 “Are there nuts in that?” was a phrase that I heard over and over again throughout my childhood. My best friend (and current roommate) is allergic to peanuts, tree nuts like walnuts and almonds, and soy. She thinks about and questions every bite of food before it is deemed safe. She finds going out to eat, which for most people is a fun and relaxing social activity, to be frustratingly limiting at best and dangerous at worst. More people now know someone with a food allergy, but are we aware of the mental burden of chronic food avoidance and fear?
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 In America, pregnant women receive a great deal of advice: Eat fish, but only the right kind and not too much. Don’t smoke. Don’t drink alcohol. Don’t take certain over-the-counter medicines. The implication is that by taking these and other steps, a pregnant woman can ensure that her baby has the best possible start in life. But just how much can a pregnant woman do? How much responsibility does she bear for her uterine environment?
 When we think about poverty and hunger, many of us immediately picture the tragic scenes from areas afflicted by famine –people too weak to walk with ribs that can be counted and children with the skinny limbs and swollen bellies characteristic of kwashiorkor. However, in the US, and many other settings, the face of hunger is much more likely to have chubby cheeks.
 What if your experiences as a baby – even before you were born – helped determine whether you were overweight or obese later in life? There is evidence to suggest that this may be the case, and that the prenatal environment and the first two years of life are very important in the development of overweight and obesity. Our early life environments help determine our biological make-up for the rest of our lives. Some of this programming may occur in the bacteria in our stool, also known as the microbiome.
 by Avik Chatterjee, MD John had gotten out of prison just a couple months before, but already felt that he was losing muscle and gaining fat. In prison, he felt he had a routine, and could lift weights and control his diet. As a homeless man, he struggled on both fronts. “Doc, I’m trying to be good, you know, low carb and stuff, but what are some other ways to eat better, you know, like Paleo?”
Obesity and obesity related disease have created a tremendous burden on the health care system, and in my practice with homeless patients, I talk about obesity, weight loss, nutrition, and exercise all the time. The sheer variety of fad diets is dizzying, and countless people, even homeless men like John, are considering trying them. So one would think that medical school and residency would be full of teaching about nutrition. You would be wrong. |
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