Noms: The Local, Wellesley

Posted on January 21, 2014 by Jonah Soolman

To celebrate Jonah’s birthday, we decided to venture out to The Local, a restaurant that just opened up in Wellesley last November. Per usual, we went for an early dinner (5:30 pm), so when we arrived, there weren’t many patrons. Suffice it to say, the place began to quickly fill up, and as we walked out the door at 6:30 pm there were people waiting for tables. The Local’s menu is divided into clever sections such as “Snack Things,” including warm potato chips and dip and spicy Chex mix, “Mac and Cheese Things,” which allowed the diner to customize his or her mac and cheese, and “Bigger Things,” which was comprised of larger entrees including chicken cacciatore, short ribs, and semolina-crusted fish and chips. Impressively, none of the appetizers is more than $14 (most were $5-8), and none of the entrees costs more than $19.

To start our meal, we had the fried pickles, which were crispy and delicious and not greasy in the least. For our main meals, Jonah had the grilled cheese sandwich with a cup of tomato soup, while Joanne had the Atlantic salmon, which came with roasted Brussels sprouts and parsnip puree. Although Jonah’s grilled cheese was smaller than others he has gotten at similar restaurants, he felt it was the perfect amount of food and was comfortably full by the end of the meal. Joanne’s salmon was perfectly cooked, and the contrast in flavors among the salmon, Brussels sprouts, and puree was addictive.

While our meal was tasty and uneventful, it appeared as though the couple dining next to us were not happy with their orders. We overheard them telling their waiter that the steak tips they had ordered were not cooked to their liking, so they sent them back. In addition, it looked like there were other issues with that couple’s meal, including missing meal components. Our guess is that since the restaurant is still only about a month old, it is working out the kinks.

All in all, The Local was a pleasant surprise for its delicious food at very affordable prices. It will surely be added to our favorite restaurants rotation!

The Real You Is Sexy

Posted on January 21, 2014 by Jonah Soolman

Aerie, the lingerie branch of American Eagle, is going with a “The Real You Is Sexy” campaign for their spring line. My understanding is that the ads are not retouched in any way and show the models just as they were when the photographers took their pictures. Aerie deserves credit for this move, but this change alone does not fix the underlying problem. The greater problem is with us, not the fashion industry.

Reality is more complex than I am about to make it seem, but the basic premise is that we compare ourselves to models, feel pressure to look like them, feel bad about ourselves for not looking like them, and adopt certain behaviors – healthy or not – in an effort to match them. Other advertisement campaigns that do retouch photos can dramatically alter a model’s appearance making him or her seem flawless. When such a picture is held up as the ideal, we are comparing ourselves to someone who does not even exist. As such, who can possibly live up to that standard? Aerie deserves credit for at least removing this as a factor from the equation.

The larger problem though is that we compare our bodies to others in the first place, and that is not going to go away even if the fashion industry completely does away with retouching. For example, I work with a patient who watches women leaner than herself pass by in town and feels bad about herself as a result. No retouching there; she is comparing herself to people she sees with her own eyes.

We do not know what somebody does to look a certain way. I do not know any of the Aerie models and I have no idea what they do to maintain their looks, but chances are neither do you. They might look the way they do because they are genetically predisposed to have that figure and on top of it take excellent care of themselves. On the other hand, they could also look that way due to eating disorders, overexercise, or other unhealthy behaviors. One of my patients, a former model who is working to overcome anorexia, tells me of the pressure in the industry to gain a certain look at any costs, healthy or not. If a model gets his or her frame through an eating disorder, are we really to look up to that image as an ideal just because there is no retouching involved? In that sense, we still should not be using models – retouched or not – for a point of comparison.

To further the point, we should not be comparing our bodies to anybody else either. I discussed with my patient, the one who compared herself to other women in town, that we have no idea what those women do to maintain their looks. Some of them are probably perfectly healthy, while others might struggle with eating disorders or other unhealthy behaviors. Some of them are deeply unhappy and live rigid lives in isolation so they can do exactly what they need to do in order to maintain their physiques. Some of them would laugh if they knew other people look up to them because no matter how great somebody else says they look, they still hate their bodies themselves. I know all of this because I just described patients of mine. These problems are much more prevalent than one might think.

