Ilya Mechnikov, a scientist arguably quite ahead of his time, shared a Nobel Prize in Physiology or Medicine in 1908 for his work on human immunity. His research interest was garnered by his (not arguable) horrid experiences with diseases caused by bacterial infection. After his first wife died from tuberculosis, he attempted to take his own life with an opium overdose, but managed to live. His misery didn’t end there however. When his second wife developed typhoid fever, he wanted to die with her, and inoculated himself with a tick-borne disease. They both survived, but it made him realize the salient significance of the body’s natural immune system.

In the wake of their bodies’ perseverance, Mechnikov grew dedicated—obsessed—with research in human immunity. During the cholera epidemic in France in 1892, as part of his self-experimentation, he drank a culture of Vibrio cholera, the bacteria responsible for the disease.

He didn’t get sick, so he gave the culture to a volunteer in his lab—who didn’t contract cholera either—but a second volunteer became stricken with the disease and subsequently died. In further lab experiments, he found that some microbes stimulated the growth of cholera bacteria and some hindered it.

He thought the human gut flora was responsible for this and hypothesized that if ingesting a pathogenic culture can make you sick, then surely a good one should promote health. “With the help of science man can correct the imperfections of his nature,” he wrote.

The use of fermented foods—which in essence and most cases are cultures of “good bacteria”—has been around for centuries. Research shows written records of the health benefits of fermented milk (yogurt) and fermented milk products date as far as back as 6000 BC in ancient Hindu scripts. The Greeks made written reference to fermented food products in 100 BC, and it is reputed that Genghis Khan fed his army fermented mare’s milk because he believed it instilled bravery in them. It was not until the 20th century, though, that a Bulgarian medical student—Stamen Grigorov—discovered a lactic acid bacteria (Bacillus bulgaricus) in yogurt cultures.

Bacterial fermented foods, thought to promote digestive health, are prevalent throughout history and ubiquitous in every corner of the globe, from Eastern European sauerkraut to Korean kimchi to Japanese natto.

In current times, a growing body of research shows that maintaining a healthy gut and microbiome with diet can have a significant impact on health and well being. Further, it is contended that the right balance of gut bacteria can help stave off disease.

The Second Brain In Our Gut

A microbiologist once told me, “You are over 90% bacteria and about 10% human.” What? Really? I then looked it up and found out it was indeed true. We have 10 times more bacterial cells cohabiting our bodies than human cells. The human microbiome is collectively the 10-100 trillion microorganisms, mainly bacteria, living in our gut weighing between one to three pounds; every microbiome is specific to a particular environment (all microorganisms interacting with each other in a particular area in the body, such as the gastrointestinal tract or gut) or body part.

The microbiome also refers to the combined genetic material of the microbiota in that environment or organ. These trillions of bacteria interact and communicate with the enteric nervous system or what scientists have labeled the “second brain.”

As Michael Gershon, Professor of Pathology and Cell Biology at Columbia University and “father of neurogastroenterology” writes, “Once dismissed as a simple collection of relay ganglia (a cluster of nerve cell bodies), the enteric nervous system is now recognized as a complex, integrative brain in its own right.”

The enteric nervous system comprises about 500 million neurons or two-thirds the amount found in a cat. It is embedded in our gastrointestinal tract—starting at the esophagus and ending at the anus.

Together, the second brain in the gut and its microbiome have a significant effect on the brain, influencing mood, behavior, and disease. As such, the National Institute of Health (NIH) in the U.S. launched the Human Microbiome Project in order to identify and characterize the human microbiota.

The Great Brain-Gut-Microbiome Connection

Recent evidence shows that the brain interacts with the enteric system in the gut (second brain) and the gut microbiome in a bi-directional manner. It’s a three-way communication circuit called the Brain-Gut-Microbiome Axis and involves three systems—central nervous, gastrointestinal, and immune. A common example of a brain-gut interaction is that “butterflies in your stomach” feeling. Your palms are sweaty and trembling, your heart rate increases, your skin becomes pale or flushed, and you (maybe) feel like you want to throw up. This is part of the fight-or-flight physiological stress response and evidence of how our gut is related to how we feel.

So just how do the microbes in our gut influence mood? In truth, scientists are not 100% clear on how these microbes directly influence our brains, but they propose that it’s through multiple pathways. For example, it is well known that the four main chemicals associated with happiness and mood in human beings are dopamine, serotonin, oxytocin, and endorphins. Research shows serotonin (although its function is complex as it is involved in many physiological processes) to be a mood regulator playing a major role in the treatment of depression and susceptibility to both depression and suicide.

The enteric nervous system in our gastrointestinal tract is now recognized as a complex, integrative brain in its own right.
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And guess what? About 90% of the body’s serotonin is made in the digestive tract; researchers at Caltech showed that gut microbes are integral in serotonin synthesis. Similarly, gut bacteria are implicated in the synthesis of other chemicals and neurotransmitters involved in mood regulation and disease. Further, scientific findings in the journal Behavioural Brain Works illustrated that some bacteria affect how these mood compounds are metabolized. Perhaps the most fascinating finding, however, is that some microbes can activate the vagus nerve, the longest cranial nerve in the body and a main line of bidirectional communication between the brain and gut.

90% of the body’s serotonin is made in the digestive tract.
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Advancements in genome sequencing technology is enabling research into the impact of the gut microbiome on disease. By mapping the genome of the gut microbiome in diseased vs. healthy humans and animals, conclusions on the role of the gut microbes in disease proliferation can—and have been—deduced. And a very interesting way to glean this information is to analyze feces.

Your poop can be very informative. One study using genetic analysis of clinically depressive folks’ poop compared to those who aren’t, found several correlations between the human fecal microbiota (representative of gut microbiota) and depression. Although they report that their findings need to be further tested in larger cohorts, their results were specific for a particular strain (sub-type of microorganism) and genus (group or class of species):

 “The Oscillibacter type strain has valeric acid as its main metabolic end product, a homolog of neurotransmitter GABA (γ-aminobutyric acid), while Alistipes has previously been shown to associated with induced stress in mice.”

“Valeric acid structurally resembles GABA, and has been shown to bind the GABAa receptor. Therefore, it is possible that bacteria involved in valeric acid production and/or metabolism could also be associated with depression.”

The work of professor Bernhard Lüscher and colleagues at Penn State University shows that enhancing the activity of GABA in the brains of depressed mice has antidepressive effects, similar to that of antidepressive drugs, bringing mice back to “normal” behavior. Noteworthy is that GABA is implicated in mood disorders and its agonists have been shown to be antidepressive and antimanic.

This includes less of a certain type of bacteria in human fecal microbiota in depressed individuals compared to healthy ones.

