Thursday, August 18, 2011

As Above, So Below. Part 1

I used to hold fast to the idea that you are what you eat, and that mentality wreaked havoc on my health, both physically and emotionally. I, and many people involved in various diet plans as well as those struggling with eating disorders categorize foods into "good" and "bad," labels that are often in tandem with particular categories of macronutients, i.e. carbohydrates, fats, and proteins. For individuals with eating disorders, and also commonly in popular fad diets, the "bad" foods are designated by their membership in a particular macronutrient family, i.e. the nearly national fear of fat and/or avoidance of carbs. The most common rehabilitation protocol for individuals with eating disorders is fairly straightforward and consists of cognitive behavioral counseling in conjunction with nutritional rehabilitation. The typical nutritional rehabilitation is hallmarked by it's emphasis on caloric intake and specific percentages of macronutrient makeup in the diet. It is a rigid sdiet structure with little to no room for individual considerations, depending of course on the particular rehabilitation program. The focus on adequate intake of those food groups is undoubtedly of vital importance particularly in severely undernourished patients as is typical of an Eating Disorder Unit at a hospital or a rehabilitation facility, however, the energy contained in those food groups in the form of calories is not going to be absorbed for optimal function in the body without various micronutrients. This is particularly true for malnourished patients, again, as is always the case for eating disordered patients. The distinction between undernourished and malnourished is a subtle, but important one. Undernourishment refers specifically to quantity, while malnourishment refers specifically to quality, both factors of vital importance in one's health.

So let's go over some basic chemistry. Carbon is the cornerstone element of life. A carbon atom can make 4 bonds and is happiest when it is making those 4 bonds. Hydrogen is also pretty ubiquitous. Hydrogen is what we call a diatomic element because it is most often found bonded to another hydrogen atom- designated as H2. Now, back to carbon. Carbon will happily bond to itself and readily creates carbon chains. The electrons that are not participating in a bond with another carbon will readily bond to hydrogen, creating what we call hydrocarbons.

Carbohydrates are chains of carbon bonded to hydrogen and oxygen (another, very obviously vital element for life) with hydrogen and oxygen existing in a 2:1 ratio. There are various designations within the overarching macronutrient group of carbohydrates, however, that you may be familiar with with the common diet lingo of "good carbs," and "bad carbs." These labels refer to the carbohydrate categories of monosaccharides, disaccharides, oligosaccharides and polysaccharides, aka, simple sugars, and complex carbs. Recently, simple sugars have gotten a bit of a bad rep, but studies haves shown that overall, there is no significant difference between the two categories in terms of their effect on blood sugar and insulin. What we know, is that the more slowly digested a food is, the more stable blood sugar and insulin levels remain and the longer satiety lingers. Some simple sugars are digested slowly, and others more quickly. The same is true for complex carbohydrates. The glycemic index (G.I.) is a measurement of a foods effect on blood sugar and insulin levels in the blood as an indicator of digestion speed in comparison to pure glucose. (By th way, blood sugar spikes are followed by a release in insulin to transport the glucose. High levels of exposure to insulin in the body are linked to the development of diabetes, heart disease and other chronic illnesses.) High glycemic index foods are digested more quickly, have a more rapid and destabilizing effect on blood sugar and insulin levels, and tend not to produce long lasting satiety, and vice versa for low glycemic index foods. Nutritionally speaking we want to include more low G.I. foods and less high G.I. foods. However, because of the methodology of measuring G.I., certain foods are classified as high G.I. when their effect on blood sugar is fast and destabilizing, but only when eaten in large quantities. The carrot and beet, for example are classified as high G.I. foods, but you would have to eat about 1-1.5 POUNDS of them to actually achieve the negative and destabilizing effects on blood sugar and insulin levels. In short, don't cut out beets and carrots just because they are labeled as high G.I. foods, there are always other considerations to be made. One good rule of thumb, however, is to eat minimally processed, whole, and carbohydrates that are closer to the earth rather than the factory or processing plant.

One good example of this is wheat, the staple crop for those of us with European ancestry. If we look at two loaves of bread sitting side by side on the same shelf at the grocery store, we can find remarkable differences. One is a package of sliced, white bread, and the other is a loaf of whole ground wheat bread. For one, the white bread has had to bleach the flour, strip the wheat of the germ and seed (where all of the protein and fat of the plant are found), and mill the wheat into very fine particles of flour under high heat and pressure, thereby destroying any enzymes held within the wheat that would help us to digest it, along with, of course, any bacteria that might harm us. Additionally, because this bread has been stripped of the natural antioxidants from the germ and seed, and will therefore break down faster, the bread company has to introduce preservatives into the bread to increase shelf life. (Several major studies show academic performance increased and disciplinary problems decreased in large non-ADD student populations when artificial ingredients, including preservatives were eliminated from school food programs.) The whole ground wheat bread uses the whole wheat, meaning, the germ and seed, and therefore cannot mill the flour as finely or under such high heat or pressure, which results in a heartier, doughier bread with more enzymatic activity.
Which bread do you choose?

These considerations are often not made in EDUs or other rehabilitation sites for those struggling with eating disorders and can aggregate the already difficult and painful process of refeeding. When the gut flora has been disturbed, as is almost always the case in both under- and malnourished patients, it is of utmost importance to reintroduce whole, intact foods that will encourage the growth of beneficial bacteria to aid in digestion, reduce bloating (a ubiquitous complain for refeeding patients), and support optimal assimilation of nutrients.

Furthermore, this information is almost completely invisible to the mass population. While it is, admittedly, incomplete information, and we are constantly learning new things in the field of health and nutrition, changes can and should be made in homes, in school food programs, and in governmental nutrition aid programs, to reflect the most up to date information about optimum nutrition for ALL. Good nutrition should not be a priviledge.

A post on fats and a post on proteins will be coming soon!

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