I don’t work in the easiest of places. I often dream that I have a job–well, I wouldn’t even call it a job because it would be so pleasant–working in a spa in Cabo San Lucas in Mexico–pushing the little buttons on the blender at the organic juice bar in the crystal waters of the pool. My own Vitamin D needs amply fulfilled by that luscious warm sun as I dispense my little quinoa pearls of wisdom to my very well-heeled clients. My muscles are toned by long walks on the sandy beaches and I teach mindful eating classes using the freshest and juiciest mangoes just picked from a nearby tree to seduce my students’ senses.
Such imaginings deepen my own diaphragmatic breathing and soften my gaze until that little bubble on the electronic medical record program on my computer informs me that my first or next patient has arrived.

I do not wish to complain. I consider it a privilege to do what I do. I believe I sit in a rather unique position as far as seeing the magnitude of the health crisis that is upon us and the consequences of our communal diet and way of life. So often, when I am following the story about food, diet, weight, etc.–no matter where– it seems either abstract and haughty in that scientific or academic way, or judgmental and blaming. The sensationalized situation becomes very up close and personal and takes on a different hue in my little office–where day after day I receive a fair amount of clients– often in quick succession. Sometimes, I wish I could give the scientists, academics, and critics a peek in.

Most people don’t ever get to see a nutritionist. It is unlikely that you have. It is not like going to the dentist–which is a prescribed semi-annual event (except for the millions who unfortunately don’t have access to dental care) the doctor or the therapist. Perhaps it should be. It would be a lot more fun to come to see me twice a year than the dentist. Access to nutritional services is usually reserved for those with a few types of medical conditions or for those with enough money and energy to fine-tune their bodies.

Interestingly, nutritional services have historically been provided in-house in the Community Health Center where I work, along with some other ancillary services like podiatry, ophthalmology, social work, and dentistry. This multi-service type facility is actually rare in our health care environments. Its purpose is to facilitate access to care for patients–and access indeed they do. My clients do not have cars parked in warm and dry garages that they hop into. Instead, they walk, trudge, take a bus– or two, or call and wait for medical transportation. I am continually shocked that so many arrive at my door to discuss this abstract concept called nutrition. Though any patient is eligible to see me, my schedule is padded with the extreme cases that the doctors are more apt to refer. Extreme becomes a relative concept–and many nutritional concerns are overlooked.

As I navigate the raging waters, the intensity increases imperceptibly at some times and quite obviously at others. Like natural phenomena that are categorized by a numerical rating system–hurricanes, white water, etc.–I think our health issues may require something similar. I wonder if my office chair should indicate what kind of conditions it can endure and if it should come equipped with life jackets. Some of what I encounter has to do with sheer weight but not all of it–though I rarely have a day without clients over 300 lbs.

Off the top of my head, let me see if I can briefly describe somewhat what cast upon my shore just within the last two weeks. The 19- year-old male–366 lbs; a 29-year-old woman, 5’2–378 lbs; a 35-year-old male with extremely elevated cholesterol levels; a 7-year-old boy with compromised growth due to ADD medications; a 13-year-old boy with gastric reflux; a 28-year-old male with a blood pressure of 160/110; and, a 23-year-old male-390 lbs who barely leaves his home. This is a very tiny sampling. It excludes the middle-aged diabetics and hypertensives, pregnant teenagers, and folks with mental health and substance abuse issues whom I see regularly.

Then, there was the 15-year-old girl with triglyceride levels of 442 (which I would have not believed except that she had a prior lab with a similar result)–when normal is less than 150. She entered my office at 3 PM with her parents. When I asked her what she had eaten that day, she told me a bottle of Mountain Dew, a granola bar and a Snapple Iced Tea. She had bought all of this just before her appointment. She had not gone to school that day. She had already finished the soda and the granola bar–showing me the wrapper. Her dad was holding the iced tea that they were still sharing. Within six minutes of our acquaintance she informed me in no uncertain terms, that no matter what I may say, she was going to have Burger King on Friday. The mother challenged me on why I was asking her about shopping and cooking. This was near the end of an already very long day–my late day. It took me about fourteen minutes to discover that this child drinks close to twelve cans of soda on many days. Diets high in sugar are a cause of high triglyceride levels. Though I was grabbing onto my chair, and despite the fact that finally the mom smiled at me–it was too late. I capsized.

Though this family seriously challenged my inner buddha, for the most part, I find my clients present themselves authentically– and that their eating behaviors and nutritional problems are consequences of many various conditions that they did not know how to or did not have the resources to control. Like most of us, they are living the hand they were dealt and eating the food that they can access and afford. They are generally unaware as to what could go so terribly wrong. Despite my sympathies, I still feel like a shipwreck survivor. Some serious stuff is going down and people are hurting.

However, the universe works in mysterious ways. Exactly one week after my encounter with the girl with the dangerous triglyceride levels, another family presented–this time a mom, dad, and their twelve-year-old son. This family had recently awakened to their capacity to make better food choices. They joyfully filled my tiny space and shared the amazing changes they had made. They described how they felt, how their bodies had responded and the new foods they were eating. The boy was pleasant and confidently told me that he no longer drinks soda. He plays some sports for fun, loves to move and is in a dance troupe with some friends. They have made some videos on youtube. As they spoke, I crawled onto the dock, shifted the lever on my chair to the lounge position and laid back to bask in the afternoon sun. There was nothing for me to do but listen and affirm. Now, this I can do.

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In health, Elyn

 

 

 

 

 

 

My Plate Buddhist Saying

Drink tea and nourish life

With the first sip, joy; with the second sip, satisfaction; with the third sip, peace;

With the fourth, a Danish.

by Jewish Grandpa