It is time to stop comparing our bodies to others. Weight, waist-to-hip ratio, and other anthropometric measurements do not define us and should not determine our self-worth. Love and accept yourself the way you are now, not X pounds from now, and focus on leading a healthy lifestyle built on a foundation of balance.

Confusion

Posted on January 16, 2014 by Jonah Soolman

A friend and I recently got into an email exchange about how rapidly nutrition advice seems to shift and how this often leaves people confused, frustrated, and feeling paralyzed about what to do.

No doubt, guidelines do evolve in response to new research, and in fact the Dietary Guidelines for Americans are updated every five years. The shifts, while perceived as quite fickle, are much more subtle than most people realize. However, the reason we perceive nutrition advice to be oscillating like the ever-changing wind is not due to this evolution, but rather because of misinformation.

Take yesterday as an example. Each day, Joanne and I receive a blast of nutrition-related articles. For each topic, we are provided with the story geared towards the general public, such as an article in the New York Times or Boston Globe, as well as the research piece or journal article on which the story is based, such as a piece in the New England Journal of Medicine.

Yesterday’s topic read, “Fats and Oils That Can Improve Your Health.” As soon as I began to read the story, something seemed fishy. Ghee and coconut oil topped the list of supposedly-healthy fats. Although alternative medicine touts both of these fats as having health benefits, the research up to this point has not supported these claims. Therefore, I was surprised to see them headlining the list. When I got to the bottom of the article, I discovered that sure enough the story was written by a “Holistic Health Counselor,” as opposed to a credentialed and licensed expert in the field.

Next, I read the position statement released by the Academy of Nutrition and Dietetics on which the above story was supposedly based. The content of the two publications bore little resemblance to each other. Regarding coconut oil, the Holistic Health Counselor wrote, “This versatile oil goes well with both sweet and savory dishes and boasts many health benefits. Made up of medium-chain fatty acids, this oil is good for those trying to lose weight because the body can easily use this healthy fat for energy. A large portion of the fatty acids found in coconut oil are made of lauric acid, which can serve as an antimicrobial, antiviral, and antibacterial, helping to combat viruses and boost the immune system.” On the other hand, the position statement read, “New food products containing coconut oil and other palm oils (eg, milk, spreads, yogurt) are touting health benefits of MCTs [medium-chain triglycerides, or medium-chain fatty acids]. Given that 44% of coconut oil is 12:0 and 16% is 14:0, and these fatty acids are hypercholesterolemic, consumption of coconut products is not currently recommended.” Do you see any relationship between these two passages at all?

Omitting a link to the Holistic Health Counselor’s story was a conscious decision on my part in order to avoid further dissemination of misleading information. If I showed you the article though, you would discover that it is concise, organized into a list with bold headings, and features colorful and attractive photos as well as a head shot of the author. Compare that to the text-heavy, chemistry-laden, pictureless, 18-page monstrosity that is the position statement. The former will attract more readers and gain steam and wide circulation due to forwarding to friends, postings on Facebook, etc. The latter is lost in the dust, only to be read by the likes of me.

Generally speaking, most people never read primary source articles. They simply trust that the stories they read summarizing said articles do so with a high degree of accuracy. Unfortunately, just like in the game of telephone, details and facts get lost or skewed with each iteration; the ultimate and initial messages conveyed often do not match. The mismatch is what makes playing telephone fun and interesting, but in real life the consequences are negative. A patient comes into my office having read the more popular article and understandably believes the content to be true, but then he or she hears me present the position statement’s stance. “Have the guidelines already changed?” the patient asks. “Who should I believe? What am I supposed to do now?” No wonder people feel stuck and confused. Part of our work then becomes to undo this confusion so that the patient can move forward.

