We Are Family

Hope springs eternal. No matter how unsuccessful their efforts to “lose weight,” people continue to try. Laudable. Applaudable. And respectable. But, for the most part, unsuccessful.

Last week I sat in a lecture and heard the results of research showing a lack of success when patients with mild dementia (minimal cognitive impairment) were taught strategies for improved self-care. In contrast, other research showed more success when patients were made part of a conversation that also included their primary caregiver. They called this teaching unit a “dyad,” meaning that there were two people, just one the designated patient. So…if you’re starting to struggle when it comes to remembering important details about your shower, your soap, your toothpaste or your nail clippers, it’s not going to help if someone sits down and goes over it all [again] with you. But if you include a loved one, the one who is actually responsible for helping you to look after yourself day after day, that looks like that strategy may actually do some good.

These are not surprising results by any means.

Years ago, when I cared for patients in a general internal medicine practice in suburban Cleveland, I observed a wonderful phenomenon. Patients not uncommonly arrived with children and grandchildren in tow, fresh from an earlier appointment across the hall at the pediatrician’s office. Bright-faced, fresh-scrubbed, engaging, chubby, usually well-behaved, American children. Pediatricians’ reminders about efforts to normalize the kids’ weights continued to be unsuccessful, and you could see on my patients’ faces how the ongoing exhortations were becoming tiresome. If they knew how to fix this problem, they told me, they already would have.

The subject changed quickly to my adult patient, who could also stand to make a few changes. Blood pressures rising, pants sizes rising, blood sugars rising. Oh boy — you wanna dance at these kids’ weddings or what?

Enter “Your Health is on Your Plate.” Stop trying to diet, I said. Don’t think about your weight. Just eat more vegetables and fruit. Stop avoiding nutritious fats. Eat avocados, scrambled eggs, olives, almonds, peanuts, anchovies. Deep-six the orange juice and eat oranges. Or berries. Or apples, which are especially good dipped into peanut butter. 

Stop buying breakfast “cereals.” Why do I put that in quotes? Because cereal is a synonym for grains, like millet or oatmeal or bulgur wheat. Not Lucky Frost-o-s or Cap’n Sugar or Raisin’ Weight or Sweetest Bran or LIKE. 

There were other ideas, too: Go for a walk and get into bed at bedtime. Turn off the lights.

Well, you know the rest of this story, or at least the next page. Patients returned to subsequent appointments with improvements all around. But that’s not the surprise. The crazy thing is that the children had experienced the same benefits.  Pediatricians were delighted to see weight curves bending toward more normal ranges, so families felt less hassled. I saw those little bellies shrinking away with my own eyes.

Human beings are social creatures. We are meant to operate in groups. As long as the medical system continues to operates mostly at the level of the individual, patients will feel hassled as doctors continue to struggle unsuccessfully to add meaningfully to conversations about lifestyle.

Successful lifestyle changes will engage not just the designated “patient” but also the individual most responsible for making lifestyle-related decisions for a family system. Especially where the patient, like a child or cognitively impaired elder, has little or no say  in creating the environment of their home. Who purchases and prepares most of the food in the family? Who schedules trips to the pool, or the soccer field? Who makes time for hikes or baseball games? Who makes the medical appointments? Who chooses where to put the rugs and lights? Who decides who sleeps where, and when bedtime starts? This individual must be at the appointment, and must play an integral role in the conversation.

We can survive on our own. We can live on our own. But we cannot really thrive on our own. We need each other for that. Early on, of course. But throughout the years, too.

#Mindful Being

A few words today encouraging you to be mindful, to be kind to yourself, to help yourself to remain centered, especially in the spinning vortex of ceaseless activity that will characterize the coming weeks of nonstop celebration.

#Mindfulness is my word of the decade. It’s the polar opposite of multi-tasking, which is not what it sounds like at all. To multi-task is not to get a whole bunch of different things done all at once, but rather to switch your attention incessantly from one focus to another, giving none your full consideration. To multi-task is to invest heavily in attention-switching at the expense of your focus and goals. It is a waste of your precious energy.

