Veggies

About a month ago a classmate on his family medicine rotation told us about the hypertension (high blood pressure) clinic he was at that week. He remarked that he was going to try the DASH diet that we tell patients to follow, which stands for Dietary Approaches to Stop Hypertension. Essentially, it is all about eating 10 servings of fruits and vegetables per day, especially at the beginning of a meal before getting to the other stuff like meat, bread, potatoes, etc. So I decided to give it a try too, not even paying attention to reducing salt, but just concentrating on the 10 servings.

It's hard! I'm so full after eating fruit and vegetables that I don't have room for much else. Of course, I also try to keep it reasonably low-fat, without actually going on an "official" diet. I don't pile on the butter, although I do use some to keep it interesting. And since I started this because I wanted to see if I could do what we tell patients to do, I also began to ponder how I could convince someone used to eating pretty unhealthily to start eating well. And I think the answer is in 1) changing expectations and 2) educating taste buds.

I was raised on plenty of veggies daily, and our minimum level was salad with dinner every single night. It was a very simple salad, but its mere existence got us accustomed to eating fresh vegetables, I think. Even for "movie night" where we had popcorn and chicken nuggets and potato chips, we also had carrot and cucumber sticks without fail. So even now I have a fundamental expectation that there will be some sort of vegetable to eat every day. In fact, if I don't have fresh veggies for a while, say I'm on a trip, I start really noticing their absence and missing them, just as I would unhappily notice if I hadn't eaten any meat or starch in several days.

A while back, my uncle Tom gave me bunch of veggies from his garden. They were delicious! And that is my second point. The typical Western diet is really just a super-saturated behemoth of taste. Like McMansions and SUVs, Americans tend to want bigger and more, like taking something sweet and adding something else sweet to it to make it even sweeter, instead of just enjoying the one sweet thing on its own. Like cake and ice cream with chocolate sauce. Deep-fried Twinkies, anyone? You get my point. It's just more! more! more!

In grade school I remember we did an experiment in science class when we were learning about the digestive tract and the enzyme amylase. The teacher told us that amylase starts breaking down starches into glucose in the mouth, even before the food gets to the stomach. And to illustrate this, we all took a bite of plain white rice. After several chews, the rice indeed started to taste sweet, and we were amazed! So really, veggies and grains have their own sweetness that we have trained ourselves out of being able to appreciate with our 30-teaspoons-of-sugar-per-can sodas. Of course steamed broccoli will taste bad when your taste buds are hungering for tons of cheese, salt, or ranch dressing; they're underwhelmed because they've been oversaturated for so long. But if you slow down a minute (take time to chew a little more and let that amylase start to do its thing) and actually learn to appreciate the subtlety of a vegetable, I think it starts to become a more enjoyable, and thus, sustainable operation. Growing your own is a great start, because you're already primed to have pride in and appreciate your creation.

This all is exactly the same as music or art or finances or NASCAR. To those unversed in it, classical music sounds all the same; so does rap or country music. Art can be pretty boring, especially modern art, which just looks like paint splotches to me, as can finance for those of us who just want to stick money somewhere and have it grow a bit. To the casual observer, NASCAR is just driving in circles. So appreciating fresh veggies is really the same as with anything; the more you take interest, the more you know, then the more enjoyment you get out of it, and eventually you will be able to discriminate higher quality from the crap.

I wonder if any of my patients will be convinced... what do you think? All right, back to the grind. I can't believe I wasted my study break thinking and writing about patients!!!