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E5: 7 Domains of Food

Nov 30, 2020

Food touches the lives of every living being on this planet. Food can make you feel happy. Consuming certain foods over others may or may not align with a specific faith. And of course, some foods will make your body not feel so good. Clinical dietitian Kary Woodruff joins this episode of 7 Domains of Women's Health to talk about how food affects a woman's life and the lives of those around her.

Episode Transcript

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Food is an Incredibly Powerful Motivator

Everybody thinks about food on occasion. And all religious holidays and cultural holidays are surrounded by food, or by fasting and then surrounded by food. So food has a powerful role in our life for health, for illness, for our spiritual lives, for our emotional lives.

My mother was a great cook, and she cooked in German, and she cooked in Mexican, and she cooked in American. She didn't really cook in Asian, but because she had lived in those countries, she was a really good cook. And she passed down some of her recipes. But all important dates and "I love you" was said in food.

And she passed on this interest in food to her four children. We are all highly food motivated. When we get together, all we do is talk about food, food we're going to eat, food we did eat, the best food we ever ate. It was hard for people sitting at the dinner table who were not food motivated, and that would include my husband, whose family is not food motivated, and neither is he.

So those of us who eat to live, and that would be my husband, and those of us who live to eat, and that would be me, and to every family, food means something different. But as we're trying to grow our children and trying to feed our grandchildren, nutrition takes our focus from just any food that is yummy to something that's good for us.

To Eat, or Not to Eat?

Often, at least in our culture, women make the decisions surrounding food. They plan the menus. They have a kid who only eats white food, and then they've got a kid who won't eat that, and they have a kid who's allergic to this, and the husband who is a meat-itarian, and they might be snacking on the food they make for everyone. So by dinnertime, they are all full.

Kary Woodruff joins this epsiode and Kary is a registered dietician, a clinical dietitian, and that means not just talking about food, but clinically thinking about food, and assistant professor here at the University of Utah about food and nutrition.

Dr. Jones: Thinking about the health aspects or the physical aspects of the seven domains, there are people who have to eat certain things or have to not eat certain things, and those would be diabetics, or people with liver failure, or maybe some people with an odd genetic disease like phenylketonuria...

Kary: So there are individuals, for example, you identified PK. Someone who has a diagnosis of PKU, phenylketonuria, they need to avoid anything that has been phenylalanine in it.

Dr. Jones: That's a basic amino acid that all of us need supposedly. And it's in everything, isn't it?

Kary: Correct. Well, all protein foods. And so it's really a diet comprised of refined carbohydrates and really sugar-containing foods. And so they rely upon dietary supplements to make sure that they're able to meet their dietary needs for vitamins.

Dr. Jones: And people with liver failure aren't supposed to eat a lot of protein, right?

Kary: Yeah, depending upon their stage of liver failure. Absolutely. Or even with kidney disease, end-stage renal disease, they need to be cognizant of their protein intake, depending upon their stage of dialysis or form of dialysis as well.

What I find is clinically there are very few patients who, in a medical setting, really don't have some sort of dietary implication of their disease. So it could be more mild or moderate. It could be more extreme. But so many of our body systems are impacted by the foods that we eat and the nutrients that we consume. And so, to some degree or another, almost any medical condition may necessitate some sort of adjustment or tweaking with our diets.

Food Allergies vs. Perceived Allergies

When I have a dinner party or invite people over or having people stay, I now automatically, in my email, say, "Are there any food preferences?" because more and more people say, "I'm allergic to this, this, and this." But I didn't know that people could be so allergic to food. What are these food allergy things? And what's a food allergy versus food preference?

Kary: The body's immune system is responding to that specific antigen. And so, in that case, that person does need to eliminate the food from their diet because if not, that could result in maybe mild symptoms of itchy, rashy skin, or very severe symptoms of anaphylaxis, which can be life threatening.

Dr. Jones: So anaphylaxis is when their throat closes, and they can't take a deep breath, and they can't breathe. So they can have hives, or they can have difficulty breathing or feeling like their mouth is getting swollen. Those are scary things.