Your poop can be *very* informative. Studies have found several correlations between the human fecal microbiota and depression.
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What is even more interesting is that researchers at the University College Cork in Ireland showed that if you transplant the microbiome from a depressed individual to animals, these animals will exhibit the same behavior of the depressed individual. These include anhedonia (not wanting to do the things you usually take pleasure in) and anxiety-like behavior.

This study also showed that depression is associated with decreased gut microbiota richness and diversity. Further, in humans, fecal microbiota transplants—introducing healthy feces into the microbiome of a diseased person—have been successful in the treatment of gastrointestinal disease and colitis and clostridium difficile infection with an efficacy rate of almost 90%.

Auxiliary Advances

Across the globe, the International Diabetes Federation report 425 million adults (or 1 in 11 adults) with diabetes while the CDC reports 30.3 million in the U.S. (with over 100 million living with diabetes or prediabetes) and 3.4 million in Canada, according to Diabetes Canada.

Diabetes and obesity are oftentimes linked as it is well-documented that obesity has a strong correlation between insulin resistance and diabetes. In a promising and growing area of research using humans, a small clinical trial in the Netherlands showed that a fecal transplant from a lean donor can temporarily improve insulin resistance in obese men.

In another growing area of research, large differences are seen in the gut microbiomes of people with Parkinson’s disease compared with healthy individuals. Further, a study published in the journal Cell show that when fecal microbes from persons with Parkinson’s disease was transferred to mice, they exhibited more severe symptoms of the disease and the aggregation of α-synuclein in the brain. (The formation of plaques in the brain via aggregation of α-synuclein is found in persons with neurodegenerative diseases including Parkinson’s, Alzheimer’s and dementia.) Meanwhile another study revealed that probiotic supplementation in patients with Alzheimer’s disease showed improved in cognitive function.

But Just How Did We Get Our Microbiome Anyway?

It has been shown that the vaginal and maternal gut microbiome changes significantly during pregnancy. Science journal PLOS|One as well as a Finnish study in Cell, respectively, showed that pregnant women exhibit lower vaginal bacteria than nonpregnant women as well as a lack of population diversity in gut microbiota.

In the International Journal of Obesity, researchers found that children exposed to prenatal antibiotics in the second or third trimester had an 84% higher risk of developing obesity compared to children who were not exposed. Further, Caesarians were linked to 46% higher risks of developing childhood obesity; your first microbe colonizers are acquired via exchanges with your mother largely during the birthing process, when you are—quite literally—slathered in vaginal bacteria.

In addition, as research shows, any disturbance to this microbe exchange such as delivery by C-section, perinatal antibiotics and formula feeding is linked to an increased risk in metabolic and immune disease. After birth, a child’s microbiome continues to grow and is changed by ingestion of the microbes in breast milk which stabilizes neonatal gut microbiome. As we grow older, our gut microbiomes can change throughout life depending on diet, environment and the drugs we may take, such as antibiotics.

So How Do We Promote A Healthy Microbiome?

There is still a lot of ongoing research on the brain-gut-microbiome connection, but it’s quite clear that the gut microbiota can have a significant impact on mood, health and disease. So here are a few ways—and foods!—that will keep your gut microbiome healthy and thriving:

1. Probiotics – research shows they can be used to maintain a healthy gut and restore the gut microbiota to health (after disruption as in the case of illness and the use of antibiotics).
2. Prebiotics foods – these cause the growth and stimulate the activity of beneficial microbes in the gut.
3. Whole grain foods/foods high in fiber – these have been shown to promote the growth of specific bacteria only digested by certain bacterial types. For example, apples and artichokes have been shown to increase Bifidobacteria (a good bacteria) in humans.
4. Fermented foods – people have been eating these foods for centuries. They have been shown to reduce the number of disease-causing bacteria in the gut and promote the growth of beneficial bacteria. It has been shown that people who eat a lot of yogurt have less of the bacteria linked to inflammation (Enterobacteriaceae).
5. Diversity in food – a diet comprising a diversity in food leads to a diverse microbiota which is considered healthy.
6. Polyphenols in red wine and grapes – these have been shown to improve specific beneficial microbiota.

What if you could get a medical diagnosis for free? No confusing copays, no being put on hold trying to argue an unexpected bill with your insurance company. A first, and second, and third opinion, all at once. Do we have the government to thank? Nope, just TV. TNT has announced it’s prepping for M.D. Live, a show where patients can apply to get their illnesses diagnosed by a panel of doctors—and a live audience.

During an episode, a panel of doctors will reportedly discuss the patient’s symptoms and possible diagnoses, before “crowdsourcing” with the audience, which seems perfectly healthy. Speaking to the Hollywood Reporter, Michael Bloom, TNT’s Senior VP of unscripted and live programming, said, “We want this show to inspire action and give hope to real people struggling with medical problems to get answers, proper treatment, and ultimately, improve their quality of life.” But responses from disabled and chronically ill people online suggest that this new breed of entertainment is hiding a far darker reality.

Chronic illness affects approximately 133 million Americans, and an estimated 30 million sufferers remain undiagnosed. It takes an average of 7.6 years to diagnose a rare disease in the U.S., and undiagnosed illnesses are associated with higher mortality rates, and lower quality of life for the people affected.

But because of the high costs involved in accessing care, many patients are forced to abandon their search for answers for years at a time. Last year, The Guardian reported that medical expenses were the most popular category of fundraising on crowdfunding site YouCaring, and that medical fundraisers on GoFundMe had increased from $6 million in 2012, to $147 million in 2014.

Unsurprisingly, women, particularly black women, and people living in poverty, face additional barriers to diagnosis. In Maya Dusenberry’s ground-breaking book, Doing Harm, she reveals that of the 100 million Americans who live with chronic pain, the majority are women. Yet research released in the study Women With Pain shows that women with chronic pain are more likely to be wrongly diagnosed with mental health conditions than men, and are frequently prescribed antidepressants and psychotropic drugs instead of pain relief.

Similarly, a study by the British Heart Foundation found that women have a 50% higher chance of receiving a false diagnosis following a heart attack, because the severity of our symptoms is not immediately believed, and we are more likely to be told we are having a panic attack.

But hidden biases in the medical system don’t stop there. Obese men and women are more likely to suffer with undiagnosed conditions, often because doctors blame their symptoms erroneously on their weight. This leads to a lack of diagnostic testing, and frequent fat-shaming may mean that sick patients stop going to the doctor altogether.

And these problems are compounded for black women, who often experience implicit racism in medical settings. Black women are three to four times more likely than white women to die from pregnancy-related complications, as illustrated recently when Serena Williams had to fight for medical intervention following the birth of her daughter. Black women also face a significantly higher risk of delayed breast cancer diagnosis than white women, and are frequently under-diagnosed generally.

