Faking Allergies – Don’t do it, but don’t assume others are faking

This article describing the process restaurant kitchens go through to avoid cross-contamination for customers with allergies was fascinating. Labels, separate cutting boards, the whole nine yards.

I have mixed feelings on the article as a whole. I think it points out a real problem but is also too quick to paint people who go gluten-free without celiac or a wheat allergy as bandwagon-hoppers.

11 percent of American households are following a gluten-free diet, even though only a quarter of them said they were doing it because of celiac or gluten intolerance.

The gluten-free spectrum is diverse. About 0.3 percent of Americans have a wheat allergy, meaning that ingesting even a trace amount could send them into anaphylactic shock. Then there is the 1 percent with celiac. Finally, there are people with gluten sensitivity, who suffer symptoms like diarrhea, bloating, or fatigue after eating gluten. Given the absence of diagnostic tools, the size of this last group is particularly fuzzy, though Fasano’s research suggests it’s in the 5 to 6 percent range.

Fasano is troubled that so many people are diagnosing themselves with gluten intolerance, changing their diet without ever going to the doctor. “You don’t say, ‘I’m drinking a lot and peeing a lot, so I must have diabetes,’ and then start injecting yourself with insulin.”

Many who go gluten-free find themselves feeling better and see that as proof that they have gluten intolerance. But a genuine gluten problem is only one of three possible explanations for their improved health, and statistically the least likely. Another reason could be the placebo effect. The most likely explanation is that paying closer attention to diet and avoiding fried and junk food — which tends to be loaded with gluten — is bound to make anyone feel better.

What’s the big deal if gluten-tolerant people go gluten-free, especially since they’ll be eating fewer Pop-Tarts?

The problem is the more these bandwagon-jumpers demand special attention, the more likely that restaurants and wider society will come to see all gluten-free people as phonies.

The assumption, based on a single poll, is that the majority of people doing a gluten-free diet are simply following the fad. But I don’t think the math holds up. If 1 percent of people have celiac disease, .3% have a wheat allergy, and somewhere in the neighborhood of 5-6% have gluten intolerance, and 11% are doing gluten-free, then the majority (6-7 of 11) of those have an allergy or intolerance to gluten. That’s odd considering that it was the main reason given by only a quarter of the gluten-free respondents to the survey quoted. (The summary of the study itself doesn’t list all the potential reasons or indicate whether respondents had to select a single main reason. And only 25% of the respondents believed that a gluten-free diet was generally healthy for everyone. So, a large majority are well aware that gluten isn’t some dietary bogeyman, but something that some people react badly to.

As another confounding factor, gluten-free diets are hawked as a potential weight loss method, and I don’t know whether “weight loss” was a reason given in that survey. And while gluten-free in and of itself isn’t likely to result in weight loss, having severely limited carb options certainly can, at least in the short term. When doctors push weight loss as the solution to any and all problems, it’s not surprising that people would flock to anything that’s promising that as a potential benefit. In their view, they are doing it for a legitimate health reason. The article mentions claiming allergies to dairy as a weight-loss tactic, but doesn’t connect that with a fatphobic culture or pressure to be thin at any cost.

I also think the “you wouldn’t just diagnose yourself as diabetic and start taking insulin” analogy is way off. If eating something makes you feel crappy, and taking it out of your diet makes you feel better, you are under no obligation to prove to anyone else that your issue with that food is legitimate. You get to eat whatever you want, period, end of story, diagnosis or no diagnosis. Sure, if you’re cutting out whole food groups, you should probably work with a doctor and/or dietitian both to verify that it’s necessary and to make sure you’re not missing important nutrients. And if you’re having symptoms that seem allergy-related, then seeing a doctor is an extremely good idea. Both to make sure you have emergency meds if needed and to nail down what precisely you’re allergic to. But if it’s a mild intolerance, and you can cut something out without stressing yourself out or severely limiting your diet, that’s your call and no one else’s. Eliminating a food from your diet isn’t even in the same ballpark as randomly deciding to take prescription medications with no diagnosis.

