I receive a lot of questions about bariatric surgery and potential malabsorption concerns with it so I thought I would share some evidence around some common deficiencies and complications with those deficiencies.
Which nutrient deficiencies might cause neuropathy?
The nutrient deficiencies that could contribute to, or be the cause of neuropathy are vitamin B1, B12, B6, vitamin E, and copper, which is associated with optic neuropathy (Becker et al., 2012). Vitamin B2 also causes “burning feet syndrome” which can be a sign of peripheral neuropathy (Martin, 2018).
How would you differentiate which nutrients might be responsible for neuropathy?
It is not always easy to isolate which nutrient deficiency is responsible for the reported neuropathy in the patient. There are several factors to consider when reviewing patients symptoms, but one major consideration is the time of the onset of symptoms, most neuropathies present years after bariatric procedure (Becker et al., 2012). Thorough review and assessment of patients diet, nutrient status, and medical history should be conducted when presented with neuropathy (Becker et al., 2012). Assessing the specifics of the neuropathy such as the time of onset and how it presents is a good starting pointing (Becker et al., 2012). Then testing for specific nutrient deficiencies and ruling out other potential causes is a good way to work on isolating which type of deficiency is present (Becker et al., 2012).
Which micronutrient is most likely to show deficiency first?
Thiamine deficiency usually presents within 8 – 12 weeks post-surgery but can be seen as early as 6 weeks (Becker et al., 2012). In my experience in working for a bariatric program for the last five years, in which three of those years I was the Program Coordinator, we most often saw thiamine deficiency. It was also challenging to get doctors to always identify this as the issue. One patient in particular had a history of alcohol abuse and he was often brushed off on the assumption that perhaps he had started drinking again. Thankfully he presented to the ER one day when one of the more progressive providers was working and he contacted me to discuss his symptoms and together we were able to identify thiamine deficiency. An easy blood test identified this. I have also worked with clients who did not have good medical coverage for additional lab work and their insurance providers did not cover some of the nutrient testing that I felt they should routinely have.
What are the general supplement recommendations for most bariatric surgery patients?
In the clinic that I worked we would routinely recommend a B complex, B12, Vitamin D, Calcium (although this is debated), vitamin C (for healing), Multivitamin, Iron (on occasion- not for everyone), and then others based on patient’s needs. From my own research I would also recommend K2, CoQ10, fish oil, and magnesium. I will say that we only performed Sleeve Gastrectomy and the surgeon I worked with INSISTED that this was not a malabsorptive procedure and therefore there was no need to supplement if patients were able to meet their nutrient needs via the diet. To support him and also do my duty as a dietitian I would confirm what he said but also reiterate the fact that they most likely will not be meeting their nutrient needs simply by the fact that their portions are so small and for many weeks they are utilizing liquid nutrients which may not be as absorbed so supplementing could help prevent deficiencies later on. Most patients agreed with this and were happy to supplement. The sleeve gastrectomy makes it easier to use any type of vitamin, but I did have a lot of clients start to look into vitamin patches per information they learned from their support groups and bariatric blogs. This is an area that I admittedly have not had the time to dive into, but I do think it is curious as we do absorb things well trans dermally.
According to the text and the readings, the common supplement recommendations post bariatric surgery are vitamin A, thiamine, B12, Folate, Iron, Calcium, vitamin D, vitamin E, vitamin K and Copper (Becker et al., 2012; Litchford, 2013).
B12 deficiency is common in patients aged 50 and older. Long-term deficiency can cause permanent neurological damage. B12 deficiency is missed in many patients because symptoms are vague, worsen progressively, and serum levels are a poor indicator of sufficiency. Outside dietary insufficiency, list at least two causes of B12 deficiency.
Two common causes of B12 deficiency that are seen frequently by dietitians are: medication use that reduces absorption of B12, and post-bariatric surgery status (Litchford, 2013). The medications that typically affect absorption most likely to be seen in a nutrition consult are proton pump inhibitors and metformin (Litchford, 2013). Bariatric Surgery includes both the Roux-en-Y procedure and the Sleeve Gastrectomy (Litchford, 2013).
Why does the risk of B12 deficiency increase with age? What is the mechanism?
B12 deficiency is more common in the elderly population because there is an increased risk for a decrease in nutrient intake, and there are increased challenges to absorption of nutrients in the aging body (Litchford, 2013). Some of the signs and symptoms of B12 deficiency are more common and expected in the aging population so can be unidentified until later stages of the condition (Martin, 2018). Nutrient intake amongst the elderly is more common because of a number of factors including but not limited to; decreased appetite, chewing and swallowing difficulties, changes in tastes, access issues to healthy foods, and cognitive impairment (Litchford; 2013).
B12 deficiency at its end stage is known as pernicious anemia and is the result of a prolonged reduction and loss of the synthesis of intrinsic factor which is essential for the uptake of B12 (Litchford, 2013; O’Leary & Samman, 2010). In the ageing population this can be diminished for a variety of reasons, one of which is the use of certain medications for conditions that correlate with ageing (Litchford, 2013).
Which medications increase the risk of B12 deficiency?
The medications that are commonly known to increase the risk of B12 deficiency are: omeprazole, lansoprazole, Tagamet, Pepcid, Zantac, cholestyramine, chloramphenicol, neomycin, colchicine, metformin, nitrous oxide anesthesia, and some epileptic medications (Litchford, 2013; Martin, 2018; O’Leary & Samman, 2010).