It takes an average of 7.6 years to diagnose a rare disease in the U.S., and undiagnosed illnesses are associated with higher mortality rates, and lower quality of life for the people affected.
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Under a medical system that so often struggles to provide equal, affordable treatment to its patients, it’s no wonder that those with undiagnosed chronic illnesses might be tempted to prostrate themselves across our TV screens, in the hope of finding answers. But the trend of producing television that depicts suffering as entertainment, is one that does real-world harm to disabled and chronically ill people worldwide.

Most recently, Netflix came under fire for its show Afflicted. Billed as a documentary portraying “baffling symptoms and controversial diagnoses,” it was alleged in an article by the LA Times that producers edited the footage unethically, to falsely suggest that the participants’ medical conditions were psychosomatic in origin.

In a joint post on Medium, entitled ‘The Truth Behind Netflix’s ‘Afflicted,’ participants in the show say they were told they would be taking part in a project that would show their lives and struggles through a “compassionate lens.” Instead, they say, footage of their concrete diagnoses and tests results was excluded, and conventional medical doctors were either not consulted during filming, or their interviews were left on the cutting room floor.

The result of this was that many of the participants were harassed online, and some were even sent death threats by viewers who believed they were either faking it, or mentally ill. But such poor depictions on screen aren’t just damaging for the patients involved. They also have a far-reaching negative impact on the millions of other people struggling just like them.

Netflix reaches 300 million viewers worldwide. When a program with that kind of impact misrepresents medical conditions that are already under-funded and under-studied, it has a direct effect on whether patients facing similar problems can access appropriate care, or whether governments choose to support research funding.

And this is the core of the problem with M.D. Live.

The trend of producing television that depicts suffering as entertainment is one that does real-world harm to disabled and chronically ill people worldwide.
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It’s likely that many undiagnosed patients will be from social groups that already experience prejudice from the medical profession, and these prejudices may be replicated by the producers, unknowingly, on-screen. It’s easy to imagine a panel of doctors telling a fat white woman she just needs to lose weight to solve her problems, or insist that a black woman’s pain can’t be as bad as she says it is. While it’s easy to see why desperate patients might approach the show to help them when they’ve exhausted all other options, it’s also all too easy to see how exploitative this could become.

Disabled and chronically ill patients often experience harmful advice from the medical profession, as well as from friends, family, and the public, if a simple cause for their symptoms isn’t easily identified. It’s difficult to see how a show in which doctors discuss potential diagnoses, before “throwing live to the crowd for additional feedback”, will do anything other than encourage dangerous speculation from unqualified viewers, and lead to damaging, pseudo-scientific suggestions in the pursuit of interactive entertainment.

Michael Bloom says TNT’s “professional team of studio and field crews will lead our charge crowdsourcing hope to help our patients solve the medical mysteries we present in the series,” but even more so than a documentary like Afflicted, as live entertainment, it’s unlikely that TNT will succeed in helping patients long-term.

M.D. Live is the direct result of a government that considers medical care as a product, not as a basic right. In a show which allows a live audience to share their opinions, while people with undiagnosed illnesses are forced to waive their right to privacy in the hope that television will succeed where their doctors have not, the potential for misrepresentation and exploitation is staggering. TNT claims to be “crowdsourcing hope,” but I don’t find much hope in a world that relies on television to heal the wounds that the medical system leaves gaping open.

I pretty much always planned to breastfeed. It seemed like a given—not even a choice, really, but something I had to do. I knew that breast was best, because that message is everywhere from billboards, to magazines, to social media, to the posters on the wall of my doctor’s office. When the nurses asked me, “how do you plan to feed your baby?” I told them I was breastfeeding. Their smiles made it clear I had answered correctly.

When she was born, the first thing I did was nurse her. As a “Baby-Friendly” hospital, they encouraged all new moms to breastfeed exclusively. I carefully logged her feeding sessions on the chart they provided—30 minutes, 45 minutes, 15 minutes. When the nurses came to check on me, they said things like, “you’re doing such a good job, mama” and “everything looks great.”

After the first 24 hours of motherhood, I felt like a rock star. Everything was going exactly as planned. Then the next 24 hours were brutal. My daughter alternated between nursing and screaming. She couldn’t stay awake to nurse, but wouldn’t stay asleep if I put her down. She cried; I cried. I was too exhausted to think.

The next morning, I called the La Leche League. They told me to “just keep breastfeeding.” Everything would work out, and my baby was fine. Then I called the hospital lactation consultant, who said the exact same thing. My milk likely hadn’t come in yet, the baby was fine, and I shouldn’t worry as long as I kept nursing. She scheduled an appointment for me to come in the next day.

I didn’t want to fail at breastfeeding. It was not an option. As I reread my worn copy of The Womanly Art of Breastfeeding, I started to panic. I knew deep down something was wrong, and she wasn’t getting enough milk, but I was doing everything right, and I wanted it to work so badly.

Everyone said that breast was best. My friends, family, midwife, and the brochure they gave me at the hospital. When I had my baby, I worked for a women’s health provider, where we talked about breastfeeding with our clients, as if it was the easiest thing in the world. Public agencies like the Centers for Disease Control promote exclusive breastfeeding, as if it’s a simple problem of awareness. The truth is breastfeeding is hard, and sometimes not even close to possible. This pressure is not only unfair, and misguided, but parents and babies end up getting harmed in the process.

At the time though, I thought I just had to try harder to make breastfeeding work. I mean, obviously the problem was me. I met with the lactation consultant. She pressed my breasts into hamburger shapes, and squeezed my nipples to produce drops of milk. I felt my daughter’s tiny mouth latch on like a snake. I felt pressure in my chest, as I saw that the number on the baby scale had dropped. My daughter was starving. I was starving her.

My baby was admitted to the hospital for jaundice and dehydration. As I watched her gulp down formula, I felt like a failure. I told myself that I would just have to try harder, to do anything it took. There was a “breast is best” sign on the NICU wall. I asked for a breast pump and left her lying there under blue lights. When I returned with less than an ounce of breast milk, the nurse said, “is that all?” I felt the weight of her disappointed gaze.

I didn’t want to fail at breastfeeding. It was not an option.
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When my daughter was discharged, I started the impossible routine of breastfeeding, supplementing, and pumping 10 times a day, to boost my supply. I don’t really remember much about the next few weeks, aside from the pressure and pain of trying to make breastfeeding work. I should have spent the so-called fourth trimester loving my baby and learning how to be a mom. Instead, I was so preoccupied with breastfeeding, that I didn’t get a chance to really be her mom. I don’t really remember things like her first smile or laugh. I just remember the pumping.

