When health is not on your side.

This post is part of the crowdfunding campaign for my dietetic internship. It is not intended to replace advice from a doctor or other health care practitioner. It represents my opinion alone and not any organization of which I am a member.

break50

Dear Michelle,

How can one achieve Health at Every Size if they don’t have health on their side?

-D.

Hi D.,

This question has a lot to do with how we define health, and also how we define Health at Every Size.

In our culture, we tend to look at health as a state or a place we can get to, a finish line to be crossed, and once you’re there, you’re finished. As you say, we look at it like an achievement.

By this definition, if you have good cholesterol, blood pressure, blood sugar, a BMI between 18.5 and 24.9, and no notable illnesses or conditions, then you’ve achieved health. Congratulations. Pick up your trophy.

And we tend to speak of Health at Every Size with similar rigidity — as using a particular approach (intuitive eating and exercise) to achieve a very similar trophy, minus the BMI requirement.

This definition of health excludes anyone with a health condition. There are lots of people in the world dealing with chronic conditions or disabilities, probably more than aren’t. Effectively sending the message that they’ve already “failed” at health, and no matter what effort they put in, they can never be healthy, is deeply discouraging.

I’ve heard people argue that defining health in exclusionary terms is the only way we can motivate people to care for their health. I disagree. I think that casting health in such a meritocratic, neoliberal way is deeply destructive and invokes healthism as well as ableism. I believe that people can be more effectively, and more ethically, motivated through compassion and acceptance, combined with the desire for positive change.

An exclusionary definition of health discourages the most vulnerable people — the people who actually stand to benefit the most from getting help or making positive changes — from caring for themselves at all. They may think, “Why bother? I’ll never be healthy anyway, so what’s the point?” Such a definition of health is oppressive. It’s also incorrect.

The reality is that health is not an achievement. It’s something you already have, and it looks a bit different for every person. Health is a dynamic resource that each person carries with them, in some form, through their entire life.

Here’s how Dietitians of Canada defines health:

“Health is a basic resource for everyday living. It is the extent to which one can realize aspirations, satisfy needs, and change or cope with the environment.”

The definition of Health at Every Size is also quite flexible and allows for individual needs and different health conditions, while also taking into account social and political barriers to health. Even people with diseases or health conditions — and that is likely to be all of us, at some point — can live with good health, provided we cope well, care for ourselves, and find meaning in our lives.

If you’re caring for yourself without using weight loss as a proxy for health, the bottleneck through which you funnel all your efforts, or the primary source of meaning in your life, then you are using the Health at Every Size approach.

By coping well and caring for yourself, in whatever way works best for your unique habitus and challenges, and by living a life that matters to you, you are also cultivating the health that is already yours.

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50 Comments

  1. Posted May 15, 2014 at 12:58 pm | Permalink

    Thank you for this, Michelle. This has been very hard for me because I can’t eat a lot of “healthy” foods do to IBS. Things I love, like fresh fruits and veggies can trigger a nasty flare. Sometimes I decide it’s worth it because I love these foods and miss them… but to eat a large quantity (as is typically encouraged as “healthy”) will actually make me feel sick.

    On top of that, I have severe fibromyalgia and horrible, chronic pain. Some days it’s a struggle just to cook dinner or even to walk to the kitchen. I do it, but it limits my ability to prepare the sort of meals I’d like to be able to eat.

    It often makes me feel as though I am “failing” at HAES… and I really do want to be healthier. It’s just this inner struggle to realize that what is healthy for one person (i.e. eating lots of fruits and veggies) actually isn’t for me. Same with things like soy. I have Hashimoto’s Disease and soy is contraindicated in large amounts, so I can’t substitute soy based products for other foods.

    So I really needed to read this post… I’m not dieting anymore. I’m not measuring my success as a human being or my healthfulness based on a number on the scale, and I haven’t in almost 7 years. I do what I’m able to do, with my health restrictions and issues, to work the HAES approach into my life. I forget, maybe because of the many years of dieting brain washing, that there’s no such thing as “doing it perfect” or “right” with something like IE or HAES. I’m sure I am not alone in this!

    • Twistie
      Posted May 15, 2014 at 1:12 pm | Permalink

      (sends unpainful thoughts your way)

      I think the thing I love about HAES is that the only way you truly can ‘fail’ at it is if you deliberately make choices to harm yourself on a regular basis.

