HEALTHY EATING
Healthy Eating and the Gift of Imperfection By Robin Eickhoff, MD, MPH
My entire life, I have battled weight. My mother says she named me after a bird because I always had my mouth open for food. It makes me smile, because I know there is truth to it. I love food. I love thinking about it, reading about it, cooking it and definitely eating it. The downside is the false perception that I must decide between being overweight and enjoying my life the way I want, because there is no middle ground. This is the battle many fight every day: “It’s all or nothing.” As with most things in life, when we try to be perfect and inevitably fail, we quit. Healthy eating and nutrition is not an all-or-nothing proposition. We must give our patients and ourselves the gift of imperfection. The topic of healthy eating can fit in two buckets: metabolic (nutrition) and behavior (dietary). The two buckets are on each end of a continuum with a myriad of conditions that may (or may not) be influenced by intervention. I will address each and how pathology can influence them, including information on eating disorders. I will then offer suggestions for interventions in an office setting that I believe improves patient outcomes. Nutrition, the metabolic bucket, requires the balance of macronutrients and micronutrients to maintain and manage good health. Macronutrients are carbohydrates, proteins and fats. Micronutrients generally refer to vitamins and minerals, which come with a balanced diet. Media influence has led many to believe that carbohydrates are bad, proteins 14
SAN ANTONIO MEDICINE • May 2021
are good and with fats, it depends. In reality, we need all three for normal metabolic function, or disease ensues. Chronic diseases, particularly in more advanced stages, can result in deficiencies and inadequate nutrition. Sometimes, however, it is the treatment of those diseases that can cause the malnutrition. Medications can cause weight loss and malnutrition (chemotherapy) or weight gain and over-nutrition (antipsychotics, insulin). When malnutrition is due to a disease state, it is rarely desired, so patients strive to correct the deficiencies to the best of their abilities. When a patient is suffering from malnutrition, I am more inclined to tell them to eat whatever they prefer until their nutrition has improved. Success depends on the cause. End-stage diseases are more likely to result in the catabolic state of cachexia, which rarely improves. Intended weight loss resulting in malnutrition is more commonly caused by an eating disorder, making it much harder to treat. DSM 5 defines eating disorders as mental health disorders, “characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” These fall more into the behavior or dietary bucket, but can cross over into the metabolic bucket affecting nutritional status when not responsive to treatment. The most common eating disorders seen in a primary care setting are anorexia nervosa, bulimia nervosa and binge-eating disorder. These disorders tend to have higher prevalence in post-industrialized, higher-income countries. Risk of developing anorexia or bulimia tends to be more likely in
cultures that appear to value thinness. As one would expect, higher risk exists in occupations such as modeling or elite athletics that focus on being thin as healthy. Going into specifics about each of these eating disorders is well worth its own article and will hopefully be addressed in a future edition. Most patients we encounter do not have an eating disorder, but instead struggle with being overweight or obese. This often comes with a sense of shame and personal failure. We want to help patients overcome these barriers by empowering them with knowledge and tools about nutrition and healthy eating. How do we do this? There are recommended nutritional guidelines, but each person must be individualized. There are numerous eating plans, but no one-size-fits-all plan. No matter what the recommendation, it needs to be sustainable. The science of nutrition changes based on new data and studies. The benefits of quality, whole, natural food do not. We need carbohydrates, but ice cream and broccoli are not created equal. Fats are necessary for living, but unsaturated fats are best. Complete proteins are required. The daily American diet typically contains more protein than neces-
