Sushi, Eggs and Oatmeal: Critical Thinking, Common Sense, and Nutrition

I’ve been around the block a few times, nutritionally speaking. I’ve been diagnosed with celiac disease (wrong) and Crohn’s disease (right, we think), I’ve spent countless hours at the allergist’s office, I’ve been told to follow diet after diet. Yet through all of that, none of my HMOs have ever allowed me to visit a nutritionist*– until now. My HMO is offering six free visits as a promotion, so I made an appointment.

I selected a nutritionist who works from the same office as my (totally fabulous and lifesaving!) gastroenterologist. I was so excited– finally, answers! Marion Nestle’s advice on what to eat is great, but with a Crohn’s diagnosis, I really felt like I needed more targeted advice. Not only that, but I’ve had some issues lately with my eating patterns. I’ll starve all day and then stuff myself at night, or eat a healthy lunch only to binge on junk food in the evening. I’ll cast around for something healthy to eat that won’t worsen a flare-up, only to come up empty-handed and drink an Ensure instead. I gain weight when I think I should be losing, and lose when I think I should be gaining.

In other words, I’ve got a weird, complex and emotionally fraught relationship with food, just like a whole lot of other people in this sexist, diet-obsessed society, and I thought maybe seeing a nutritionist would help.

The verdict? Helpful, but not in the ways I expected.

I think I expected that my nutritionist (let’s call her Gloria) would be a brilliant, status-quo-questioning Slow Food heroine like Marion, and together we’d figure out delicious ways to keep me healthy while subverting the food industry.

Then I got there, and my nutritionist’s desk was piled with product wrappers. They were everywhere- 100-calorie packs, whole grain cookies, South Beach meal replacement bars, Benefiber, you name it. You know how Michael Pollan advises us not to eat anything that makes a health claim on the wrapper?** Well, here were all of those wrappers, arranged on her desk and shelves, trumpeting their whole grains and omega-3 fatty acids.

I explained that I try to stick to a Slow Food diet as much as possible– I try to avoid mass-produced foods and ingredients I can’t pronounce, and I buy local food whenever possible. I don’t think Gloria ever had a client say something like this before: it seemed to throw her for a loop. She had a boilerplate diet plan in Word that she was customizing as we talked, and it was full of mass-produced, brand-name foods. I had to explain that I don’t think much of Kraft cheese slices, although I’m sure they are a fine source of calcium, and she brightened a little as we talked about our favorite “real” cheeses. I asked about healthy snacks, and she steered me toward 100-calorie packs of various junk foods.

To be fair, I get what she’s trying to do. Most people who aren’t obsessive foodies don’t venture far beyond their local supermarket or convenience store. When the Average American (that mythical creature) goes to a nutritionist, they want to be assured that they can make healthier choices without having to give up familiar brands and tastes, shop in inconvenient places, or eat foods they’ve never heard of. That’s why food companies put health claims on their products, after all– why should you have to spend time cooking, shopping and reading when you can just pick one box instead of another?

But doing those things will actually help you become much healthier. They’ll help you to connect your food with your culture and environment, get to know and support local farmers, and start thinking about the food you eat in its political, historical and cultural context. Oh yeah, and it’ll won’t have that nasty chemical taste, and it probably won’t be recalled.

So what did I learn that was useful? Well, Gloria knew quite a bit about Crohn’s-specific nutritional issues, and that was helpful. She stressed choosing foods that are easy to digest, and preparations that maximize your body’s ability to absorb vitamins. These recommendations focus more on that than on weight loss– she didn’t seem terribly concerned with fat and sugar– but they’re certainly useful. Gloria also respected my request that we focus on my Crohn’s rather than on weight loss, and didn’t criticize my body, which was a pleasant surprise.