In a culture where we have limited time and attention spans, we get a great deal of our news through tweets, scrolling headlines at the bottom of the television, and sound bites. Media members, fully aware of the small window they have to present an idea and under pressure to break a story first, sometimes sacrifice checking facts and preserving key messages. The pressure to be first and to accumulate clicks, retweets, and Facebook likes is king while the responsibility to be accurate gets lost in the shuffle.

Somewhere along the line, somebody suggested to me that I should shorten my blogs. People have neither the time nor attention span for my entries, and who besides my mom reads all the way through to the end? Shortening my blogs, I am told, could increase our Facebook fans and Twitter followers, thereby making Soolman Nutrition and Wellness LLC more popular. That could be true, but my position as a source of reliable information is one that I take seriously, and I am not about to sacrifice my credibility for some extra likes and retweets. Despite today’s be-first-and-keep-it-short media culture, accuracy and completeness are still necessary in order to minimize confusion.

Eating Flowers

Posted on January 14, 2014 by Jonah Soolman

If you are like me, your eating pattern is somewhat repetitive. Your grocery shopping involves focusing on the usual suspects while consciously or subconsciously dismissing most of the foods in the store due to cost, lack of knowledge about how to prepare them, ethical reasons, bad experiences last time you had them, or a variety of other reasons that can eliminate them from consideration for purchase.

Once upon a time, my shopping trips were so consistent from one to the next that my visits to Whole Foods were showcases of machine-like precision and efficiency. Within 10 minutes of turning off my car’s ignition in the parking lot, I was buckling my seat belt with a trunk full of groceries in the back.

While routine has its upsides, at some point along the line I realized that I was doing myself a disservice by always eating the same foods. From a health standpoint, I was missing out on nutrients that were deficient in my regimen. In terms of enjoyment, I often felt bored with what I was eating. Food can and should be fun, and as Joanne pointed out, we tend to absorb more nutrients if we enjoy what we are eating. The grocery store is full of foods that I might have really liked if only I was adventurous enough to give them a chance.

Once I realized that, I decided that each time I went to the store I would purchase one food that was either brand new to me or that I had not had in a very long time. I tried all sorts of things, some of which probably sound mundane to you, but they were departures from the norm for me: exotic melons, crab cakes, pies, tabouli, strange-looking vegetables I had no idea how to prepare, dairy-free “ice creams,” pumpkin pasta sauce, teff, vegan hot dogs, etc. Each week I came home with something new. No, I did not like everything I tried and many of them I never bought again, but there was still value in the experimentation. I expanded my palette, rediscovered foods I had forgotten, and realized that some foods I used to dislike now hit the spot.

Although I maintained this tradition for years and got a lot out of it, recently I found myself sliding back. Once again, I gravitated towards particular shelves while ignoring the vast majority of the inventory. As soon as I caught myself doing this, I reminded myself how much I enjoyed my years of experimentation. At that moment, I was standing in the produce section in front of a package of edible flowers. My hesitation reminded me, “I am not someone who eats flowers.” As I reached for the package and put it in my cart, I thought to myself, “I am now.”

How should one measure health?

Posted on January 10, 2014 by Jonah Soolman

“I really like your blog posts. They’re really well thought out and are a step above what I imagine normal nutrition blogs are like. It’s like the philosophy of nutrition or something. Question, though, when you say this: ‘Joanne and I advocate focusing on health rather than weight. In that sense, weight outcomes are only somewhat interesting to us.’ I think you’re right, but it also seems challenging to measure one’s health without focusing on weight. There are very few things a person can do other than stepping on a scale (without regular blood draws and periodic EKGs [electrocardiograms]) to measure their health. In other words, how do you recommend someone measure their health to see if their health is improving?”

The above email arrived in response to a blog I posted earlier this month in which I compared the slim hopes of winning the lottery to the poor success rate of weight-loss endeavors. Indeed, Joanne and I do advocate adapting lifestyle changes in pursuit of better health as opposed to taking a weight-centered approach because the latter rarely turns out well.