For example, I don’t eat pad thai. I’ve had it twice, once at a restaurant and once homemade. Both times, it tasted delicious, then sat in my stomach like lead, and I felt lousy. Did I just eat too much of it? Is there something in it or some combination of things that I react badly to? Was it a total coincidence? I have no idea. But when given the opportunity to eat pad thai, I think “ick,” associate it with an upset stomach, and don’t want to repeat the experience. But as long as green curry, chicken satay, and tom kah gai exist in the world, I can live quite happily without ever eating pad thai.

If we decide that I’m not allowed to go “pad thai-free” without a real medical diagnosis, how do I accomplish this? If I go to the doctor and say, “When I eat pad thai, I feel sick to my stomach?” do you think they’re going to run tests or try to figure out if I’m intolerant to fish sauce or tamarind or beansprouts, or do you think they’ll tell me not to eat pad thai? Yes, I know there’s a difference between cutting out one highly specific food and avoiding a staple like wheat, but even people with definite gluten sensitivity often have trouble getting a diagnosis. So they do what they need to do for themselves to feel better. If there are barriers to their getting appropriate medical care (and there are an awful lot of those in the US), we should work on those, but in the mean time, people are still going to take care of themselves as best they know how.

I agree that people shouldn’t lie about allergies. If something upsets your stomach or gives you gas or triggers a gag reflex, it’s not an allergy. That doesn’t mean you should be expected to eat it for politeness’ sake, but lying about allergies does cause people to jump through totally unnecessary hoops to avoid cross-contamination. But I also think that people are too eager to “catch” somebody faking and that they jump on inconsistencies that may or may not be dishonesty. The person who can’t have dairy and then ordered ice cream? Maybe they lied. Maybe they weighed the risks and decided it was worth it. Getting to make your own decisions includes making decisions that aren’t optimal. And sometimes people have multiple competing things going on with food that they don’t feel the need to fully explain, which might look inconsistent or dishonest on the surface. This Captain Awkward post about a part-time vegetarian is a good example. People seem really quick to jump to “Lying!” “Attention-seeking!” instead of “Needed protein!” or “Don’t fit fully into either the carnivore or vegetarian box!”

Personal example time again. I don’t generally tolerate spicy foods well, both in taste and in GI unpleasantness afterwards. But it really depends on the day. There will be times when I think, “Bring on the heat!” and times when lamb korma somehow tastes “hot” to me. And while I’ve had GI unpleasantness from Mexican food, I’ve never had that reaction to hot wings. (Possibly because they go with pizza, so the percentage of “hot foods” to “overall meal” is lower.) So, if I turn something down because it’s too spicy and then next week you see me eating hot wings, it may look like I’m bullshitting you, but that’s not actually the case.

I do think it’s impolite to put other people to trouble you won’t go to yourself. If you’re going to expect a kitchen to slow way down to do the allergy dance for you, then you should be willing to forgo the tasty food with the ingredient you just told them you can’t have. And it would be kind of jerk-like as a semi-vegetarian to insist that your steak-loving friends always go to the vegetarian place rather than having your once-every-so-often chicken come from the place they like.

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Real Food, Real Life

Michele, the Fat Nutritionist, has a fabulous post on why the idea of “real food” is problematic. She talks about how, for every food that’s viewed as unhealthy, worthless junk, there’s someone who depends on that food in one way or another.

Right this minute, there is someone going through chemotherapy shopping at your grocery store, buying popsicles and ice cream to help their sore mouth, and worrying what the cashier is going to think.

There is someone on hemodialysis buying white bread instead of whole wheat, trying to keep their phosphorus levels reasonable between appointments and hoping for the best.

There is a person attending intensive outpatient treatment for their eating disorder who has been challenged by their therapist to buy a Frappuccino.

There are dietitians picking up a dozen different candy bars to eat with their clients, who feel ashamed and guilty about enjoying them.

There is someone who just doesn’t have it in them to cook right now, and this frozen pizza and canned soup will keep them going.

There are people recovering from chronic dieting and semi-starvation who are buying chocolate and chips at their deprived body’s insistence.

All around us are people listening to what their bodies need and attempting to make the best possible choice within a context of overwhelming food pressure. All of their choices are valid, and every single one of these foods is “real.”