Some helpful hints:

  • Nuts are hard to digest; nut butters are easy, and they’re a great source of protein.
  • Eggs are your friends– they’re jam-packed with protein and vitamins. (And cholesterol, so you can’t go too crazy, but one a day is fine if you don’t have cholesterol problems.)
  • Don’t be fat-phobic– fats are important in absorbing vitamins. Eating vegetables with fats is the best way to gain all of their nutritional benefits, so go ahead and put dressing on that salad.
  • Big, greasy meals, however, are not helpful. Try to keep it light.
  • Although whole grains are the Next Big Thing advertised on every box, refined grains are easier for Crohn’s patients to digest.
  • Even if you’re not lactose-intolerant, avoid dairy products if you’re having a flare-up. The act of digesting lactose basically involves fermenting it in your stomach, and if your intestines are already experiencing turbulence, the last thing you want to do is add to it. Even if you’re not flaring, a few dairy digestion pills can be helpful.
  • Generally, try to stay away from small, sharp, hard things. Fruits with seeds, nuts, chunky peanut butter, etc. can all irritate our already irritated intestines. And for god’s sake, stay the hell away from popcorn!
  • Small meals are easier to digest than big ones– a huge lump of food sitting in your stomach can really make things go haywire. (I know this, but those pork sandwiches at Abner’s are just so hard to resist.) Eat a few small meals and lots of snacks throughout the day, and don’t eat much at night.
  • Hydrate like crazy. Crohnies are particularly subject to dehydration, so just keep drinking. Water is best, but if you’re flaring and you can’t eat, you can get some calories from Gatorade or Vitamin Water.
  • My intuition was right– the two best foods for flare-ups are oatmeal and sushi. Seriously, sushi works miracles! I ate it last time I had a flare-up and felt better almost instantly. Skip the veggies and wasabi and go straight for the fish and rice.

So that’s what I learned… lots of useful Crohn’s tips, some not-so-great product recommendations, and very little subversion. Gloria also suggested keeping a food diary, something I’ve attempted several times with limited success. It turns out that not all nutritionists are on the bleeding edge of radical food politics, something I probably should have guessed– but even the mainstream ones have some useful advice, as long as you know how to think about it critically.

Readers, what’s your favorite Crohn’s nutrition tip? What kinds of experiences have you had with professional nutritionists?

*I was told by my insurance company that only diabetics may see a nutritionist. No, people in danger of developing diabetes may not see a nutritionist, and neither can people with severe nutritional issues, such as celiacs. Think that’s insane? Advocate for health care as a human right!

** “Of course it’s… a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness.”

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10 Responses to “Sushi, Eggs and Oatmeal: Critical Thinking, Common Sense, and Nutrition”

  1. Tisha Says:

    Once upon a time, my back-up plan for life was to be a nutritionist and cooking instructor. On bad days when I feel like strangling my college students, I think back with regret on that alternative career plan. No more. After reading this, I’m so glad that my job doesn’t involve hawking packaged food to people who hate cooking.

    On a side note, my sister has a long history of digestive troubles. I think she either has celiac or Krohn’s. How were you misdiagnosed? I thought it was a simple blood test, but I’ve heard of more than one mistaken diagnosis.

    Thanks! Tisha

  2. therealpotato Says:

    Hi Tisha,

    Thanks for stopping by! I hear you… there are certainly some progressive nutritionists out there, but I haven’t met any yet. (If they’re reading this, I hope they’ll comment!)

    I was misdiagnosed with a blood test… the gluten panel contains 4 tests for reactions to specific glutens, and I tested highly positive for one and negative for three. My doctor’s office at the time was a training ground for Beth Israel residents, so I never had the same doctor twice and they were all brand new MDs. The doctor I had that day took a look at my panel, told me I was a celiac, and sent me home with a printout about the gluten-free diet. No counseling, no nothing. I did a ton of research on my own and stuck faithfully to the GF diet. I never cheated, ever! If I had, I might have figured out that it was a misdiagnosis, but I was suffering so much already that I wasn’t willing to take the chance. A celiac diagnosis really requires an endoscopy. Definitely make sure she seeks out a gastroenterologist who specializes in this stuff– don’t trust your GP!

