If you think of good health as an investment in three different kinds of activities — eating, moving and relaxing — then I would say that many, if not most, of the human endeavors that best exemplify these activities actually occur at their intersections.  

As the school bus pulled away almost every afternoon when I was growing up in New Jersey, I would drop my bag and head off to spend time in the 600 acres of woods directly across the street from my house.  Those walks that I took in the woods every day after school cleared my mind, calmed my brain, focused my thoughts, and piqued my appetite.  I came inside ready for food, homework, and whatever else was about to come my way.

Last summer there were many days when I started dinner by collecting arms full of Swiss chard and tomatoes, knowing that my daughter and I had nailed together the boards to make a raised bed, had filled that bed with yards of compost and topsoil, and had watered and weeded and weeded some more.  It’s not everyone’s cup of tea, but it certainly is mine.  Watching vegetables grow — I can’t think of a more pleasant way to enjoy a late summer afternoon!  

This morning I was invited to share in a most generous meal.  Plans to spend time with my new friend, Judith, turned into an invitation to eat poached salmon with mint pesto, strained yogurt cheese with za’atar [hyssop] and crusty bread, caramelized Brussels sprouts, carrot and blueberry salad, olives, homemade baked goods and dark chocolate truffles.  The mint for the pesto came from the local supermarket, but it usually comes from her mother’s mint patch, lovingly tended not far from here.  The Brussels sprouts tasted as if they had been sprayed with a light coating of honey.  They had not; patience was the secret ingredient, she said.  We laughed together when I shared my own discovery that nothing cannot be made delicious in 8 hours at 250 degrees.  

Also for brunch we enjoyed an embroidered beribboned table runner, matching milky white serving dishes on pedestals, thoughtful conversation, dreams for the future, sincere admiration for all kinds of work well done and stories well told, and friends, silver and gold.   

Yes, you can purchase food for a few coins through a small window while you remain seated in your car.  You can put that stuff into your mouth, and use it to make hunger pangs disappear for a little while.  But it is not an investment in good health.  It is just calories without history, calories to which you have no connection.  And because it consists of eating without movement or relaxation, you receive only a little bit of sustenance.  At the end of the day, it’s a question of how we nourish ourselves, in the broadest sense possible.

Here’s a repost of a popular entry from last December — it’s that time of year!

This month, a lot of people weigh more than they did in the fall at their last appointment.  The problem is so widespread that, especially in people who are working to lose, I make it a point to applaud their efforts even if they have simply maintained their weight at the same number over the last few months. That’s because December is probably the single time of year in which people are most likely to eat large amounts of sugar and white flour.

Some folks don’t want to know what they weigh, so we make an agreement.  I get the number, and I don’t tell them what it is.  I remind them that I don’t really care about the number itself; I’m just looking for changes, up or down, from the last visit.  I really care a lot more about how their pants fit.  Are they looser, or tighter, or the same?  That’s a lot more important to me.   

Why is December such a problem?  It has to do mainly with the amount of desserts.  What happens when you eat a lot of sugar or starch?  You use a lot more insulin.  What happens when you use a lot more insulin? You store fat more efficiently, and you lose the ability to tell when you are full.  Then you increase your food intake accordingly.  In other words, you eat more. 

In my experience, about three days after you start eating a diet that requires less insulin, you notice that your appetite decreases a little bit.  Here’s why:  When you eat a diet like the standard American diet, which requires a lot of insulin, the high insulin levels coat the satiety centers in your brain and make it very hard to tell that you are full.  When you make changes like the ones in my “Four Recommendations,” you end up using less insulin.  On the third day after you start using less insulin, your body finally gets the message that it doesn’t need so much insulin anymore.  That’s how long it takes your body to begin to respond to the fact that it doesn’t need as much insulin.  Then your pancreas “downregulates” insulin production.  Then you’re not as hungry anymore.

Less insulin means less hunger. Three days after you start eating an “insulin-conserving” diet, you wake up noticeably less hungry than you used to be. 

So don’t worry about what you weigh.  That the number will take care of itself as you get back on track making smart choices.  And it does.  It’s okay to celebrate the holidays.  It’s okay to have a piece of wedding cake.  Or birthday cake.  It’s probably okay to have a slice of pie every weekend.  But you can’t have it every day.  Our insulin levels will manage fine if we let them spike only once in a while.  The problem comes when we eat foods that make them spike every day.  Every meal.  Because when your insulin levels are rising every day, they are no longer spiking.  Now they are just high. 

That’s why I say that what happens in December stays in December.  It’s not what we do once in a while that gives us trouble.  It’s what we do all the time.  You can’t live in December and expect to remain healthy.  But you can visit it from time to time.