I think this is hugely important and can’t be stated enough. People vary. People’s needs vary. And just trying to get yourself fed is hard work sometimes. Trying to navigate your own particular health stuff, combined with your preferences, your time and ability to cook, all the messages you get about food. It can be overwhelming. And then, after you’ve done the work of making what really is the best choice for you at the time, and someone takes you to task for that choice, it’s incredibly discouraging.

One time I was out for dinner with family, having recently decided to cut out alcohol (interferes with meds) and caffeine (screws up my blood pressure and ramps up my anxiety). Everybody else was getting beer or wine or soda, and I missed being able to have the occasional drink. So, I’m sitting there pondering what can I actually drink. I settle on ginger ale. And my mother-in-law makes a comment about how she’s not sure she can approve me drinking soda. (I didn’t snap back with “That’s why I didn’t ask you,” but it was tempting.)

I feel like that, in a nutshell, is a perfect summary of our screwed up food culture. It doesn’t matter how “good” I’m being in avoiding things that aren’t good for me, it’s never going to be enough for the self-appointed health police. And my mom-in-law wasn’t even being mean–it’s just such an accepted thing to judge and moralize about food that it was a completely natural comment for her to make.

Predictably, a bunch of commenters on Michele’s post wanted to distance themselves from judging people who kale or low sodium is going to make horribly ill, but still judge anyone who “could” eat better (for that commenter’s definition of “better” of course).

There are, of course, lots of problems with that. First and foremost, adult human beings get to decide what they want to put in their mouths, and someone who *can* eat organic, free-range, whole grain homemade everything is under no obligation to *want* to.

Secondly, “sick” and “healthy” are not binary conditions. Neither are “rich” and “poor.” There’s a whole spectrum of both. Just because someone won’t die if they eat kale doesn’t mean it may not give them a little indigestion. Just because someone makes more than minimum wage doesn’t mean they feel comfortable paying twice as much for organic, or buying fresh veggies that may spoil before they can use them.

A side piece of this is that lots of people move in and out of those conditions throughout their lives. They may go through periods of illness interspersed with periods of relative health. You can go from being a broke college kid to a comfortable white-collar professional to a suddenly unemployed professional living on ramen all over again.

And the messages you absorb stay with you. If you cross that border from well-off to poor, or from healthy to sick, there’s no switch in your brain you can flip to turn off all the guilt and moral judgment you’ve picked up around food.

And, last but not least, as Rachel Held Evans is fond of saying in a completely different context, if your gospel isn’t good news for those who are struggling, then it’s not really good news. If your food gospel doesn’t work for people who are broke, or stressed out, or sick, or tired, then it’s not really the one true way of eating, and perhaps you should stop trying to preach it to everyone who will listen.

How long can you hold your breath?

Just ran across the comment “If you regain weight, it’s because you eat more calories than you burn,” on Twitter. (It was from Suzanne Lucas, aka Evil HR Lady, whose unhelpful advice to fat job-seekers I’ve mentioned before.)

Technically, that’s a true statement. Your body can’t create adipose tissue out of nothing, and calories that are used through the day aren’t available to be turned into fat stores.

*But* there’s no guarantee that “more than you burn” isn’t still “less than you need to get through the day” or even “less than you need to avoid passing out.” (My first hint that the South Beach Diet forum I was participating in may have been a tad unhealthy was when people were talking about feeling faint and light-headed and experienced dieters responded, “Oh, yeah, that’s detox. It’s totally normal and it’ll be fine.”)

There’s also a limit to willpower. Sure, in theory, every bite you put in your mouth is a choice, but bodies are good at overriding conscious controls to do things that ensure survival. For instance, have you ever heard of someone holding their breath until they pass out? (There’s apparently a “fainting game” but it sounds like you need to press on the arteries in the back of your neck or have someone else make you hold your breath. So not quite the same thing.) Even toddlers throwing tantrums, if they pass out, it’s apparently breath-holding syndrome, where they stop being able to breathe. Not just that they hold their breath out of stubbornness until they fall over.

