AN ER STORY

I work in the ER.  I see people struggling with their health every day.  I see people suffering, when most of the time, they shouldn’t be.  This is a story of a patient, I will call her Susan, one of those struggling unnecessarily.  She was 52, same as me, but seemed much older.  She had called 911 because of a cough and weakness.  We moved her from the ambulance stretcher to the bed using a large slider sheet which our ER had recently acquired for every room.  They were back-saving devices that were becoming commonplace and necessary. Susan was obese, and, as is often the case, diabetic as well.  She had hypertension, atrial fibrillation, congestive heart failure and lymphedema.  She was on multiple medications that didn’t seem to be helping her health.  She already had one leg amputated and had lost most of her fingertips.  Then I saw her “good” leg which she hadn’t even mentioned as a concern – this leg was literally rotting away.

I removed the soaked through ace wrap and gauze from her leg wound that she told me she had changed a week ago. Her wound was greenish black and was one of the worst odors I’ve encountered, and I’ve been a nurse a long time.  We immediately placed two IVs, put her on the heart monitor, started fluids and antibiotics. She started talking more about her attempts at improving her health. Following her doctor’s suggestion to cut out processed food, she indicated she made the transition in one day, “cold turkey”, going from what she had been eating for years, to whole food. She indicated that what came next was diarrhea, vomiting and coughing up blood.  With tears of frustration and despair in her eyes, Susan told me “I just don’t know what to eat anymore”.  More accurately though, her body simply didn’t know how to digest real food anymore.

We have forgotten how to nourish our bodies and our bodies have adjusted. Our bodies have forgotten how to function.  We have epidemic rates of diabetes and obesity, and along with the accompanying chronic illness and autoimmune disease, our health care (sick care) system has become overwhelmed.  The only way to shift this paradigm is to teach our patients how to take care of themselves better, preventative care.  Like many patients, Susan needed our help, she needed our guidance, patience, time and empathy.  We had let her down.

Most doctors today are allotted an average of 7 minutes for each patient.  This obviously isn’t enough time to address every question or every problem the patient has let alone time to teach, inform and provide resources. Susan’s doctor had told her the right thing, to give up sugar and processed food, but it seemed she really didn’t know how to put that advice into action.  Susan had multiple chronic disease processes, she was on a long list of medications, was an amputee with a prosthesis she had outgrown, lived alone and had no support.  She had just put her dog down because she could not care for him.  She was doing the best she could.

I asked her more about what “going cold turkey” meant to her.  Usually that was a term people used when giving up alcohol or drugs.  To her, however, food was her drug of choice, so giving it up was no different.  She was addicted to sugar and processed food.  She went on to tell me more about how she had tried to change her eating habits.  “I am eating lots of fruits and vegetables, and a little meat”.  “I even tried apples and tomatoes but still can’t keep it down”.  With the amount of confusing and contradictory information available today, she didn’t know how to make a smooth transition to real food.  Her definition of healthy eating was simply “fruits and vegetables”.  Trouble was, her body didn’t know how to process this food anymore, how to process the fiber and bacteria that are in real food.  In short, her gut needed to heal and it wasn’t going to happen overnight.

Changing her diet was not simple or easy for Susan, but she did try.  I’m sure this was not her first attempt at changing her diet, and likely would not be her last, and without support she would continue to feel frustrated and hopeless.  It was not her fault.

So what the heck are we supposed to eat? Plant-based?  Vegan?  Vegetarian?  Carnivore? Keto? Paleo? And what is Paleo anyway? Are we supposed to hunt mammoths?  High fat, low fat, no fat?  What’s the deal with eggs and bacon?  What about saturated fat?  Where does vegetable oil fit in?  And now we are supposed to fast too?  It can confuse anybody.

Unfortunately there is no one size fits all when it comes to optimal nutrition, or a healthy eating plan.  But there is a one size fits most and like Susan’s doctor indicated, most of us will do well to cut out processed foods and sugar.  But what does that mean exactly?  The easiest way to look at it is that anything in a package, or with a label, especially with a label that has more than 3 ingredients, is usually processed.

“But I don’t eat sugar” is one of the most common things I hear people say.  We often think of “sugar” as just the white stuff that’s added to coffee and baked goods, but there are over 50 different names for sugar now.  Since the food industry wants to keep selling products,  they are getting very creative with their labels. When looking at labels, think of them as warning labels. They sneak these hidden sugars into everything, including breads, pastas, muffins, bagels, waffles, pancakes, cereal, and even items labeled “no added sugar”. Sugar from natural sources or not, whether in fruit or fruit-eos is still sugar, your body knows no difference, so some people may have to eliminate fruits, it depends on personal goals and levels of health.  Most beverages should be avoided, but especially beer, fruit juice, soda and wine due to sugar content. Sweeteners are a bit controversial but can generally be used on occasion or as a transitional item.

One last point.  As mentioned, the biggest first step to improving health is to cut out processed food, with its sugar and seed oils, but the second step, almost as important, is to replace these items with more than just fruits and vegetables, like Susan did.  It is simply not sustainable or healthy.  Replacing these items gradually, with nutritiously dense foods, including non-starchy vegetables, protein and healthy fat, will allow your body to heal and will allow for satiety.  There is no need to suffer or deprive. 

Susan ended up being flown out by helicopter to see a surgeon. Unfortunately, two weeks later, I heard she lost her battle.  She chose not to have her rotting leg removed because she could not face having both legs amputated, and along with it, her independence.  Cases like Susan’s are unnecessary and completely avoidable.