processed foods make up nearly 60% of the standard American diet for adults and as much as 70% of our kids’ diets.

The problem is that there was very little testing involved in approving the substances that go into ultra-processed foods, since most of them aren’t digested by our bodies. It was long thought that the additives were something our bodies couldn’t use and they would just pass right through us, like the random facts we’d cram right before an exam, gone the next day. Only, it turns out that our guts aren’t empty tubes, they are lush gardens, and the substances that we don’t digest—fake sugars, emulsifying agents, and thickeners—the bacteria that make up our microbiome do digest. And what we feed our microbiome matters a lot. Our ultra-processed diets have been fertilizing the microbial weeds instead of the flowers, leading to increased rates of obesity, diabetes, and maybe even some cancers.

So, what’s a good gut gardener to do? Most importantly, don’t panic. Nothing has been done that can’t be undone. You can make choices today that can radically benefit your health. Cut out the ultra-processed stuff, replace it with whole foods that you enjoy, and within a day or two you will start to see big changes happening in your bowels, your blood sugar, and quite possibly your mood. So, here’s how you do that.

In my book, Eat Everything, I list 25 additives to avoid, but for the sake of simplicity, a good rule of thumb is to look at the ingredient lists on the foods you are buying. If an ingredient is listed that you can’t picture in nature, put the package back on the shelf. It’s important to recognize that ultra-processed foods aren’t just the chips and candy bars that we might be avoiding when trying to eat healthy. We are getting tripped up because many of the so-called healthy foods that are promoted as being good for us, are just as ultra-processed as the chips, maybe even more so.

When you go shopping, ignore the front of packages that have words on them like “natural” or “organic” or even “handmade” and start becoming an ingredient list reader. Instead of ultra-processed, too sweet yogurt with 10 ingredients, opt for yogurt made with just milk and bacterial cultures. Top it with some fresh fruit. Instead of a shelf-stable salad dressing made to last for years with all manner of gums and additives, mix up some oil and vinegar or lemon juice and dress your salad with that. This week, maybe don’t buy the supermarket bread that may say “whole grain” or “whole wheat” on the front of the package, but the back of the package reveals a whole bunch of ingredients that you can’t picture in your mind’s eye as growing anywhere but on a laboratory bench. Instead, look in the freezer section for bread with minimal ingredients, preserved by freezing, not additives. By making a change or two every time you go to the grocery store, within a few weeks, you will start to walk back the ultra-processed takeover of your kitchen.

Lastly, ignore the voices that are telling you that you can’t do this—that we all just have to accept that our food supply is a mess and we will have to struggle with diet-related diseases as a consequence. When we first can recognize an ultra-processed food (read those labels!) and then instead choose a whole food or less processed alternative, we are taking back control over our bodies. Food should be a source of joy, not discomfort. Replace those ultra-processed products with things that you enjoy just as much or even more. You absolutely can make positive changes to get this stuff out of your diet. It starts with just one bite.

Get the book!

 

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It’s Time to Ditch Erythritol

erythritol

“Seriously people, just use a teaspoon of sugar and throw out the garbage additives! The stuff tastes horrible anyway!”

That was the first text I sent to a friend when I saw the recent study on the artificial sweetener erythritol. The study reported an increased risk of heart attacks and strokes in people who had higher blood levels of the substance. The sugar-substitute, called erythritol, is a type of sugar alcohol, known as a polyol that has long been associated with short-term gastrointestinal side-effects. People who suffer with irritable bowel syndrome (IBS) have been told to avoid the polyols for years due to their causing flatulence, abdominal pain, and diarrhea. Erythritol was thought to be the best of the bunch in terms of these unwanted effects. Current evidence, however, suggests that it might be far more dangerous than having to spend the day in the bathroom.

The study researchers did not expect to find erythritol in high amounts in the blood of heart attack and stroke victims and weren’t particularly looking for it when they started analyzing the study participants’ blood. Because they were so surprised by these findings, they then tried to figure out why the erythritol was leading to strokes and heart attacks by investigating whether it increased the ability of the blood to clot. It did.