      With the more traditional definition of health, most of us fail just getting up in the morning with bad breath and bed hair, let alone anything more earth-shattering than that.

    • mickey
      Posted May 15, 2014 at 3:02 pm | Permalink

      Wait, soy is contraindicated for Hashimoto’s?!? Noooooo.

      That being said, Jessica, you have a lot to balance, don’t you? Wishing you many, many pain-free days!

      • Posted May 15, 2014 at 3:08 pm | Permalink

        Small amounts are okay… though it’s recommended you wait a while before eating it after taking Synthroid because it’s believed to impair absorption.

        But if I wanted to go vegetarian, for example… since so many vegetarian protein sources rely heavily on soy, that could be a problem. I also stopped using iodized salt. Most people need the iodine, but I do not. I use sea salt now. My thyroid had been really unstable up until I stopped using regular table salt. Maybe a coincidence, but I prefer sea salt anyway so it works for me!

        And thank you. <3

        • Lani
          Posted May 16, 2014 at 11:05 pm | Permalink

          Oh boy, another thyroid-problem-haver! /sad high-five.

          I don’t have Hashimoto’s, but I am thyroid cancer patient, and a lot of what you’re describing sounds familiar. For my Iodine 131 radiation treatment I had to go on a low-iodine diet for several weeks before hand that banned a ton of foods. No dairy, no soy, no eggs, no seafood, no iodized salt or sea salt, not chocolate, no molasses, no premade food, no restaurant food… it sucks to have to take things out of your diet, even in order to avoid pain or for the sake of effective medical treatment!

          I have a good friend who has IBS issues similar to yours with regard to vegetables. He has to really limit his intake or it’s very painful for him, and he has similar complaints about it as you. Your so right in that “health” looks different for everybody, and you need to make your choices based on your individual experiences and needs, and not based on a one-size-fits all approach that leaves no room for chronic illness or physiological variations.

          I hope you find a balance that works for you! Much love, my fellow defective-thyroid-haver. <3

  2. Twistie
    Posted May 15, 2014 at 1:05 pm | Permalink

    The way I’ve always seen HAES is that it’s about finding and making use of the healthiest choices for the individual, and that’s kind of a fluid thing in my book. Also, in my book, it includes taking care of your mental health.

    But yes, it’s going to wind up meaning different actions/options for different people, because our needs and most useful strategies are so very different.

    So for me intuitive eating works just fine 90% of the time (sometimes I do need reminding to actually fuel my body because I get obsessive about something and forget to eat at all until I’m snapping at people and about to topple over), but someone else might need a more rigid schedule/menu than I do.

    For me, a daily walk combined with some Le Creuset weight training is just the right amount and kind of exercise. For someone else, either or both might be completely inappropriate or unfeasible. For them, running, swimming, bicycling, or an aerobics class might be just the ticket.

    For Mr. Twistie, HAES looks like taking his meds regularly (Type II Diabetes, hypertension, and congestive heart failure definitely require these things), eating as regularly as possible, minimizing carb intake, and finding ways to reduce his stress.

    For a good friend of mine, HAES is about doing yoga, talking to supportive friends regularly, and taking her anti-depressants.

    We’re all prioritizing our health, but doing so in ways appropriate to our different situations.

    Seeing health as behaviors and choices rather than as a specific target that few of us can truly reach has done wonders for my, well, health. I’m happier, less stressed, more energetic, and more likely to make a healthful choice when I have an option simply because I believe I get to choose how I define my own health goals.

    • Rachel
      Posted May 16, 2014 at 1:00 pm | Permalink

      I love this, Twistie.

      It is so easy for me to think of health as something that is “off limits,” because I have brain weasels, but in fact there are things I do to manage those brain weasels and keep them from taking over my life.

      Thank you for the reframing. I needed that.

  3. Gretchen
    Posted May 15, 2014 at 1:34 pm | Permalink

    Narrow definitions of health and HAES can also be limiting for ostensibly healthy people too. I am, on paper, a HAES poster child: good bloodwork, no chronic illness, regular exercise, a diet that tends toward the hipster foodie end of the spectrum. But I don’t feel particularly healthy, and I haven’t for a couple years now. I’ve never been able to pinpoint what it is I’m missing, only that something just seems a little bit off with my body. When I take various complaints to doctors they don’t particularly know what to do with me because I look good on paper (well, some just tell me to lose weight, but, you know, doctors) and anything they would recommend in that journey-to-the-finish-line-of-health sort of way are things I’m already doing. It is frustrating and I do often wonder if getting to the bottom of the issue would be easier if I didn’t look so damn “healthy”.