Similarly, pain tolerance tests are done by having the subject stick their hand in cold water (called a cold pressor test). The cap is usually five minutes, and between half to two thirds of people can actually make it that long. One interesting test showed that tolerances were the same whether participants were offered a dollar for every 15 seconds they could keep their hand in or only a penny per 15 seconds. (To me, that indicates that it’s a pretty involuntary thing, if money is no motivator when your test subjects are undergrads. Make it the whole five minutes and you can order pizza.)

So if you can’t hold your breath until you pass out, and you can’t hold your hand in cold water indefinitely, why would we think that most people could ignore hunger by sheer force of will, not just one day, but for the rest of their lives, eating only enough to keep them below their target weight (regardless of whether that’s enough to actually function on)?

I mean, sure, I “choose” to be fat in that there are things I can do that would make me temporarily less fat, and I might have a tiny chance of maintaining them permanently if I want to make it a part-time job. Or possibly a full-time job. I’d probably destroy my joints and my gall bladder in the process and further wreck my metabolism, but sure, that’s a choice. Not a choice I owe someone who doesn’t like looking at me. No more than I owe it to someone who doesn’t like looking at acne to take Accutane for the rest of my life. (I know, silly me, being selfish and wanting to have a family, rather than taking meds that cause fatal birth defects so I can fulfill my sacred female duty of being as attractive as possible to random men.)

And that’s really what it comes down to. Bodies, particularly fat and/or female bodies, are seen as public property, so in this bizarro-world, it’s reasonable to expect someone to reshape their whole life and risk their health to make their bodies culturally acceptable. And because it’s “a choice,” it’s totally okay to discriminate against those who can’t pull it off, or who aren’t willing to try because, you know, they aren’t masochists.

Doggie on a Diet

[Possible trigger for weight loss talk. Primarily about animals rather than people, but connected to diet culture.]

As I’ve mentioned before, the hubby and I foster dogs for a rescue organization. Our first foster, Reba, is now happy in her new home, and we have a second foster, Hershey Girl.

Hershey is an eight and a half year old beagle. She’s incredibly sweet, though shy at times and somewhat concerned about cats (largely because my cat Thomas is, well, kind of a butthead).

She has mammary tumors which we’re hoping are benign. Fortunately, they frequently are, but we won’t know anything until they actually do a biopsy. We’ll try to get her adopted out either way, but if she does have cancer, it will most likely become our job to make her remaining time as happy and comfortable as possible and be with her once it’s time to put her to sleep. (She belongs to the rescue, so that would be their call, not ours.)

Hershey Girl is also very fat. Average for a female beagle is 22-25 pounds, and she weighs 37. So, we’re going to try to help her lose some of that. Which, as you can imagine, is a little conflicting for me.

I know dogs aren’t people, and I don’t want to conflate the two or let my feelings about diet culture interfere with taking the best possible care of this dog that I can. And yet, I have to think that if it’s not as simple as “calories in, calories out” in people, is it really that simple in animals?

Heck, I know it’s not. I’m sitting next to a fat cat (Haley) who’s far more active than our other cat (Thomas). Thomas, however, isn’t fat. He has a bit of a belly, but mostly he’s just a big cat. Thomas, the leaner cat, is also the first to the food dish, the first to mew piteously if we haven’t fed him the minute we get up, and the first to get all indignant when we make food for ourselves and don’t give him any. But the fat kitty is also a spayed female, which tends to cause weight gain.

The other tricky thing is that dogs and people have very different internal cues. Dogs tend to be always hungry and not necessarily self-regulate. There are plenty of dogs who would eat their dinner, the rest of the bag of food, and everything vaguely edible on the counter if given half a chance. I know this isn’t true of all dogs (Diamond is sleeping next to a bowl with food left in it as we speak), but it’s pretty common.

People, on the other hand, are usually good at self-regulating if they have access to a variety of food and real permission to eat.

So, while it makes me a little twitchy, we’re going to count calories for the puppy dog, limit treats, and take her for lots of long walks. But, at the same time, we’re not going to focus too hard on weight loss. If a reasonable quantity of high-quality food and fun exercise doesn’t make her a smaller puppy dog, it’s possible that she’s just not going to be a smaller puppy dog, and I have no intention of getting sucked into the “weight loss at any cost” panic. Basically, we’ll worry about keeping her as healthy as possible, with the hope that healthy things will also lead to weight loss, which is likely to be good for a senior puppy dog’s joints and energy level.