Becker, D. A., Balcer, L. J., & Galetta, S. L. (2012). The neurological complications of nutritional deficiency following bariatric surgery. Journal of Obesity, 2012, 1-9. https://doi.org/10.1155/2012/608534
Litchford, M.D. (2013). Nutrition focused physical assessment: Making clinical connections. Case Software.
Martin, C. (2018). Detect nutrient deficiencies with NFPE. Today’s Dietitian, 20(3), 42.
O’Leary, F., & Samman, S. (2010). Vitamin B12 in health and disease. Nutrients, 2(3), 299-316. https://doi.org/10.3390/nu2030299 (Links to an external site.)
I stepped outside today in my bare feet onto a dry spot of ground. I stood next to the dog and cat who were sharing my little dirt patch and let the sun bathe me in Vitamin D. I took off my coat and was tempted to put on a t-shirt because I was getting so warm, after all it was a balmy 35 degrees. Sounds cold if you are reading this in Florida or Mexico, but for us here in Minnesota today is a 60 degree increase in temp from a week ago. It's almost a heat wave, this sounds especially strange considering that in Texas they are in a deep freeze. This isn't the first time the weather has felt a little funny, like things were backwards or upside down. And I know I'm not the only one to notice, all you have to do is turn on the news and you are inundated with phrases like "climate change", "Paris climate accords", "sustainable resources", and "green energy", amongst many more. It seems like we have been talking about environmental concerns for a while and suddenly we have jumped head first into action. The environmental crisis debates are increasingly more challenging to follow. Suddenly there is more depth to the conversation and answers are not as easy as originally thought.
When the idea of all electric cars was presented, at first glance it seemed amazing, no emissions! Yay! But what about the mining for the material to build the batteries for those cars? What about the plethora of cars that already run on gas? Do we just throw them away? Do we convert them? What will that cost be? Would it be a better idea to reduce drivers instead and have less cars on the road? Maybe reinvest in public transportation, encourage more incentive for companies to provide work from home opportunities? Create efficient cross country train travel? More commuter friendly neighborhoods? Could we advocate for busses for after school activities to reduce 55 suburbans parked by the curb after soccer practice? Maybe encouragement for households to have one car instead of five (like we have...)? So many questions and who has the answer? The left? Maybe. The right? Maybe. Most likely its someone in the middle.
What about the idea of wind and solar energy? Another fantastic dream at first glance, but look at what is happening in Texas right now. Or look at some challenges other countries utilizing wind power have faced. Sometimes there is no wind. What do you do then? Build bigger more efficient batteries to store power for those times? Great! More mining for batteries. Maybe create a hybrid blend of energy: wind/electricity/fossil fuels/solar? Another great idea but maybe a little overkill and what would it take to switch back and forth, how much manufacturing would have to go into create a system for that switch? Maybe not that practical of a solution and certainly not accessible for all nations. Maybe we could be a little less dependent on energy to being with? On a sunny day could we keep all the lights off? Could we build houses with windows that are strategically placed to allow sunlight to be the primary light source all day long? Could we tolerate a slightly lower temperature in our house during the winter and a slightly higher temp in summer? Could we go a whole day without using any electricity? Who has the answer to this challenge? The left? Maybe. The right? Maybe. Most likely its someone in the middle.
What about agriculture? How do we solve this problem? More genetically modified crops? Less genetically modified crops? Should we eat less meat? Should we garden more? Should we subsidize farmers? What about overfarming and stripping the land of its resources? Can we just put some resourced back in there? Or do we need to let the land rest? Could we continue to rotate crops or could we get creative and find a cycle of animals and crops? Could we let sheep graze in a crop field one season and then let chickens pick and poop their way through it the next? Could we create more urban green space? Could we teach individuals how to garden in their apartments? Would that require more energy? More resources? Is the payoff worth it? Maybe we could just eat less food? It probably wouldn't hurt.
So. Many. Questions.
And honestly there is probably not one right answer. The key to saving our planet is going to be multi-pronged and going to be a work in progress. The biggest question I have and the biggest question I don't think is addressed is: What can I do?? What can the individual consumer do?? How do we make a change that has impact and meaning? Maybe we can't afford to convert our house to solar energy and maybe we don't agree with the logic. We don't have to make or be part of big industrial change, perhaps we will be and perhaps we will all be forced at some point to do these things, but for now there are some very simple and easy things EVERYONE could do to make a difference.
Try a few or try all of these ideas. Figure out what works for you and just do it. Encourage your friends and family to do the same. Teach your kids to enjoy the natural light, teach them how to fix things so they have that skill, teach them efficiency. Share with friends and co-workers. Suggest a walk to the store to run errands with a coworker over lunch (if your location permits). Just do something. Too often we are plagued with the idea that our efforts don't matter. They do. Especially if we all do something. I think Im going to start with the lights out snuggle time :). I like the immediate benefits of that effort...
How about you? What will you change?
Share privately or in a comment if you want, I would love to hear from everyone.
Disclaimer- This article is ENTIRELY opinion based, not fact based. It is my personal feel on things and is in no way a claim that this is how others feel, manage or navigate being ill.