The treatment for multi-tasking, as well as the frazzled nerves and inability to focus in which multi-tasking results, is mindfulness. Mindfulness can take the form of meditation, yoga, stretching, walking, knitting, cooking, massage, playing piano, praying, petting the dog, or kicking a soccer ball with a child. Its essential character is applying oneself completely to the task at hand, and minimizing interference from random distracting thoughts. Mindfulness is self-care that connects you with your inner self. It refocuses your energy to help you understand what your body needs. It’s a key that connects you with yourself. The rest falls into place like a puzzle.

Mindfulness guides you to be comfortable in your own skin. It accepts you. It connects you. It likes you. Why else would you give yourself this kind of time, uninterrupted even by pet worries, concerns, and random thoughts?

A few weeks ago I saw a captivating videotape presentation. A man steps into a cab. Music is playing. Hard, loud, angry music. Every intersection, every movement of every individual on the street, is colored by the music. A random passerby’s raised arms look threatening. A policeman is shouting at someone, a child? Worried, distracted people are hurrying to their destinations. The images fade, and then the scene returns to the very beginning. The identical videotape plays once more, but this time with one significant difference. This time, when the man steps into the cab, the soundtrack plays gentle, melodic music. Now, the random passerby with raised arms seems to be conducting the music. The policeman is calling a greeting to a child. The pedestrians look focused, but no longer frightened.

The presenter’s point was this: “You see the world through how you feel.” Let’s take a moment to think about that. It is not frustrating experiences that make your world a more frustrating place. It is your response to those frustrating experiences. Frustration is a given; attitude is a choice.

Mindfulness is a deep form of respect, the place where “Expect respect” and “Be the change” intersect. When you give yourself time you are giving yourself a message: “I treat myself to the best of me. I am worthy.” And, indeed, you are.

YOUR HEALTHY PLATE: Pasta, Pignola, and Butternut Squash

One of my favorite things is a one-pot meal, placed right in the middle of the table. This gorgeous dish, with its range of deep colors, is good enough for company, but don’t feel the need to wait for such an occasion. It also makes a wonderful dinner for two, or three, or four. If you need to get organized, you can roast the squash and toast the pine nuts one day prior, like I did. Continue reading

YOUR HEALTHY PLATE: Great Northern Beans over Rice

This is the kind of thing that you can often rustle up from things you already have in the kitchen. Like my mom always says, if you have a can of beans, then you have a meal! Continue reading

Let’s Go For a Walk

This is a good week to talk about taking a walk. When it comes to health care, I consider mobility a goal of the highest priority. The one other goal about which i feel this way is blood sugars; I’ll pay any price to keep patients’ blood sugars normal. And I’ll pay any price to keep a person mobile. When my kids were growing up, and they were feeling crummy (I’m cranky; I don’t feel well; I’m bored; I have too much homework), I would always say, “Go for a walk!” It got to be a joke in our house. They took it to the next level. Fever? Go for a walk! Migraine? Take a hike!  Broken leg? Walk it off! Appendicitis? “Very funny,” I said. Continue reading


Here’s a sweet little recipe, something to do with cranberries that I am sure NEVER occurred to you before! It makes a perfect appetizer or salad course for a Thanksgiving meal. Happy Thanksgiving from our home to yours… Continue reading

A Commodity-Based Diet

A few months ago Michael @Ruhlman lent me a captivating new book written by Chef Dan Barber and called The Third Plate: Field Notes on the Future of Food. In 2009 Time Magazine named @DanBarber one of the 100 most influential people in the world. I’m a little bit chagrined to admit that I am still reading this book, primarily because it makes me think so hard that I can only get in a chapter at a time before I have to set it aside and think about what the author just said. Continue reading

YOUR HEALTHY PLATE: Apple-Walnut Oatmeal

Late last week, somehow, while no one was looking, autumn flew by and winter blew in. It’s an achingly beautiful look — trees still completely covered with gold or red leaves, shivering in the foreground of a white crystalline landscape, the lake dark grey in the distance. And it’s really cold, unexpectedly so, so here’s what I’m having this morning. It’s a lot of flavor for breakfast, and they’re all the right kinds. You might smile while you’re eating it. Continue reading

Lentils & Collards Soup

I’ve posted this recipe on these pages once before, but I thought it was worth repeating. I love how the aromatic cumin and cinnamon and lemon flavors in this soup are so different from the spice combinations I usually use. Continue reading