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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Food and Consent

I love this post from the Fat Nutritionist about a couple where one is a picky eater and the other is a foodie and keeps pressuring her to try new things.

People have to come around to food in their own time. If they aren’t allowed to, if they are pressured or forced or coerced into trying something that they find intimidating, there is a very good chance they will not suddenly love that food, will not have the Foodie Switch in their brain flipped to the On position.

More likely, they will associate more anxiety with that food, not less, and it will probably taint the memory of the delicious thing you were hoping they’d enjoy.

So what do you do instead? I’m going to sound like a broken record, but: follow a Division of Responsibility.

Not the one for parents and children. The one that exists between adults.

As an adult, you are responsible for your own eating. The other adult is responsible for what, when, where, how much, and whether they eat. You can negotiate certain things — where and when are sometimes necessary to coordinate, and if you’re deciding on a restaurant or a recipe, some negotiation around what will also be useful. But you need to remember that any negotiations around what end at offering. Not ingestion.

What this means is, you can both decide on a place to eat, or a recipe to try, and you can put the food on the table and both sit down.

After that? You must chill.

No one has to put anything in their mouth or their stomach that they don’t want. To insist that they do is a serious boundary violation, and a breach of their bodily agency. There is a spectrum of not-okayness that starts with coaxing, wheedling, and pressuring someone to try something they don’t want, and ends with force-feeding. Don’t be that guy.

One of the many (many, many) ways our culture is screwed up around food is the idea that consent isn’t as important as getting someone to eat the “right” things. This shows up a lot in the idea that it’s healthy and normal to pressure someone to eat :healthy” or try to lose weight, but it’s also depressingly common in the pressure to try new foods, or to eat a wide range of things. There’s the assumption that a diet that includes sushi and Brussels sprouts and kimchee is both healthier and more grown up than one that doesn’t, and that it’s the more enlightened foodie’s job to show their picky partner the light. Oh, and the classism. Let’s not forget the classism. Fancy restaurants, exotic ingredients, even the ability to waste food if you ruin a recipe or end up not liking something—those are all privileges.

Also, I love the idea of applying the Division of Responsibility to adults, with each person having total control over what they eat. I think Michelle is absolutely right that wanting to control what someone is eating, even if it’s by “gentle” pressure, is not treating them as a competent adult. I like the extension of the Division of Responsibility as applied to adults. For kids, it’s pretty easy to make that distinction. The adults choose when, where, and what to offer, while the kid gets to decide if and how much they’ll eat. With adults, as Michele says, there can be negotiation around when and where for a shared meal, and even some negotiation around what, as long as it stops when the food goes on the table.

This got me thinking about how this gets worked out in relationships where one person does most or all of the cooking and one partner is very picky or has food restrictions. (These can be related—a lot of severe childhood pickiness results from choking incidents, and the pickiest person I know also has a long list of foods that will make her sick. When food can and has hurt you, it’s pretty understandable that you’d be wary about it from then on.)

If you’re splitting the cooking 50/50 (or thereabouts), this is pretty easy. When the picky/restricted person makes dinner, they know they’ll get food they like. And the more adventurous person has the option to include foods they like when they cook dinner, as long as they make sure there are also things the other person will eat.

If one person is doing the majority of the cooking, though, it gets more complex. Especially in situations where that division of labor is due to work/school schedules, illness or disability, or other things that make it harder for one person to cook. In general, I think the cook gets final say on what they serve. One of the trade-offs of not doing the work of cooking is giving up a certain amount of control over what gets made. (With the obvious caveat that making someone a meal that doesn’t include things you know they can/will eat is a jerk move.) But at the same time, if you’re preparing most of the meals that your partner eats, and they have food sensitivities or restrictions, I think you owe it to them to provide foods they can/will eat that meet their basic nutritional needs. I’d go beyond including one thing you know they’ll eat and say that at most meals, you should include carbs, proteins, and fats that you know they’ll eat. For example, let’s say the only protein they’ll generally eat is chicken, while you’d much rather have steak, or pork, or wild game. If you do breakfast and lunch on your own and split dinner 50/50, that’s only three meals out of twenty-one where they might miss a protein. Probably not a big deal, especially if some of those meals include other sources of protein like beans or dairy. But if you’re cooking every single meal, and a large portion of those don’t include a protein they’ll eat, that’s really not great. And would probably contribute to a stronger sense of insecurity around food and even less desire to try that awesome quail recipe you found.