But then there are people who say, "Oh, no, I'm allergic to this, that, and the other." So I always ask as a clinician, "What happens when you eat that?"

Kary: A lot of times, there are perceived allergies. And by that, it could be an intolerance. So a very common example would be gluten intolerance. Now, there is a condition called celiac disease, which is an autoimmune disorder, whereby the consumption of gluten, which is a protein type in wheat, barley, and rye, causes damage to our gastrointestinal system.

But some individuals really do seem to be more sensitive to gluten. The challenge is some of the studies, if you actually do a placebo-controlled study, if someone thinks that they're consuming gluten, they may often report the same symptoms even if there actually was not gluten in the food.

Some degree of bloating is normal when we consume food, and some degree of just feeling of fullness is very normal. Fiber is contained in many healthful sources of wheat, and so some of that can just be normal digestion. But I think there's a little bit of media hype around bloating and distension that we've almost become... potentially, some individuals are a little hypersensitive to that.

Food is Love

My table food is love, because that was my upbringing. Food is love. I want them to be completely comfortable with what I offer. My goal is to honor everyone's dietary preferences, which can be an emotional choice. It can be a spiritual choice, meaning people who've made either a religion... their faith demands that they not eat meat, or they can't eat certain kinds of meat. I think of religions, and I think of Islam, and I think of Judaism where they can't or don't eat pork and shellfish.

There are some reasons some people have. Epidemiologists and anthropologists have said, "Well, here are the reasons that people don't eat pork and don't eat fish." But I want to make people comfortable at my table.

Dr. Jones: You work in the hospital. You have people who say, "I can't eat this because of my faith," or, "I'd prefer not to eat that"?

Kary: Yes, absolutely. And it absolutely depends upon the specific faith. So, for example, someone who is Jewish and they follow the Kashrut would dictate that they don't do animals that actually chew their cud, or that have, I think, split hooves is what the Bible says. So, in those instances, they would not eat cow products. And so pork would not be allowed.

And they would not eat shellfish because it doesn't have both fins and scales. So that's in accordance with the Kashrut, which is provided by the Bible in the Old Testament. And so those dietary practices are followed by members of the Jewish faith.

Now, someone, for example, who is Hindu, they're going to follow the do no harm principle. And so, for them, they may choose to be vegetarian or vegan, depending upon their personal preference and their interpretation of that principle. They may limit their intake of animal foods or omit them altogether. And that's out of the principle of doing no harm to other organisms, to other animals.

And so it does depend upon the specific faith as to what foods might be not allowed and why, but many different religions do have specific dietary principles.

Your Food Choices Have Environmental Effects

The WHO came out and said, "If the planet ate less meat, we would have less carbon dioxide. It would be a healthier planet." So some of the choices we make actually affect our environment just in terms of the food choices that we make.

Kary: The production of meat, it results in greater carbon emissions. And then also the input, so the amount of water, for example, that's part of the food manufacturing system of producing meat is much greater than for plant sources of protein.

Dr. Jones: In terms of trees, I think of what's happening in Brazil. Do you have to burn down the rainforest so you can make places where cows can graze? Because they don't graze on the rainforest. It becomes difficult.

Respecting Other's Food Choices

Can a vegan be happily married to a meat-itarian? How does that work out? There are obviously going to be some ethical implications of that as to why someone is following a vegan lifestyle, out of what principle. And if it's for how the animals are treated, there might be some ethical tensions there.

Michael Pollan says it best. He says, "Eat foods, mostly plants, not too much." And whether you consume some meat as part of that dietary approach, it can still fit into a plant-based diet. Plant-based diet is sort of a catchall phrase, but it's a diet that subsists of mostly plants. But sure, maybe some chicken or other environmentally sort of sustainable forms of protein are included in that, and yet still be a plant-based diet.

It's done with honor. As long as each honors the other's choices and supports them as best they can. It doesn't help when people don't honor someone else's choices.

Do Diets Actually Work?

