My current internship rotation is a pretty big departure from the last one. It’s outpatient nutrition counseling at a community health center with multiple locations around the city; I’m splitting my time between Harlem, Chelsea, and the Bronx. The work is nearly all diabetes management, with some weight management and general nutrition guidance thrown in.
The work often feels repetitive, and in some ways I miss the intensity and variety of intellectual challenges that I had working in the hospital this fall. But this rotation brings me back to counseling, which is my passion; it’s the very thing that made me pursue the RDN in the first place.
Nutrition counseling is a funny thing. In some ways, it underscores how incredibly different each person’s food story is. It definitely affirms the fact that there’s no “right” eating style or nutrition formula for everyone; in many years of working one-on-one with people, I’ve yet to see an approach that didn’t have to be tailored sensitively to the individual.
Yet at the same time, I’m continually struck by how much shared terrain there is in peoples’ experiences with food. The internship year has given me an opportunity to work with new, and extremely diverse, populations of patients. In spite of how many cultures, ages, lifestyles, and stories I’ve crossed paths with, so much of what I hear echoes what I’ve heard from clients in my own practice for years. Every patient finds a way to communicate to me a fundamental desire to preserve good health. Most people say that they know how they “should” be eating, but that everyday life often vies with their intentions. Nearly everyone feels a little better when they move and eat vegetables.
And then there are the shared struggles. In nearly every nutrition counseling environment I’ve worked in, I’ve heard people admit to deep shame surrounding how and what they eat. People spend a lot of time apologizing, for the food choices they’ve made, for the things they crave, and especially for their bodies. Too big, too slow, too weak, too small—I hear so many apologies for shape, size and ability. Many people carry around good/bad binaries surrounding food; oftentimes, their conceptions were shaped very early in life, by caretakers or peers and the way their appetites were criticized.
I’m both heartened by how much we share in our experience of food and saddened by how universal these issues of shame, regret, and struggle are. I feel sorry that eating is so often complicated, be it for practical, socioeconomic, or psychosocial reasons.
What motivates me in the work is the fact that, at least once in each counseling session, I see a patient or client’s face light up in describing something positive about eating. It might be a memory of something delicious, the happy surprise of discovering that a healthful food is much tastier than was assumed, the pride and reward people feel when dietary changes lead to health improvement, or the relief they express when their experiences are acknowledged and validated.
In any of these cases, I feel deeply lucky to be present and to bear witness. This rotation is reminding me of how difficult and tricky nutrition counseling can be, but it’s also giving me daily reminders of why I love to do it. And it’s making me excited for next fall, when I’ll be doing it on my own again.
I’ll be taking my meals with a sense of appreciation for our shared experiences with food this week. Wishing you some good eats. Here are my recipe picks and reading links!
Green apple in guacamole! I’d never have thought of this, but I love the idea.
Pretty much drooling over Cadry’s vegan reuben. It looks so authentic, right down to the marble rye!
If I didn’t already love falafel enough, here’s a version that’s stuffed with vegan feta (made with Violife cheese, which is pretty great).
An umami-packed vegan miso mushroom bowl from the talented Ania.
Finally, and just in time for Valentine’s Day, the prettiest vegan chocolate cupcakes.
1. New research suggests that vegetarian diets might boost insulin sensitivity.
2. A really interesting article on the science that underlies loneliness. It’s a topic that hits close to home for me, and I like the author’s suggestion that loneliness is part of life, but that there are ways we can choose not to be crippled by it.
3. A very interesting new study points to links between metabolic factors and the risk of developing eating disorders. This is news to me, but I was interested to read that prolonged low body weight/BMI in childhood may be linked to higher rates of anorexia nervosa. I’d be curious to see more research on this, but the findings definitely help to explain why and how EDs can develop very early in life (before social pressures to diet would be prevalent).
4. I enjoyed this essay on the power and meaning of rituals. Especially this line: “Tiny, everyday rituals are a hand-crafted prayer to domestic order, beckoning the divine to step inside a moment.”
5. Perhaps I’m biased—rutabaga is one of my favorite vegetables—but I loved Alicia Kennedy’s tribute to the humble root (and the recipe that accompanies it).
