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.”