So let's talk about Princess Kate and the Dukan diet. It's very popular in some circles—it's a periodic fasting. And that actually makes sense to me based on how we evolved to eat. We evolved, I think, not having a refrigerator full of yummies that we could eat on every couple of hours. We might have had things that we ate every couple of hours, but we had lots of time and we didn't have food.

Kary: Metabolically, there are some advantages to the intermittent fasting approach. Now, keep in mind, intermittent fasting is a catchall phrase. There are so many different ways to approach that. So it could be alternate day fasting. It could be limited hour fasting, so eating for 8 hours a day, fasting for 16 hours. So there are lots of different iterations of it.

But here's where my bias as an eating disorder dietitian comes in. So what happens, though, when we don't have food?

Dr. Jones: You mean other than I get hangry and I get pretty cranky?

Kary: Right. And then from an evolutionary standpoint, our bodies have evolved to prompt us to think about food. That sort of concept of deprivation can really result in the opposite end of the spectrum, of thinking about it all the time and seeking it out and can result in bingeing.

So, from sort of a medical and metabolic standpoint, it can work. And for some people, it's very sustainable. They don't experience any of these sort of increased thoughts and fixations on food. But for some individuals, they find that restriction of intermittent fasting can really exacerbate or worsen one's relationship with food and can prompt some unhealthy thoughts as well.

But more and more, we're learning diets don't work in terms of long-term studies of how effective they are. Now, short-term, three, six months, people may lose weight. Ninety percent to 95% of individuals gain the weight back. Sixty percent of those individuals will gain even more weight back. Long term, now. We're talking three, five, or more years out. So that's the challenge.

Eventually we're going to go off of a diet. And so, if what we're doing is something that is viewed to be temporary... even though there's sort of this wellness culture that now is putting everything as a lifestyle. But cutting out so many food groups like the ketogenic diet, for very few people, that's actually a lifestyle, and it really is more of a diet. Then when they go off of that approach, they then resume their previous dietary habits.

So what's the best diet? I really have come back to sort of my catchphrase... balance, moderation, and variety as an approach to food. I really like Michael Pollan's tagline of "Eat foods, mostly plants, not too much," and really just focusing on increasing the healthful components of our diet, decreasing some of the what I call foreign substances, foods that our bodies are not used to consuming, so the more processed foods.

It's not very sexy, it's not very exciting, but it really is how we can sustain a helpful relationship with food and try to sustain our health.

Food Do's and Don'ts

It's hard to do the right thing, but the good news is there are so many ways to do the right thing. There's no one perfect or right way.

  • DO have both everyday foods and sometimes food in the house. Everyday foods are foods like fruits, and vegetables, and proteins, and dairy, and healthy fats. And sometimes foods will be the sweets, and treats, and snacks.


  • DON'T moralize food. It's not that the apple is morally good and the chocolate cake is morally bad. The chocolate cake can be just as good for us sometimes as the apple is. And so it's just recognizing that we have our everyday foods and then we have our sometimes foods and try not to moralize it.


  • DO eat a balance meal. Include a protein source, a whole grain source, and a fruit and/or a vegetable.


  • DON'T be a short order cook. Cook one meal for the family. If someone doesn't like it, they can make themselves some neutral food, such as peanut butter toast


Dr. Jones: I think the fabulous thing about living in a multicultural society is how many fabulous flavors we have. But actually looking at the way the grandmothers of our multicultural societies cook, whether it's Indian, or whether it's Middle Eastern, or whether it's Mexican, or whether it's Asian or if it's Native American, you take a look at the way the grandmothers cook, that gives us a view of probably a healthier way to eat.

Kary: Absolutely. They are preparing foods that are minimally processed, lots of chopping and cutting up of vegetables as a good base, and whole grains, and really sticking to foods that have been around for thousands of years.

Dr. Jones: Well, that's my pitch for keeping grandmothers healthy.

Health Haiku

Food is personal
You don't like stuffing or sprouts?
Hey, don't yuck my yum

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