The study reported an increased risk of heart attacks and strokes in people who had higher blood levels of the substance.

Looking at what additives do in the real world, on a variety of different human bodies, is leading to a plethora of disheartening findings, with diseases such as diabetes, colitis, and cancer, having been recently associated with some. Nutrition studies are far from perfect and the association with various disease states isn’t settled science. But from the perspective of scientific rigor, the erythritol study is superior to the small scale, short-term, mostly animal studies that get additives approved in the first place.

No one could have predicted that erythritol would increase the risk of blood clotting and cardiac events because no one had ever looked for anything like this before. Additives are not generally studied for their long-term effects on our bodies. They are also not studied in very large groups of people and usually not in combination with other things that we might be ingesting.

A wise person once said, “You don’t know what you don’t know.”

But here’s what we do know. A teaspoon of sugar has about five grams of carbohydrates. How many grams a day of carbohydrates someone consumes is important to people struggling with their blood sugar. In general, I ask patients with diabetes to try to keep their carbohydrate count for the day to less than 150 grams and to try to get those carbohydrates in the form of whole foods like fruits and vegetables with small amounts of minimally processed whole grain products. And if they want a spoon of sugar in their coffee or a cookie? I tell them it is absolutely fine. Because it turns out that what’s most important is what their entire day looks like, or better yet, what their week looks like. Eating whole foods, consistently, while avoiding the highly processed, additive-laden stuff, is the key to a healthy diet. Unfortunately, for many of us, we’ve forgotten how to do this.

This study is a bitter pill for us all to swallow. We’ve become accustomed to artificial sweeteners like erythritol. Even though I don’t personally use them and haven’t for years due to my own struggles with IBS, I keep some packets in my house for guests who prefer them. It won’t be as difficult for me to toss them out as it might be for everyday users who may not have had a teaspoon of real sugar in years.

And that’s okay. This study isn’t cause for panic, but it is a good reason to reflect on what we are eating. While this is only one study pointing to one additive, the evidence for eliminating highly processed foods in favor of real, whole foods, has been building for years.  If you’ve been thinking about ditching your highly processed and maybe artificially sweetened breakfast cereal and instead going for a bowl of oatmeal, sweetened with just a little sugar and lots of natural fruit, tomorrow would be a great day to try it.

To learn more about how avoiding key additives can help you feel better:

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Holiday Meal Shortcuts That Won’t Hurt Your Gut

Easy holiday foods that are gut-safe

I started watching Ina Garten on the Food Network about ten years ago, when I first attempted to make food from scratch instead of from boxes. She told me to buy “good vanilla” and “good olive oil.” So, I did that. When holiday time came, Ina’s advice was to never spare the butter and to always have extra chicken broth on-hand. I did that too. Afterall, if Ina said it, even if it was a little pricier and a bit more work, I was on it.

Her food is aspirational. Like trying to dance or sing—I’m not going to do it perfectly, but I’m going to be better for having tried. And I figure, the more I try, the better I’ll get (okay, maybe that’s not true for the singing).

But in a twist that felt like a departure from her usual commandments, this year, Ina told us to head to the supermarket and stock up on packages in a New York Times article titled, “Ina Garten’s Store-Bought Thanksgiving: To make the holiday easier for home cooks, we asked the culinary contessa to create a menu that lets premade ingredients do much of the work.”

Reading the headline, I felt gut-punched. If Ina was giving up, what hope was there for us mere mortals? But reading the article, I began to get inspired. In my book, Eat Everything, I devote an entire chapter to making more gut-friendly foods with ready-made ingredients that are less processed. Instead of just everyday foods, could the same strategy also work to make holiday meals more gut-friendly?

I decided, like my idol Ina did, to find out.

Pie is not only a Thanksgiving and Christmas staple but a classic American dessert.

holiday pie crusts without additivesAnd the filling generally isn’t the hard part. It’s the crust that can throw us off track. Could I find a decent pie dough that didn’t have emulsifiers and dough conditioners? I went to Whole Foods to find out.