She’s been in the shelter for a while, and she was surrendered because her people lost their house. So I imagine that she hasn’t gotten enough exercise for quite a while. And beagles don’t tend to be demanding about exercise, so it’s easy not to get them as much activity as they need physically. Our last foster, Reba, was a crazy, crashy, two-year-old pit bull. If you wanted her to be sane and not eat the couch, you would make sure she got a long walk and the chance to run around every day. Hershey Girl, on the other hand, gets excited when you put shoes on, but is pretty content to snooze on the couch all day. So, with all of that, I’m fairly confident that she’ll lose a few pounds once she has a chance to get plenty of walks.

Right now, she has kennel cough, so we won’t worry about weight stuff until she’s better. She’s currently on the all-chicken all-the-time diet because her throat seems to be bothering her and she wants nothing to do with kibble. I’m not sure Ellyn Satter’s awesome food pyramid applies to dogs, but “enough food” and “acceptable food” are definitely the first priority. And we’re being very conscientious about not pushing it on walks, because exercise aggravates the coughing. This is part of where health takes priority over weight.

Holidays and Body Image

I just got back from visiting my parents for Christmas. It’s over seven hours’ drive between our place and theirs, so we don’t see them nearly as much as I’d like. I had a fantastic Christmas in pretty much every respect except the fact that I didn’t go to church. (Yes, I am a slacker. Yes, I have one excellent idea for a New Year’s Resolution, not that I ever actually keep those.)

My dad always makes a ton of food, because he loves feeding people. And there were no comments about this or that food being “bad” or judgment about who was eating what. Well, we did give my brother a little grief over his love of stuffing, but not in a “You shouldn’t eat that” kind of way. More in a “pass the stuffing to him *last* so the rest of us get some” way. And I ate what I wanted, not to the point of feeling gross or overfull afterwards.

And my mom, when she asked what size I wear for clothing gifts, didn’t say anything negative about the fact that I need a plus size. She just went out and bought me a gorgeous sweater (which I love).

I feel really blessed that my holidays weren’t a weight-related minefield, like so many people’s are.

It made me a little wistful to look at all the old family photos and see myself five, or ten, or twenty years ago. I thought of myself as a fat girl in high school, but when I look at my homecoming pictures, I see someone who’s a pretty average size. Kind of chubby arms, and a round face, but not what you would call fat. Probably wearing a size 14 at the time, so very average. And the pictures of me in college, I’d actually call thin, although I never felt that way at the time.

It’s strange to look at pictures that don’t reflect what felt like reality. But then, it’s not like I manufactured that feeling of “too fat” in my own head. That was what bullies said to me (among other insults, of course) all through later elementary and junior high school. I got called a whale, and all the usual insults. And my parents tried to help me with my “weight problem” and encouraged me when I dieted, and when I lost weight. So even when I wasn’t fat, I was viewed that way. But when I look back at actual pictures, I see a slender child become a chubby young teenager, then an average teen and a slender young woman (who then became an average, then chubby, then fat woman, helped by both regain after dieting and my thyroid throwing in the towel).

It seems like the negative messages are always louder and more prevalent than the positive ones. I’m sure I heard, implicitly or explicitly, that I was fat, or ugly, or weird, or gross, much more often than I heard that I was beautiful, or special, or loveable. Which is not to say that my parents messed up my self-esteem. Heck, my mom always had plenty of positive, encouraging things to say to me–they were just drowned out by the overwhelming onslaught of negative. The fact that I emphasized and magnified the negative and took it to heart, while discarding most of the positive, didn’t help.

I also think this ties into sexism. Our culture spends so much time teaching girls that their only value is a very narrow sort of beauty and that they can never be pretty enough, so of course when you’re told you don’t meet the standard, it hurts worse, and it sticks with you.

I didn’t mean for this to be such a depressing post, because I had a wonderful Christmas and am still having a fantastic vacation. But remembering how much I used to hate myself for not looking the way I thought I was supposed to look, well, it just seems sad. So much wasted time, so much needless pain. And I think that if we could figure out how to build a culture that doesn’t teach people, particularly girls, to hate themselves, that would be pretty awesome.