I felt so much pressure, not just to breastfeed, but to breastfeed exclusively, as though my entire existence depended on increasing my supply. My midwife secretly prescribed me expensive prescription drugs that aren’t approved in the U.S.  I drank breastfeeding tea, took herbal supplements, and ate food reputed to increase supply. My nipples bled and cracked. My supply increased, only to dip again, and never became enough for my baby. I continued for months, not taking time to sleep, eat, or bond with my baby.

I felt shame. Rather than be seen in public giving her a bottle, I would hide in the bathroom to feed her. My identity was so wrapped up in how much milk I was making. I thought I was selfish, lazy, and a bad mother. Other people thought this too—the woman in the formula aisle said, “don’t you know that breast is best. The relative at my grandpa’s funeral said, “oh, you stopped breastfeeding? That’s so sad. My breastfeeding friend said, “you should just try harder.” Strangers on the Internet went so far as to tell me that formula was like feeding my baby McDonald’s or that it would make her sick. Hell, even the can of formula has the phrase Breast Is Best on the side.

As a woman, I’d spent my life under pressure—to be pretty and thin, to be pleasant, to succeed, to get married and have babies. I had been molded by society and myself into a perfection-seeking missile, never wanting to miss the mark. After 30 years of living up to expectations, there was no way I was going to fail to provide the best for my baby.

Eventually, I cracked under the pressure. I started to think my daughter would be better off without me. I made plans for her, once I was gone. I figured that my husband would be fine. He would have help from my parents. Or maybe someone else could care for her. A breastfeeding mom could nurse her. I wasn’t able to think straight, to really process what I was feeling or how the pressure to breastfeed was making me hate myself. My daughter was thriving on a combination of formula and breast milk, but I still thought I was not enough.  

Hell, even the can of formula has the phrase Breast Is Best on the side.
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Now, I have breastfed and formula-fed three babies to varying degrees, and I learned there are so many more important parts of being a mom. The constant refrain of “breast is best” made me hinge my success as a mother on something I couldn’t control—the physical ability to exclusively breastfeed—which I later learned was never going to be possible for me. It actually isn’t possible for a lot of new moms.

As human milk researcher Shannon Kelleher, PhD notes on themomvist.com, between 10 and 15 percent of moms can’t produce milk, and many more cite supply issues as the reason they stopped breastfeeding. While organizations like the World Health Organization and the Baby Friendly Hospital Initiative (BFHI) recommend exclusive breastfeeding for at least six months, only 22 percent of moms in the U.S. meet that goal.

Recommendations like this sound awesome, but fail to acknowledge how physically challenging breastfeeding is. Not to mention other pressures moms face in our society to “do it all”—working jobs with no parental leave, and not having enough support to raise babies, let alone exclusively feed them with our bodies. For many of us, the pressure to breastfeed contributes to postpartum depression, which impacts an astonishing one in seven new moms.

In July, Trump Administration rejected a breastfeeding resolution at the World Health Assembly in Geneva to promote exclusive breastfeeding worldwide and fund initiatives like the BFHI. And while people largely dismissed this move as patently bad, I had a moment of relief. As a culture, we’ve set the bar so high, and put new moms under so much pressure to achieve the impossible, that they are literally dying.

When you consider that in the U.S., babies do just as well on formula as breast milk, it’s time to take a step back from the “breast is best” rhetoric, to support all new parents in choosing to feed their babies in a way that works for them, and relieve some of the pressure of new motherhood, which is hard enough as it is.

As a culture, we’ve set the bar so high, and put new moms under so much pressure to achieve the impossible, that they are literally dying.
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I still remember the day the pressure started to dissipate for me. In the middle of my panic over breastfeeding my first child, I called a friend, the only formula-feeding mom I knew. I don’t know why I called her that day, but she came over. She sat with me, while I called my doctor to schedule an appointment. She held space for me to cry and vent all of the worries, and fears I had about formula, and all of the shame I felt about not breastfeeding. She offered no pressure, just support.

Most importantly, she told me about how her kids had done well on formula when breastfeeding didn’t work out for her. As we watched our beautiful children smile and coo from a blanket on the floor, I knew that she was right. Breastfeeding or not, I was enough. Formula was enough, or maybe even best for us. It was like being reborn as a new mom, without the crushing pressure to breastfeed. Slowly, but surely, I began to thrive, and my baby thrived, too, without another ounce of breastmilk.

My mother and I came for the salted caramel budino. That, and I like that the restaurant uses one big ice cube for their Old Fashioned. It’s the type of place that requires an Open Table reservation two months in advance. My mother and I entered the narrow space on a whim, with the knowledge that we’d likely turn around and go to a less popular, less packed restaurant with no salted caramel budino and no good ice, but there they were: two vacant bar stools. It was one of those gifts from the universe, like having just enough milk or just enough toilet paper or just enough gas or just enough of really anything.

As we waited for our dessert – layers of Oreo cookies, caramel pudding, crème fraiche whipped cream, and sea salt served in a trendy mason jar – my mother said she had something to tell me. Shoulders back and glint in her eye, she looked like a child moments away from blurting out a big secret. 

And here it was: My mother, who had recently begun working at a prominent city hospital, had officially signed the paperwork exempting her from assisting on abortion procedures. She was so proud of her decision. I sat staring into my Old Fashioned.

In theory, I support my mother’s right to religious freedom and her right to refuse participating in any activity opposing her religious beliefs. In theory, I believe no nurse should assist in abortion operations if they are morally opposed to the procedure. But in practice it’s so much more complicated when my mother and I are on two different sides of an issue, especially when she delivers the news with this expectant expression, as if we’d high five over it. As if I’d ever said anything that would have given her that impression. 

In theory, I believe no nurse should assist in abortion operations if they are morally opposed to the procedure. But in practice it’s so much more complicated.
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My mother is anti-choice and I’m pro-choice, and both of our stances are unlikely to ever change. I know that because we’ve spent years trying to sway the other. Debates, mostly in the cramped spaces of different cars throughout the years, usually ended the same: I’m mean and condescending and she’s narrow-minded and too religious. Nothing ever changes, except maybe the car.

Since the setting, this particular time, was the popular restaurant with the good ice cubes, I tried to avoid being mean or condescending. I didn’t ask what the point of signing such a document was, since she worked as an ENT nurse and abortions weren’t normally performed via ear, nose, or throat. I didn’t even launch into a speech about stigmatizing abortion because yes, yes, religious freedom. I reminded myself that my mother has a right to religious freedom, but I still felt betrayed by her decision.

Instead, I asked my mother if the paperwork was limited to women who had chosen to terminate their pregnancy for personal reasons or if it included women who were terminating their pregnancy for medical reasons. My mother told me she was excused from all abortions. Even those performed when the fetus has no chance of survival. Even those performed to save the life of the mother.