Wholly Wholesome has a crust that is just flour, palm fruit shortening (which they state is “responsibly sourced”), water, sugar, and salt. No emulsifiers, but also not in stock on the day I went. Instead, Whole Foods was carrying the unrolled-out version by the same company, which contained both guar gum and locust bean gum.

These gum additives have been shown to disrupt the gut microbiome and people seem to feel much better when they cut them out.

So, I also looked at their gluten-free version even though, in general, I eat all the gluten I can. And to my surprise, no gums in the gluten-free pie crust! These gum additives have been shown to disrupt the gut microbiome and people seem to feel much better when they cut them out. There were two reasonable options for ready-made pie crust out there (and I wound up finding another at Trader Joe’s a few days later). The key is to always check the ingredient list, even from a brand you might trust.

Next up, potatoes—a holiday table must-have.

Ina suggests that there are good frozen or refrigerated mashed potatoes out there if you add enough sour cream, parmesan, butter, salt and pepper to the pre-prepared stuff. And it’s true for your gut too.There are brands of pre-mashed potatoes like Simply Potatoes that don’t have much else added to them except for dextrose (which is a simple sugar) and a few probably “okay” preservatives.

Check the sour cream for additives (the affordable Daisy brand has none!) and please take a minute to grate your own parmesan from a block to avoid gut-roiling added anti-caking agents. If you are celebrating Hanukkah (I am!), you can get shredded, frozen potatoes to make latkes—a huge time saver—with the same dextrose and probably “okay” preservatives as the mashed stuff. Just remember to defrost and then drain the shredded potatoes on paper towels to get as much of the moisture out as possible before you mix in the egg, onion, salt and pepper, and fry until golden.

Finally, the main course.

If you are tired of turkey after Thanksgiving, so tired in fact that you don’t feel like making anything at all, you could always pick up a rotisserie chicken, or three. But be careful, a lot of store-prepared poultry has flavor-enhancing additives like maltodextrin that you probably want to avoid if you are going for stomach-safe. Many stores will sell chicken that is just chicken, but don’t forget to check how it’s seasoned for a happier holiday.

We’ve been given permission to make holiday cooking easier to do, now we can also harness our ability to make the shortcuts easier on our stomachs, too.

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You know your body best.

A well-known professor of neurology was giving a lecture to a large audience of internal medicine physicians.

“If a patient says they have a headache, do you believe them?”

The audience nodded in agreement.

“But you can’t do a blood test for a headache. A headache won’t show up on a CT or MRI. How do you know they truly have a headache? How can you confirm it?”

The answer, the professor revealed, was that no one feels compelled to “confirm” that someone has a headache because most of us have experienced a headache. A person merely saying their head hurts is enough to diagnose a headache. It is easy to relate to a pain someone is describing when you yourself, or perhaps a good friend or relative, have experienced similar symptoms.

What can be more challenging is when we are trying to describe a feeling that is not as commonplace as a headache. Sometimes we are experiencing a symptom that will reveal itself as a disorder on a blood test or radiological study. But often, there is a vague discomfort or malaise, that may not show up on any test. The symptoms may range from slight to severe enough to keep someone from being able to go to work or school. Something is wrong and it isn’t clear what that something is.

But you know your body best. You know when something has changed or if something isn’t right. And we want to be able to give a name to something that isn’t right. Because once we have a name for it, we can try to find a reason for it, and then hopefully a way to make it better.

In an era of seemingly endless test options, it can be difficult to accept the fact that we often don’t have a test for many ailments. There is no reliable test to confirm IBS, myalgic encephalitis/chronic fatigue syndrome, long-Covid, various pain syndromes, and a host of other illnesses. We should recall that, before we had widely available imaging tests for conditions such as multiple sclerosis (MS) or endometriosis, patients (who happened to be mostly women in the case of MS and all women in the case of endometriosis) were dismissed as “hysterical” or told it was all in their heads. Abandoned by their doctors, they were more easily victimized by the snake-oil salesmen of their day as they searched for something, anything, to get themselves better.