It’s hard to log onto to any type of internet platform without seeing recommendations for what to do with all things COVID related. In fact, I did a quick review and in under 5 minutes I found a variety of opinion and evidence-based articles sharing data, tips, or general recommendations on how to navigate through our newest viral instigator. Information on how to quarantine… how to order food online… what supplements to take… what healing remedies to implement… what OTC meds to take… which OTC meds to avoid…. how to apply for unemployment… how to talk to your kids during quarantine… how to talk to your boss during quarantine… how to tell others that you have COVID…. how to keep the household uplifted during quarantine…the list goes on. To say we have ample support for what to do if we get COVID, if others have COVID or how to manage in quarantine, is an understatement. But what happens if we have a regular run of the mill cold? What if we or our kids come down with Strep throat? What if a coworker is coughing while at work because of her asthma? What if the dry air in our homes is making us have a sore throat in the morning? What if a parent comes down with pneumonia UNRELATED to COVID? What do we do? How do we navigate these other conditions that didn’t go away when COVID came? What do we say to ourselves and others? What do we do when it isn’t COVID?
I had the opportunity to be in this space this past week and I can say I was unprepared and overwhelmed by the enormity of how to navigate. We had an outbreak of strep throat in our home. I can say I never thought I would utter the words “Oh good..” when the nurse called with the positive strep results. But here we are, in a time when we are grateful for what we know and overly cautious of what we don’t. In the past I would simply have told friends, family, and clients that my daughter was sick, and I too am not feeling well. I would have made the decision to cancel clients, call in sick or stay home based on whatever symptoms we had and whether we were contagious, as well as what my own body said it needed. I would then do what needed to be down and most likely have made the decision to lay low, stay home, and give my body time to heal. But that path didn’t feel good enough. Being sick in this COIVD era is no longer a personal experience and an opportunity to be responsible for yourself, it is now a public health matter. And depending on how much interaction you have in the community and what you do for work, it can be an absolute nightmare.
I found myself acting in such uncharacteristic ways. For example, at one point I was googling whether I needed to “quarantine for strep”… Ummmmm WHAT?!? I am more rationale than this, but I was doing it all the same. Then when I finally reached out to my clients, I shared a longer than necessary explanation either over the phone or via text about why I was cancelling classes or sessions, and I felt the need to assure them, in an annoyingly high multitude of ways, that NO we did not have COVID. I made sure to obtain documentation from the doctor to share with school, work, or anyone else that may have need of it. I was overanalyzing every symptom any of us had. I became obsessive about checking temperatures of everyone despite no one at any time having a fever. I agonized over how to call in sick to the hospital I work at once a week, I worried if I stayed home one day, they may require a 14 day quarantine no matter what (this isn’t there policy and I know this, but the irrationality was thick at this point). I even debated dosing up on meds so that no one would know I was sick, and I could continue with none the wiser (obviously not a good plan but again, please note the irrational state I had sunk to). In general, my anxiety had tripled from its usual elevated stance and it was trickling down to everyone else. My daughter started to apologize if she coughed and she began to do hourly temperature checks on herself. My husband and I even started bickering as I agonized, and beat to death, how to call in sick. He was tired of hearing how hard this was, and I was tired of saying it, and yet I couldn’t stop myself. Suddenly I had lost all skills for how to be sick and I was slipping into a very unhealthy and irrational management of it all.
Thankfully I had a breakthrough on Friday. I had finally cancelled the last remaining client commitments for the week, a private client Friday night and a private yoga class for Saturday morning, and in completing that task, I received the most incredible sense of relief I have ever felt in my life. It was like suddenly my worries melted away. Suddenly it was ok to be sick, t was ok to rest, and it was certainly ok to recover. It was alright to not have all the answers, I didn’t need them, I just needed to release my obligations to the rest of the world for a short period of time. I was so worried about how clients would react to me being sick or to my cancelling classes that I forgot that sometimes it doesn’t matter. Sometimes we must do what’s best for ourselves and allow others to do the same.
So, what do we do if it isn’t COVID?
What do we do without the step-by-step guidance that we have been groomed to look for?
In my opinion and from this limited experience, I feel that we need to get back to trusting our instincts and let go of what the world expects. Of course, we need to be responsible and mindful of others, but we also need to remember to listen to our bodies’ needs. In fact, DON’T do what I did and agonize over what people will think of you in how you handle yourself. Just do what’s best for you, your family and those around you. I can’t promise things will always be fine or that others will be ok with your decisions, but it will release you from an extra dose of stress which is not conducive to getting better.
I felt the relief that I felt because I had finally given myself permission to get better, I was no longer trying to hide being sick, or beat myself up for being sick, instead I had accepted it and allowed myself the opportunity to be well again.
Maybe this is one thing, among many, that COVID has taught us; to take a step back when our body demands it. But there are still things we need to learn. Like how we set aside our judgement and regain trust. This is not only regarding the judgement and trust of, and for others, but also how we apply these to ourselves. We must trust if someone says they have a cold that they have a cold. We must let go of judgement when we hear a cough from someone during a meeting. We must trust our own body when it says “rest”, or in many cases screams “TAKE A BREAK!!!” And finally, we must learn to take responsibility for ourselves and for our own health.
This is what we do when we don’t have COVID, but surprise, surprise, this is what we also do when we have COVID…
Moral of the story, take care of yourself, don’t worry about what everyone else is doing or thinks, manage your own health and that of your family and see how your sense of wellbeing slowly improves.
This morning, as is usual on a Sunday in our house, I was compelled to stop my work tasks to address the ever-growing pile of dishes. I often grumble about the kids not helping or my husband conveniently occupying himself with other tasks, but today I found myself unexpectedly in a mindful state of existence. The warm water on my hands, the inability to multitask, the quiet as the household vehemently avoided the kitchen in the event I would petition for help, the scent of the lavender soap, and the sense of accomplishment as I scrubbed pans that had been sitting for the entire weekend. Watching them glisten as I scoured them clean with steel wool.