No, My Right To Abortion Did Not Cost Hillary The Election
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So logically, I asked my mother if she thought women who had abortions at the direction of a medical professional were, in fact, sinning. Because that’s what her religious disapproval comes down to—that it’s a sin—right? My mother is an intelligent, practical woman. She graduated first in her nursing class and supported our family while putting herself through nursing school. I thought this woman must know that it definitely isn’t a sin to terminate a pregnancy when a doctor tells you that you’ll likely suffer medical complications otherwise.

As I write this, I’m aware that my mother may sometimes apply a similar rationale to me. She must think of how I’m the same law-abiding girl who wouldn’t even sneak candy into movie theaters. She must think that I’m the sweet girl who she sent to Catholic school for twelve years. And that girl, my mother may think, must logically know that it’s always a sin to have an abortion, no matter what. Or perhaps, it’s the opposite. Perhaps my mother hears my pro-choice arguments and secretly knows I’ve been evil ever since that one time in the third grade when I found out Mary is the Queen of Heaven. I was eight years old and I wanted to be the Queen of Heaven when I died, so I said I hated Mary. My mother told me to say ten Hail Marys to repent, but I never did.

My mother and I are of the same blood and flesh, yet separated by this issue, and also our religious faith, and also our brands of logic. We’re two different radio stations playing the same exact song just a few beats off. We are so much of the same, but we are never the same.

My mother sidestepped the question. She said she didn’t want to aid in abortions, period. I could have asked hypothetical questions, like what if my mother was the only nurse in the whole hospital who could help, and the patient was going to die unless she terminated her pregnancy? Wouldn’t God think letting a woman die was just as serious an offense as an abortion?

But instead of the hypothetical questions, I ordered another Old Fashioned with a big ice cube and thought about my abortion.

I’ve never written about having an abortion before because I feared becoming “that girl who wrote about her abortion that one time.” I feared the story would become the first thing that popped up when someone Googled me and it would become all of me. I feared what someone from my biology or algebra or world history class would think if they read that essay. Or what about all the boys I had ever kissed, what would they think if they read that essay? I feared that my experience would be discussed and ridiculed and dissected on Twitter and Reddit and conservative websites. I feared Donald Trump and Kevin Williamson and Retribution. I feared, so I never wrote. But there are worse things to be in the world than the girl who wrote about the abortion she had one time.

But instead of the hypothetical questions, I ordered another Old Fashioned with a big ice cube and thought about my abortion.
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 My abortion story isn’t very special or different or significant. I had sex with a boy, and we were both irresponsible. The pregnancy test was positive, but I was in college and had taken out student loans and graduating was important to me. After a predictable chain of events and one awkward phone call later, I sat in stirrups much like I had done during my run of the mill trips to the gynecologist, only it was in the basement of Planned Parenthood, and before entering I was patted down by a security guard with a visible gun on his hip.

I had been called back several times: the psychological exam, the payment, and the ultrasound which I asked to see, partially out of curiosity and partially out of a sense of responsibility. If I was going to have an abortion, I was going to look at what I was aborting. I reasoned that I owed that much to whatever it was inside of me. And it was something—a blob, a ball of cells, a dark splotch in the ultrasound version of my body. It wasn’t a baby with a foot with toes I would one day call little piggies. But there was a distinct matter in my body. Seeing this made me feel both better and worse. It didn’t have little piggies, but it was also there and it soon wouldn’t be.

Finally, I was called back and given a gown. The nurse knocked, waited for the customary okay from me, and entered the room. She managed to achieve the ideal tone,neither cheery nor somber nor cold. She was professional, yet also personal. More than anything else, she seemed to understand that I was a real person in a less than desirable situation. I was making a choice I would have rather not have had to make, and this medical procedure may be something difficult for me. But she also made no assumptions in the matter. She was perfect. She told me that the doctor was male and she’d be in the room the entire time. She also told me the doctor usually narrates the procedure so his patients know what he’s doing to them while he’s doing it, would I like that? I nodded.

I Had An Abortion Because I Love My Son
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When the doctor entered, he was already wearing a surgical mask, so I never actually saw his face. For so long, this felt like a personal slight—it’s only now, as I type this, that I realize this man may have simply not wanted the risk. He provided my autonomy, but he demanded his anonymity. Years later, I’m okay with that. But sitting in stirrups that day, I wanted to see that he was a person, too.

The doctor didn’t make eye contact with me. He simply sat in the stool and asked if he could begin. I said yes and spiraled with the certainty that he was judging me as he parted my legs wider and disappeared into the tent of my hospital gown. I didn’t take into consideration that this was his job, which was likely exhausting and largely thankless and demonized by a whole group of citizens. And maybe he was sick of the cold weather we were having, I don’t know. There were so many possible reasons for his curt bedside manner, none of which had to do with me, but I took it personally. It was my abortion; I was taking everything personally. And why wasn’t he saying what he was doing to me? 

My face must have lit up with all these thoughts because the nurse stepped into the space next to me, held my hand, and narrated the procedure as the doctor silently worked. She explained every detail with language I can’t distinctly remember now, but I do remember her voice was calm and even. And she didn’t complain when I squeezed her hand from the pain. 

When the doctor needed assistance, the nurse politely asked if she could let go of my hand. It wasn’t a question, not really, but the fact that she phrased it that way was especially kind. We unlaced our fingers and I lost her to my lower hemisphere, but she kept narrating what was being done to my body and asking if I felt okay. That nurse’s compassion was the only bright spot of the procedure. 

I could get into the pain of the procedure, the tears my dog licked off my cheeks later that night, and the months of getting drunk and, one by one, telling my close girlfriends, some of which confessed their abortions to me, too. But, it’s all really pretty standard. 

I thought of telling my mother on several occasions, including over our fancy dessert. But if I told her in that crowded restaurant with people to either side of us, she would have likely had thoughts about my posture and my expression. She would have to remind herself that I have a right to reproductive freedom, but she’d still feel betrayed by my decision, as I did hers. And we’d both sit there in our betrayal, and the big ice cubes, dessert in the mason jar, and good fortune of those two open seats would be all for naught.

For a long time, I felt like I owed my mother an admission of my abortion because, if nothing else, she had gotten pregnant once, hadn’t had an abortion, and ta-da here I am. But there are also so many things that mothers and daughters don’t tell each other. I once went into the bathroom after my mother had showered and found that she had left behind a vibrator. I never told her I knew what she did during her showers and she never told me she liked to masturbate after shampooing. My sophomore year of high school, my mother had to pick me up from school because I bled through my tampon, through my underwear, and through my uniform. She knew the reason the school nurse had called her and she cleaned the large butterfly-shaped bloodstain from my skirt, but we never spoke of it.

