Last week I talked about my October visit to DC with three old friends, and our visit to George Washington’s grist mill.  You might say that it wasn’t exactly at the top of their list, but they are great sports, and we are still friends!  Actually, they agreed it was pretty interesting, and Ronnie even sent me a copy of The Gastronomica Reader (Darra Goldstein, ed.) yesterday. 

This week we continue talking about how the past 200 years of food-related inventions (which decreased markedly the work of gathering, preparing, and metabolizing food) have finally caught up with us.  Less work means easier to digest, which means more insulin.  That’s not what you want.  The more insulin you use, the hungrier and heavier you get.  If your insulin levels are high, you are more likely to be having problems with your blood pressure, fertility, and triglyceride levels.  And the button on your pants.  Not to mention that your blood sugars begin to rise the minute your insulin supplies start running short, which starts to happen about 10 years before you are actually diagnosed with diabetes.  That’s why diabetics usually have about 10 years worth of damage to their blood vessels by the time they are formally diagnosed. 

The 20th century was a time of mergers, acquisitions, efficiency experts, and assembly lines.  Someday, it will also be remembered as the time when we learned how efficient is too efficient, how big is too big.  Too big is when one company’s failure threatens the stability of an entire economy.  The 20th century was a time of substitutions, when we learned to use Crisco and margarine instead of butter and lard, beaters instead of eggs, soda pop instead of milk and water, boxed cereals instead of breakfast, and TV dinners instead of meals.  In contrast, the 21st century is when we began to realize that, at a certain point, food can be so easy to manufacture, acquire, and eat that it becomes costly in an entirely different way. 

Healthwise, we are now paying a very hefty price for the privilege of being the land of good ‘n’ plenty.  Our bodies and metabolisms were not designed to be spoon fed to the extent that we are.  I’m not saying we should thresh our own grain.  I’m saying that since we don’t, we need to eat less.  How much less?  Well certainly no more than our ancestors, who actually worked very hard for it.  Just because refined (stripped) flour is now available in bulk doesn’t mean we should eat large amounts at every meal.  Remember, everything in moderation.

The 20th century was when we learned to take large-scale advantage of the production efficiency of the combine harvester, one of the greatest labor-saving devices ever invented.  Why is the combine harvester, patented by Hiram Moore in 1834, called a “combine”?  Because it combines several operations (reaping, binding, threshing, and winnowing) in a single machine, and drastically increases the rate and efficiency of harvesting. 

Before the introduction of the combine harvester, wheat was harvested by a group of people, several reapers plus a binder.  The reapers would slice across the ripe grain stalk with hand-held scythes.  Next, the crop would be bound together for drying and storage.  Later, dry grain or seed was separated from the straw and the chaff.  It was laborious as well as inefficient, for a large amount of the grain fell to the ground.  That grain became the equivalent of today’s food banks.

In contrast, a combine harvester first gathers and cuts the standing stalks, and then feeds the cut stalks, with their attached grain, to a threshing unit.  Inside, kernels of grain are separated (threshed) from the straw and chaff, which are blown (winnowed) out the rear of the machine.  Threshed grain is cleaned and collected for storage or transfer. 

Many seeds (soybeans, canola, and flax) and grains (wheat, corn, oats, barley, and rye) are universally harvested in bulk by combine harvesters.  The relatively sudden availability of virtually endless amounts of grains and seeds set the stage for an explosion of processed, food-like, edible products.

Next week:  Washington’s grist mill.
********************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

What does low-carb mean?  Well, the first thing it means is that something else has more carb.  So what are you comparing it to?   Breakfast cereal?  Angel food cake?  The standard American diet (sAd)?  Anything would be low-carb compared to those. 

A whole bunch of folks at the Nutrition & Metabolism Society have been working hard to help people understand that carbohydrate, and not dietary fat, is the main dietary component causing our obesity and diabetes epidemic.  They say we all need to be eating a low-carb diet, and they have the research to prove it.

I agree with a lot of what they say.  But I disagree about what to call it.  I’m sort of saying the same thing as them, because I do believe that carbohydrate [especially refined carbohydrate, manufactured carbohydrate, processed and stripped carbohydrate] is one of the major players in the obesity epidemic.  I just don’t think we should be calling it a low-carb diet.  I admit it; I’m mincing words (instead of garlic).  But if it’s called a “low-carb” diet, that would mean that a high-carb diet is the normal default.