According to Merriam-Webster, the Definition of mindfulness states:
1: the quality or state of being mindful
2: the practice of maintaining a nonjudgmental state of heightened or complete awareness of one's thoughts, emotions, or experiences on a moment-to-moment basis
also: such a state of awareness
Does this definition say it is only when we are sitting in a quiet corner of our house, our legs crossed in meditation? Does it say that it only happens when we read a “mindfulness” book? Is it only when we do one of the tasks our favorite podcaster lists as acceptable mindfulness tasks? Or is it only when our app tells us it is time to be mindful? Maybe it isn’t this or that, maybe it’s all the above and then some. It is in those little moments, the in between, the time that you are waiting in the exam room for your doctor and you aren’t on your phone because you don’t want to have to put it away when he/she walks in. Or maybe it’s in your evening shower, as you feel the warm water rain over your body and the worries of the day wash down the drain. Or perhaps it’s when we are walking to get the mail and see a squirrel run out with some sort of snack in his mouth. You smile at the unexpected cuteness and welcome feeling of joy you get as your soul appreciates the life of another being. Or could it be when you are standing at the sink, looking out the window at the snow-covered yard, up to your elbows in hot soapy water, your thoughts quiet and contemplative, the world quiet around you, and you are simply washing the dishes?
Wherever and whenever you find yourself in these treasured moments, take a minute to appreciate the opportunity. Be happy your kids don’t keep up with dishes, so you GET this profound opportunity to do them. Be thankful your husband forgot to grab the mail on his way into the house the night before so you COULD make an excuse for a walk. Be filled with joy that your doctor is running a couple of minutes behind affording you the rare opportunity to sit longer in a space of healing and wellbeing.
Mindset or Mindfulness, you oversee when you get to experience either, so instead of lamenting that your life is too crazy and busy, make the most of the times when things take a pause and show a little gratitude. I promise things always go better when we have a heart full of joy. Plus, nothing makes you feel accomplished like cleaning a sink-full of dishes.
Here is a letter that I wrote to my clients this week, so many commented how much it meant to them that I decided to share it with a wider audience. As I wrote this letter I felt like I was writing a bit to myself and I didn't realize how therapeutic it would feel. Because of this, I encourage you to take my same step, write a letter to "someone" about how things are, how you feel, thoughts, concerns, whatever comes to mind. Then feel free to send it or just rip it up. Either way, I promise you will feel better.
I wanted to take a minute and check in with everyone. It has been a while and I miss everyone. Although the studio is beginning to awaken, there are many faces I have not seen in some time. I hope you all are doing well, not just surviving, but thriving if that's possible.
We are living in tumultuous times which is not news to anyone. Lately I often feel like quoting Dickens... "It was the best of times, it was the worst of times..." And this is how it feels right now. There are so many challenges that we are facing each and every day, yet at the same time there is opportunity woven in there as well. We often need a reminder of this though as the challenges take center stage and it is easy to overlook the good.
As we come into the season of Thanksgiving I want to invite you to take the opportunity to focus on some silver lining moments that you have had through our COVID/election year. What are the changes you have had to make, either by choice or necessity during this time? How have they impacted your mental and physical health? If all you can think of is negative, switch your mindset and ask yourself 'What have I learned during this?' Maybe you don't see a glowing "perk" but if you examine what you have learned then perhaps you can see some benefit in that. I, for one, have learned a lot of lessons during this time and I am still being educated in many areas.
In addition, here is a reminder to take care of yourself. I know that you are hearing this a lot and your response may even be along the lines of "easier said than done" and I hear you. In fact I am there with you. There are more times than I care to admit that I spend sitting in a state of fear and worry. Keeping our sanity during times like these requires more than just a bubble bath and glass of wine (although those do sound fantastic). It requires us to go a little deeper. It requires us to move into a state of non-judgement, non-judgement towards ourselves and non-judgement towards others. Judgement is an easy outlet right now. We can point fingers and blame for the pain and hurt we feel. But what would happen if we all took a moment to think through our response in a situation rather than reacting. This isn't just to others, its also to ourselves. It is said that when we judge we are just looking in a mirror. Moving into non-judgement can be as easy as showing more kindness to yourself. The effect will be 10 fold. In fact, this is where the real work happens.
As you work through these thoughts remember, you don't have to do this perfectly. In fact I wouldn't expect any of us to ever be perfect. That's the beauty of this life. We are constantly growing as a person, evolving into a higher state of being. There are many bumps along that road.
And remember when all else fails, go to your mat. Maybe you just sit there, maybe you practice, maybe you take a nap. But continue to go back there. Build that consistency. Experience that grounding. Find your peace.
Have a wonderful week!
What a crazy moment in time we are experiencing. In another post I wrote today, I took the time to encourage everyone to pause and reflect on this moment. And for me when I pause then I start to think. I think about a lot, in fact, I over analyze and get myself worked up with my over-thinking. Today is definitely one of those days, in fact we could say its one of those weeks even. On my mind today, amongst so many other things, is a reflection of how our efforts to keep safe during COVID could impact our planet in a negative way.
