Healthy Diet, Healthy Voice

After 35 years of contributing medical advice for readers of CS, I thought that I had covered every possible topic, and planned to graciously exit into the wings of the (virtual) operatic stage. It turns out, I was wrong! Medical science and treatment continues to advance, and how we think about some fundamental health issues continues to evolve, and invite re-evaluation.

Food and diet are examples. There is a great deal of wisdom, old and new, in the field of  nutrition (along with a constant barrage of ulteriorly motivated fake news), and, in answer to several questions from readers, I would like to share just a few of my thoughts on this most important topic. I am purposely not addressing everything- items such as reflux, for example, are well covered in the literature, and could form the focus of another column.

The topic is, indeed, extremely important, in fact, vital! As the old adage has it, “You are what you eat.”  Your DNA, inherited from your parents, is nothing more than an architectural blueprint for your body. All of your body’s building materials and fuel comes from the raw materials you put into your mouth every day. Your digestive tract then converts, in ways that we still don’t completely understand, these elements into the most precious element of all, your living body. In the words of the 15th century physician and astrologer Paracelsus, “ The stomach is the alchemist in the belly.”

Bad food, too much food?

Let’s first look at what we eat. Incidentally, the word “diet” has nothing to do with weight watching, or slimming: it refers simply to what you eat, as in “The panda’s diet is bamboo.” So, everything we eat makes up our diet, whether healthy or not, organic, chemical, excessive, or deficient. In this regard, both quantity and quality of food intake are issues. Dr. Tamdin Sither Bradley, a Tibetan physician practicing in the United Kingdom, looking at the typical Western diet, stated the problem eloquently: “We are overfed but undernourished.”

Simply re-stated, many of us eat too much of the wrong stuff! Our food is nutritionally monotonous, overprocessed,  full of additives. For most of us, in this visually dominated world, our food choices are based on what we see. Fruit is picked unripe, oranges are painted orange. Ripe and nutritious vegetables not the perfect size and shape are discarded at the farm. Flavors are invariably added to otherwise unappetizing foods, with sugar and salt, the two cheapest flavor additives, dominating. A more sophisticated version of this process is the trend toward ethnic and “spicy” foods. Salted and jalapeno flavored nachos represent the same un-nutritious processed carbohydrate.

Even foods generally considered healthy may be insidiously adulterated.  For example, salmon, generally accepted as a healthy source of protein, can vary greatly, depending on how it was raised. Farmed salmon is vaccinated, flooded with antibiotics and hormones, and makes for quite a different dish than wild-caught salmon. In this regard, if you follow a seemingly healthy diet, it may be worth investing some time into researching where your food comes from, how it’s processed and stored, and what the effects of those hidden additives may be on your body. Most people give more thought to picking out their bathroom tiles than they do selecting the building blocks of their own body.

Quantity is a second consideration. Most of us eat too quickly, and too much. We need to keep this in mind especially when we eat food prepared by others. Restaurants usually serve excessive amounts of food- otherwise, how could they charge those prices? And since we are indoctrinated to “clean our plates,” we unquestioningly accept that platter as an appropriate meal portion. In reality, it may be more than enough in that pile of food for you and your companion, even without the appetizers and the dessert.

Processed food manufacturers are also culpable in the conspiracy to overfeed us. Misleading advertising may trumpet “Reduced Calories per Serving,” when all they have done is to reduce the size of the serving.  A small bag of potato chips is actually labelled as three servings! Carbohydrate-heavy snacks, especially simple sugars, raise our blood insulin levels,  drop our blood sugar, and make us hungrier sooner, perpetuating a vicious cycle.

When we eat slowly and mindfully, we can titrate the correct amount we should ingest–our body tells us when it’s enough! Our “appestat,” a region in the hypothalamus in our brain, signals when we’re sated, and when to put the fork down. Our blood sugar level rises with food, and also provides a brake on our appetite. If, however, we eat too fast and in a distracted fashion, we can overshoot these control mechanisms, and eat excessive amounts. Mindful eating also means eating when we’re hungry. Ignoring our internal signals and eating by external clues (by the clock, or when we see others eating), is another contributor to the “eating too much” problem.

Intestinal bacteria and probiotics

A truly revolutionary recent direction in nutrition has been the recognition of the intestinal microbiome, the vast population of bacteria and yeasts that live in our gut. These micro-organisms are beneficial, and we continue to make discoveries about how they contribute to our general health. When living organisms co-exist without harming each other, and especially when both organisms gain from this co-existence, we have symbiosis. The natural world is full of symbiotic arrangements, whether the bees and the flowers, the clown fish and the sea anemone, or endless others. With our intestinal microbiome, the complexity and sophistication of this mutually beneficial symbiosis is truly staggering. A healthy growth of gut bacteria has been implicated in the prevention of many illnesses, physical and possibly even mental.

Enter the commercial health industry, and probiotics. These are pills or capsules containing beneficial yeasts and bacteria that can “restore intestinal health.” Is this just another supplement touted to restore your health, or to prevent illness? Well, yes, given the right circumstances, these supplements may be beneficial. But what are those circumstances? Simply put, you need to eat the right foods for these micro organisms to thrive and to help your body. Imagine that you want to plant a seed, but the soil can not sustain it- too rocky, too acidic, too toxic. You can sow as many seeds as you like, if it “falls on rocky soil,” it will simply not take root and thrive. So yes, you can take probiotics to restore the correct intestinal bacterial flora, but only if you eat foods that will sustain their growth and reproduction. And, like vitamins, you don’t need much, and more is not necessarily better.

So how are we doing?

We don’t have the space to cover every diet-related topic, but let me bring one more idea to your attention. How do you know when you are eating correctly? The right amount, the right quality, the right schedule? There is no single test, or even a combination of  tests that can give us an exact  answer. While many monitor their weight, this is a very rough measure that may just tell us that we are not habitually eating excessive quantities. The body mass index (BMI), derived from combining your height and weight, is only marginally better: two people of medium height and similar weight can vary greatly in muscle mass, fat distribution, and general health.

The answer to the question comes from considering many aspects of your physical and mental function. Are you fit? Do you sleep well? Can you concentrate? Are you happy? Unfortunately none of these answers come from numbers or charts. They require each of us to live a sentient, in-the-moment existence, allowing our bodies to tell us that we are truly well nourished.

Got Health Questions?

Email and we’ll send them to Dr. Jahn to answer in an upcoming article.

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website