If you call something low-  then there must be a high somewhere.  If you call dessert “blond brownies,” there must be a not-blond type.  And there is.  If you call someone pro-, then everyone else can be presumed to be con-.  So if people advocate a low-carb diet, then what does a high-carb diet look like?  And the answer is — the American diet.  The standard American diet (sAd) consists mainly of illness-producing amounts of refined carbohydrate.  Cereal and toast for breakfast, sandwich and chips for lunch, pasta for dinner.  You want fries with that?  No wonder America has an obesity and diabetes problem.  That diet, the sAd, is profoundly unhealthy.  It causes diabetes, obesity, high blood pressure, arthritis, heart attacks, and strokes.  That’s not okay with me or my patients.  So why would I pick a name that presupposes the sAd is some kind of normal?  I wouldn’t.  That’s my point.

This perspective highlights the difference between absolute and relative comparisons.  Let’s pick an example from something quite familiar to me, the medical industry.  Imagine, for example, that a new medicine came to market that decreased the chance of developing a rare and horrible side effect (say, a severe rash) from 2 in 10,000 to 1 in 10,000.  For every 10,000 people who tried the medicine, the chance of getting the rash would be halved, from two to one.  You could say that the medicine was “twice as safe.”  That’s called a relative comparison.  And while it is true, technically speaking, it’s not the whole story. 

The other way to look at this is that, in fact, the chance of developing the horrible rash is already very small, and it becomes slightly smaller if you switch to the new medicine.  That is the conclusion I reach from evaluating the absolute, or actual, numbers.

When we call smart eating a low-carb diet, we are making a relative comparison.  And relative comparisons are notoriously undependable because they don’t take into account where you started.  They tell you where you landed, but not how far you went. 

I don’t want to call a diet with healthy amounts of carbohydrate “low-carb.”  What then?  Smart-carb?  Natural-carb?  Garden-carb?  Pre-industrial carb?  I’ve heard some people talking about the Paleo [PAY-lee-oh] (short for Paleolithic) or caveman diet, which presumes that the right amount of carbohydrate would be the amount that the average human ate in that pre-agricultural era.  Why pre-agricultural?  Because that’s before humans began to grow and domesticate grain, especially wheat.  Wheat (along with corn and soy) is the grain used to make large amounts of the processed, food-like products that may be found at the American supermarket.  But Paleo doesn’t feel right either, unless I don’t mind eating the Industrial Revolution diet.

It’s important to remember that all carbs aren’t all-bad.  Not for everyone.  It’s certainly true that some folks are so sensitive to carbs that even an apple a day will make their pants too tight.  Practically the only carbs this group of people can eat comfortably are green vegetables.  But there are lots of other people who can eat all the peaches and lima beans they want.  So, instead of low-carb, I’d like to hear people start saying they eat a low-grain diet, or a low-processed-food diet, or even a low-grain and low-fruit diet.  That’s going to tell me a lot more about how well this person understands his or her own metabolic needs. 

When we call a diet “low-carb,” we are making a comparison with the sAd.  And the sAd is so high in processed carbohydrates that virtually every other diet is an improvement.  Low-carb, therefore, doesn’t tell us much.  It doesn’t say whether the recommendations target all grain, or only processed grain, or all grain and fruit, or all four categories of carbohydrate:  grains, fruits, beans and vegetables.  And it presumes that the sAd has a normal amount of carb.  Which it does not.
***************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

     Last month, I spent a few days in Washington, DC, with my three oldest friends.  Growing up together on Long Island, we had sleepovers under Jane’s mother’s grand piano, starred together in the best-ever 5th and 6th grade production of Oklahoma!, and held Game of Life competitions almost every day after school for an entire year.  When we get together we have a lot to talk about.

    As usual, the plans for this year’s reunion were complicated.  Ronnie got us tickets to see the White House from the top of the Washington Monument.  Jane and Lee got us to Georgetown for dinner and shopping.  I got to convince my friends that we had to visit George Washington’s grist mill.  Not exactly your run-of-the-mill tourist stop, but my awesome friends were ready and willing.  Then the grist mill got me thinking about food-related inventions over the past 200 years. 