Most of my breakfasts this winter have been in the form of baked oats, which I prep over the weekend and enjoy with fresh fruit and/or nut butter before leaving for work. This week, though, I’m returning to my savory breakfast roots with the leftovers of a favorite tofu scallion scramble. I’m sharing the recipe (long overdue!) in a couple days. Till then, be well.
Weekend Reading | The Full Helping
When I was in college, I had a different relationship with “going home” than most of my peers. For them, winter and spring holidays meant booking flights and spending a week someplace else. For me, it meant a subway ride or a walk forty blocks south of campus.
As someone who’s chosen to stay in the place she grew up, “going home” has continued to be a matter of shifting neighborhoods, which sometimes means that it feels unremarkable. I’m lucky to be so close to my mom, especially as we both get older. But it certainly changes my experience of “home for the holidays” and other rituals of returning to one’s childhood locale.
Occasionally, something compels me to make a visit home ceremoniously; not because I have an extra container of soup or loaf of bread to give my mom, not because there’s a book in storage at her place I’d like to read, but because I need my childhood home and everything associated with that. This week was challenging, and Friday was particularly so; I felt more lost in more dimensions that I have in a long time.
So, last night, I came home. I slept at my mom’s, and I treated the whole thing as if it were a special thing—a true homecoming—rather than a quick walk to a place that’s not so far away from my own. My mom and I didn’t do anything special for the occasion, but that wasn’t the point. The point was to reconnect with my origins, even if they’re only 15 blocks away from my present.
It worked. It was soothing to look at familiar titles on the bookshelves in my room (now my mom’s workspace), to smell the familiar smells of my mother’s toiletries in the bathroom, to gaze at a few childhood photos. I visit my mom’s apartment often enough that it’s all incredibly familiar, but when I really pay attention, it’s profoundly nostalgic, too.
Nostalgia can be complicated, but on this weekend, it was welcome. I needed to be reminded of past selves and past phases of life. I needed to tell myself that life will continue to pull me through beginnings and endings and tiny, subjective epochs, but that there will always be a strong and fundamental self who bears witness to it all. I suspect I’m not making a whole lot of sense, but what I’ve experienced in the last 24 hours is less about logic and more about the powerful feelings that accompany homecoming, in every sense of that word.
I recognize that I’m deeply privileged to have a home space—my mom’s—that feels safe to me. In the coming week, I wish you all a safe space to connect with and inhabit; a place that makes you feel nourished, loved, and reminded of where you’ve been and where you’ll continue to go.
Here are some recipes and reads.
I can never get too many simple tofu recipes, and Katherine’s black pepper tofu looks particularly versatile.
A fresh, crispy, colorful broccoli and red cabbage salad for spring.
I’m loving the looks of Liv’s roasted red pepper cheese sauce.
I make a lot of chickpea flour pancakes, but I’ve yet to make a chickpea waffle. These spicy, savory waffles look so good!
I have yet to perfect my own vegan chocolate chip cookie recipe, let alone a GF and vegan one. But Sarah’s on it.
1. Via Medium, a critical look at “extreme wellness” in both the food and fitness realms. The author interviews RD Emily Fonnesbeck, who has spoken out bravely on this topic before. I always appreciate how candid Emily is about her struggle, which began with elimination diets and resulted in full-blown disordered eating.
2. I like chef Ronna Welsh’s musings on how being the parent of a child with special needs humbled and unmoored her, and how her relationship to cooking changed as a result.
3. A reader tipped me off to this ode to arugula. (It’s my favorite salad green, too.)
4. A new study points to risks of high animal protein diets.
5. Finally, I was so touched by this Audubon article on an unconventional bald eagle family (two dads and one mom) and how they’ve braved circumstances together. Be sure to check out the live webcam of the eagles if you have the time!
OK, friends. It’s a beautiful spring day in New York, and I’m determined to savor it. Have a great Sunday.
Weekend Reading | The Full Helping
I used to write about digestion all the time on this blog, but it’s been a while since the topic came up. It’s not that my interest in GI health has waned—it hasn’t—but it’s become more of a professional focus and less of a personal one, mostly because my own struggles with IBS have receded over the years. Why? Hard to say, but I suspect that consistent eating patterns (as opposed to the extremes of my eating disorder years), plenty of soluble fiber, and better coping skills with stress and anxiety have a lot to do with it.