When COVID started (I just love this phrase and I probably use it more than I should..) I thought that this was a fantastic opportunity for the earth to take a moment to breath. I felt like we would finally be able to have the opportunity to reverse some of the damage we have so rapidly been inflicting. I struggled in other areas around COVID of course, but I often took comfort in the idea of the earth renewing itself. Then as we started to slowly awaken, re-open and move around again, I saw the reverse take place. Our collective fear of this virus pushed aside any thought towards sustainability or conservation. Everyone shifted into survival mode. The phrase we would often hear was "we just have to get through right now.." This meant that suddenly plastic, whom we all had started to recognize as not so good, was welcomed back. We started covering everything in it. The reusable bags at stores- no longer allowed, back to- "paper or plastic?". Regular plates and utensils at a restaurant were replaced with plastic and styrofoam. Anywhere you looked items were starting to be individually wrapped in plastic. It is an understatement to say that plastic definitely worked its way back into our lives. Don't even get me started on not being able to use reusable cups and mugs.....Reusable was the enemy and disposable became our friend.
Another change.. suddenly ride sharing isn't a good idea and public transportation is frowned upon. So instead of clearing the roadways we added more cars back on.
Then we see the ma and pa shops who had worked so hard to bring home cooked and hopefully healthy food can barely keep their doors open as cars line up outside of fast food establishments.
Remember when we got so excited that people were actually getting outside again? That they were enjoying the outdoors? Well this is still fantastic of course, but we need to take a look at how people are enjoying those outdoors. ATV sales are through the roof. What does this mean? More fossil fuel usage and more emissions. I am not demonizing the use of these vehicles because we too own an ATV (the same one for the past 16 years) and we use it to haul wood, to pull fallen logs, and sometimes for a ride. So no, I am not ripping on their use, I am merely pointing out our skewed idea of what it means to spend time outside. Some people are on the right track and recognize the opportunity to do more camping, hiking and biking. This has increased ten fold (not a true statistic- I made this data up- no need to fact check). Many of these individuals are new to outdoor recreation and don't have the understanding of sustainability while doing these activities. They have their brand new or rented camper of some sort with their propane grill set up, they spray their bug fogger everywhere, light their tiki torches and settle in for a night of outdoor living. No one is actually roughing it except those that have been camping well before COVID started. And so many of these outdoor enthusiasts bring their plastic wrapped granola bars or plastic water bottles and let's just hope everyone is taking the time to separate out their trash and at least recycle.
In addition to all this, we start using hand sanitizer like its our one saving grace. For years now I have been fighting the use of excess hand sanitizer with my clients, emphasizing the importance of "good bugs" and keeping their immune system strong by cultivating the bacteria in and on their body. Now people are so fearful that they have actually resorted to trying to DRINK hand sanitizer, there are warnings now "not to ingest this product". Do I have hand sanitizer at my establishment? Absolutely! Do I use it? Absolutely. Do I use it in place of washing my hands? No! Do I use it unnecessarily out of fear and just because it's there. No! Washing our hands still does the trick and should be our first choice. For me I use hand sanitizer if I am in a situation where I can not wash my hands and I will be touching, or have touched surfaces that others will potentially touch within a window of time.
Obviously I have gotten off on a bit of a tangent and I might say a hypocritical one as well as I am also guilty of slipping in my eco ways and I have bought a plastic water bottle or two, and I certainly visit the coffee shop more than my wallet should allow. I also threw away things that could have been repurposed or re-homed. And I definitely have succumbed to convenience more than I want to admit. I justified some of these things as ways to support the businesses struggling, but most I did because my desire for whatever I wanted at the time superseded my need to support the planet.
As cranky as this post sounds it is actually meant to be a reminder to us all that it is time to snap out of it. We need to get back to being sustainable and mindful. We need to care for our planet again. Let's encourage the science over the fear and get back to taking care of our planet because if we don't it won't be able to take care of us.
Today seems like a good day to reflect and remember. It is also a good day to look forward to the future, as well as acknowledge the present. This day will forever be embedded in my memory and will forever fill me with a sense of pride for my country and for my countrymen. I realize that we are in a state of great unrest right now. We are battling a pandemic, dealing with challenges in our communities around racism and police brutality, we have wildfires devouring our forests and politicians devouring our media. Wearing a mask or not has suddenly become a political statement. Our children are battling each other on social media around their "political views" and I say that with air quotes because let's face it, most of our children end up just mirroring our own political inclinations. We have become communities of tattle tailors, calling in our neighbor for not wearing a mask or for having a gathering. We have become individual experts in areas of science, civics and history- areas that many of us have not researched or reviewed since our high school days if even then. The media is filled with hashtags to #standtogether #alonetogether #wewillovercome... the list goes on. But how many of us are actually listening to each other? How many of us are taking the time to try to understand another viewpoint? From where I see it, not as many as should.
This day brings us all together again. It reminds us of a time when none of our differences mattered, when we literally pulled each other from the rubble. Of course I say we collectively, I wasn't in New York that day and neither were my friends or family, but I felt that pain across the country and I shared that sorrow after. New York is the quintessential american city. It is the city we all romanticize about in one capacity or another. Movies are made about it, people travel there to pursue their dreams. Heck, I am not a fan of cities and even I have been there. That attack, which honestly feels like not that long ago, hit us all in our hearts and if there is one silver lining from the suffering that was endured not only that day but in the weeks, months and years following, is that it is a day we all share. It is not a holiday for one religion or a historical event that only favors half the population. This is an event that we can all remember and take a moment of silence for. This event binds us all and reminds us that despite our differences we are one nation and I hope that we can all strive to remember that.