It is said that history may not repeat itself, but it rhymes. Being taken seriously when we know something isn’t right with our bodies is still a challenge. The big difference today, is that we are now able to share and hear lots of stories from around the world. And there is strength in numbers. It may not raise a diagnosis of IBS or long-Covid to the level of understanding that most of us have of what a headache feels like, but it hopefully will increase empathy for those who experience symptoms for which there is no quick and easy test.

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Gut Health—it’s different than you think

Poop jokes aren’t my favorite, but, they are a solid #2. Okay, not the best dad (or in my case, mom) joke, but I have others! We all do. There are a lot of poop jokes out there.

Gastrointestinal health is something that hasn’t been taken seriously for a long time—at least not since the position of attendant to the British monarch’s stool (known as the Groom of the Stool) was abolished in 1901. Considered a posting of honor (as opposed to a crappy job) for hundreds of years, as flush toilets and toilet paper became all the rage, poop was relegated to becoming the butt of our jokes (sorry).

But with the rise of DNA analysis and the ability to see just what is inside our most comedically valued organ, gut health has become anything but a laughing matter. It may be the key to unlocking better health for many of us.

Let’s examine what’s changed:

  1900s thinking:
Our gut is a long tube from our mouths to our behinds.		2000s thinking:
Our gut is a complex organ made up of our own cells along with trillions of microorganisms. It has vital impacts on our immune system, our moods, and even hormonal regulation of how much and when we want to eat.
1900s thinking:
Our gut will absorb the nutrients we need and poop out the things we don’t.		2000s thinking:
Whatever we aren’t digesting, we are feeding to those microorganisms in our guts (called the microbiome). What we eat promotes which organisms grow and where in our guts they are growing.
1900s thinking:
The total amount of calories you eat along with macronutrients like carbs, fats, and protein will determine how much you weigh and how healthy you are. 		2000s thinking:
Calories and macronutrients can be important, but they aren’t the whole story. Eating ultra-processed foods (especially those with emulsifiers) can cause us to eat more and gain excess weight, can disrupt the microbiome and our gut lining, and are a contributor to the exponentially rising rates of a host of diseases.
1900s thinking:
It doesn’t matter how ingredients are processed. Adding vitamins and other supplements to ultra-processed foods is the same as getting them from whole foods.		2000s thinking:
Getting nutrition from whole foods is critically important to good health.

Our bodies, along with our microbiomes, digest whole foods differently than food that has been ultra-processed. We are just beginning to understand how an additive, when extracted from a “natural” source, may be disruptive to the synergistic relationship between ourselves and our microorganisms.

There are a lot of new and exciting discoveries being made in gut health, because ultimately, medical ideas are like diapers (okay, last one, I promise). They need to be examined and changed when they aren’t quite right.

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It might not be gluten or dairy. The issue might be this instead.

Gluten and dairy have been deemed the enemy. For some people who have celiac disease or complete lactose intolerance, yes, these foods need to be avoided.

But what about the rest of us?

Many people abandon foods that contain gluten or dairy in the hopes of feeling better. Maybe we have joint pains or stomach trouble. Maybe we are putting on weight and don’t understand why. We start by getting rid of these foods and perhaps feel a little better. So then we hear that we should avoid other foods, like tomatoes or garlic, and drop those. Before we know it, our diets are extremely restricted, but we really don’t feel that much better. There may be an easier and far less restrictive way to improve our health.

The biggest problem in the so-called Standard American Diet, which has now become standard in the diets of almost every country today, is ULTRA-PROCESSED foods.

How can we tell the difference between processed and ultra-processed?

There are a few definitions out there, but I’ve found the simplest way to figure out the ultra-processed stuff that should be avoided is to be on the lookout for certain additives in packaged food.
Is this a perfect method? No. Nothing is perfect. Trying to be perfect is a recipe for feeling inadequate and defeated. The goal is to feel better and that means accepting what we are able to reasonably accomplish in the midst of a busy day. Avoid these additives, eat everything that is actual food, and see how much better you feel.