The same goes for vegetables, although they tend to be higher on the pyramid of Satter’s Hierarchy of Food Needs, probably hanging out anywhere between “good-tasting,” “novel,” and “instrumental.” So, a meal with a veggie that you can’t eat is less of a big deal than a meal where you don’t get enough of the macronutrients to get you through to the next meal. Still, I think you should meet the person you’re cooking for halfway on veggies. If you don’t do veggies at all, and they need vegetables to feel like a meal is complete, then have a side salad or a simply cooked vegetable at most meals. Likewise, if they will only eat corn, peas, or carrots, you should offer one of those three at most meals if you’re doing the majority of the cooking.

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.

Restaurant Portions

Kate Harding wrote a post about restaurant portion sizes, and how you don’t get to go “OMG, that’s why ur all so fat hur hur” in the very same breath as you’re noticing that people take leftovers home. That is, they’re generally *not* finishing that ginormous portion. Though, to be fair to the person who posted it, lots of people *here* fail to grasp the same concept and go on and on about the evils of portion sizes–yes, you get a freaking boat ton of food at a lot of restaurants; that doesn’t mean you have to eat it all. Honestly, I’d rather get too much than not enough, because I can almost always take leftovers home–if I’m still hungry, I have to order (and pay for, and wait for) something else.

I know they’ve done studies where people’s sense of how much they’ve eaten varies dramatically based on things like plate size and whether you’re eating out of a big communal bowl (of chips or popcorn, say) or an individual bowl or plate. The thing I have to wonder is how such an experiment would turn out if you controlled for dieting behaviors or an eating competence score. My theory is that the more you focus on external cues, whether that’s a calorie count or the amount of food on your plate, the less attention you pay to your own satiety signals. So, I’m thinking that people who have been doing intuitive eating for a while would be less affected by things like plate size than someone who hasn’t.

Granted, distraction plays a role too. One of the things that I’ve been working on lately is trying to take time at work to just sit and eat, rather than multitasking, especially if I’m eating something particularly filling. Because if I’m just eating and not paying attention, I go past comfortable and straight over to stuffed before I even notice. Though I will say that on the occasions when I do that, it’s a relief to think of it as a learning experience, rather than an “I’ve wrecked my diet and I’m a horrible person” experience. And it doesn’t happen often.

Go, Paula!

Anthony Bourdain apparently needs a massive reality check. He called Paula Deen “the most dangerous person in America.” Funny, not who I’d have picked. There are murderers, rapists, drug dealers, terrorists, corrupt politicians, insurance company execs letting people die to improve their bottom line, drunk drivers, and your Enemy #1 is a lady with a cooking show? Because clearly all those other ways of dying or being harmed pale in comparison to the scary, scary fat.

Fortunately, she can give as good as she gets. She said she didn’t know if it was a “publicity thing” or if “someone had peed in his cereal.” She also told him to get a life.

I have peaches I want to do something with–I may just try out Paula’s peach cobbler recipe. If you guys don’t hear from me, you can assume it killed me.

Hat tip to Life on Fats

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.

A spoonful of sugar

Katja Rowell over at Family Feeding Dynamics has a good post on how a little sugar helps kids learn to like new foods.

I will definitely say that sugar was instrumental in helping me learn to like coffee. I’m not sure if that’s a *good* thing, exactly, but when I was in college, I sometimes really needed coffee to stay up late working on papers. So I either drank super-sugary lattes or put a ton of milk and sugar into regular coffee. But, gradually, I started to appreciate the flavor of coffee itself and used less and less sugar. I still think my husband’s habit of drinking black coffee is weird, but I have a much stronger sensitivity to bitterness than he does. And, with really good coffee, I might drink a sip or two black.

Also, if sugar is forbidden, a kid is going to want it all the more. Part of appreciating things without sugar is actually satisfying that natural desire for sweetness somewhere else.