She would have to remind herself that I have a right to reproductive freedom, but she'd still feel betrayed by my decision, as I did hers.
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And there were those quiet morning drives to school, during which we passed an abortion clinic. Even before 8 am, protestors would be outside with their chants and their signs and their rosaries. I’d wordlessly watch them from the window while my mother stared ahead. She was too tired from last night’s restaurant shift to discuss the protest, or maybe too tired to even notice.

Pregnancies seem to be marked by food. Women can recall with such specificity what they craved, what they missed eating, and what made them sick. My abortion, too, is marked by food. There was the sushi dinner I threw up, which was, in retrospect, likely the first sign of my pregnancy. There was the pizza I ate after my abortion, which went on to become my favorite pizza in the city. But every time I’ve ever eaten a slice, I remembered the first time I had this pizza was when I was wearing a jumbo pad and watching Rosemary’s Baby (an admittedly strange choice for post-abortion entertainment).

The salted caramel budino, too, has gone on to mark a moment in my story about my abortion. Between my mother and me were our vaginas we don’t talk about, religious freedom and reproductive freedom, decisions to or to not become mothers, and the nurse who never signed a paper exempting her from my abortion and who held my hand when I needed to hold someone’s hand. Between us there were no answers to be found, but there was dessert. And we split it. 

The World Health Organization released the International Classification of Diseases, ICD-11, on June 18th of this year, to the excitement of some transgender activists. In past years, the ICD defined being transgender as a disorder; a form of deviance in need of treatment. But this year was different. The latest update forgoes diagnoses such as “transvestic fetishism” in favor of the far friendlier “gender incongruity.” Having someone’s lived gender experience changed from a deviant “fetish” to a simple contradiction felt like a step forward.

Despite much celebratory discussion of this as a progressive step, there are numerous troubling factors in this re/de-classification that are being ignored. This friendly term is still a sexual health condition listed in a classification of diseases. Gender non-conformity is still pathologized, just differently costumed.

The ICD does nothing to “destigmatize” gender incongruence by renaming it, because it still rests on the presupposition of disorderly bodyminds. In defining “disorder,” it must draw arbitrary dividing lines between the real trans experience and the things outside it. They suggest that there is a concrete and diagnosable difference between gender non-conforming (GNC) cis people, and people who are legitimately transgender. And that the only person who could tell that difference is a doctor.

In defining 'disorder,' it must draw arbitrary dividing lines between the real trans experience and the things outside it.
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This notion of gender incongruence reifies the concept of biological sex as the only “real” bodily experience, which is used to further power structures and gender norms under the guise of what is “natural.” For example, cultural norms of male aggression are biologically validated when erroneously connected to testosterone. Cisgender women are pushed toward motherhood because of an imagined “maternal instinct.” But the maternal drive—often arising from pregnancy itself and certainly not from the mere fact of being assigned female—is cultivated, not inherent. Sometimes, this cultivation begins in childhood, but it is still not inborn. The idea that men are born to fight and women are born to birth, instead of being culturally expected to adhere to these norms, is a damaging consequence of the social construction of sex and gender.

Some activists, educators, and others argue that sex is not gender and gender is not sex, in an attempt to to distinguish the “fact” of biological sex from the ‘feeling” of gender. But this distinction will not save us, either. This is especially true when doctors are in the business of diagnosing what is understood as deviant behavior. Contrary to what the ICD—and well-meaning allies—might say, it isn’t that gender is mutable and only sex is concrete. There is no such thing as “incongruent” sex and gender because, as Judith Butler illustrates in Undoing Gender, there is no sex without gender; no gender without sex. The two produce and naturalize each other, just as testosterone and aggression do.

The ICD’s new rules for real-transness were not meant merely to de-pathologize some experiences in favor of others. Instead, they are part of an ongoing process to assign more specific diagnoses to certain experiences; to widen the pathological catalogue. In doing this, it draws arbitrary dividing lines between the real trans experience and the things outside it, suggesting that there is a concrete and diagnosable difference between GNC cis people, and people who are legitimately transgender.

Yes, Trans Women Can Get Period Symptopms
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This is a common practice that Michael Foucault discussed in Madness and Civilization. The trend of meticulously diagnosing difference is a relatively recent phenomenon, Foucault argues. Though we presume these diagnoses to be natural and timeless because a medical authority declared them so, this paradigm is only about two centuries old. It was invented as a means to mark some people as deviant and others as sane—not as a way to realize an essential “truth.” Diagnoses shift not due to a gradual march toward accuracy, but instead as a means of accommodating shifting social (and thus, psychological) conditions.

By these rules, one is only really transgender when one is interpellated that way by some authority figure, like a doctor. I only become “really me” when some authority recognizes me. Introduced by Louis Authusser, “interpellation” happens when a subject is recognized as such within a certain ideological framework: in this case, gender and disease. The classic example of interpellation is a police officer shouting, “hey you!” at a subject. The “hey you!” is the moment of interpellation. Similarly, according to ICD logic, a subject “becomes” trans not when they determine they are, but when a doctor names them gender-incongruous by the WHO’s guidelines. The idea of gender-as-interpellation contradicts the prevailing assumption that transness is intrinsic, and reveals this as a major flaw in the ICD’s thinking.

If we are only trans when some authority hails us that way, I was not trans until age 18. At 18, I began seeing a therapist and had my gender dysphoria “diagnosed,” all with the express intention of getting a bilateral mastectomy covered by my insurance. Although many trans people are “undiagnosed” until adulthood, we are also expected to produce lengthy historical testimony proving our lifetime of transness, divulging the intricacies of dysphoria that supposedly should have afflicted us since childhood.

If we are only trans when some authority hails us that way, I was not trans until age 18.
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If one isn’t trans until marked that way, but must also have been “born that way,” transness-as-diagnosis is revealed as a paradox; it simply doesn’t make sense. And what do we make of trans men and women who choose not to receive sex-reassignment surgery; who are comfortable with and even enjoy the genitalia they were born with? What do we make of the “Borderlands” (a borrowed term from Gloria Anzaldúa’s work) between butchness and transmasculinity, as Jack Halberstam discusses in Female Masculinity? How do we come to basic conclusions about what “normal gender” is so as to define incongruity in the first place?

If we look to Judith Butler, who notes the ways in which gender is an ideal to be imitated and not a fundamental truth, it would appear that efforts to nail down a true trans diagnosis are grounded in efforts to further clarify (primarily Western) gender roles in general, by defining those who violate them. Pathological incongruity helps to mark normative gender’s outer limits.