    This post is the first in a series of three entitled “Food Used to be Hard Work.”  Over the past year, I’ve talked a lot about how the amount of work we do to get our food ready to eat is inverse (opposite) to the amount of insulin we release to catch the food and escort it to our cells.  The more work we do, the less insulin we use.  And the reverse is also true:  the less work we do to prepare and break down the food we eat, the faster we absorb it, and the more insulin we must release to catch it.  The goal is to find the balance. 

    So — where did the obesity and diabetes epidemic come from?  What’s different now compared to 100 years ago?  And what does Washington’s grist mill have to do with obesity and diabetes?  Well, let me tell you a story.  Once upon a time, not very long ago, almost everyone worked in agriculture.  They had to.  Given the limited technology of the day, it was the only way families could hope to raise enough food to get from one growing season to the next without running out.  Every family had its knives, scythes, and wooden plows, the tools that dominated agriculture for thousands of years.

    For 10,000 years, civilizations followed the same annual pattern of plowing in early spring, sowing in late spring, and harvesting in the autumn.  Plowing could be done by a farmer with a horse- or ox-drawn plow, and sowing, or spreading seed, could be done by anyone.  Harvesting, on the other hand, was back-breaking, hard work.  Obesity would be virtually impossible in a world where people worked so hard for their food.

    The past 100 years have been a time of unprecedented industrial growth and change.  Automation in industries of all kinds, including energy, finance, construction, and transportation, introduced us to the concept of “economies of scale,” whereby we learned that the unit costs of production would shrink as a company’s growth permitted it to save money by purchasing its raw materials in bulk.  It was a time of expansion, of testing the limits.  How big could companies get?  What were the consequences of that kind of growth?  In every industry, revolutionary inventions were increasing automation and improving efficiency.

    In the food sector, that meant a few things.  Some brilliant inventors built machines that would harvest crops more efficiently that ever before.  Next week I’m going to talk about the combine harvester, one of the greatest labor-saving devices ever invented.  The following week, I’ll get back to Washington’s grist mill, which revolutionized the milling process and, for the first time, allowed a single person to convert large amounts of whole grains into flour.  Other inventors figured out how to remove the bran fiber coat and the germ to make the flour look cleaner and increase its shelf life.  Lastly, new edibles like breakfast cereals, chips, instant soups, and granola bars, made with manufactured products such as partially hydrogenated oils, textured soy vegetable protein, and high-fructose corn syrup, were being developed.  These manufactured products cost substantially less than traditional foodstuffs, and soaring profits provided a significant inducement to develop more of the same. 

    All of these inventions had one important feature in common: They decreased the work of food gathering, preparation, and metabolism.  That means they increased the amount of insulin we used to break down our food.  And that high insulin state became the norm across America.

    The 21^st century is a different kind of time.  At least with regard to food, it is the time when we begin to understand and address the limits of making food easy to eat.  There is such a thing as too easy.  Too easy is what causes diabetes and obesity.

    Next week:  why is a combine harvester called a “combine”?

**********************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

Early one morning, now decades ago, I looked far down a hallway and saw two very obese women walking toward me.  Backlit by the rising sun, the two women appeared only in outline; all I could see of them was the dark shapes of two large bodies surrounded by golden rays.  I stood, transfixed, watching their movements as they walked.  Their arms swung far out from their shoulders like ribbons on a maypole.  Instead of swinging easily to and fro with each step, their upper extremities flew back and forth like propeller blades.  The force of their arm rotations supplied energy to fling their hips and torsos forward, while their legs, stiff and straight, worked to catch up with each step.  It looked like hard work, and I forced myself to look away. 

Then, a couple of years ago, having arrived early to a large celebration, I saw a woman, clearly an organizer of some sort, crossing the still empty party room on some urgent last-minute mission.  What I saw astounded me.  Though of normal weight, she was flinging her arms back and forth like propeller blades.  Immediately, I knew.  She had not always been this size.  I also knew something else, and it troubled me greatly: Part of her brain still thought she was heavy.  Despite the many hours she had invested in her health and recovery, and despite her obvious success, not all of her had healed. 

Last week I saw it again.  This time it was a young woman walking along briskly on the sidewalk. 

Gastric bypass operations have become commonplace, and many individuals who thought they were consigned to a life of obesity, diabetes and knee pain have found a way out.  It’s not enough, though.  We seem to be making some headway treating the physical part of the disease.  We need to do a much better job treating the mental and emotional part.  I’m sure that Dr. Sara Stein, the renowned bariatric psychiatrist and author of Obese from the Heart, would agree.

