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HEALTHY
EATING

Healthy Eating and the

Gift of Imperfection

By Robin Eickhoff, MD, MPH

My entire life, I have battled are good and with fats, it depends. In reality,
weight. My mother says she named me we need all three for normal metabolic func-
after a bird because I always had my mouth tion, or disease ensues. Chronic diseases, par-
open for food. It makes me smile, because I ticularly in more advanced stages, can result
know there is truth to it. I love food. I love in deficiencies and inadequate nutrition.
thinking about it, reading about it, cooking Sometimes, however, it is the treatment of
it and definitely eating it. The downside is the those diseases that can cause the malnutri-
false perception that I must decide between tion. Medications can cause weight loss and
being overweight and enjoying my life the malnutrition (chemotherapy) or weight gain
way I want, because there is no middle and over-nutrition (antipsychotics, insulin).
ground. This is the battle many fight every When malnutrition is due to a disease state,
day: “It’s all or nothing.” it is rarely desired, so patients strive to cor-
rect the deficiencies to the best of their abil- cultures that appear to value thinness. As one
As with most things in life, when ities. When a patient is suffering from would expect, higher risk exists in occupa-
we try to be perfect and inevitably malnutrition, I am more inclined to tell tions such as modeling or elite athletics that
fail, we quit. Healthy eating and them to eat whatever they prefer until their focus on being thin as healthy. Going into
nutrition is not an all-or-nothing nutrition has improved. Success depends on specifics about each of these eating disorders
proposition. We must give our the cause. End-stage diseases are more likely is well worth its own article and will hopefully
patients and ourselves the gift to result in the catabolic state of cachexia, be addressed in a future edition.
of imperfection. which rarely improves. Most patients we encounter do not have an
Intended weight loss resulting in malnutri- eating disorder, but instead struggle with being
The topic of healthy eating can fit in two tion is more commonly caused by an eating dis- overweight or obese. This often comes with a
buckets: metabolic (nutrition) and behavior order, making it much harder to treat. DSM 5 sense of shame and personal failure. We want
(dietary). The two buckets are on each end of defines eating disorders as mental health disor- to help patients overcome these barriers by em-
a continuum with a myriad of conditions that ders, “characterized by a persistent disturbance powering them with knowledge and tools
may (or may not) be influenced by interven- of eating or eating-related behavior that results about nutrition and healthy eating. How do we
tion. I will address each and how pathology in the altered consumption or absorption of do this? There are recommended nutritional
can influence them, including information food and that significantly impairs physical guidelines, but each person must be individu-
on eating disorders. I will then offer sugges- health or psychosocial functioning.” alized. There are numerous eating plans, but no
tions for interventions in an office setting These fall more into the behavior or dietary one-size-fits-all plan. No matter what the rec-
that I believe improves patient outcomes. bucket, but can cross over into the metabolic ommendation, it needs to be sustainable.
Nutrition, the metabolic bucket, requires bucket affecting nutritional status when not The science of nutrition changes based on
the balance of macronutrients and micronu- responsive to treatment. The most common new data and studies. The benefits of quality,
trients to maintain and manage good health. eating disorders seen in a primary care setting whole, natural food do not. We need carbo-
Macronutrients are carbohydrates, proteins are anorexia nervosa, bulimia nervosa and hydrates, but ice cream and broccoli are not
and fats. Micronutrients generally refer to vi- binge-eating disorder. These disorders tend to created equal. Fats are necessary for living,
tamins and minerals, which come with a bal- have higher prevalence in post-industrialized, but unsaturated fats are best. Complete pro-
anced diet. Media influence has led many to higher-income countries. Risk of developing teins are required. The daily American diet
believe that carbohydrates are bad, proteins anorexia or bulimia tends to be more likely in typically contains more protein than neces-

14 SAN ANTONIO MEDICINE • May 2021