Furthermore, weight in and of itself is generally not a good indicator of health (although there are some exceptions to this generality, such as for a patient who is recovering from anorexia nervosa). About a decade ago, I had a weekly doubles game with three other guys. One player was very lean and clearly had the lowest body mass index (BMI) of any of us. Was he the healthiest in the group just because he was the lightest for his frame? After we had been playing together for a few months, I got a call one afternoon saying he had had a heart attack. I came to find out he was also diabetic.

So if not by weight then, by what should we measure our health?

First, we need to understand that just because a measuring tool is convenient and easy to use does not mean it is valid. In other words, just because gaining access to a scale and stepping on it are actions that most people can perform does not mean that the resulting data are automatically useful.

You know from my biography that I have an undergraduate degree in mathematics. For a statistics class project, I analyzed the November 6, 1997 trade between the Red Sox and Rangers that sent Aaron Sele, Mark Brandenburg, and Bill Haselman to Texas in exchange for Damon Buford and Jim Leyritz. In an effort to determine which team got the better end of the deal, I analyzed the past performances of the trade’s cornerstones, Sele and Leyritz, and determined which metrics were the best predictors of the outcome that ultimately mattered most: team wins. Some statistics, like strikeouts for a pitcher or home runs for a hitter, are easy to compute and understand, but it turned out that other metrics that were more complex to calculate and comprehend were better predictors of team wins.

While I was in the process of switching careers, I did a similar project in my nutrition assessment course in which I tried to determine which anthropometric measurement is the best predictor of cardiovascular disease. The results were complex, but the conclusion that I reached is not the point of this blog entry. The point is that just as I found with the baseball project, the ease of obtaining a particular measurement has nothing to do with the utility of said measurement. In other words, just because it is easy to count the number of home runs a player accumulates or to step on a scale and find out our weight does not mean that these numbers are great indicators of team wins or our health, respectively.

With that in mind, let us now turn our attention to just some of the ways we can measure health. This list is far from complete, but it gives a sense of all of the measurement tools healthcare practitioners have at their disposal.

We have anthropometric data, such as waist circumference, waist-to-hip ratio, body fat percentage, and BMI. We have the numerous biochemical markers that doctors can examine through blood and urine tests, including blood glucose, insulin, total cholesterol , LDL (“bad cholesterol”), HDL (“good cholesterol”), triglycerides, red blood cells (RBC), white blood cells (WBC), and markers of liver health, protein stores, electrolytes, and inflammation. Clinical indicators include hair and skin quality, finger nail appearance, and tests for hydration status. Electrocardiograms and blood pressure readings comprise part of a cardiovascular system assessment. Men and women can screen themselves for signs of testicular and breast cancer, respectively, through regular exams.

When I was a personal trainer, I used tests like the eight-repetition maximum bench press, Rockport walk, and sit-and-reach to assess my clients’ fitness and track their changes over time. In my realm of nutrition, dietitians will sometimes use tools, such as a 24-hour recall or food frequency questionnaire, to assess the health of one’s food intake. Aside from one’s intake of fruits and vegetables, for example, one can track other health-related behaviors themselves, such as physical activity duration and frequency as well as usage of tobacco, alcohol, and recreational drugs.

Health is not just about the physical; emotional and psychological health is also important. This is not my area of expertise, but I am sure psychologists and psychiatrists have ways of screening for and assessing the magnitude of conditions ranging from depression to schizophrenia.

With all of these different tools we have for assessing and tracking health, the criteria that one uses has to be individualized, which is why it is important to talk with your healthcare team about how you should track your own health. For example, diabetics may measure their health in part by monitoring their blood sugar at home and keeping their A1C under a benchmark value set by their doctors. A patient with a family history of cardiovascular disease may monitor his health in part through periodic blood lipid level checks and self-monitoring of blood pressure at home. A patient with celiac disease may monitor her health in part through bone density screenings and tTG blood tests. A patient with a history of skin cancer may measure his health in part through routine screenings with the dermatologist.

