THE MEDICINE

The Monthly (Australia) - - FRONT PAGE - Karen Hitch­cock

Ionce read a book called Eat!, which I vaguely re­call claimed you could eat as much as you wanted as long as the food had zero fat. I wasn’t over­weight, but I was 21 and thought ex­treme skin­ni­ness would solve all my world’s prob­lems. I gave it a go. Fat-free yo­ghurt and milk, fat-free stir-fry and pasta and soup, fat-free crack­ers. Even if it were true that you could con­sume tonnes and never gain an ounce, who’d want to over-eat those ter­ri­ble in­dus­trial con­coc­tions? Who’d want to give up but­ter and cream and olive oil? Diet trends ap­pear, cap­ture the pop­u­lar imag­i­na­tion, fill plates and on­line fo­rums, and then fade away: cab­bage soup, Rus­sian gym­nast, low-carb, no-carb, fruit, juice, Pa­leo. The most pop­u­lar ones have in com­mon the claim that you can still eat lots and lots but only of a cer­tain thing. But right now it’s all about in­ter­mit­tent fast­ing.

One day each week I see mor­bidly obese pa­tients who seek to lose weight. I spend about a quar­ter of each con­sul­ta­tion re­fut­ing dele­te­ri­ous diet myths they’ve heard, read or watched: eat six times a day, don’t skip meals, brown bread doesn’t count, ar­ti­fi­cial sweet­en­ers are fat­ten­ing, a litre of fat­free ice-cream is not. One 200-kilo­gram wo­man told me, “My main prob­lem, I know, I know, is that I don’t eat break­fast.” When I told her she didn’t have to eat break­fast her eyes nar­rowed, as if she were con­sid­er­ing re­port­ing me to the med­i­cal board. Bloody break­fast and its pur­port­edly mirac­u­lous fat­melt­ing, me­tab­o­lism-boost­ing, hunger-di­min­ish­ing qual­i­ties. I don’t eat break­fast and never have. I’ve been lec­tured about the in­ju­ri­ous ef­fects of this trivial life­style prac­tice in­nu­mer­able times. So it was with ut­terly bi­ased glee that I started to read re­ports of the health ben­e­fits of not eat­ing break­fast, of not eat­ing con­tin­u­ously, and of ac­cru­ing a de­cent fast to break.

Cur­rent re­search in­di­cates that eat­ing break­fast does not lead you to con­sume fewer calo­ries over­all through­out the day, it doesn’t boost your me­tab­o­lism in any mean­ing­ful way, and for most of hu­man his­tory it didn’t even ex­ist. His­to­ri­ans blame the in­ven­tion of break­fast on the aris­toc­racy (and the mim­ick­ing of them), the in­dus­trial rev­o­lu­tion, and Mr Kel­logg squash­ing a stale ker­nel of corn in 1906. Eat­ing three meals a day is a so­cial cus­tom and a habit, not a phys­i­o­log­i­cal re­quire­ment. An­cient Greeks and Ro­mans ate only one per day, in the mid af­ter­noon. In Eng­land, un­til the mid 19th cen­tury, the cus­tom was two meals per day. The av­er­age ci­ti­zen in a Western coun­try to­day eats reg­u­larly for 15 hours of each 24-hour pe­riod, feast­ing and snack­ing and slave-driv­ing our liv­ers as if in prepa­ra­tion for a famine that never comes.

In 2015 the word “hangry” was granted a place in the on­line Ox­ford dic­tionary. Hangry – a hy­brid of “hun­gry” and “an­gry” – refers to an ir­ri­ta­ble mood caused by hunger. It’s a funny time in his­tory for the word to ap­pear, a time when hardly any­one in the de­vel­oped world need truly be hun­gry. Did our fore­moth­ers and fa­thers get hangry dur­ing the De­pres­sion? Did en­tire vil­lage pop­u­la­tions walk around snap­ping at each other dur­ing times of famine? It seems hunger has be­come such a nox­ious sen­sa­tion to us that it brings with it an emo­tional dis­e­qui­lib­rium wor­thy of its

very own word. What’s so bad about tem­po­rary hunger?

For thou­sands of years peo­ple have fasted for health, for weight-loss, for re­li­gious rea­sons, in po­lit­i­cal protest, or as a symp­tom of a men­tal ill­ness (such as anorexia ner­vosa). There are now hun­dreds of blogs that solely doc­u­ment a week or two’s wa­ter fast, with daily up­dates on how the faster feels, their ke­tone and blood sugar lev­els, their toi­let­ing, mood, de­creas­ing weight, in­creas­ing en­ergy and lack of hunger, il­lus­trated with stylised pic­tures of glasses of wa­ter spiked with mint. These blogs of­ten have dozens of com­ments – con­grat­u­la­tory or mock­ing or warn­ing about the dan­gers of not eat­ing. But noth­ing reaches the hys­te­ria trig­gered in com­menters by the fast-to-the-death, pro-anorexia web­sites and vlogs. The pro-ana sites are full of “thin­spi­ra­tional” pic­tures of scar­ily skele­tal teenage girls, ou­tra­geous star­va­tion tips and a per­va­sive self-dis­gust. A few hours of read­ing this stuff and veg­etable broth for dinner starts to look like a binge.

Eu­ge­nia Cooney is a pop­u­lar YouTube vlog­ger who is scar­ily un­der­weight. Each of her posts has thou­sands of com­ments, most of them crit­i­cal. There is con­cern for her well­be­ing and that of the peo­ple who watch her, but there is also rage, as if her body is at­tack­ing those who eat. Yes, she looks heart­break­ingly starved, but to seek to have her banned? For most young girls she will func­tion more like the warn­ing pic­tures on a cig­a­rette packet than a role model. Starve your­self for too long and you will die. It only took Bobby Sands 66 days. The more com­mon prac­tice of eat­ing your­self to death takes years.

A bariatric sur­geon said to me the other day, “We live in a toxic food en­vi­ron­ment. To stay lean you have to em­ploy con­scious re­straint and say ‘no thank you’, a lot.” If you take a short break from eat­ing, your body gets a chance to metabolise what you’ve con­sumed so it’s not stored as fat, and per­haps to tap into the fat you al­ready have. Liv­ing in a state of con­stant sati­ety also dulls the taste­buds, such that the only food able to rouse them is saltier, sweeter, fat­tier and usu­ally pack­aged in crack­ling, brightly coloured wrap­pers. Eat what you wish, but for fewer hours per day or days per week. The re­search into the di­a­betes­re­vers­ing, brain-pro­tect­ing and life-ex­tend­ing ben­e­fits of this way of eat­ing is com­pelling. Per­haps it will turn out to be the real deal. Wait for hunger. Wel­come it. And then, as my high-school English teacher once told me: never waste your ap­petite.

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