  4. Posted May 15, 2014 at 2:21 pm | Permalink

    Twistie, I really like the different examples of health-related behaviour you give.

  5. Posted May 15, 2014 at 10:11 pm | Permalink

    So well said. Living with type one diabetes, which is not associated with any particular weight, I have always felt both healthy and sick at the same time. It has nothing to do with status, but I notice I function well in some ways that others do not, and vice-versa. Health At Every Size is the only approach that really makes sense to me, because it is obvious that many conditions can be treated directly, rather than indirectly through the vague window of weight. But thinking of health as a static state, regardless of your world view, sets us up for failure. And thinking of it as a fluid thing reveals different pathways that might be very useful, which we might not have considered otherwise.

  6. Alyssa S
    Posted May 16, 2014 at 12:14 pm | Permalink

    I love this. I have hard days when it feels like there’s no point to my healthy habits because, deep down, I will always be a sick person, I will always take 20+ pills a day, I will always get labs drawn, and so on and so fourth.

    I really appreciate the way that you’ve framed the idea of health not as an achievement, but as a process and something you carry with you each day. I hope that I remember this when I have one of those hard days again and come back and read this.

    Thank you :)

  7. The Real Cie
    Posted May 16, 2014 at 3:43 pm | Permalink

    I think that I’m reasonably healthy for a 49 year old and very much doubt that being thinner would have prevented the health conditions that I have. I have a mitral valve prolapse, which has zero to do with my size. Ditto the mild to moderate asthma. Hypothyroidism was not caused by being a larger person, but has kept me on the larger end of things. I have been told that I “ate myself into diabetes,” which onset a few months ago, and that my hypertension would be “resolved” if I would “just lose weight.”
    Here is how I’m supposed to “just lose weight.” Eat less, exercise more, and take my magic thyroid medication.
    I take the magic thyroid medication. I exercise on average an hour a day four times a week, and I walk an average of three miles a night when I’m working. (I work four nights a week.) I eat a lot less than I did before I was diagnosed with diabetes, because the metformin kills my appetite, and since I have an eating disorder, I have a tendency to try and starve myself into sainthood.
    The weight that has “just fallen off” is approximately 25 pounds.
    People still make tons of nasty assumptions that I’ve “eaten myself” into any less than optimal health conditions.
    People can take their assumptions and shove them where the sun don’t shine.

  8. Angela P
    Posted May 17, 2014 at 12:49 am | Permalink

    A year or so ago, I heard Kelly Bliss (HAES-oriented fitness instructor & lifestyle coach) say that she chooses to use the term “wellness” to avoid potentially loaded interpretations of “health.” No matter what our “health” conditions, we can make choices that support & improve our wellness. Those of us who have ongoing health challenges may need to make an extra effort to prioritize our self-care. Furthermore, each of us is the true expert on what it feels like to be in our own body, so only we know what is the best choice at any given time. This includes food, drink, movement, and everything else that affects our well-being. It’s helpful to have some basic guidelines, but paying attention to our own experiences provides the best feedback about what works best for us & in that way informs our future choices.

    Of course, people tend to take care of things that they value and neglect things that they despise. If you are frustrated or angry with your body, then taking care of it is likely to be a drudging chore. By contrast, appreciating & cherishing your body (even with its inherent challenges), will inherently lead you to make choices that improve your well-being — Not due to arduous willpower and not for the sake of validation/approval. Simply put, self-care becomes worth the effort — The time & energy that we invest in our wellness is repaid many times over in the form of more energy, less pain, etc.

    Such has been my experience, in any case.

    • Cath of Canberra
      Posted May 26, 2014 at 12:27 am | Permalink

      Personally I hate the term “wellness” because I find *that* to be a loaded term. I associate it with a kind of hippy/new-age approach. Cleanse your crystal chakras and eat vegan kale raw superfoods and meditate reiki yoga and bingo! if you’re not healthy it’s because deep down you don’t want it enough for the universe to bring it to you.