In recent years, mental health and emotional well-being have been a bigger focus for me than digestion; the physical ailments I cope with often have a strong psychosomatic overlay, which means that mental health gets a lot of my attention even if I’m presented with immediate physical complaints. This is all my way of saying that digestive health has taken a backseat to the stuff that feels more urgent to me, even if my intellectual curiosity about it remains strong.
This week, I started my 5-week GI rotation. I was immediately reminded that the gut is really what sparked my interest in health and healthcare to begin with. I was also reminded of the fact that, to date, supporting people through digestive illness is the counseling work I’m most proud of. I suspect it’ll stay that way.
I’ve learned a lot already; my preceptor is a great dietitian and a true digestive health expert, but she’s also an excellent preceptor. She likes teaching, has a knack for it, and is generous with her time and expertise. Writing notes under her tutelage is humbling, but I’ve learned a lot from it already.
In addition to rekindling my interest in all things gastroenterological, this rotation is also bringing me back to my own experiences as a GI patient: first the long, drawn out struggle with IBS and digestive woes post-anorexia, then the long and mysterious bout of gastroenteritis (or so it was labeled—two GI doctors and I never figured it out) that I had in the years following my post-bacc. It is reminding me of how profound digestive illness is, how vulnerable it has made me and makes anyone who’s affected by it.
Digestion is the process that converts food into nourishment; when it’s compromised, the whole business of eating becomes vexed. Digestive ailments can cause particular kinds of anguish around food, and the fear and anxiety they cause can linger long after symptoms are actually resolved.
In my own work, I’ve often seen how digestive struggle and disordered eating are, or become, intertwined; yes, eating disorders usually leave a person with GI trouble, but it can work the other way, too. Years of GI illness can make people prone to all kinds of disordered eating.
Next year and in the years beyond, when I’m working one-on-one with people again, I hope that I can make a small difference in the lives of the many folks who are coping with digestive distress. I hope I can do this not only because I want to make a difference in my clients’ day-to-day quality of life, but also because there’s symbolic importance in helping people to heal the channels that allow them to take in food.
Here’s to four more weeks of learning more about how to do this. And here’s to a new week. Here, too, are some recipes and reads.
One of my nutrition goals for this year was to get more servings of fruit into my diet. I’m doing a lousy job so far, but at my last rotation a colleague of mine made a fruit salad with mint and ginger that reminded me of what a good vehicle a snazzy fruit salad can be! I love Liz’s colorful fruit salad with maple dressing, and she’s got some great tips on assembling fruit salads in general.
The ever-talented Eva is inspiring me to try my first-ever, vegan Massaman curry.
A delicious vegan pizza with naan as a base. Can’t wait to try this, especially once summery produce is in season.
This vegan pasta and bean salad with tahini orange dressing has my name written all over it.
Finally, I make a point of never saying no to a vegan blondie. All the better if “cookies n’ cream” is part of the description 🙂
1. The hospital where I did my oncology rotation was starting to offer CAR T-cell therapy, which is a relatively new treatment for leukemia and multiple myeloma. I found the process—in which the body’s own T cells are converted into killer T cells that can attack cancer—fascinating. This article details how it might be an option for the treatment of solid tumors, too.
2. An interesting new report has listed some of the best foods that we can eat regularly in order to promote biodiversity. NPR reports.
3. Speaking of biodiversity, The Atlantic has an interesting article on Bd (Batrachochytrium dendrobatidis), the fungus that has decimated frog populations and condemned more species to extinction than any other pathogen.
4. Very important reporting on how clinical trial data can be misrepresented to patients.
5. I try to remind myself each day that a little bit of kindness never hurt anybody, least of all me. US News & World Report explains how acts of kindness benefit both the giver and the recipient.
In kindness, I’m signing off. I’ve got a creamy, nutritious, and very simple soup recipe to share with you this coming week!
Weekend Reading, 3.31.19 | The Full Helping
On Friday I wrapped up my very short but incredibly meaningful two-week rotation at the John Theurer Cancer Center in Hackensack, New Jersey. The commute wouldn’t have made it sustainable for me to stay any longer, but I wish I could have. I valued pretty much every moment of the experience.
One of the things I was told about the dietetic internship before starting was that I’d probably be surprised by what I loved and what I didn’t. Having had some counseling experience before starting my rotations, I wasn’t sure how much this would apply to me, but it has. Not across the board, of course: there are some rotations I’ve suspected wouldn’t be for me, which turned out to be true. And I’m reasonably sure that I’ll love my GI rotation, which starts tomorrow.