Carrageenan (commonly used in creams and dairy substitutes for stability)

Cellulose (pre-shredded cheeses and powdered parmesan are generally coated in cellulose. DO NOT use pre-shredded and bagged cheeses which can also contain anti-fungal agents.)

Food Gums (commonly used in shelf stable products like dressings):

  • Acacia Gum
  • Cellulose Gum (Also called: Carboxymethylcellulose)
  • Gellan Gum
  • Guar Gum
  • Locust Bean Gum (Also called: Carob Bean Gum)
  • Xanthan Gum

Inulin (Also called: oligofructose, oligofructose-enriched inulin, chicory root fiber, chicory root extract or fructooligosaccharides)

Lecithin(can be derived from soy, sunflower, or other sources and are used in many different packaged foods, so may be the most difficult to avoid—just do your best, but don’t sweat if you are consuming a little of it)

Modified fill-in-the-blank Starch (used in shelf stable products)

Maltodextrin (used as a flavor enhancer and stabilizer in shelf stable products)

Monoglycerides/Diglycerides (used in breads, especially those that stay soft like flour tortillas that don’t need to be kept frozen)

Polysorbate 60/80  (commonly used in frostings and desserts)

The following are generally used as sugar substitutes. Please just use real sugar (in moderation) and NOT these:

Glycerol (glycerin/e)

Mannitol

Sorbitol

Xylitol

Sucralose

Stevia (Stevioside)

Reductive nutritionism: playing into the hands of ultra-processed food industry

What should we be eating?

Tomatoes!

They have lycopene in them! And lycopene should protect us from cancer and heart disease. Do we cook them to get their maximal benefit or eat them raw? Should we be eating them everyday? It was all anyone could talk about ten years ago.

And then…we stopped talking about lycopene and started talking about lectins.

Tomatoes have lectins in them! And lectins might promote disease. Should we remove the seeds from tomatoes? Should we cook them? Should we avoid them altogether?

What’s someone who doesn’t want to die (at least, not right away) to do?

Since pretty much everything we eat has been labeled as potentially toxic by someone, somewhere, calling themselves a health guru (or maybe even a doctor), better be safe and reach for “food” wrapped in shiny packaging proclaiming how natural and organic it is.

GMO-free! Hormone-free! No lectins!

Or better yet, reach for a bottle (or ten) of supplements that are supposed to ward off disease and be much better for us than whatever dangers may lurk in the produce aisle. That we have been lured away from fresh fruits, vegetables, and grains by all kinds of diets and self-proclaimed experts is one of the greatest cons perpetrated on the American people since George Parker was offering to sell his marks the Brooklyn Bridge.

I’m not a conspiracy theorist by nature and am more likely to attribute the missteps we make to earnest ignorance rather than to malicious intent. But, the rate at which the latest entrant into the “real food is bad for you” diet seems to sweep the nation, makes me wonder if the ultra-processed food industry doesn’t give the craze a small, or maybe even a big, push.

It turns out that fad diet gurus and ultra-processed food purveyors make for strange, but profitable, bedfellows. The more real, whole food you are afraid to eat, the more packaged stuff you’ll be forced to buy—after all, you have to eat something to sustain life, let alone prolong it. Whether that package is a cardboard box filled with flakes of questionable health value or a plastic bottle of the latest and greatest dietary supplement, someone, somewhere, is spending very little to charge you a whole lot for what you could probably get from an apple.

The profit margins on produce are thin. The money made on ultra-processed foods runs into the trillions. The supplement industry is also doing quite well. So, maybe it’s not a conspiracy, but there’s not a lot of marketing dollars to be spent on salads.

A professor once told me that any drug the pharmaceutical companies have to advertise probably doesn’t work very well.

“If it’s really good, everyone will just use it. It will advertise itself.”