      * not that there’s anything wrong with meditation, kale or yoga :)

  9. Mab
    Posted May 17, 2014 at 2:17 pm | Permalink

    Thank you so much for your article ! :)

    I’m lucky enough to have a chronic illness on a really light level, but I’ve suffered from depression along with eating disorders, and I think that what you’ve said here can also help people dealing with mental health issues.

    It’s incredibily difficult to maintain physical health when dealing with mental illness, as it can be paired with eating disorders, side effects from medication, or simply being just too sick to even care about yourself anymore. So I think an approach like HAES can help people suffering from mental illness, as its main focus is more self care than just “Health”.

    • Robyn
      Posted July 4, 2014 at 4:17 pm | Permalink

      I completely agree. I’d venture a guess that the majority of people who have chronic health conditions have experienced effects on their mental health. Because it effing sucks to not be able to do things that others can. It’s depressing. It’s exhausting. Physical and mental state are closely linked. I don’t believe that anyone can care for one without the other!

  10. Posted May 19, 2014 at 1:40 pm | Permalink

    I love this quote: “Our society arbitrarily defines health as the capacity for work and a capacity for enjoyment, but true health is something quite different. True health is the strength to live, the strength to suffer, the strength to die. Health is not a condition of my body; it is the power of my soul to cope with the varying conditions of my body.”-Jürgen Moltmann, God in Creation

    And for me self-care can be a challenge. Managing my various chronic illnesses is a part time job– one I’d like to quit but can’t ):

  11. Posted May 23, 2014 at 8:44 am | Permalink

    Hi !

    I’m kind of not at ease with this post, in the same way I was unease by reading in your previous post that “health” has a too restricted definition.

    I think it is because while you remove the meritocratic / neo-liberal aspects of health, you still use a very individualistic definition of health.

    Having a very strict definition of health is actually a very good thing when you start thinking that health is not the sole responsibility of an individual but of the broader society.

    I know that sounds like people fatshaming us “for our own good” but this is really NOT what I’m talking about.

    I’m talking about people, societies, States, taking responsible for the way they hurt other people’s health.

    How can you attack a company that uses depression-inducing harassment as a managerial strategy for damaging their employees health if your definition of health is broad enough to include depression ? How do you punish a man who’s violent to his wife to the point she is not able to work, if your definition of health does not include the ability to work ?

    (To situate my comment : I’m a fat French woman with depression)

    • Posted May 23, 2014 at 12:20 pm | Permalink

      I think you’re bringing up the very important concept of social determinants of health, and the fact that societies should be responsible for ensuring these conditions are met. You’re right, this post IS about individual concepts and experiences of health, not population health, because that is how the question was framed to me by the asker – they specifically asked me a question relating to their own personal experience of health, and not about population or public health. (Personal details were omitted from the question and my answer for privacy reasons, leaving this rather general summary.)

      You bring up a good point that some definitions of health may be important in order to hold people/organizations/societies accountable for damaging people’s health or impeding their ability to live their life. But I think you may be seeking a more legal definition than a personal one. In this post, I’m trying to consider definitions of health that motivate people to care for themselves personally, which is a somewhat related but different issue.

  12. inge
    Posted May 23, 2014 at 6:23 pm | Permalink

    Sorry for being late for this, but I read it when I could ponder it, but not reply…

    Going by the WHO definition of health, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, health can only exist in the realm of pure ideas. Which, for humans, it probably the safest place to put it.

    One can attempt to get into that general direction, which seems to be more an art than a science and depends a lot on inborn talent, opportunity, luck and effort. We (as a society) can not really quantify health in a meaningful way, so we substitute numbers for the real thing, and end up with an unhealthy obsession with numbers. Also, for ideological reasons, we focus on the “effort” part, so if you refuse to play the numbers game, your social well-being suffers. It’s a perfect Catch-22, which makes the whole issue so maddening.

    On the other hand, the WHO definition does not talk about numbers, but about “well-being”. And that’s a thing that most of us know when we feel it, although it is impossible to prescribe. So, everything that preserves or increases one’s physical, mental and social well-being is healthy behaviour. And that’s the frame where I see “Health at Every Size”. (Or age, or level of ability, or mental state, or …anything, really.)

    This “everything”, however, also shows that Health is not a social value, and in fact, quite amoral, unless combined with moral values like caring and respect.

