Trying to Eat in a Hospital

My mom doesn’t take diabetes medicine; she keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption. A few years ago, she had to be hospitalized at her local hospital for what she called a “minor procedure.” The procedure went fine, but the food did not. The very first meal they brought consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (with two sugar packets). “If I ate that, my blood sugars would go through the roof!” she said. She drank the tea, and called my dad, who arrived shortly with chopped salad, roasted peppers, and meat loaf. This week’s post is about hospital food, if you can call it that. There’s certainly lots of opportunity for improvement. Most hospitals make it pretty hard for patients, families, visitors to find real food.

Imagine, for example, a diabetic guy in the intensive care unit. This patient’s blood sugars have been completely out of control, up and down, up and down. He is recovering slowly from a dangerous pneumonia, and is only now beginning to eat again. The nurse asks if I would like to order an 1800 kcal ADA diet. I do not.

An “1800 kcal ADA” diet means 1800 calories total each day, in accordance with the recommendations of the American Diabetic Association. This diet is loaded (I am not exaggerating) with stripped, processed carbohydrate products guaranteed to make it nearly impossible to control one’s blood sugar. No thanks.

Years ago, when I was seeing hospitalized patients, instead of an 1800 kcal ADA diet I would order a “low-glycemic diet,” which was not actually one of the approved options in the hospital. I knew I was setting myself up, but there were no other options I could order in good faith. Real food? High fiber and protein? Low-processed-carb? I wish. The hospital kitchen routinely sent fake scrambled eggs (“beaters”) and a large blueberry muffin. No kidding. This is one of the options that hospital cafeteria actually sent my diabetic patients. It should surprise no one that this kind of meal can easily send blood sugars into the 400’s. Once I asked if we could just get the patient a hard-boiled egg. No, we could not. The hospital did not actually have eggs. Just beaters.

Patients aren’t the only people who eat in hospitals. A few years ago I purchased a cup of coffee in the hospital cafeteria. I looked for the milk, but there was none. Just single servings of liquid non-dairy coffee whiteners. I don’t use those because they are not food. I was told that if I wanted real milk I would have to purchase it.

Patients in better condition than my intensive care unit patient were permitted to choose their own meals. They were provided with lists, or “menus,” as the Dietary Department called them, of all the items available for consumption in the hospital. Patients would choose what they liked, and a version would be prepared that attempted to meet their dietary restrictions.

A common scenario for me, as a physician, would be one in which I am working to control a patient’s blood sugars in an attempt to heal a leg infection and avoid an amputation. High blood sugars interfere with healing because they prevent white blood cells from working correctly. Imagine me walking into a room and seeing a patient eating a bowl of Raisin Bran (one of the highest sugar-containing cereals), along with a glass of orange juice, tea with sugar packets, and 2 slices of toast with margarine. I know these items will spike my patient’s blood sugars and make it virtually impossible to get them under control. I am left wondering why those options were on my patient’s “menu” in the first place.

If it weren’t so serious, it would be comical. “Like putting a humidifier and a de-humidifier in the same room, and letting them duke it out” (thank you, comedian Steven Wright). I don’t want to duke it out. I simply want to ask for, and receive, the tools I need to do my job successfully. Assigned the task of healing patients and controlling their blood sugars, I have a good idea of the tools I need. Different kinds of professionals use different kinds of tools. I start with food.


I Like Patients Vertical

If I can help it, I like patients vertical, not horizontal. I want to make sure that nobody gets a disease that could have been prevented. Sure, accidents happen. And illnesses show up every day in the lives of patients and their families who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses. Continue reading


It’s Not Really Health Care

Everyone has a lot going on this week, so I’m going to keep it short and sweet.

There continues to be a lot of talk about why measures of obesity and infant mortality are so high in the U.S. relative to other Western countries. These kinds of measures are commonly employed to assess the overall health of a population. As a country, the U.S. spends significantly more for medical care. Why, then, does it not translate into improved health outcomes? Continue reading


United We Continue to Stand

When I cared for adults in an internal medicine practice in suburban Cleveland, I frequently observed a wonderful phenomenon. It was not at all unusual for patients to bring along their children and grandchildren, fresh from a prior appointment across the hall with their pediatrician. Beautiful, bright-faced, fresh-scrubbed, engaging, chubby, usually well-behaved, American children. The pediatricians’ well-intended recommendations on reducing the rate of weight gain continued to be unsuccessful, and my patients’ faces told me that the ongoing exhortations had become tiresome. If they knew how to fix this problem, they told me, they already would have. Continue reading


Research: One Cup of Broccoli at a Time

This past week I went to hear Dr. Mark Hyman speak to our medical students about functional medicine. My brain was spinning a mile a minute. That happens whenever I spend time thinking about actually preventing illness instead of chasing it. I channeled my energies by spending a good part of the time busily writing tweets to send out on my Twitter feed: Continue reading