The permutations of how to measure health are endless and must be customized with the help of your doctor and any other healthcare practitioners who are on your treatment team. Just because weight is easy to measure does not mean one should put much stock in the number or even track it at all.

The Lottery

Posted on January 3, 2014 by Jonah Soolman

Ralph Francois, of Quincy, won $1,000,000 playing Mega Millions. Marjorie Teixeira, Frank DiMascio, and Christine Cummings, of Melrose, Watertown, and Dedham, respectively, all won lottery prizes on the same December day. Stanley Goryl of Smithfield, Francis McPherson of Somerville, Marque Scott of Fall River, Patricia Cannata of Attleboro, and Linh Dang of Dorchester are just a few of the 15 locals who won at least $1,000,000 through the lottery last month. Their pictures, smiling and holding up enlarged replicas of their winning tickets and prize checks, are both evidence of their victories as well as enticements to the rest of us suggesting that we can be winners too.

Despite these testimonials that fill us with hope, most people do not walk away a winner. Massachusetts lottery players, on average, will only win back $0.72 for every $1.00 they spend on lottery tickets. According to a study by Bloomberg, state lotteries “have the worst odds of any form of legal gambling” in the country. To put things in perspective, one reportedly is 1,400 times more likely to die in an asteroid apocalypse than he or she is to win Powerball. As if the odds themselves were not concerning enough, playing the lottery can sometimes spiral out of control. A link on the Massachusetts State Lottery’s website directs people to where they can get help for compulsive gambling.

Some people enjoy gambling, including the lottery, and as one of my friends said to me recently, “You can’t win if you don’t play.” Going about it with a sporting attitude for the sake of entertainment and excitement is one thing, but nobody actually believes that playing the lottery will really net a profit, right? Wrong. According to a couple of 2005 surveys put out by the Consumer Federation of America and the Financial Planning Association, 21% of the surveyed Americans believe that winning the lottery represents the most practical way for them to accumulate several hundred thousand dollars. I imagine one would be hard pressed to find a legitimate financial adviser who would suggest that playing the lottery is a sound investment strategy.

Given the time of year with people around me making all sorts of resolutions, the clear parallel between playing the lottery and resolving to lose weight has been on my mind. Joanne and I have written extensively about the chronic failures of weight-centered dietary approaches. Although the exact outcome depends on the specific parameters of the given study in question, research across the board shows that the chances of keeping off lost weight are poor. According to one group of researchers, “Less than 20% of individuals that have attempted to lose weight are able to achieve and maintain a 10% reduction over a year. Over one-third of lost weight tends to return within the first year, and the majority is gained back within three to five years.”

Joanne and I advocate focusing on health rather than weight. In that sense, weight outcomes are only somewhat interesting to us. However, for programs and approaches that revolve around weight, shouldn’t the results at least be better than this?

However, just like people who play the lottery despite the terrible odds of making a profit, we get sucked in by glamorous testimonials, peer pressure, advertisements, and the like, all encouraging us to lose weight. We enter the weight-loss game with the expectation, whether by delusion, misunderstanding, or overconfidence, that we will be the rare exception who comes out on top. “You can’t win if you don’t play,” right?

The difference is that we are not playing a game; we are playing with our health. At best, the weight-loss-weight-regain cycle postpones behavior change that will actually improve our health. More likely, the cycle itself can leave us in a less healthy state, either physiologically, psychologically, or both. Furthermore, just as the lottery can lead to a gambling addiction, weight loss pursuits can lead to serious eating disorders which add a whole new layer of complexity to one’s health problems.

Instead of entering a game that you are likely to lose, leave weight-centered approaches behind and focus on making healthier choices. No, lifestyle change is neither sexy nor rapid. Lifestyle change does not make for good reality television. What it can do though is increase your chances of getting healthy and staying that way.

The Wrong Idea

Posted on December 30, 2013 by Joanne Soolman

In addition to the many patients I see for eating disorders, I often have individuals come to see me for help with weight loss. This goal is completely understandable in the current context of our society. Most of us have been told by numerous sources that weight loss is essential for health, and only if we are at the “right” weight will we live long and healthy lives. And up until about five years ago, I would have agreed with this assumption.