  13. Posted May 24, 2014 at 4:10 pm | Permalink

    I find the term healthy to be tough to wrap my head around.

    All my life I have always gone from one illness situation to another, as I seem to catch everything. Despite my best efforts, my body is out of whack. After 13 years of increased problems, was told I have chronic myofascial pain syndrome and fibromyalgia. I believe my body is dysregulated, as these conditions came with a whole laundry list of other issues– with no known cause or mechanisms of remedy.

    What is interesting is this: other than being overweight, my other indicators deem me “healthy”. Exercise daily, eat wholesome homemade food, stress management, good cholesterol, BP, etc. On paper (sans diagnoses) I am the picture of glowing health. Yet I am told that I must do more to be more ” healthy”, whatever that means. Despite everything, I feel pretty darn healthy, and am thankful for being as well as possible (that no-man’s-land only those with baffling chronic illnesses can fully appreciate). Mind you, I put a great deal of effort in to function as well as I do, on every front.

    I don’t identify with being either disabled, unhealthy, or broken, just out of whack. No matter how much effort I have thrown at my body, it seems I will never be able to make the grade to be called healthy. So, what, am I healthy or unhealthy?

    Well, that depends upon whom you ask and your perspective. So very strange to not have health on my side, yet living as if I did. Maybe that’s what healthy is?

  14. Mich
    Posted May 29, 2014 at 8:03 pm | Permalink

    Just a heads up that your Marilyn Monroe post is gone. Searching on google says it was from June 2002, but it’s not listed in the archives, and your “top hits” doesn’t have it anymore. Maybe other posts are missing, or there are time limits to these. I don’t know.

    • Posted May 30, 2014 at 11:47 am | Permalink

      I made it private for the time being. I’m trying to decide what to do with it permanently. It’s 12 years old, the links are all dead, and there’s one really big caveat that needs to be included. People make a lot of hay about stuff like that (“FAT BLOGGERS CLAIM MARILYN WAS A SIZE 16, THEY ARE DELUSIONAL HAMBEASTS!!1!”), and frankly it’s driving a lot of traffic to the site that I’d rather not have. I may put it back up in an altered form soon, but honestly I couldn’t care less about what size Marilyn Monroe was at this point in my life. She was not fat, but not extremely thin either.

      • Mich
        Posted May 31, 2014 at 9:36 pm | Permalink

        Ok, I was talking about Monroe with a friend online, and it made me notice that the post was gone. That’s ok though.

        • Posted June 3, 2014 at 7:48 am | Permalink

          Kate Harding did a really good post about it, called Marilyn’s Law. I think it is still online.

  15. Kris G
    Posted June 13, 2014 at 3:02 am | Permalink

    This is a large part of why I comfort eat (and have for years). At 16 I was taking more pills than my parents, or grandparents. I figured if so much of my life was bad, I would not deny myself any physical comforts I could have. I still fall into a lot of non-healthy eating (junk food and eating when I’m not hungry) when I’m unwell. Which happens a lot. Because why the heck should I bother making myself miserable not eating chocolate ice cream when I’m -already- miserable with a week-long migraine?

    And it’s hard to take care of myself in general when it takes so much effort. It’s so much easier to stay in bed, not get up at regular times to eat, not go out for some form of regular activity, not take my meds (and this one is huge), than to do so. People without long-term health issues don’t understand how much time, effort, and money go into treating things, when you don’t have a body that can catch a bug and go into work everyday and just “push through it.” When it’s not a disease, but an illness, not something that can be cured, just treated.

    Never mind when most of the things going on are hidden, and everyone else judges you for not acting “normal” or having a “normal life”.

    Wow, this upset me more than I thought. Shaking.

    • Posted June 13, 2014 at 9:52 am | Permalink

      I hear you, Kris. It is upsetting. There is so much judgment around food that even people doing their best, who have other challenges and other priorities than having a “perfect diet” can’t seem to escape that judgment, and it’s really not fair or helpful. You have to do what makes the most sense to you in the moment, with the resources you have available to you. That’s all any of us can do.

    • Tona Aspsusa
      Posted June 17, 2014 at 3:49 am | Permalink

      Fantastic comment, Kris.

      It so totally sums up the experience of dealing with health stuff, trying to take care of yourself and feeling that you are only getting kicked in the head by the health & wellness brigade all the fricking time.