In attempting to find an ontological difference between true trans people and mere “cisgender GNC people,” the ICD cordons off trans identity that needs to be validated by medical authorities. The layperson is presumed to be unqualified to determine who is diagnosably trans and who isn’t. It also seals up gender norms for all people; in the shadow of the clearly-set rules for gender incongruity are the un/spoken expectations around correct gender congruity.

What Trans People Really Think Of Your Dress Code
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Furthermore, in reserving transness for only those who qualify under its medical definition, others in our community are denied the solidarity they need. Medical notions of true transness appear in trans communities themselves, leading to the harassment and vilification of those deemed “not trans enough.” To qualify as real in the first place, one must submit to the scrutinizing eyes of the medical establishment (and be able to afford being seen by a doctor in the first place), and beg to be seen.

In order to qualify for medical transition, I had to strategically choose not only the medical and psychological professionals I sought diagnosis and permission from, but also which aspects of my health history to disclose. In doing transness with a bilateral mastectomy as my goal, I monitored my behavior, clothing choices, vocal pitch, placement of my feet and hips, and disclosure not only of diagnoses but also of aspects of my personality. I wore an oversized men’s shirt and jeans from the boy’s section, hoping that their bagginess would convincingly hide the shape of my body. I spoke with my chest-voice while hiding the fact that my chest was unbound beneath my shirt. An apparent lack of chest binder or improper attire, I feared, could arouse suspicion of my realness. In order to track down the essence of physical dysphoria, guidelines such as the ICD’s push me toward sheer performance of proper gender incongruity. This is not performance in the Butlerian sense, even, but in the literal sense: I was putting on a show.

The ICD’s classificatory shift of transness is by no means worth celebrating, as that “shift” only works to conceal the workings of the medical system; to make onlookers more amenable to its decisions. A long history and present of pathology leaves all people unable to imagine gender (non-)conformity without medicine and psychiatry. This ICD update only draws slightly different distinctions between the “real” (dysphoric) and “fake” (insufficiently dysphoric) trans people. Its depathologization of the latter group will, paradoxically, do more harm to some than good: it forecloses the possibility of getting surgery and hormones for those not trans enough to diagnose.

Those who are diagnosed receive gender-affirmative care, but only at the cost of being marked as a psychological deviant. All of these situations naturalize sex even as they claim to transcend assigned gender. Compared with the real ramifications of the ICD-11, the romanticized notion of a trans-inclusive medical establishment is dangerous at worst, and incongruous at best.

On the pilot of the CW’s new feel-good dramedy, Life Sentence, a young woman with terminal cancer, Stella (the lithe, doe-eyed Lucy Hale) picks out a cake for her own funeral. Later in the episode, the cake is repurposed for a celebration, because Stella finds out that her cancer has been miraculously cured. Instead of a projected six months left to live, she now will now enjoy a normal lifespan. In typical Hollywood fashion, a reevaluation of her priorities and relationships ensues.

Let me tell you about someone who did not luck out like Stella did.

Candace* a mother in her mid-thirties, was diagnosed with aggressive breast cancer when she was young, like me. Along with her friends and family, she created a Facebook page, “Candace Crushes Cancer,” to update others on her medical journey, as soon as she realized how serious her case was. It happened quickly. Metastatic lesions invaded her hipbone, then ate away at her liver, and finally appeared in multiple spots in her brain. Terminal. She tried medication after medication — harsh chemotherapy regimens that sapped her energy — and attempted to enroll in clinical trials for experimental drugs. She rapidly ran out of options as her blood counts tanked. Candace posted that she wasn’t ready to die. She wanted to fight. It was October, but her doctors cautioned that she probably wouldn’t see Christmas. I don’t need to tell you what happened next, but, to put it crudely: Cancer Crushed Candace. In the final photos from just before she entered hospice care, she was bald, weakened, unrecognizable. She left behind a partner and four young children.

To The ‘Cosmopolitan’ Editors Who Offered Cancer As Diet Advice
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This is unfortunately the real outcome of almost all terminal cancer cases, in 2018. Early stage patients have a very good shot at curative interventions, remission, and long life spans, but for many of us — those with cancer that hides out for years before making itself known, or is repeatedly misdiagnosed, or mutates into a treatment-resistant subtype, or simply spreads very quickly — it’s too late for a miracle. By definition, the cancer will win, and not the long-suffering patient, unless they get hit by a bus first.

Fantasies that tell us otherwise are dangerous and insulting, and they don’t only come from Hollywood. The idea of the “miracle cure” represents a conglomeration of media mythmaking, mainstream religious tropes, New Age spirituality, pseudoscientific quackery, and good old-fashioned commercialism. It’s based on the imperatives of hope and optimism that pervade our conversations about illness and disability, to the detriment of patients who grow weary from having to perform a “positive attitude” about experiences that resemble physical torture.

It’s a grave offense to be fatalistic in the face of cancer.
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It’s a grave offense to be fatalistic in the face of cancer. When you get sick, the trite messages found on embroidered pillows, pastel Instagram graphics, and t-shirt slogans become directives for how to approach your illness the right way. You are somehow supposed to “expect miracles,” while watching fellow patients waste away, drop dead, and orphan their children. You notice that sympathy is reserved for the most upbeat survivors, and that fear, anger, and especially candid resignation make other people deeply uncomfortable. Although patients already have enough on our plate, we are also tasked with the labor of managing other people’s emotions about our own disease. I discovered early on that presenting as cheerful and hopeful yielded more support from strangers, acquaintances, and caregivers, while being honest about my fears left others unsure of how to react, or eager to dismiss my feelings as too “morbid.”

My friends and family, understandably, don’t want to think about my death. But I do. In fact, it’s the only real way that I’m able to process what has happened to me, and what is likely to happen in the future. I have to confront it, to stare it in the face. The problem is, because of social taboos, I am left to do this daunting work on my own, tossing and turning in the dark each night imagining the assortment of painful ways my body will one day shut down. It’s a very lonely reckoning. The silencing of “negativity” is a recipe for patient isolation.

The Cherry Blossoms Tattoo Where My Breast Cancer Scar Was
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The reality is, my cancer doesn’t care how I feel about it, and while a positive attitude may help some people get through the day, it cannot actually stop one’s illness from progressing. “If you visualize your body receiving a cure, a cure will manifest,” a well-intentioned nurse told me on the day I was diagnosed, as if the “Law of Attraction” could be applied to the genetic mutation that caused my cancer. As if the rogue cells in my body could possibly know how much I wished for them to stop multiplying, and then simply bend to my will.