But, as I have written about in many other blogs, I’ve had a paradigm shift. There is more and more scientific evidence out there that weight and health are not inextricably linked. In fact, it is completely feasible for someone to weigh considerably more than the BMI and weight charts tell her to and to be perfectly healthy. In contrast, I have seen countless patients in my office who are at their “ideal” weights, yet are using extremely unhealthy measures to stay there and have numerous health issues as a result.

Therefore, I am concerned when the New Year comes around, as I know that our office will become busier than ever with people wanting to lose weight. I’m afraid that prospective patients will have the wrong idea about what I will and will not do. As a registered dietitian, I am knowledgeable about nutrition for health promotion. This means I can provide nutrition education for my patients and help them figure out ways to establish some healthier eating habits. While these healthier eating habits may lead to some weight loss, weight loss will not be the inherent goal of our work together. If any weight loss occurs, it is just the byproduct of the lifestyle changes one instills. It isn’t the primary goal.

Maybe 2014 will be the year that we can all start taking our eyes off of the scale and instead focusing on making healthy lifestyle changes instead.

Extreme Disappointment

Posted on December 3, 2013 by Joanne Soolman

In general, I don’t watch reality weight-loss shows. I used to. Biggest Loser was one of my favorites. I was always in awe of how many pounds the contestants would lose each season, many of them shrinking to half of their starting size. But, ever since I became a dietitian, I view these shows in a much different light. Shows like My Big Fat Revenge, Biggest Loser, and Extreme Weight Loss promote dangerous messages about weight management – namely, that fat people are inherently unhealthy and that the only way to be healthy is to lose copious amounts of weight quickly by drastically restricting one’s calories and exercising like a maniac.

Despite my dislike of these shows, I do (rarely) catch an odd episode from time to time. Many of my clients watch these shows and take what the “experts” say as gospel, so it helps if I am in the know about the latest and greatest gimmicks these shows use, so I can help re-educate my clients.

Last night, I stumbled across an episode of Extreme Weight Loss that truly disturbed me. In this episode, a 23-year-old woman named Alyssa was the individual who was chosen to undergo a year of restrictive eating and over-exercising courtesy of trainer Chris Powell. The episode started predictably enough: initial weigh-in tears, a loss of 100+ pounds over the first 3 months (Phase 1), and the inevitable struggles to lose weight during Phase 2 (months 3-6).

This is where things take a serious turn. After Phase 1, Alyssa found that the weight just wasn’t coming off like it had been before. No matter how much she tried to follow the meal and exercise plan, her weight was at a plateau. So, in order to reach her goal of losing another 60 pounds during Phase 2, she decided to drastically reduce her calories even more, at times eating close to nothing. This resulted in rebound binges and subsequent purging. Alyssa developed an eating disorder (ED).

At this point, the show’s producers should have stopped the program for Alyssa, insisted she get treatment for her ED, and take all of the focus off of her losing weight. Instead, Alyssa had a heartfelt talk with Chris and his wife Heidi (who herself struggled with an ED for eight years), and despite the fact that clearly Alyssa needed help dealing with her ED, they continued to encourage her to lose weight and restrict her calories. She was instructed to eat 1500 calories per day while exercising for at least three hours per day to achieve “healthy” weight loss.

At the very end of the program (and after she had completed the program, losing a total of 200 pounds), Chris offered Alyssa a two-month stay at Shades of Hope, an ED treatment center. While at first she rejected the offer, Alyssa ended up going to the program two weeks later, as it was clear that her eating issues were continuing. Why wasn’t this offer made immediately after Alyssa admitted her ED to Chris? Why did they wait until the end of the year to offer her help?

When someone is struggling with an ED, there should be no talk of trying to lose weight, whether it is in a “healthy way” or not. In a sense, the show itself taught Alyssa how to eat in a disordered (re: restrictive) way, priming her for developing an ED. By letting her continue on in her weight loss program, the show did Alyssa a real disservice and gave the message that EDs are no big deal and are just a “phase” that can be dealt with easily. Unfortunately, EDs are not only extremely damaging (and potentially fatal), but they also often turn out to be a life-long struggle, not something to be glossed over.

