✨ 🌎 Field Notes: Hopeful & helpful takes on climate change, ultra-processed foods, diabetes, & more
Plus, why doctors should avoid using the word "need" for patients facing acute end-of-life illnesses
Hello, dear friends! I’m writing to you from Seattle where I’m visiting my sister this week. It has been smoky with poor air quality because of the nearby wildfires, though it’s clearing today. The extreme weather has been happening all over the world for awhile now, and I’m feeling it acutely this summer in my tiny part of the planet. Between the horrific Maui fires, the Canadian wildfire smoke over New York, record tropical storm/cyclone in Southern California, and our local historic flooding of 8+ inches of rain in a day in the Hudson Valley, this feels like the summer when climate change became a noticable force in my everyday life. Do you remember when you first felt the impact of climate change? On your skin, or your lungs, or your home?
The first link in today’s Field Notes, an essay by Rebecca Solnit on climate change, was just what I needed to read this week — a reminder that there’s actually a lot available to counter climate change, and yet nothing will change if we don’t believe change is possible. True of so much in life.
1} We can’t afford to be climate doomers (The Guardian) — Rebecca Solnit writes about the defeatism that seems to run through the conversation about climate change: there’s nothing we can do, the technology isn’t there, the political will isn’t there, the future is already written, it’s not worth our attention. NOT so, she argues, and what’s more, this attitude is unhelpful. I found this essay so hopeful and motivating, worth reading for facts (she talks about the progress already being made and what experts see as possible) and for a perspective shift. “I don’t know why so many people seem to think it’s their job to spread discouragement, but it seems to be a muddle about the relationship between facts and feelings,” she writes. “I keep saying I respect despair as an emotion, but not as an analysis. You can feel absolutely devastated about the situation and not assume this predicts outcome; you can have your feelings and can still chase down facts from reliable sources, and the facts tell us that the general public is not the problem; the fossil fuel industry and other vested interests are; that we have the solutions, that we know what to do, and that the obstacles are political; that when we fight we sometimes win; and that we are deciding the future now.” Also, I loved this frame for climate change and illness and so many things: “I wonder sometimes if it’s because people assume you can’t be hopeful and heartbroken at the same time, and of course you can. In times when everything is fine hope is unnecessary. Hope is not happiness or confidence or inner peace; it’s a commitment to search for possibilities.”
2} Please stop telling patients with Type 2 Diabetes to “Just eat less sweets and carbs” (Weight and Healthcare newsletter) — Diving into one woman’s Type 2 Diabetes case and a recent interaction with her doctor, researcher and health and fitness professional Ragen Chastain discusses how “managing blood sugar is complicated and ‘eat less sweets and carbs’ is not nearly adequate advice.” I’m still getting up to speed around diabetes and learning many of my assumptions are wrong about what causes diabetes, what causes high blood sugar, and how it’s managed. This is a small dip in a bigger scope, but an enlightening one.
3} The Truth About Ultra Processed Foods - Part 1 (Can I Have Another Snack? newsletter) — Laura Thomas, PhD, RNutr leaps into the controversy around ultra processed foods, the “latest super villain of the nutrition world,” and brings a helpful science-based and balanced perspective: “Counter to the popular narrative around UPFs, they are useful in helping us meet our nutritional needs.” This is a long read but packed with interesting info. She explains the 4 categories of NOVA classification around processing, from Group 1: Unprocessed or Minimally Processed Foods, like fruits, vegetables, meat, eggs, flour, to Group 4 Ultra Processed Foods, branded food products made in a factory. These categories may be useful for researchers tracking world trends but they don’t translate well into valuable guidance for people on what to eat. Mostly, it just seems to make people feel bad about what they are eating. She points out: “The level of processing doesn’t necessarily tell us anything about the nutritional value of a food.… It’s very easy to think of the NOVA groupings as rankings — with group 1 being the ‘best’ and group 4 being the ‘worst’ — but keep in mind that we are all, almost exclusively, eating group 3 foods. Even if we are cooking all our food from scratch at home. NOVA is intended to be objective, but in practice it has been weaponised as hierarchy to police what people are eating.”
4} Reconsidering the Language of Serious Illness (JAMA perspective by Drs. Jacqueline Kruser, Justin Clapp, and Robert Arnold ) — "Need" is a common word for clinicians — but should it be? The authors write: "Consider a scenario in which clinicians would typically say, Your mother needs to be intubated. We suggest avoiding this phrase and others like it with all patients facing acute life-threatening illness and replacing it with Your mother’s breathing is getting worse. Can we talk about what this means and what to do next?” I see what they mean: The word “need” seems to pre-fill the answer with an intervention, while a more open phrasing allows space for family members to consider their loved ones' desires, priorities and best decisions for them. The authors conclude: “This shift will take real effort; the way ‘need’ is used in clinical language is so common that clinicians rarely even notice when doing it.”
5} Unlocking Joyful, Healthy Achievement in Our Kids This Year: A special back-to-school newsletter (Raising Good Humans with Dr. Aliza Pressman newsletter) — Dr. Pressman interviews Jennifer Wallace, author of Never Enough: When Achievement Culture Becomes Toxic — And What We Can Do About It, about the pressure on children to achieve and how to raise joyful, healthy kids in this competitive time. The major finding in her reporting: “The kids I met who were thriving emotionally and academically had a deep sense that they were valued by their parents, schools, and larger community. They felt like they mattered.” OH, YES. True for all of us, of course true for kids! Jennifer goes on to say: “Mattering is the deep human need we all have to feel significant, seen, and understood by those around us. As long as we live, this need to matter never goes away. Researchers say mattering at the core of what makes us human and what makes our lives meaningful: do people notice me, care about me, and do I make an impact on others' lives?” She goes on to share ways she has changed her parenting to help amplify the message to her own kids that they matter.
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6} Enchantment: Awakening Wonder in an Anxious Age — I’m in the middle of reading this lovely book by Katherine May. Here’s one quote to leave you with:
“Enchantment came so easily to me as a child, but I wrongly thought it was small, parochial, a shameful thing to be put away in the rush towards adulthood. Now I wonder how I can find it again. It turns out that it had nothing to do with beauty after all—not in any grand objective sense. I think instead that when I was young, it came from a deep engagement with the world around me, the particular quality that accompanies close attention, the sense of contact that emerges from noticing. I worked hard to suppress all those things. I thought it was what I had to do in order to grow up. It took years of work, years of careful forgetting. I never realized what I was losing.”
“But enchantment cannot be destroyed. It waits patiently for us to remember that we need it. And now when I start to look for it, there it is: pale, intermittent, waiting patiently for my return. The sudden catch of sunlight behind stained glass. The glint of gold in the silt of the stream. The words that whisper through the leaves.”
I hope you have a lovely day ahead, perhaps with glimpses of enchantment, too.
To our journeys,
Brianne