This past summer I had the pleasure of reading The Body Has a Mind of Its Own, by the  mother-son neuroscience writing team of Sandra Blakeslee and Matthew Blakeslee.  Rated one of the top science books of 2007 by the Washington Post, it explains how our minds create networks of body maps that are exquisitely related to how our bodies interact with the environment.  Like a tree that grows new limbs while others are pruned, body maps change over time, shrinking and expanding in response to changes in our bodies and the environments within which we function. 

Doctors, and occupational and physical therapists, are now using the new research about body maps to develop methods to heal phantom limb pain, anorexia nervosa, and other body map distortions.  I look forward to its application for all those whose minds could use some help learning that the bodies they inhabit are no longer obese.
**********************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

This afternoon I went to the Cleveland Botanical Garden’s RIPE! Food and Garden Festival.  The advertising said that RIPE! celebrates the edible gardening revolution and our region’s thriving commitment to local food.  Boy, oh boy, if anyone doubts that the culture of food is undergoing a real revolution, just show up next year.

I watched the folks from Snowville Creamery make vanilla ice cream using an old fashioned churn whose paddle was attached to a stationery bike.  The result was truly extraordinary.  I also drank a glass of their creamy milk, a gift from 235 Jersey cows who spend their days grazing on a farm down in Pomeroy.   

Meadow Maid  was sampling a wide variety of their delicious cheeses, also from grass-fed cows.  I met Andrew, of Kitchen Basics’ Real Cooking Stocks (beef, chicken, vegetable, seafood, veal), and learned that all their stocks are made locally.  Who knew?  I love that stuff; I buy it by the case and use it all the time.  I also ran into Green Pastures Poultry‘s owner, Ariella Reback, whose poultry I’ve purchased and enjoyed in the past.  The name says it all.

I sampled 12-year-old balsamic vinegar and Coratina Marcinase extra virgin olive oil at The Olive Tap‘s  (Medina) booth.  I drank an exquisite elixir made from Andean Fire Orchid, courtesy of Nora Egger and her company, the Lounging Gourmet.  There were gorgeous tomato and vegetable pizzas being grilled on a huge outdoor oven, and my friend bought herbal tea from a local vendor whose granola is sold at Heinen’s under the store brand name. 

I met Jody Lathwell, who runs the Tremont Farmers’ Market , and we revelled in the large number of markets that have been established in the past few years, including the Downtown Farmers’ Market at Public Square (Fri), the mid-week market on the grounds of the Cleveland Clinic, the Coit Road Farmers Market (Mon, Wed, Sat), the Chagrin Falls Market (Sun), Kamm’s Corners (Sun), Lakewood (Sat), and Shaker Square Market (Sat), the granddaddy of them all.  I am filled with joy to know that almost none of these markets existed just a few short years ago.  And I know that there are many more.

I had the good fortune to meet, from Kent, Lucky Penny Farm‘s Abbe Turner, whose business cards advertise her as CEO, cheesemaker, entrepreneur and optimist!, to taste honey from Bedford Heights’s Beecology, and to eat three different kinds (pumpkin, black truffle and garlic chive) of artisanal goat cheese (chevre) brought in by MacKenzie Creamery  from nearby Hiram.

I saw trucks advertising grass-fed milk shakes and burgers for sale, butternut squashes, apples, heirloom tomatoes, herbs, flowers, homemade chocolate chip cookies, displays of sculpted vegetables and an expert pumpkin carver hard at work.  All well and good.  But what’s for dinner?  So, now, the moment we’ve all been waiting for — a couple of interesting recipes for your enjoyment:

#1 Mexican cucumbers.
Sprinkle a cucumber with chili powder, salt, and the juice of 2 limes.  Enjoy.

#2 Pickled Red Sandwich Onions with Mustard Seed (from Jess Thomson)
Combine 1 c. sugar, 5 c. vinegar, and 1 T. kosher salt in a large pot and bring to a simmer, stirring occasionally as the sugar dissolves. Place 2.5 lb. sliced onions in a large bowl (or two), pour the vinegar mixture over the top, and let sit for 30 minutes, stirring occasionally.  Into squeaky-clean canning jars, place a few dill blossoms, a few peppercorns, and a big pinch of mustard seeds. When the onions have softened and turned bright pink, stuff each jar full. Add brine until it comes to 1/4” from the rim, wipe rims, add lids, and process in a water bath for 20 minutes after the water returns to a boil.  The onions are ready to eat as soon as the jars cool.  Yield: 4 pints pickled onions

P.S. Instead of throwing away the extra leftover brine, return it to a boil and pour it over fresh, clean baby carrots, green or yellow wax beans, or cooked, sliced beets.  Refrigerate for a few days.  These are called refrigerator pickles.