      I deal pretty well with that, I think. But I have had so many positive factors in my life that has helped me be able to do that: supportive upbringing that was never shaming about food, a brush with unintedended weightloss/underweight and what it does to your brain to know that I never want to experience that again, a supportive GP, an actual DNA-confirmed rare dx, and a thick skin.

      And still it irks me something fierce this fetishizing of “health” in the sense of slimness and sporty fashions.
      I’ll move when and how I want to, eat what I enjoy and what makes me feel good, and you can just buzz off to your all organic natural cardio-yoga with crunchies on top, thank you very much!

      Michelle, one thing I always really appreciate about your writing is that your perspective on nutrition incorporates the actual clinical thingy. It is NOT only a handful of old ladies recuperating from chemotherapy that are in need of this aspect of nutrition – we are MANY, normal-looking, of all sizes, out and about people who have some physical, metabolical, brain-chemistry, or functional thing that is “non-standard” and means eating in a way that makes us feel good can be a challenge. And for whom the vulgar mantras of the health&wellness brigade: “no sugar, no salt, less fat, less protein, plenty of raw veg” are just a recipe for disaster.

      I consider myself _fortunate_ compared to many, but just on that list almost everything is wrong for me: must have sugar (preferably glucose, porphyria), been recommended more salt by GP to deal with lowish BP, I feel *a lot* better eating more fat, I really enjoy steak & beans, and larger amounts of raw veggies than half a carrot makes me stomach seriously unhappy.

      • Posted June 19, 2014 at 12:32 pm | Permalink

        It is NOT only a handful of old ladies recuperating from chemotherapy that are in need of this aspect of nutrition – we are MANY, normal-looking, of all sizes, out and about people who have some physical, metabolical, brain-chemistry, or functional thing that is “non-standard” and means eating in a way that makes us feel good can be a challenge.

        Thank you, this exactly reflects how I feel. Working in hospitals made me acutely aware that there are people with health challenges and unique conditions everywhere, of all ages, of all sizes and appearances. It’s troubling to me how this is left out of most conversations of health, especially give that every. single. person. will experience sickness or disability or injury, guaranteed, at some point in their life. Some of those things will have an impact on food and eating, so it’s not good enough to assume, when creating and distributing public health messages, that those messages should only target the “average, healthy” person. I’m not convinced that person actually exists, at least not in the numbers commonly assumed.

  16. sportzriter13
    Posted June 16, 2014 at 12:35 pm | Permalink

    As a kid and young teen I was super skinny. No one questioned my habits because I “looked healthy”. I didn’t feel it. A big thing that changed was when I went on bc and it counterbalanced the adhd med that supresses my appetite. Suddenly, I became a health risk, having most of the same habits.
    I’m 23 now, probably the heaviest I’ve been in my life. Finding HAES helped me realize that true “wellness”‘is as much mental as physical, and helped me start putting the mental demons (the ones that tried driving me into an ED) . My labs are good but what’s even better is that I’m mentally and emotionally in a good place. Stress happens, but I’ve found exercise that works as an enjoyable stress buster. I’m no longer hating my very being, and I realize that my body, like all bodies, deserves love and respect. Now when people act like jerks, I can and do stand up for myself, instead of taking it lying down. I don’t agonize over what I should eat vs what I would like to eat.
    Health seems more of a journey than a destination, starting with self respect.

  17. Robyn
    Posted July 4, 2014 at 4:02 pm | Permalink

    This hits home for me. By the 1st definition I am not healthy, nor will I ever be. I have an uncurable, chronic health condition. I was diagnosed and have been managing it fr over 20 years. I take care of myself according to my physicians’ direction. However, I am physically unable to do things that others are able to do. When health is defined as “strong” or “capable,” those with “dus”ability are forever excluded. It feels like just another way to shame. You’re a size 14+ so you’re lazy, and ugly, take up too much space in society, and an affront to the aesthetic sensibilities of thin people. “If I can do it so can you.” If your physical and/or psychological abilities are compromised then it’s your own damn fault and you’re a waste of space and can never be allowed in the healthy club. I’m lucky to have access to excellent health care. With fewer resources my ability to manage my health would be greatly compromised. But on those forms? I defiantly mark myself as in “good health.”