Do you have that friend whom you can share anything with? Does he or she listen without judgement, give feedback if needed, or otherwise just lends an ear? I do and sometimes I throw a lot at her. In fact, I have a couple of friends that fit that profile. Great friends who are always there for me no matter what and they truly listen without bias or judgement, because honestly, they know I am already judging myself far more than anyone else ever could. Sometimes I even treat these friends like my diary. I send them my thoughts throughout the day, my musings, my introspection of the world and myself. I send them my opinions on current topics and my interpretation of popular science. I basically use them as an outlet for all the thoughts that ruminate in my head day in and day out. During the past few months I have had an extra amount of material to share and today was no exception. In fact, today I spent some time alone and therefore had even more time to cultivate theories and proclamations and what have you. In fact, about an hour ago as I was once again sending a long story like stream of text to Friend #1, I realized that I could be sharing these thoughts with everyone (I know, lucky you..). In fact some of the things that go through my head have some merit and are pretty profound and others might actually gain some insight into their own life from my over-analytic, hyper sensitive, silver-lining edged trains of thought (see you are getting wiser by the moment in reading my self-descriptive phraseology). So, here is the start of an occasional blog series that won’t gain its own heading, but will rather be occasionally titled My Daily Reflections. I know, super original and creative.
My Daily Reflections: Thursday June 25th, 2020
Today I had the opportunity to listen to three podcasts. Now, 4 months ago when I was driving back and forth to the hospital I was working at twice a week this would have been a regular Monday for me, however with all the changes and being furloughed for an extended amount of time I find myself rarely, if ever, listening to anything anymore. I am sure there is a deeper reason underneath this shift, just as it correlates and relates to so many other recent changes, but for now I am going to superficially say I am just too “busy” to listen to them. ANYWAYS….. The three podcasts I listened to all had a different theme but yet they all connected in some cosmic way.
The first one was about many things but a message I took from it was the danger of accumulation. Not just clutter in our homes although accumulation affects us on all levels and often the space around us reflects our internal state as well –(something to think about as you pile that mail up on the counter), but rather her focus was on the internal accumulation of poor habits and poor health. This leads into Ayurveda a bit in that disease is imbalance in the body and the build-up of ama (toxins from unhealthy lifestyle, pollution, and all sorts of other things). She discusses her own health journey in letting stress, success, chasing the dream, all these things accumulate into heart disease, fatigue, weight gain, and more. I found myself feeling a bit of kinship to her struggle. She discusses how success for the sake of success will only lead to disappointment. We need to seek happiness and fulfillment and let success manifest on its own into whatever form it wants to take, not the picture we see in our mind. This led me to think about attachment which has been a hot topic in my head the entire duration of COVID. I have never been forced to confront my attachments as much as I have these past four months. I finished that podcast thinking how attached we are to the picture that our ego paints of what our lives SHOULD look like rather than trusting the space and events that are happening to be part of a bigger plan. She talked about approaching things in life from a place of love of faith instead of fear. I especially like how she connected our current health and wellness efforts, although cloaked well in the guise of self-care, are often fueled by fear. Fear of old age, fear of death, fear of weight gain, fear of incapacitation. She was so right. No one ever comes to me and says, “Hi Jessica, I want to love myself more can you guide me on this journey?”. They say- “Please- my blood pressure is high, and my dad died of heart failure at age 50, HELP! What can I eat?” or “I’ve tried every diet, how can I lose the extra 20 pounds I have been carrying since my last baby?” I had honestly never looked at where their request stemmed from. Of course, I try to dig down with each patient and find what is inspiring them to make change, but I never thought about the fact that fear is the deep-down motivator for nearly everyone. See- PROFOUND! This is the actionable item I took away from this particular talk- I need to have better self-care that is truly about loving myself, not self-care focused the “outcome” of the act that was motivated by a desire to prevent something I fear. That is seriously deep there, I mean I brush my teeth because I don’t want cavities, I fear having bad teeth when I am older because I won’t be able to eat the foods I want, I will spend way too much money at the dentist, and ultimately my vanity gets the best of me every time. How can I now start brushing my teeth because I love my teeth? Can I even do that? It’s certainly something to reflect on…..
The second podcast I listened to was about acceptance. Which I thought complemented the prior message in that we can’t move forward with a life of love and faith and not of fear if we don’t have acceptance for where we actually are in our life. This podcast was a little shorter and was not an interview type like I so enjoy but rather the host giving his thoughts on what acceptance means to him and how he works every day to let that guide his behavior. He discussed how we can get through challenging times not by giving in or succumbing to a situation, but rather by accepting that things are what they are. We don’t have to agree or disagree, acceptance is about being in the moment and understanding that you may not be able to control or change the situation at that very moment but you can learn from it and not let it destroy you with worry or stress. This was a hugely important message for me, anyone who knows me knows that I worry so much you would think I was getting paid for it. I worry about the weather, I worry about the climate, I worry about current events, I worry about my kids, I worry about my extended and my immediate family, god knows I worry about my husband far more than I should, I worry about my pets, I worry about money, I worry about bears when I take a walk, I worry about bees when I work outside, I worry about cancer, I worry about heart disease, I worry about flesh eating bacteria, I worry about amoebas in a neti-pot, I worry about mold in coffee… (I think you get the point….). For me to sit in something and accept that it “is what it is” is honestly almost too difficult for me to even approach, but its good stuff and I know I need to work on it. I had a difficult time wrapping my head around how I could bring this into action, it seems easy enough- stop worrying, accept the moment- but it’s not that easy to take years of this accumulation (see how they connect….) of worry and way of thinking and just let it all go. IT should be that easy, but it doesn’t feel that way. I am practicing a little tonight, at least trying, I am the only one home right now, so this is when my worry is in full force. But I am working on trusting that everyone is ok. I even resisted the urge to drive a bottle of Benadryl to my daughter who is at a friend’s house because she called me and was stung by a bee. She’s fine but my worrying mind thought-‘what if she swells up and has a delayed reaction?’ I have no reason to think she would have an abnormal reaction to this sting, she was exhibiting no signs of severe allergic reaction, yet my fear (another connection to the prior podcast) and worry were so great that they consumed my thoughts and I got in the car with Benadryl and headed out. I did settle down in the drive and called her and realized she was just fine, and I was overreacting, I accepted that she was ok in the situation without my interference. That was HARD! So maybe I am doing the work, we’ll see. My big take away, aside from practicing acceptance as often as I can, is to do the work and follow up with some of the resources he shared. If you are interested in these resources I will share them at the end of the post.