Hope to celebrate real food with you at RIPE! next year.  Hearty appetite!

**************************************************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

Yesterday I didn’t eat until nightfall.  It was Yom Kippur, the Jewish Day of Atonement.  Putting aside for now the reasons why someone might do such a thing, I’d like to talk about the results of such an endeavor, the what happens when you fast.  Well, for one thing, I didn’t do a whole lot of anything else.  Fasting really takes it out of me.  I certainly didn’t have enough energy to go for a walk, for example.  So, except for a short mid-afternoon nap, I spent almost the entire day sitting still.  A lump on a log.  Starvation mode. 

I spent most of the day yawning, which is something I tend to do when I’m hungry.  It can be a bit problematic for patients whose appointments fall between 11 and noon.  But I promise I’m not bored; I’m just hungry. 

When I dressed in the morning, I picked out a large woolen scarf to wear over my clothes.  I do this every Yom Kippur, whether the outside temperature is 40 degrees or 80.  That’s because I spend most of the day freezing cold.  Basically, I left home yesterday morning wearing a wool blanket.  It was large enough to cover not only my own shoulders, but also those of others who might happen to be seated close by.  I was very grateful for the ability to wrap myself up and stay warm. 

I’m starting to see a pattern.  I skipped breakfast, didn’t feel like moving, was freezing cold, and exhausted.   I was conserving energy.  What does that sound like?  Well, I’ll tell you — it sounds like some of my obese patients.  And that’s not a coincidence.

Now I’m going to guess that the thought has entered your mind that obese people would do themselves a world of good if they would go for even a short walk every day.  One stereotype of obesity is that people get that way because they’re lazy.  Well, I’m going to challenge that assumption.  What if heavy people aren’t lazy at all?  What if the reason they don’t move around much is because they’re starving?  I skipped my walk yesterday, remember?

You may have heard some people say that they can’t understand why they are fat, because they eat so much less than everyone else.  “Yeh right,” you may have said to yourself.  Well, guess what?  I believe them.  Notwithstanding those folks battling a serious addiction to potato chips, soda, and doughnuts, many obese people are struggling along on 1500 kcal/day of nutrient-poor, manufactured calories. 

Obese patients are routinely deficient in B vitamins, magnesium, Vitamin D, and other nutrients.  In medical school, I learned that these were markers of malnutrition.  Think alcoholism when you see these deficiences, I was taught.  But a much more common cause, it appears to me, is obesity.  Normal levels of Vitamin D run around 40-50, but I routinely see Vitamin D levels below 10 in my most obese patients.

I don’t think this is just about vitamins either.  I think it’s about protein and fat as well.  I’ve written in the past about how some people seem to need more water, or calories, than others.  So it does not seem far-fetched that some people need more protein than others.  Or fat, for that matter.  What if a low-fat diet is well tolerated by some people, but causes others to go into starvation mode?  What if some people get enough total calories, but not enough protein?  What would that look like?  How many calories of protein does it take to sustain a body that weighs 300 pounds?  A lot more than you might think. 

Many overweight people carry their extra weight in their abdomen and below their chin, a sign of insulin resistance, which is caused by excessive amounts of processed carbohydrate.  Their skin, especially around their eyes, looks very pale and puffy.  This is a sign of protein deficiency.  As people increase the amount of quality protein they eat, that puffiness resolves.  Their skin becomes bright and smooth.  Their friends sometimes ask if they’ve had a haircut, or even a face lift! 

People who get adequate nutrition become less lethargic, and begin to move around more.  Maybe, instead of sending a child, or waiting until they’ve saved up a list of reasons to make the trip, they’ll surprise themselves by going upstairs to get a different sweater, or downstairs to change a lightbulb.  Believe it or not, many of my obese patients need to eat more, and not less, food.  Some people are obese because they are in starvation mode, conserving energy and calories to the greatest extent possible.  It’s wrong to assume that laziness causes obesity.  If anything, I believe, it’s the reverse. 

And that is one of many things I pondered on Yom Kippur this year.