My mom doesn’t take any diabetes medicine.  She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.  A few months ago, she had to be hospitalized for what she calls a “minor procedure.”  The procedure went fine, but not the food.  The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar packets on tray).  “If I ate that, my blood sugars would have gone through the roof!” she told me.  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.  You are not going to believe what it’s like to order meals for hospitalized patients.

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

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

Instead of an 1800 kcal ADA diet, I order a “low-glycemic diet,” which is not actually one of the approved options in the hospital.  I know I’m setting myself up, but there are no other options I can order in good faith.  Real food?  High fiber and protein?  Low-processed-carb?  I wish.  The kitchen sends fake scrambled eggs (beaters) and a large blueberry muffin.  I kid you not.  This is what Sodexo, which supplies the hospital food where I work, actually sent for my diabetic patient a few weeks ago.

It should surprise no one that his blood sugars spike into the 400’s after lunch.  I ask the nurses if we can just get the patient a hard-boiled egg.  No, we cannot.  The hospital does not actually have eggs.  Just beaters.

Patients aren’t the only people who eat in hospitals.  A few years ago I decided to get a cup of coffee in the hospital cafeteria.  I looked for the milk, but there was none.  There were only single-sized servings of flavored liquid non-dairy coffee whiteners.  I don’t use those; they are not food.  I asked for milk and was told I would have to purchase it.

Patients who are less ill than my intensive care unit patient are permitted to choose their own daily meals.  They are provided with printouts, or “menus,” as the Dietary Department calls them, which are simply lists of all the items available for consumption in the hospital.  Patients choose what they like, and a version is prepared that attempts to meet their dietary restrictions.

A common scenario for me, as a physician, is one in which I work 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.  Now, imagine me walking into a patient’s room and seeing that patient eating a bowl of Raisin Bran (one of the highest sugar-containing cereals) on a tray that also contains a glass of orange juice, tea with sugar packets, and 2 slices of toast with margarine.  I know these options will spike my patient’s blood sugars and make it nearly impossible for me to get them under control.  I am 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 want to be able 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 expect to be given the tools to do so.  Different kinds of professionals use different kinds of tools.  My first tool is food.

If you’ve been reading along, you know that my friends and I spent a gorgeous October day at Washington’s Grist Mill, on Dogue Run Creek, 3 miles southwest of Mount Vernon.  The current mill is actually a reconstruction of the mill that Washington built in 1771 to replace one his father built on the same spot forty years earlier. 

At Washington’s grist mill, wheat flour and corn meal were made for the plantation, and a super-fine flour was made for export to Europe and the West Indies.  The mill’s power supply came, then and now, from water that is diverted into Dogue Run Creek from Piney Branch, above the mill.  The additional waterflow significantly increases the mill’s production capacity. 

My friends and I also investigated a nearby threshing building.  The round, two-story building, built into the side of a small hill, was constructed with a central post.  Horses walked up a short ramp to the building’s upper level, where the floors were covered with large amounts of cut wheat stalks.  The horses were tethered to the central post.  As they trotted around the post, the stalks broke apart and the straw and chaff became separated from the grain, which slipped through spaces between the floorboards down to the lower level.  Trotting (instead of walking) kept the grain cleaner by preventing horses from passing waste as they moved.  Behind the building, ground level doors opened to rising mounds of whole grain, which were then collected and brought to the mill for grinding. 

Washington’s grist mill, for which Oliver Evans was awarded U.S. Patent No. 3, is the only operating “Oliver Evans Automated Milling System” in America.  Power is supplied by a 16-foot water wheel whose spinning motion turns the shafts, gears, and belts that propel the machinery.  Elevators move the grain vertically between the floors in small buckets attached to an endless belt running inside a closed shaft.  The small buckets dump their contents into a hopper, or container, which sits directly above two large, horizontal millstones.  Grain drops slowly into a central hole leading to the tiny space between the millstones, where it is ground into flour.  If the operator chooses, the freshly ground flour may then be moved into a long, rectangular sieve that retains the coarser materials and allows only the smallest, finest particles of flour to pass through.

Washington’s mill produced a finer, drier flour than had ever before been made.  Previously, hard-wheat milling produced a coarse, brown flour that retained the bran, with its essential nutrients, but Washington’s new automated mill produced a bran-less, superfine flour that was much lighter.  Unfortunately, without its bran it was also less nutritious. 

Washington’s horse-driven threshing house, combined with Oliver Evans’s extraordinary automatic mill, dramatically increased the availability of grain and flour.  The improved efficiency allowed many more people to be fed with less work.  Bread and flour, both coarse and fine, could now be obtained with comparatively little human energy. 

We were starting down a road whose destination we could not see.  At a certain point, the benefits of increasing the quantity of food are outweighed by compromises to the quality of that food.  It would be a couple of centuries before we would reach that point.

For now, Washington and Oliver Evans had figured out how to substitute horsepower and water power for elbow grease. 
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