  18. Mich
    Posted July 14, 2014 at 9:42 pm | Permalink

    HHHiiii!!! How you doing?

    Did you hear about this in the news today: http://www.canada.com/health/much+sugar+really+that+Ottawa+proposes+food+label+changes/10028962/story.html ? I figure you’d put it into wider perspective for us, even though I think you’ve already done something similar. This was the only link I could find for the first two pages of hits, but I heard it on the radio and the news on tv. I think this is the same article too: http://www.660news.com/2014/07/14/how-much-sugar-is-really-in-that-ottawa-proposes-food-label-changes/ It was not on the main page and I had to search for it. Apparently listeners to this station only care about local, national news, traffic and weather. Medicine doesn’t count as news.

    • Posted July 18, 2014 at 2:08 pm | Permalink

      Well, it’s interesting because there are different recommendations for how much added sugar a person should eat floating around, depending which organization you’re looking at. For the Institute of Medicine, who publishes the DRIs (which include things like the RDAs and which, it seems, most nutrition labels are based on), the recommended added sugar intake is 25% or less of total energy intake. For the 2,000 kcal diet usually used on nutrition labels, that would mean about 125g of added sugars (which means not those counted in milk or fruit, not sure how they handle juice) per day. That’s roughly equivalent to 3 cans of regular Coke or 31 tsp. of table sugar per day. But the World Health Organization recommends 10% or less of one’s total caloric intake, and is making noises about lowering that recommendation to 5%. That would mean between 50g and 25g of sugar per day (6-12 tsp. sugar or 1/2 to 1 can of regular Coke per day), which is not very much, given that added sugars are in lots of things, and it adds up quickly.

      But none of the articles I’ve read on this have clarified to me which level would be used for the nutrition label. One article even suggested a 100g recommendation per day, which I guess is at least in between all the others, but which is based on…what, exactly? I’m not sure what evidence any of the three different levels is based on, and that’s what I’m interested in. The WHO claims that there are additional health benefits to lowering to 5%, but I personally have not read the evidence they are using to back that recommendation, and I would be interested in knowing more. I’m not saying the evidence doesn’t exist, just that I haven’t read it, and the media articles never mention it. (I would guess it’s based on epidemiological studies, which, okay, those are useful, but I’m not convinced should be the sole basis for such specific, population-wide recommendations.)

      On a nerd note, I like having information like this on food labels, but that’s because I work in nutrition and because it doesn’t send me into a tailspin of disordered eating or guilt about my food. Being able to see added sugars separately from total sugars would be interesting to me as a bit of trivia. I’m not convinced this information will actually do anything to improve most people’s eating, though I can understand why people want it.

      I also think this is as much of a cultural shift as it is a scientific one. Sugar is a highly symbolic food that has been viewed with suspicion for decades, and which is currently being targeted as the cause of a lot of humanity’s ills. And that is a very attractive thing to believe, because then the solution to all those varied issues seems so simple – just get people to eat less sugar, or maybe to stop eating it altogether. But if humans continue to be human, they will continue to have an inborn preference for sweet tastes, and a biological desire to eat easily absorbed and utilized forms of carbohydrate, that is, sugar, since sugar is in fact the preferred fuel for all the body’s cells.

      I’m not sure that setting these limits or adding this information to our nutrition labels is going to solve any problems, and it might make some of them (like disordered eating and orthorexic thinking and class-based food judgments) worse.

      • Mich
        Posted July 18, 2014 at 9:32 pm | Permalink

        Thank you for your reply. I asked the same question at Ragen’s blog, and I got 2 responses, and basically they said as diabetics it’d be nice to see how much actual “sugar” is in the product. I can see the benefit in that.

        But the media stories are touting this as “parents want to know how much sugar their kids are getting” and that’s about the only issue that we are led to believe is going on. Like your last paragraph, I agree that it will only fuel future disordered eating patterns.

        • Posted July 21, 2014 at 7:40 am | Permalink

          That’s interesting because labels already show how many grams of sugar (as well as grams of total carbohydrate) a food has in it. They just don’t tell you what % of the suggested daily intake it is, nor whether it is added or naturally-occuring sugar (it’s pretty easy to guess in most cases though!) People with diabetes often have a specific carb level they are eating to, and so the information in grams should be adequate enough as it already is, because they already have a personal suggested daily intake to compare it to. And actually that personal suggestion is probably a lot more accurate than any generalized, population-wide one they will put on the label.