Well, it turns out, that professor underestimated how effective marketing can be or maybe he just overestimated how smart we are.

Because whole foods have been proven in study after study to promote a healthy weight and long life. No fad diet has ever been shown to do much of anything for adherents long-term (very few people can stick with them for very long anyway). And the evidence for 99.9% of the supplements out there is shaky at best and sometimes shows that they are harmful.

And yet, the hucksters selling us the equivalent of the Brooklyn Bridge are making best-seller lists, while whole-food proponents like Marion Nestle and Tim Spector, sometimes seem to be shouting into the void. The latter has the bulk of the evidence, but the former has the sales pitch.

So, I’ll propose a new diet—the half-plate vegetables diet. Just make sure every time you eat, at least half of your plate has veggies on it (and no, French fries don’t count, kids). What I’ve learned though, is that if the diet is going to be a success, it’ll need a catchier name. I’m taking suggestions….

 

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How to talk to your doctor

Doctor,And,Patient,Discussing,Something,While,Sitting,At,The,Table

How should you talk to your doctor? Short answer: Like you would talk to any other human. It’s your doctor’s job to listen.

Here goes the longer answer.

This week, I gave a lecture to first-year medical students on how to take a medical history from a patient. I’ve delivered this lecture for the past seven years. The central message I impart to the students is one that reaches back to the beginning of modern medicine, but is no less relevant today.

Sir William Osler, a physician from the 1800s, stated it most clearly when he said, “Listen to your patient. (They are) giving you the diagnosis.”

I put this quote up on a slide for the students, who are new to medical school, but who have nevertheless heard this quote already from several faculty before hearing it from me. I tell them, “We repeat it a lot, but then we ignore it.”

I ask the students, “If it is so important to listen to our patients, why don’t we?”

“There’s not enough time.”

“We’re too busy.”

“We have biases.”

“We forget how important it is.”

The students call out all the right answers. What used to a be a 30-minute office visit has been cut down to 15 minutes, if that. Computer work and paperwork have increased at an astronomical rate, further cutting into patient care time. We rush to judgement, abandoning the idea that we should be thinking about all possible diagnoses before narrowing our focus. And, in an era where blood tests and imaging studies abound and require only a click of the computer mouse to order, minutes can be saved by just doing that, at the expense of giving our attention to the person in front of us.

Over the next three hours, through practice patient interviews and other small group exercises, I try to convince the students that no matter what the external forces pressing on them are, when they have a patient in front of them over the course of their careers, they should try to block out the rest of the world and just listen. They will have many more practice and empathy-building sessions over the next several years of their medical education, but eventually, they will enter the real world. And the real world does not pay doctors to listen to their patients. It pays them to go quickly and “efficiently” through their day.

So, what’s a patient to do?

I have a friend who is dealing with a very serious health issue. She tells me how she brings copies of her tests and CDs of her scans along with her so the results are always on hand in case the doctor doesn’t have them. She tries to be as brief as possible and show little emotion to her obviously harried physician, who she fears will dismiss her if she is too “difficult.” Instead of being able to focus on what she needs from her visit, she tries to bond with the doctor over shared interests and manage the doctor’s needs. And my heart breaks for her every time I hear about her latest visit. In addition to dealing with a miserable diagnosis, she has to expend mental energy to try to figure out how to make the most of the time with her physician.

It shouldn’t be this way, but for so many patients, it is. As medical professionals, we have to do better. Someone who comes to us for care and compassion deserves just that. There are some medical facilities that give their physicians the resources to be able to spend more time with their patients. There are physicians in private practice who have, through a combination of good luck and good business sense, figured out how to keep a practice afloat and give their patients the time they need. In some areas, these practices can be hard to find, or even if they exist, they are not necessarily on your insurance plan.