**************************************************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

“The more things change, the more they stay the same.”  J.A. Karr

I have a dear friend who was diagnosed with Type 1 diabetes as a child.  I have learned more from her about caring for patients with diabetes than from any other single source.  She is an expert at every aspect of being diabetic.  It’s not just about the food, in case you’re wondering.  It’s about taking care of your insulin pump and your toes.  It’s about protecting your sleep.  It’s about getting the right amount of exercise, and learning to ride the waves of blood sugar ups and downs due to a sinus infection.  It’s about accepting the fact that seeing the doctor for that sinus infection does not take the place of regularly scheduled appointments for diabetes care and medication refills.  It’s about helping friends and relatives to understand that accepting or declining to eat a special treat or a second helping has everything to do with health, and nothing to do with friendship.  And it’s about understanding that these examples are just the tip of the iceberg.  Having a chronic disease affects absolutely every aspect of your life.

In case you’re wondering, diabetes is not the only chronic condition that falls into this category.  All chronic conditions are better managed with careful, ongoing vigilance.  Which problems can be considered chronic?  Anything that isn’t expected to resolve any time soon.  Like high blood pressure, arthritis, asthma, colitis, and obesity.  And eczema, lupus, HIV, psoriasis, emphysema, anxiety, depression, celiac, and nut allergies.  There are a great many chronic conditions.

At this time of year, when the days get shorter and the weather gets cooler, my diabetic friend prepares to make a number of changes.  In the warm weather she takes her rambunctious dog for a long walk virtually every day, and often twice, morning and afternoon.  But by late fall, in anticipation of those long weeks when the weather is simply uncooperative, she switches to her treadmill.  The dog will have to be content to run free in a snowy yard surrounded by an invisible electronic fence, so my friend’s to-do list probably includes a fresh battery for her dog’s collar.

I myself look forward to walking at least 2 miles a day during the months that I arrive home from work in daylight.  I also enjoy yoga, but that is usually a cold-weather activity.  It’s not that I don’t enjoy yoga classes in the summer; it’s just that I crave the sunlight.  I always want to be outside if I have a choice.  So, along with gardening, walking is my main summer activity.  Yoga is my main winter activity.  Routines developed for the summer will not serve in the winter.

Another friend has a son with a different chronic condition.  His illness is in remission, but it takes a lot of medicine, and that medicine has to be taken on a very particular schedule.  Last year, when he went off to college for the first time, it took a fair amount of thinking to figure out how to structure his classes and activities so he wouldn’t miss his meds.  This year, with a new part-time commitment, he has had to make a few additional changes to keep things on track.  “It’s all about the pill counters,” he would tell you.  He worked it out before he left for school.

With every season, we must once again become conscious of the coming changes.  This is true not just for those of us with chronic conditions.  We all benefit greatly from rethinking how our eating and activity patterns will change, and then preparing.  With fall comes the ripening of produce with a higher carbohydrate content, such as squash, beets, and potatoes.  Before the age of refrigeration, these foods were harvested, stored and then expected to get us through the winter.  Eating foods with a higher carbohydrate content is sort of the default setting for winter.  It makes sense if you think about the cycle of the seasons.  Centuries ago, food was harder to come by in the winter.  Carbohydrate-rich foods helped us survive.  If we don’t want to eat that way, we have to make plans and compensate.

Recently, my sister was telling me about her neighbor with a vegan daughter who has just moved back home following many years abroad.  Her diet contains no animal products whatsoever, not even eggs or dairy, and consists mainly of produce, nuts, beans, and whole grains.  The daughter generously offered to take on the task of preparing all the family’s meals, but that is turning out to have some unintended consequences for the neighbor, who is highly sensitive to the amount of grain in this diet.  So now they are working on a better solution for both of them, trying to be conscious of what is actually being cooked, and figuring out substitutions where necessary.

Changes to our environment  always change the routines of how we care for ourselves.  Figure into this equation a chronic condition that affects every aspect of one’s life, and you begin to realize how thoroughly seasonal change affects us.  At this time of year many things are changing, and they all have a myriad of consequences.  Acknowledging those changes, and making plans to address them now, ahead of time, will noticeably improve your ability to take good care of yourself.

Change requires us continually to reassess, to ask ourselves how best to maintain our health.  Seasons pass one into the next, children move in and out, people become ill and then heal.  Change is the one constant.