Last but not least, the third podcast I listened to was much more current events focused. It was an interview with a reverend regarding us being in a state of two pandemics, the COVID pandemic and the racial pandemic. The discussion was very interesting and focused on how we are in the dawn of a new era on this planet and that we are all integral in the forward movement. He discussed the role that white people play and he called upon white people to dig deep into their ancestry and pull out the abolitionists and suffragists in ourselves during this time. He shared his views on how we are all important and we all need to participate in the changes that are occurring. He shared how recent events are different than past movements and what makes them more impactful. He discussed sharing love and forgiveness with our neighbors. He discussed the meaning of the word sacrifice and how we often need to remember that it is “to make sacred” and whenever we look at something as a sacrifice, we need to reflect how what we gave up made space for something great. Overall it was very uplifting and inspiring. My big take away from this was tied into the other two. I learned that I need to look at the accumulation of centuries of racism and how it has integrated its way into every system, I need to look for this, I need to be aware of it and work to educate myself, my friends, my family and most important, my children on this. I also learned that I need to find acceptance in these tumultuous times. Without acceptance I can’t open myself up to the beauty of what the future will hold. Without acceptance I will live in worry and fear and this will block me from doing the good work and moving forward. Above all though, this reverend reminded me that I need to continue to learn about racism and to stop defending myself in it (more acceptance- see it’s all so connected!!).
So much I know! If you made it to the end, I applaud you. I’m not even sure I will make it to the end for a re-read. In fact, aside from a quick spell check, I don’t think I’m going to edit this post. I wrote it all in one sitting and usually those are my favorite pieces to share. I’m sure there are errors and it’s probably not the most well written post online today, but it feels real, it feels raw and that’s kind of what we need right now. We don’t need things fancied up and made to look pretty. We need to see what is really there, what people are feeling, what they are experiencing. That’s how we move forward, with transparent honesty and acceptance of each other.
Resources- The three podcasts I listened to today were all from The Broken Brain podcast with Dhru Puroit and the resources I wanted to share from him are:
Book by Eckhart Tolle: A New Earth
www.thework.com – Byron Katie, and her book is titled “I Need Your Love- Is That True?”
Travel is one of the most spectacular things we do. It introduces us to new people, new places and a whole new experience in culinary delights. Travel affords us the opportunity to sample everything from crisped insects in Indonesia to bulls testicles in Denver. Everywhere we go, we get the opportunity to try new and exciting things, but as fantastic as this sounds, it can also lead to overeating, unhealthy choices, and inevitably bringing home an unwanted souvenir of a few extra pounds around our middle. How does one manage this and still enjoy their trip? Is it possible to feel pleasure with the culinary aspects of a trip without sacrificing the pure joy of eating good food? Of course there is a way, it just takes a closer look at your choices and creating more balance with them.
Airport Food Choices- First and foremost don’t waste calories on airport food before you board. Either pack a healthy snack or if necessary get a light salad. Don’t get me wrong, I have had fantastic food in the airport and I do love eating and drinking during a layover, however the food in airports tends to be expensive, is not necessarily cooked for health and can be overly salted to enhance the flavor. If you need/want to eat before the flight and have access to Delta SkyClub or some other club status I highly recommend you take advantage of this. They usually offer some healthier choices and most often have vegan options as well. They are buffet style so you only take what you want, and they include a place to comfortably relax between flights. You can also fill your water bottle, have a small glass of wine and chill before take off. However, do not take the “all you can eat” as an excuse to eat more. Whenever I eat at a buffet I try to imagine that I am paying for each dish and each glass of wine. This can help keep it into perspective. Resist that urge to “Get the most for your money”- you are in sky lounge, act like VIP and pretend like it doesn’t matter if the food is free.
If sky club is not an option for you, then try to eat before your flight and pack a light snack for in flight to carry through security. Remember to make sure you follow TSA rules on what you bring through.
Prefer to eat at the airport still? Then find a restaurant or café near your gate to have something light, lower in carbs (since you will be sitting you do not need the extra energy from added carbohydrates) and a good source of protein and vegetables (the first will help you feel full and the latter will give you fiber to help manage travelers constipation).
Inflight meals- If you are preparing for a long flight and meal service is part of your passage, then order the vegetarian option. This usually means you will be served more vegetables which many times correlates to “healthier”. Sometimes these choices are a bit fresher as well.