      • TheHistorian
        Posted July 20, 2014 at 12:12 pm | Permalink

        I think the intention is probably good with this proposed change, but I have to agree with the suggestion that it could be problematic for a lot of people. As a person prone to orthorexic (“sugar is poisonous and most be avoided at all costs!” and other similarly stupid statements), I suspect this will make grocery shopping much more difficult for me. So while I’m glad the government is doing something to make nutritional information accessible, I feel like the information it’s providing has to put into more context for it to be useful.

  19. Posted July 21, 2014 at 3:34 pm | Permalink

    I have a question. I rarely feel hunger and I rarely have an appetite. I eat on a schedule (if it’s morning, it must be breakfast, etc.) b/c I know I need to eat. What could cause this lack of hunger/appetite? A medical condition such as IBS which I have or ….?? thanks…

    • Posted July 21, 2014 at 4:42 pm | Permalink

      I can’t say for sure, but my guess is that IBS could interfere with hunger signals and appetite. Stress and mood can as well, as can medications, sleep cycle irregularities, and lots of other things. But since IBS affects your GI tract directly, it seems a likely candidate for contributing to lack of appetite or hunger. If you wait to eat, do you start feeling hungry at some point?

      • Posted July 22, 2014 at 8:34 am | Permalink

        Yes eventually. However: it is morning now and I haven’t had food since about 8 pm last night. You would think I’d be ravenous but yea, nothing. Thanks Michelle.

        • Posted July 23, 2014 at 2:03 pm | Permalink

          Sometimes a warm drink will stimulate peristalsis and get you feeling grumbly in the tumbly, but your mileage may vary. I do that sometimes when I first wake up if I don’t feel like eating. Within an hour or so, my GI tract feels more awake and I’m hungry. Beware caffeine, though, since it can suppress your appetite.

          • Mich
            Posted July 23, 2014 at 10:12 pm | Permalink

            Is there some mechanism that can explain this: when I drink coffee on an empty stomach in the morning (and I may or may not be already hungry), why does it make feel like barfing? Others seem unaffected but the coffee.

          • Posted July 23, 2014 at 10:24 pm | Permalink

            Mich, I don’t drink coffee straight (only lattes/mochas), but it doesn’t surprise me. Coffee is very acidic. If I even drank a latte or a mocha on an empty stomach, I’d have that same feeling.

            I also get that with water, though it lasts for hours after I first wake up, even after I’ve eaten. I can’t drink water until I’ve been awake about 3 – 4 hours or I feel nauseated. It’s really weird.

          • Posted July 25, 2014 at 11:08 am | Permalink

            It could be the caffeine, or it could be the acidity of the coffee itself, or it could be the combination of both.

          • Posted July 25, 2014 at 1:35 pm | Permalink

            Thanks Michelle, will try this trick.

          • Mich
            Posted July 26, 2014 at 2:47 am | Permalink

            Interesting. I’ve had that problem with water, too.

            I will keep that in mind regarding the acidity. I never take coffee black (nasty), but with cream and sugar. Even with that the feeling is still there.

            Regarding my last line in previous comment, I have no idea what exactly I was referring to. Must have been half asleep. I think I was referring to other people not having the same symptoms as me.

          • Angela
            Posted July 26, 2014 at 7:41 am | Permalink

            Mich, I used to notice that if I drank coffee in the morning, it stimulated a need to go to the bathroom (#2). More recently, I’ve developed a couple of health conditions, specifically small gallstones and impaired glucose tolerance which led to my being prescribed Metformin. These have made me much more aware of what bile production feels like. (The Metformin triggers it, and keeping the bile moving may help reduce those pesky little gallstones.) Since then, I realized that part of the “gurgly” feeling that I get in my tummy when I drink coffee is bile production. I don’t know if you can relate to any of that, but maybe something to consider.

  20. Posted July 22, 2014 at 1:53 pm | Permalink

    I am so excited to discover your website. I LOVE the definition of health. I will admit that I have been on a diet journey for the past 2 months to lose weight. However my ultimate goal is to be healthy enough to enjoy my life – just like you said, “cope with my environment”

    As a working mom my environment is filled with stress and change every day – having enough energy to cope with whatever comes has been life changing. Thank you so much for your honest article.

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