The ugly realities of an obesity epidemic and an environment of ever-dwindling supplies of inexpensive whole foods are reminders of the urgency of the situation. As clinicians, it is incumbent upon us to catalyze the behavior change that leads to the consumption of real food and nutrition.
But doc, I’m a meat and potatoes kind of guy!
And therein lies the problem. Unfortunately nutritional health has never been a primary focus in American society, despite our endless preoccupation with weight loss and dieting. But I see this tide turning. Recent changes to USDA guidelines advocating for the intake of more whole grains, the plethora of studies substantiating the benefits of a Mediterranean or DASH (Dietary Approach to Stop Hypertension) diet, and perhaps on overall increased awareness of the importance of eating real food (as opposed to foodstuffs or food-like substitutes) have to some extent improved the overall nutritional landscape in which clinicians operate. However the ugly realities of an obesity epidemic and an environment of ever-dwindling supplies of inexpensive whole foods are reminders of the urgency of the situation. As clinicians, it is incumbent upon us to catalyze the behavior change that leads to the consumption of real food and nutrition.
But how? Beyond the city limits of Manhattan and Los Angeles, most people still eat processed, canned, prepackaged fast food-like substances rich in high fructose corn syrup, sucrose, preservatives, hormones, antibiotics, washed down with a gargantuan supply of sweetened carbonated drinks. I am not speaking hyperbolically here. I am merely reciting what my outpatients tell me they eat. Not surprisingly, the more chronically ill the person is, the more depleted in essential micronutrients are the foods they eat. Furthermore, this depletion leads to poor bowel habits, chronic bloating, increased abdominal girth, worse chronic pain, and troubling constitutional symptoms that are usually refractory to treatment. In the context of such a dire societal problem, I am of the persuasion that it is in each individual clinical interaction that clinicians must be compassionate teachers who prove to be useful and effective. Giving advice or referring elsewhere is far from adequate.
So this is what I do. I evaluate where a patient is at any given moment and I assess the long-term risk of continuing to eat what they currently eat. Usually I feel it absolutely necessary to use gentle motivational interviewing methods to transition the patient to better food intake. If they are a "meat and potatoes" kind of person, I determine what specifically they eat - ground meat vs. Burger King vs bacon – and how they take in the potatoes - French fries vs. a baked potato.
Then I draw a food pyramid on a piece of paper the patient can take home, and I introduce the importance - and deliciousness - of whole grains. At Walmart you can purchase Goya brand brown rice, black beans, and split peas for less than $2/bag, and each bag contains a two-week supply. At any East Indian grocery store (that is present in most large and medium-size towns in the United States in 2011) one can purchase several pounds of whole green mung lentils for $3. The grains are cooked in boiling water. After boiling, lentils, black beans, brown rice, and split pea have wonderful taste. Over a generous bed of whole grain, the patient then can layer their meat and potatoes.
This I consider a good starting point for dietary change. I emphasize lentils. Lentils contain no saturated fat and no salt. They are packed full of protein (18g protein in 200g lentils), B complex vitamins, folic acid, choline, omega-3 fatty acids (73mg of EPA in 200g of lentils), and minerals, especially magnesium, phosphorus, and potassium.
Notably lacking in lentils are phytosterols and Vitamin D. Most importantly, they are delicious. They are the staple base of Indian food. Despite initial trepidation that comes with dealing with any change, my patients report enjoying the lentils, losing weight, having less periprandial constitutional symptoms, having improved bowel habits, and the starting to feel that they are doing better.
It is only after I have established some amount of rapport on topics culinary and gustatory do I then bring up the toxic effects of processed red meats, and the fact that the potato is the only vegetable that perhaps does more harm than good, as it brings with it a high glycemic burden. If the patient is psychologically ready at that moment do make more adjustments, then I recommend replacing potato with yams, and replacing processed red meat with lean white meats and fish. If patients report enjoying vegetables (a minority of people, I’m sad to report), then I recommend every vegetable other than potato.
Of course dealing with sugar and salt is a major issue. A big salt load itself leads to frequent hospitalizations for chronic heart and kidney patients. We’ll address seasonings, vegetables, and herbs at a later time. For now, encourage those lentils.
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