I can ask you to find a doctor who will give you the time to listen, but I imagine that you’ve tried this already. So, as much as it pains me to say it, my friend is doing what she needs to do to be heard and treated appropriately. Bring your important records with you (never assume the doctor has them). Be ready to summarize your story as “efficiently” (yes, I hate this word in medicine) as possible. For some people, bringing a typed-out version of their story can help. Tell your doctor all the issues you would like for them to address at the beginning of the visit so you can be sure that something you may need isn’t left until the end when time may have run out. And importantly, be your own advocate. If something isn’t right, say so. If something isn’t working, say so. Ultimately, your doctor wants you to get better. They want to help, but the system we all find ourselves in isn’t conducive to forming a strong patient-doctor relationship. There are some who are working to change this, but as always, change can never come fast enough.

 

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Searching for Superfoods

A few years ago, my not-quite-teenage son began commenting on whether or not the food I was making was a “superfood.” Salmon and blueberries had been designated by him as “super” and not because they were particularly tasty (although I think they are). According to my son and the latest articles he had perused on the internet, there was supposedly a magical array of nutrients in the food that would somehow help us to live longer.

“The search for superfoods (or whatever they were called back then) has been a time-honored tradition since at least the 1950s, when American physiologist, Ancel Keys traveled to countries around the Mediterranean and documented their lower rates of heart disease, cancer, and other ailments.”

I was just glad he was eating salmon and blueberries and let him keep on thinking they were magically super since I was also super exhausted trying to get my kids to eat foods that were nutritionally sound. So, if nutritionally sound was being rebranded as super, I wasn’t going to argue the point.

The allure of finding a faraway magical food or foods, is in many ways like the quest for the Fountain of Youth, and so, my son had hit on a historically popular trend. The search for superfoods (or whatever they were called back then) has been a time-honored tradition since at least the 1950s, when American physiologist, Ancel Keys traveled to countries around the Mediterranean and documented their lower rates of heart disease, cancer, and other ailments. He posited it was something in their diet. It was called the Seven Countries Study and like its name implies, Keys looked at food from seven countries—which happens to be a lot of countries and a lot of different foods. The common threads in the so-called Mediterranean Diet, were identified as olive oil, fish, fruits, veggies, nuts, whole grains, and wine.

Scientists wondered what exactly was in those foods that was so super and began doing research studies that added nuts or wine or olive oil to see if those things in isolation were helpful. Many of those studies (though poorly designed) showed that they were. And so, in the coming decades, Americans were encouraged to eat more of those foods. Not a bad idea, but not the whole story either. Despite switching over from canola oil to olive oil and from white pasta to whole grain pasta (which isn’t exactly traditionally Mediterranean), our higher rates of disease persisted. It turns out that you can’t take out two or three components of a healthy diet and add them to an unhealthy diet and viola—expect similar results. Even worse, you can’t extract a chemical or two, package them in a supplement and declare victory over disease.

Resveratrol was supposed to be one of the substances that made blueberries super and was also found in red wine. But instead of having to find berries out of season or drink wine which was high in calories (and also one would be limited by the alcohol content if one were sensible), a pill was created. Why bother with actual foods and beverages if one could just find a magic pill? Better yet, pill purveyors could charge upwards of $100 a bottle and so advertised their wares heavily. By offering the secret to longevity with barely any effort required, daytime talk shows brought in lots of viewers, clinics sprung up, and people parted with billions of dollars. And yet, our life expectancy has not increased.

What is starting to be increasingly recognized by researchers is that it isn’t one substance or a handful of foods that make the Mediterranean Diet special. It isn’t even the Mediterranean. There is longevity to be found around the world (see: “Blue Zone” below) where there are fewer chronic diseases and people live longer lives (but even Blue Zones are somewhat Western-centric and undoubtedly there are many other places that would qualify). Blue Zone residents practice lifestyles where they eat whole, fresh foods, have communities ties, and walk or do a fair amount of physical work. This is what was going on in the Mediterranean when Keys visited.

And yet, as my son made clear, we are still looking for the magical super foods, or even more reductive, magical supplements, when the answer for how to eat and how to live has been staring us in the face for decades (Hint: the answer isn’t in a supplement).