My mom was a very no-nonsense type of person. When her blood sugars began to rise slightly as she entered her 70s, she announced that she did not want take any diabetes medicine. From then on, she kept her blood sugars normal through a combination of common sense and careful carbohydrate consumption. Once, she was hospitalized for what she called 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 (without sugar), and called my dad, who arrived in short order with chopped salad, roasted peppers, and meat loaf.

This week’s post is about hospital food, if you can call it that. I don’t know if it’s still like this in the hospitals, but I suspect it’s still exactly like this. Ordering meals for hospitalized patients is difficult at best.

Imagine a diabetic patient in the intensive care unit. His blood sugars have been completely out of control, not unusual in the setting of overwhelming infection and stress. He is recovering slowly from a serious 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 a day, in accordance with the recommendations of the American Diabetic Association. This diet is loaded (no exaggeration) with ultraprocessed items guaranteed to make it nearly impossible to control one’s blood sugar. No, thank you.

Instead of an 1800 kcal ADA diet, I would like to order a “low-glycemic diet,” which is 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. There was no real food diet. No “high fiber and protein” diet. No low-stripped-carb diet. The kitchen sent fake scrambled eggs (“beaters”) and a large blueberry muffin. I kid you not. This is what the company that supplied the hospital food where I worked at the time once sent for a diabetic patient of mine.

It will not surprise you to learn that this patient’s blood sugars climbed over 400 after lunch. 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. I once stopped in the cafeteria for a cup of coffee at this same hospital. I looked for the milk, but there was none. There were only single-sized servings of flavored liquid non-dairy coffee whiteners. I do not use those; they are processed edibles, manufactured calories. I was told that if I wanted milk I would have to purchase it. 

Patients less ill than my intensive care unit patient choose their own daily meals. They receive printouts, or “menus,” as the Dietary Department calls them, that 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 the market) on a tray with a glass of orange juice, tea with sugar, and two slices of toast.  I know these options will spike this patient’s blood sugars, making it nearly impossible for me to get them under control. I am left wondering why those options appeared on my patient’s “menu” in the first place.

If it weren’t so serious, it would be comical. As comedian Steven Wright said, it’s like putting a humidifier and a de-humidifier in the same room, and letting them duke it out. I don’t want to duke it out. I want the tools I need to do my job successfully. Assuming the task of healing patients and controlling their blood sugars, I need certain tools to do so. Different kinds of professionals use different kinds of tools. Food is one of mine.