You Are What You Eat (and so might be your kids…and their kids!)

Posted in Susan Fekety on January 23rd, 2009
Unless otherwise noted, © Copyright 2009 by Susan Fekety. All Rights Reserved.

I spent a wintry evening recently looking over my notes from a seminar I attended last April taught by Dr. Jeffrey Bland. The founding father of Functional Medicine (he would probably reject this title, but it’s his just the same), Bland never ceases to expand my mind and re-teach me with a whole new color scheme the physiology I learned in nursing school OR teach me anew the stuff that has come along since that. Thank goodness HE’s willing to read Science and Nature and the Journal of Applied Microelectroimmunobiophysicnutritional Health, since I just won’t (one picture of chicken-wire molecular structuring and my eyes go crossed). Anyway, I always love to hear this fellow speak — so much so that I was happily willing to give up a beautiful spring Saturday in order to sit in a room without windows taking notes and following a PowerPoint lecture. It was great.

I left with a renewed appreciation for the extent to which food is not just a vehicle for getting caloric energy into our bodies. Food is information we give to our genes, and that information inspires the genes to DO THINGS. Depending on the food messages, we will either like or regret the things the genes do — but the good part about that is we are in charge of our food messages. We can speak to our genes with “Lunchables” or we can speak the elegant language of organic ratatouille. If there is a “polypill” that everyone should be taking in order to reduce their risk of disease, I think it lies more in the ratatouille category. This is as much a spiritual as an intellectual conviction, I realize.

Bland also talked about the emerging science of epigenetics, about which you will undoubtedly be hearing more as time goes by. Based on some provocative observations in animals, it is becoming clear that the food you eat may be talking not only to your genes, but to your kids’ genes, and their kids genes.

For instance, epigeneticists (?) have observed that special fat golden lab mice called Agouti mice, who die young because they are particularly prone to obesity, diabetes, and cancer (so they are bred for use in research about those diseases) give birth to slim dark brown babies who are NOT prone to obesity, diabetes, and cancer if the mother mice are given a special diet that is rich in B vitamins, zinc, betaine, choline, and methionine. The babies also come out healthy and dark if the GRANDMOTHER mice ate the supplemented diet. OK, do you get this? This is not a genetic mutation – this is food substances changing the expression of disease-related genes, transgenerationally. The Agouti mice’s genes themselves are not changed,  but the food-based instructions they get are. Nothing but nutrients and the life expectancy of many baby mice increases. This is huge. It makes me even more passionate about feeding pregnant women well!

I can hear people now, though, complaining that it’s hard enough to take responsibility for the developing health and well-being of ONE person while you’re pregnant — and now the burden is even heavier.

As always, mothers are on the frontline of social evolution. For them, the idea of considering the impact of one’s actions on the next seven generations is not just an intellectual exercise. I don’t know a way around it!

The Tyranny of the Scale

Posted in Susan Fekety on January 6th, 2009
Unless otherwise noted, © Copyright 2009 by Susan Fekety. All Rights Reserved.

A rainy and overcast fall morning, unseasonably warm for Maine. I’m reflecting today on a conversation that developed recently at our FirstLine Therapy group, reminiscent of innumerable previous talks I’ve had with other groups and also with patients one-on-one and in my own head.

It’s about what I have come to call “the tyranny of the scale,” and the absolutely inexplicable way in which numbers on a simple little inanimate device can derail the emotional equilibrium of even the most powerful and capable of individuals. Scale weight goes up — disappointment, self-recrimination, whips and chains, depression. It goes down — elation, perhaps an excuse to binge, blow off healthy activity, perhaps even some fear and self-sabotage.

It’s fascinating, if it were not so pervasive and tragic. I feel so sad to see cool people (mostly women; I do not hear much of this from men, but it could be they’re just not talking about it) so unhinged by this weight on the scale thing.

This particular discussion surrounded how often various members of the group got on the scale. One felt clear and confident that daily weighing was right for her, and it was convincing to hear her describe how that order of frequency made weight just part of the landscape, and therefore less emotionally powerful — like brushing your teeth. Others agonized if they EVER had to know their weight; this is pretty common and I have several patients who explicitly do not want to even hear a number. They stand backwards on the scale, and our staff have put little flags on their medical charts to remind us that standard procedure is not the right thing for them.

Women with weight issues often find that they avoid going for needed health care, in fact, simply because they so do not want to go through the weighing ritual — and probably, the more or less thinly veiled shaming lecture that may well follow it. (Honestly, the stories are really amazingly awful. I have several patients of size, in fact, who came to my practice because they were tired of being badgered to have gastric bypass surgery in other offices, or who have experienced explicit shaming, rudeness, criticism — but that’s another rant, the whole weight discrimination thing in our medical culture.) Others have admitted that when they know they are coming to see me, they DO NOT EAT prior to the visit so their weight will be lower (they think.)

What I was struck by in this conversation was the wide variety of ways to approach the “scale thing” that seemed to work for different people. Daily, weekly, only at the clinic, never — all had adherents. Still, when the numbers finally do show up, there were some consistent stories about how people tended to react to them.

For some women, dropping weight is scary. They feel exposed, in new territory, having surprised themselves by actually accomplishing something they set out to do — it raises the stakes for their entire life. Staying at a particular weight, or gaining, triggers many to run tapes of critical voices from childhood (”See, you’re a failure, you’ll always be fat, there’s something terribly wrong with you, lazy slacker glutton, bla bla bla”) or to bargain (”Well, my bladder was full,” “It’s the end of the day,” “My shoes are heavy today,” or “I’m about to get my period”). What a waste of precious personal energy!

I have no solutions to offer here, just an observation of the impact of this seemingly simple medical ritual. Now that we know the correlation between scale weight and most conventionally-accepted measures of “health” is not as directly linear as we used to think, it seems timely to explore the difference between what we know, what we think we know, and what we tend to believe — whether it’s really true or not.

I have obese clients who I’d say are healthier than quite a few other skinnier ones. Feeling healthy has more to do with attitude, activity, and habits than with pounds on the scale.

I do know that one of the reasons I like offering electronic body composition analysis in the office (the medical grade version of those body fat analyzer scale gadgets you see at Target or the gym) is that patients can use these results to un-hook from the more superficial pounds-on-scale paradigm and convert (eventually) to a newer and more valid measure: what’s my lean body mass doing lately? It’s a measure that is less variable over time, less subject to diurnal fluctuation or variation due to hydration — and overall, more meaningful when you’re really looking at what constitutes health. It also just doesn’t have the history, the emotional baggage that the scale does, just because it’s newer and different!

Yeah, I have to weigh you in order to properly program the machine, but over time I’ve noticed more and more people expressing their awareness that scale weight wasn’t the really important thing: “Oh, I don’t care about that. Let’s do the body composition test and see what’s really going on!”

Would that one day these gadgets are in every medical practice.