June 2017

The Medicine

by Karen Hitchcock

The next big thin

Dissecting dietary fads and habits

I once read a book called Eat!, which I vaguely recall claimed you could eat as much as you wanted as long as the food had zero fat. I wasn’t overweight, but I was 21 and thought extreme skinniness would solve all my world’s problems. I gave it a go. Fat-free yoghurt and milk, fat-free stir-fry and pasta and soup, fat-free crackers. Even if it were true that you could consume tonnes and never gain an ounce, who’d want to over-eat those terrible industrial concoctions? Who’d want to give up butter and cream and olive oil? Diet trends appear, capture the popular imagination, fill plates and online forums, and then fade away: cabbage soup, Russian gymnast, low-carb, no-carb, fruit, juice, Paleo. The most popular ones have in common the claim that you can still eat lots and lots but only of a certain thing. But right now it’s all about intermittent fasting.

One day each week I see morbidly obese patients who seek to lose weight. I spend about a quarter of each consultation refuting deleterious diet myths they’ve heard, read or watched: eat six times a day, don’t skip meals, brown bread doesn’t count, artificial sweeteners are fattening, a litre of fat-free ice-cream is not. One 200-kilogram woman told me, “My main problem, I know, I know, is that I don’t eat breakfast.” When I told her she didn’t have to eat breakfast her eyes narrowed, as if she were considering reporting me to the medical board. Bloody breakfast and its purportedly miraculous fat-melting, metabolism-boosting, hunger-diminishing qualities. I don’t eat breakfast and never have. I’ve been lectured about the injurious effects of this trivial lifestyle practice innumerable times. So it was with utterly biased glee that I started to read reports of the health benefits of not eating breakfast, of not eating continuously, and of accruing a decent fast to break.

Current research indicates that eating breakfast does not lead you to consume fewer calories overall throughout the day, it doesn’t boost your metabolism in any meaningful way, and for most of human history it didn’t even exist. Historians blame the invention of breakfast on the aristocracy (and the mimicking of them), the industrial revolution, and Mr Kellogg squashing a stale kernel of corn in 1906. Eating three meals a day is a social custom and a habit, not a physiological requirement. Ancient Greeks and Romans ate only one per day, in the mid afternoon. In England, until the mid 19th century, the custom was two meals per day. The average citizen in a Western country today eats regularly for 15 hours of each 24-hour period, feasting and snacking and slave-driving our livers as if in preparation for a famine that never comes.

In 2015 the word “hangry” was granted a place in the online Oxford dictionary. Hangry – a hybrid of “hungry” and “angry” – refers to an irritable mood caused by hunger. It’s a funny time in history for the word to appear, a time when hardly anyone in the developed world need truly be hungry. Did our foremothers and fathers get hangry during the Depression? Did entire village populations walk around snapping at each other during times of famine? It seems hunger has become such a noxious sensation to us that it brings with it an emotional disequilibrium worthy of its very own word. What’s so bad about temporary hunger?

For thousands of years people have fasted for health, for weight-loss, for religious reasons, in political protest, or as a symptom of a mental illness (such as anorexia nervosa). There are now hundreds of blogs that solely document a week or two’s water fast, with daily updates on how the faster feels, their ketone and blood sugar levels, their toileting, mood, decreasing weight, increasing energy and lack of hunger, illustrated with stylised pictures of glasses of water spiked with mint. These blogs often have dozens of comments – congratulatory or mocking or warning about the dangers of not eating. But nothing reaches the hysteria triggered in commenters by the fast-to-the-death, pro-anorexia websites and vlogs. The pro-ana sites are full of “thinspirational” pictures of scarily skeletal teenage girls, outrageous starvation tips and a pervasive self-disgust. A few hours of reading this stuff and vegetable broth for dinner starts to look like a binge.

Eugenia Cooney is a popular YouTube vlogger who is scarily underweight. Each of her posts has thousands of comments, most of them critical. There is concern for her wellbeing and that of the people who watch her, but there is also rage, as if her body is attacking those who eat. Yes, she looks heartbreakingly starved, but to seek to have her banned? For most young girls she will function more like the warning pictures on a cigarette packet than a role model. Starve yourself for too long and you will die. It only took Bobby Sands 66 days. The more common practice of eating yourself to death takes years.

A bariatric surgeon said to me the other day, “We live in a toxic food environment. To stay lean you have to employ conscious restraint and say ‘no thank you’, a lot.” If you take a short break from eating, your body gets a chance to metabolise what you’ve consumed so it’s not stored as fat, and perhaps to tap into the fat you already have. Living in a state of constant satiety also dulls the tastebuds, such that the only food able to rouse them is saltier, sweeter, fattier and usually packaged in crackling, brightly coloured wrappers. Eat what you wish, but for fewer hours per day or days per week. The research into the diabetes-reversing, brain-protecting and life-extending benefits of this way of eating is compelling. Perhaps it will turn out to be the real deal. Wait for hunger. Welcome it. And then, as my high-school English teacher once told me: never waste your appetite.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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