I could never have guessed how much I would love working with seniors, though—a passion that emerged only as I was completing my rotation in long-term care. And while I thought oncology would be meaningful to me for personal reasons—having watched a loved one go through chemo and radiation therapy years ago—I didn’t expect to enjoy the work in as many ways as I did.
It was intellectually stimulating and deeply interesting. I loved observing how teams of practitioners—doctors, nurses, social workers, researchers, and dietitians—came together in patient care, especially when handling a complex case. Most of all, I loved getting to know the patients and their families.
The big downside of this rotation, my commute aside, was feeling crummy for most of it: both the cold I started with and the seasonal allergies and fatigue that plagued me for the rest of my time at JCTT. I was so tired after my last day that I fell fast asleep on my commute home. It was an easy rotation insofar as my engagement goes, but it was difficult physically.
Over the years I’ve gotten good at recognizing traces of body judgment or body dysmorphia in how I relate to my appearance and shape. In recent years I’ve become aware of a related tendency, which is to feel easily exasperated and frustrated with my body when it’s not at “peak performance.” I’ve always been prone to stress, digestive troubles, allergies, and picking up bugs, which makes it easy to judge. And since I’m not twenty-five anymore, peak performance looks quite different than it used to. My energy reserves get depleted a lot quicker than they did even five years ago.
I have a ways to go with accepting my body’s energetic limits. I know my boundaries, but I resent them; there’s always a part of me that wishes I could do more. Illness can feel oddly triggering, the way fluctuations of the scale used to. Working in the health/wellness space, where boundless energy is often presented as an ideal, doesn’t always help.
I’ve developed a lot of strong muscles when it comes to avoiding self-comparison about the way I eat. It’s important for me to exercise that same strength in resisting the temptation to compare my health and stamina to other people’s. My body is its own quirky, lovable entity. Sometimes I wish I’d given it an easier time when I was younger, rather than pushing its limits with overwork and self-starvation. I often wish it weren’t as sensitive and responsive to triggers as it is.
But if my time at JCTT has reminded me of anything, it’s the supreme importance of meeting our bodies where they are, both in sickness and in health. I’ll continue to encounter physical challenges as my life goes on. Some will be irksome, others more serious. In those times body respect and self-care will matter more than ever. I can cultivate those capacities right now, by choosing not to dwell on the fact that I’ve been strung out. Instead, I can rest and give thanks to my body for getting me through another rotation, which is exactly what I’ve been up to today.
Giving thanks for this body of mine, and celebrating your bodies, too. Happy Sunday. Here are some recipes and reads.
Dreena Burton’s recipes are always no-fail, and I love the looks of her new sweet potato pasta sauce.
A simple recipe for spicy, garlicky broccoli steaks.
Laurel’s chipotle sofritas bowls look so colorful and tasty—not to mention they’re packed with plant protein.
Isa’s garlicky white bean and asparagus soup is on my spring cooking list.
I think I’m going to celebrate getting to my final community rotation by making Kathy’s irresistable glazed donuts.
1. I’m guessing that a lot of you are familiar with the basic lifestyle patterns observed in the world’s so-called blue zones, but if you’re not, here’s a good recap.
2. The New York Times examines the link between pain perception and anxiety.
3. If I’ve ever appreciated simple and intuitive recipes and cooking, it’s been throughout the last eight months. But I do like to have my hand held by a cookbook author, too—especially if it means I’m less likely to mess something up—and I could understand some of JJ Goode’s case for long recipes. Even if I’m unlikely to re-enter that mode anytime soon.
4. Many religions ask for periods of abstinence or other special considerations around food. This topic can be under-discussed in our dialog about eating disorders, though in the last couple years I’ve seen many more personal testimonials about having an eating disorder during Ramadan. Likewise, I love Kimberly Robins reflections on reconciling eating disorder recovery with kashrut, or Jewish dietary law.
5. Undark takes a look at the difficulties associated with patient-matching, or matching patients with their appropriate medical records.
I had a delicious and lightly sweetened treat to share last week, but my rotation took priority in the last seven days. The good news is that I’ll have it ready to share with you tomorrow. Till then, be well.
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