These shows are not only doing damage to the contestants, but also doing an enormous amount of damage to their viewers. I am hopeful that one day these shows will run out of steam and stop reinforcing the idea that losing weight and the number on the scale are the end all, be all. Maybe someday shows will promote healthy behavior change, without focusing on the numbers. But, I guess that wouldn’t make for scintillating TV.

Philosophy and Ethics

Posted on November 5, 2013 by Jonah Soolman

The following blog entry appeared as a guest commentary in the Wellesley Townsman on November 14, 2013.

Early Saturday evening, I was driving home from the office after seeing my day’s last patient and the car immediately in front of me struck a deer. We were in the left lane of a divided highway going east. The deer ran across the west-bound lanes, jumped over the barrier into our lane, and got hit immediately. There was nothing the driver could have done to avoid the collision.

While the driver was able to pull over into the breakdown lane, the front side of his vehicle completely demolished, I was stuck in the left lane. I slammed on my brakes to avoid running over the deer and I put on my hazards in hopes that nobody would crash into me. Everybody else just kept on driving, and as such I was not able to move over. I had a close-up view of the deer dying right in front of my car.

The deer tried to get up, which I hoped might signify that it was miraculously okay, but then it fell over and was kicking its legs. The flailing slowed and became almost nothing. Eventually there was an opening in the traffic and I was able to pull around the deer. As I did, I looked out my side window to the animal on the ground just a couple feet away. It was bleeding profusely from its mouth, still alive, still moving its legs ever so slightly.

I pulled into the breakdown lane and called 911. In addition to reporting what happened and the exact location, I made a point of telling them that the deer was hurt really badly and needed help. (The driver who hit the deer, by the way, appeared to be physically fine as he stood outside his car making a phone call of his own.)

After hanging up with 911, I had no idea what to do. Getting out of my car and going to check on the deer crossed my mind, but the chances that I would get hit by a car myself were high and who knows how an injured wild animal would react to a human approaching it. Besides, I am not a vet, and even if I was I had no medical supplies of any sort and no way to transport the animal. In other words, the best I could have done anyway would have been to keep it company.

Feeling completely helpless, I left. As I drove away, I saw a single police cruiser approaching the scene. Traffic continued on, squeezing through the bottleneck caused by the dying deer in the road. (I did later follow up with the police, who termed the deer’s injuries “catastrophic” and confirmed that it did not survive.) Angry at what I perceived to be an underwhelming response, I thought to myself, “If a human ran out into the road and got hit like that, an ambulance and fire truck would have been here immediately, not just a lone police cruiser, and other drivers wouldn’t be passing by the body like it was nothing more than a nuisance.” One of my friends who is a veterinarian later explained to me why there was nothing that could have been done to save the animal even if the entire staff of Angell instantaneously arrived on the scene.

When Joanne and I met up at home, she could tell that I had been crying. We love animals. Any of you who have seen our waiting room pictures know how important our pet bunny is to us. Our honeymoon largely revolved around animals: snorkeling with marine life in Fiji, spotting mountain goats, dolphins, seals, and penguins in New Zealand, and getting close up with kangaroos, wallabies, emus, parrots, casuaries, and koalas in Australia. We like deer too. Helplessly watching one die in front of me in obvious pain was very, very difficult.

Although I am still am omnivore, my eating pattern has been trending towards vegetarianism in the last few years for reasons that have nothing to do with health benefits or supposed virtue. At first, I started eating less animal products just because they tend to be more expensive and require more care in food preparation than vegetarian alternatives.