Mediocrevores

I really like this article about all the guilt, judgment, and general craziness around food choices. The idea is that a huge part of this comes from the dizzying array of things to consider in order to feed yourself. Not just what do I have access to and what do I like, but all the health and ethical and other things. And there’s no way to do it perfectly.

Given the range of food options and the variety of demands we try to satisfy when we shop and cook, it is no wonder that most of us feel like mediocre eaters – call us “mediocrevores.” We do the best we can, but we know every meal we eat could have been lower calorie, higher fiber, less processed, more local. The Chorus of self-hating eaters is what happens when mediocrevores see people who appear to have solved the food problem and then project their dissatisfaction with their own choices onto them. The Soloist is what happens when a mediocrevore needs to persuade you of his superiority in order to persuade himself.

I would love to see everyone chill out about food, especially at work. I always feel weird if I’m eating a salad or a “healthy” frozen meal and people talk about how “good” I’m being.

Hey, let’s start the food craziness as young as we can.

A school in Chicago is actually banning homemade lunches (unless a kid has allergies). If they don’t want the school lunch, oh, well, sucks to be them. If they don’t qualify for free or reduced lunch, but $2.25 a day still seems a little pricey compared to a sandwich and a baggie of veggies, too bad.

There are so many things wrong with this that I don’t know where to start. First off, it’s really overstepping the school’s boundaries to say parents can’t send a lunch with their kids. It’s a slap in the face that implies parents are too dumb to properly feed their kids and that teenagers aren’t capable of putting their own lunches together.

Secondly, the fact that they only offer reduced fat dressings and mayonnaise–well, that sounds good, but it depends on the salad dressing. Since it’s a school cafeteria, I’m guessing they’re cheap and not wonderful. A lot of reduced fat dressings are kind of gross, and if that’s the only option a kid has for eating a salad, how many will just pass on the veggies completely? But somehow that’s supposed to be better than eating and learning to like veggies with real salad dressing.

Third, if a school is insisting that its meals are the only thing kids can have, they had darn well better be providing meals acceptable for all religious and ethical food requirements. And not, “Oh, you’re a vegan, you can eat salad every day”–an actual balanced meal with kosher, halal, and vegetarian/vegan options. Something tells me they’re not managing that.

I’m pretty sure that parents and older kids have a much better idea of what would be good for that individual kid to have for lunch on a daily basis than a cafeteria trying to feed hundreds of kids. Depending on metabolism, growth, and activity level, some kids might need a lot more food than others. I worry that all the concern about “not making kids fat” is going to mean not feeding them enough–which can, ironically, screw up their metabolisms and make some of them heavier.

Plus, the main function of school is to have kids learn, not to be their babysitter, dietitian, life coach, and parent. School lunches should support that purpose, but if kids don’t get enough food or are skipping meals because they aren’t allowed to pack their own lunch, their academic performance is going to suffer. And seriously, with budgets getting cut left and right, schools are hard-pressed to do their one main job and do it well. A lot of them don’t do it well. Do they really need to divide their attention by being the food police too?

The other really problematic thing about this is that it teaches kids a restrictive attitude toward food, as well as making sweet and fatty foods forbidden—and all the more attractive. When I was in high school, I remember coming home at 3:45 or so absolutely ravenous, having had lunch around 11:30. And the first thing I wanted was a sweet or fatty snack. Limit kids’ calories and severely restrict their choices at school, and a lot of them will probably tear into the potato chips and Little Debbies the minute they get home. Not because they’re greedy or gluttonous or bad, but because that’s what your body wants when you haven’t had food for a while, and because when you get past a certain level of hunger, your sense of fullness gets out of whack. Especially if, you know, you’re a growing child.

Even worse than this school, though, is a school in Tucson mentioned toward the end of the article. They have a bunch of restrictions on what parents can send with their kids: they can send a lunch “only if nothing in them contains white flour, refined sugar, or other ‘processed’ foods” but the school doesn’t have a cafeteria. Seriously, when you’re not providing an alternative, you shouldn’t get to dictate what parents provide.