  3. Q Finder Says:

    Sometimes, I read things that just click, like your sentence that goes:

    “When the Average American (that mythical creature) goes to a nutritionist, they want to be assured that they can make healthier choices without having to give up familiar brands and tastes, shop in inconvenient places, or eat foods they’ve never heard of.”

    Thanks for putting words to thoughts that have been floating around in my head for a while. I’m getting into Slow Food, but I never seemed to be able to tell myself that I only wanted to shop in convenient places. Crazy! I came to your blog via Shapely Prose, by the way.

  4. therealpotato Says:

    Thanks so much, Q, and welcome! The Slow Food path definitely takes some hard thinking and assumption-challenging, but there really are ways to make it work without going out of your mind.

  5. Cat Says:

    Was Gloria a nutritionist or a dietitian? I’m taking Nutrition right now, and the first unit was on the difference in regulation/education between nutritionists and dietitians. Basically, the title nutritionist isn’t standardized nationally, and different states have different requirements education-wise (or lack thereof). To be a registered dietitian, an individual would have to complete an American Dietitian Association-approved course of education at the Bachelor’s level and participate in a lengthy supervised internship. In Pennsylvania, Dietitian/Nutritionists are licensed through the Board of Nursing, but I’d be curious to know if she’s registered with the ADA as well.

    Cat

  6. therealpotato Says:

    Ooh, good question. I believe she said she was a nutritionist– I don’t remember ever hearing the word ‘dietitian’. I don’t know what her background/licensing was. I’ll definitely ask next time, though.

  7. Meghan Telpner Says:

    I am not sure how I missed this post- somehow got lost in the fun of the summer. I believe I got to your blog through Green as a Thistle (The Thistle is one of my bestest friends). I had Crohn’s once upon a time and healed it with diet and lifestyle. I then went back to school and am now a certified nutritionist. I practice slow food natural nutrition. I will never catch me counting a calorie, or recommending that anyone eat refined carbs… ever! Soaking whole grains for 12-24 hours greatly increases their digestibility. There. We can start with that. I shop only at markets and a packaged food is hard to come by in my cupboards. There is a big difference between the nutrition that I practice and that of a nutritionist/dietician that you would find in a GI’s office. If I can ever be of any help- do not hesitate for a second 🙂 This is what I do. I use food, whole, unadulterated food, to heal. My story is up at http://www.thehealthycookie.com and an outline of my work at http://www.meghantelpner.com. Be well,
    Meghan

  8. Meena Says:

    hey there
    thanks for all the handy info on this page, my boyfriend suffers badly from crohns and after recently coming off his medication for it his flare ups seem to be getting worse, could you suggest any ways of having a healthy but also ‘normal-tasting’ diet, and more foods that can calm his flare ups down, also do you think stress causes flare ups?

    thanks
    x x x

  9. Meena Says:

    also, what is a ‘slow food diet’ ?!

  10. Jared Bond Says:

    “Eggs … you can’t go too crazy, but one a day is fine if you don’t have cholesterol problems”

    Browsing through Google, had to comment. Dietary cholesterol has almost no effect on blood cholesterol levels. 80% of blood cholesterol is synthesized by your own liver. Also, it is not clear if LDL cholesterol is really an indication of heart disease, or anything else. People have heart attacks no matter what their cholesterol is– in fact more if it’s lower (sorry, I can’t remember the specific facts are). Cholesterol is a vital nutrient that is the basis for many hormones as well as synthesis of vitamin D by sunlight, and also cell membrane structure.

    “There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.” –Ancel Keys, Ph.D., professor emeritus at the University of Minnesota 1997. (Ancel Keys was the originator of the “Lipid Hypothesis” in the 1950s, which first proposed that saturated fats raise cholesterol, and cholesterol causes heart disease.)

    Here are some links for those who want to know more:
    http://www.westonaprice.org
    http://www.proteinpower.com/drmike/
    http://www.second-opinions.co.uk/trick-and-treat.html


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