If you are not seated in a cabin that has meal service, then it is a good idea to purchase something to bring on board rather than settling for the inflight options. Airports have come a long way from plastic wrapped sandwiches in a stand-up cooler. Depending on where you are leaving from you can get anything from sushi to a gourmet salad in an eco friendly compostable container. Make sure you are mindful of the smell of your food and its always wise to avoid bring peanuts on board as you may not know of potential peanut allergies in flight. Also make sure you drink plenty of water the days leading up to your travel so that you are well hydrated for your flight and for when you arrive in your location. It is inconvenient to have to go to the bathroom in flight, but it is also very important to stay hydrated while flying as this is important for feeling your best when you land.
Drink plenty of water while in the air and even ask for a hot tea while in flight to help keep your fluids moving through your system. If you brought food with you, time your meal when it is most in line with what a normal eating time would be. It’s always important to keep as normal of hours as possible while traveling, this includes meal timing.
Once you land - Make sure you drink plenty of water, again (notice a trend here??). Depending on the time that you land and the type of travel you are doing will determine when, what and if you should eat a meal right away, or fast until the next day. If you have a long vacation planned, are traveling solo and/or arrive at your destination later in the day it may be a good idea to just settle into your dwelling, drink some more water (J ) and get an early night’s rest. This will give your system an opportunity to refresh and restore before your vacation begins. If you have a very short trip where every moment counts, and/or if you arrive early in the morning to your destination, then settle into your routine and eat at the next appropriate meal time.
Eating while on the trip-
Once you have settled in and woken up fresh in your destination it is time to enjoy yourself -NOT to stress about food choices. However, pick which meals you plan to indulge and which meals you can be more mindful at. Perhaps alternating this over the course of each day is a good way to have opportunity to explore different options at different meals. Sometimes it is so decadent to sit down to the richest most decadent breakfast you can think of, or maybe you are traveling where there is a world-renowned donut shop. Why WOULDN’T you have one?? Balance would mean that this is not the day to also have that triple chocolate cake you eyed up at one of the restaurants on your list.
Another tip is to alternate your more indulgent meals with added activity. Take a walk in the early morning, go to the gym at your hotel, plan some hikes if you are in a spot to do so, or go for a swim in the pool or ocean. Activity doesn’t negate unhealthy food choices, but it does allow your body to use the energy from those foods in a better way.
Try to avoid snacks while traveling, unless of course it suits the time and place, in which case make sure that you balance those snacks with a lighter dinner. When choosing meals at your destination make sure that you try to choose foods that are local and special to the area. Supplement with nutrient rich accompaniments, these accompaniments are usually the diamonds in the rough. Traveling to the southern part of Portugal is not necessarily where you want to eat a burger with fries. This is where you want to try some octopus with a side of roasted olives. The burger and fries IS totally appropriate though for a trip to the American Midwest, especially if those fries and burger are sourced from a local farm. Try to avoid eating from chain foods while traveling and try to avoid all inclusive if at all possible. Travel should support the local economy of your destination, not hurt it. Research locally owned restaurants and visit these. Not only will you feel good about doing so but chances are the food will be far superior to anywhere else.
Drinking while on vacay- This is the area where most people slip up. Vacation equals relaxation and where I come from relaxation also correlates with having a drink. Now an argument could definitely be made that the area of change needs to be made in that association, but that is for a different discussion. Instead figure out what is the best way to balance alcohol intake in your style of travel. If you are traveling to watch a baseball game at Yankees stadium its completely appropriate and expected to indulge in some beers with your hotdog and popcorn. Same to say if you are traveling to the Valencian region in eastern Spain. A gorgeous glass of sparkling Cava would be wonderfully appropriate while you enjoy the setting sunset on your garden terrace and wait patiently for your traditional paella. The point is that this is the time to step out of your box. Sample Scotch while in Scotland, sip on Saki in Japan and toast a glass of whisky while in Tennessee. Ask for suggestions from the locals or your waitstaff.
Desserts while on vacation- I saved the best for last and appropriately so as dessert typically comes at the end of the meal. The best suggestion I can say (and this comes from an honest to goodness dessert fiend) is to do your research here. Sometimes you can go to a restaurant that has the most amazing steak in the world with Brussels sprouts grown in gardens on the roof, but their desserts are frozen and plopped onto a plate before serving. Around the corner from that same restaurant might be a 24/7 diner with handmade pies. Logical option: enjoy the meal, pass on dessert and go find your pie.
Look at the menu before you order. Maybe you won’t know how things are prepared but you can always ask or look for key words in the description. Find out if things are baked in house and if they are baked the day of. Aside from talking to your server, read reviews beforehand if available. Notice if desserts are seasonal and ask the server if they change. What does the description say on the menu? Are there ingredients used to enhance the flavor, things like spices? Maybe you don’t have dessert everyday and especially not every meal. Perhaps pick your best times and locations to enjoy your dessert and then don’t worry about what the menu says, ask the waitstaff for their favorite.
Always split dessert if it’s an option. Depending on the style of restaurant you are dining at, desserts tend to be much too big and way too much for just one person. Everyone will feel better for sharing. Flying solo? Bring it back to your room to enjoy after an evening stroll with a glass of wine off of your private terrace.
Now that you have a plan in place, I want to share the most important tip of all.
Enjoy each and every eating adventure you embark on. Savor each spoonful and truly bask in the beauty of a well-crafted meal. Any potential guilt felt overindulgence will only bring negative energy to your trip. Eat it, enjoy it and move on.