Then ethical questions came into play. We nearly went to an Italian restaurant once before discovering that they serve rabbit, a decision that is certainly within their rights, but one that we felt we could not support by giving them our business. From that evolved several questions: Why was I okay eating other animals, but not rabbits? If I owned a pet fish, would I still eat seafood? If chickens were cuter, would I still eat poultry? If I like feeding the pigs at the local farm, what am I doing eating pulled pork sandwiches? How can I find cows funny, stop to take their picture when I drive by them, and then eat a hamburger as if the patty grew on a tree somewhere? Given that I criticize steak houses and BBQ joints that decorate with pictures of cows and pigs, respectively, because I do not want to be reminded of what I am really eating, aren’t I just turning a blind eye to reality by seeking out restaurants without such decor? Where do we each draw the line between the animals we value and protect and those that we are okay sacrificing to feed ourselves in the face of perfectly fine plant-based alternatives? No answer is right or wrong; these are questions of personal philosophy.

After Saturday’s accident, we went out to dinner as planned to a nearby Greek restaurant that we like. I ordered a bunch of side dishes: tatziki and pita, butternut squash, and rice pilaf. Someday, fad-diet aficionados will no doubt focus their fear on protein, just as they once did on fat and now do on “carbs,” but until then I don’t think anybody will deem my meal anything close to balanced. Still, the idea of ordering my usual Mediterranean salad with a skewer of chicken on it after what I just witnessed felt disgusting.

I tell my patients all the time that they are not lab animals or homework assignments from some nutrition textbook. Real life is complicated, messy, and far from perfect. I know all about the advantages of eating meat (complete proteins and essential amino acids, heme iron, zinc, B₁₂, and the like) but being a dietitian and having that knowledge does not make me exempt from the complexities that influence the way we eat. Our food choices are about way more than just nutrients and calories.

Meal Enjoyment and Nutrient Absorption

Posted on October 25, 2013 by Joanne Soolman

In nutrition school, I was taught that there were certain nutritional facts that always held true. A calorie is a calorie. If you eat 500 calories less per day for a week, you will lose one pound of body weight. Just because a “healthy” food might not be enjoyable to you or taste good, it is still important to eat it for good health.

Well, there is some interesting evidence that when it comes to nutrition, how much we enjoy our meals may be just as important as what our meals are made of. In October of 2000, Tufts University Health and Nutrition Letter discussed a study that measured how one’s enjoyment of a meal affected one’s nutrient absorption. In the study, researchers from Thailand and Sweden teamed up to see if cultural preferences for a food would affect the absorption of iron from a meal.

In the first phase of the study, two groups of women, one from Thailand and the other from Sweden, were fed a typical Thai meal. Needless to say the Thai women preferred the taste of the meal more than the Swedish women did. Interestingly, even though all of the meals contained the exact same amount of iron, the Thai women absorbed twice as much iron from the meal than the Swedish women did. In the second phase of the study, the two groups were served a typical Swedish meal with the exact same iron content. In this case, the Swedish women absorbed significantly more iron from the meal than the Thai women did.

In the second phase of the study, the Thai group and Swedish group were split up into two subgroups. The two Thai subgroups were given an identical Thai meal, but one of the subgroup’s meals was pureed into a mush. Even though both of the meals had the exact same iron content, the women who ate the mushy meal absorbed 70% less iron than the other group. The study was repeated in the Swedish group and the results were similar.

So what does this tell us? Taste and enjoyment matters to nutrient absorption! If you are one of those “nutrition martyrs” who eat foods that you really don’t enjoy just because they are “good for you,” it’s likely that you aren’t absorbing much of the nutrients from those foods. Conversely, even if you are eating a food deemed “unhealthy” by the food authorities, if you are truly enjoying and savoring it, you will be absorbing more nutrients from it.

Now, this isn’t license to only eat “junk.” But, instead of forcing yourself to eat healthy, but not tasty food, how about finding healthier foods that you enjoy? Instead of eating fat-free cheese, which, ahem, tastes like plastic, how about savoring some real sharp cheddar from a Vermont dairy? Instead of munching on low-quality chocolate, how about enjoying a piece of dark chocolate that is full of antioxidants? I am willing to bet that if you start to incorporate more pleasure into your meals, you’ll be happier and healthier.