The most visible voice of dissent in this tyranny of “good vibes only” has been journalist Barbara Ehrenreich, whose work critiques the “sugar-coating” of cancer as a way of burying a grim reality “under a cosmetic layer of cheer.” Sadly, little has changed in the decade since Ehrenreich wrote about her own experience navigating a cancer diagnosis in a culture of positivity so relentless that it borders on delusional. After all, just last year, a company invented a high tech handheld mirror for cancer patients that only reveals your reflection if you smile. Otherwise, the implication is, you might as well not exist. You are nothing without compulsory optimism.

It’s no coincidence that “hopeful” people are more likely to spend money chasing miracles, as the line between blind optimism and gullibility can be blurry. Ehrenreich and others have written about the pink ribbon symbol as a crass corporate marketing strategy, but the problem goes beyond breast cancer, and has infiltrated the current wellness movement. Companies that sell unproven homoeopathic remedies in the forms of vitamin supplements, juices, essential oils, cannabis products, healing crystals, and other pseudoscientific modalities are banking on the fact that sick people will try anything for a potential cure. When “alternative” doctors peddle special diet programs and alkaline treatments, they anticipate that our desperation for a miracle will override our critical thinking skills and better judgment, and optimism is warped into something actively harmful.

The Path Of Living With Chronic Illness
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The media plays into the miracle narrative with fantasy shows like Life Sentence. In episode three, we learn that Stella was cured because of her participation in an experimental clinical trial. While mainstream Western medicine certainly has a better track record compared to alternative therapies, clinical trials are notorious for disappointing results when it comes to curing cancer. Too many terminal patients are given false hope when they enroll in these studies expecting recovery, as new cancer drugs typically only prolong life by a few extra months rather than years. Life Sentence perpetuates the tendency to showcase medical anomalies rather than the average patient, whose journey is much more of a bummer.

When covering real-life cases of cancer, the media is often guilty of using what disability activists call “inspiration porn.” Sometimes, these are stories about the rare statistical outliers who beat the odds, framed to make it seem like they did so by virtue of impressive internal fortitude rather than sheer luck. (The message: if these model patients can cheat death, everyone else must be doing something wrong.) Other times, inspiration porn presents buoyant dying patients as examples to show healthy, able-bodied people how to live meaningfully — “as if each day is your last.” But most of us sick folks would happily trade in our newfound insights and emotional resilience for a clean bill of health. We shouldn’t be trotted out as motivational teaching tools to help everyone else put their own banal problems into perspective.

Most of us sick folks would happily trade in our newfound insights and emotional resilience for a clean bill of health.
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In the vast majority of cases, terminal cancer patients do not make sudden miraculous recoveries, no matter how much they fight, rally, love their children, and don’t want to leave their families. No matter if they travel outside of the country for costly alternative treatments, or eat apricot pits or vape cannabis oil. They still die. They are prayed for, sometimes by hundreds of loved ones. They die anyway. If my own cancer metastasizes to my bones or organs before a cure is found, I will die, anyway.

I had to confront this horrific reality at 31 years old, and integrate it into how I understood the world. Now it’s everyone else’s turn. But it means facing some distressing truths about death, disease, and our sense of justice. First: the fact that humans are mortal, and sometimes we die too young, for no good reason, and by no fault of our own. (This clashes with several adages about God working in mysterious ways, never making mistakes or giving us more than we can handle. It also contradicts the widespread belief that we all ultimately get what we “deserve.”) Second: cancer remains a death sentence for millions of people, even during a time of impressive, awe-inspiring technological and medical progress. It takes time — years if not decades — for the latest laboratory discoveries to jump from petri dishes to mice to human subjects, so when you read about a promising new finding, remember that it won’t actually help the people who are living with/dying from terminal cancer today.

Cancer remains a death sentence for millions of people, even during a time of impressive, awe-inspiring technological and medical progress.
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And third, medical miracles — to the extent they exist at all — are much more likely to happen against the backdrop of care that is affordable and accessible to everyone, something we don’t yet have in the contemporary United States. My chemotherapy treatments were about $20k each, and there were six of them. One night recovering in the hospital was $75k. I am lucky to have a robust health insurance plan (thanks, Obamacare) but I still needed to crowdfund for the various expenses that weren’t covered. In my cancer support groups, fellow patients with no insurance, or ones who live in states that did not expand Medicaid as part of the ACA, are on the hook for thousands of dollars they don’t have, during a time when they can’t actually go to work and earn income. The financial stress takes an emotional toll. I imagine it is easier to stay positive when you don’t have to worry about going bankrupt.

If there is anything at all to be hopeful about, it’s that the culture of toxic positivity might one day shift. The fact that “thoughts and prayers” are now recognized by many young Americans to be an insufficient way of addressing gun violence suggests we may be amenable to reevaluating our stubborn magical thinking in other areas. I sure hope I’ll be alive to see this happen.

*The name has been changed to out of respect for the privacy of her family

Content warning: descriptions of disordered eating behaviors and publications using problematic language surrounding eating disorders

It’s the holiday season, and I don’t know about you, but I’m pretty into it this year. Maybe after the abject horror of over 1 year and 340 days of President Trump, I’m in need of some cheer. Warm hats and fuzzy socks. Pretty lights.

This year I didn’t even mind the constant barrage of the same Christmas music everywhere I went. (Although I still don’t know why they can’t play one song from one of the other December holidays.)

But there’s one thing that does rain on my parade: the inevitable articles from every website claiming to be about “health,” popping up to shame me about what I eat during this food-focused season. The holiday—“Holy Crap You’re Eating More Food Than Usual, Fret and Panic”—articles come out around the same time as the Peppermint Lattes.

Every year it’s “5 Ways to Have a Healthier Thanksgiving” and “Burn Off Those Holiday Splurges.” It bums me out, not just because I’m trying to have a healthy body image and you are not helping, but because I worry about all the people I know who have eating disorders.

In recent years “health” publications have become a little more sensitive about how they approach the topic of weight and dieting thanks to body positive movements and the efforts of those struggling with/recovering from eating disorders, but we’re far from where we need to be.

There is a more than slight chance that this has something to do with how lucrative the business of telling people to lose weight has been. Three of the five most-circulated health magazines — Prevention, Men’s Health, andWomen’s Health — are owned by Rodale, Inc.

This October, it was announced that the book and magazines owned by Rodale will be bought by the mass media conglomerate Hearst Communications for close to $225 million. This might seem like quite a hefty chunk of change to us normal human beings, but Hearst saw a revenue of $10.8 billion in 2016. According to U.S. News (which, ironically, has its own health section with annoying and potentially harmful headlines), the diet industry rakes in $60 billion every year.

That’s a lot of influence in the hands of publications that claim to be relevant at least, and imperative at best, to your entire life. Remedy’s Healthy Living, with over three million active subscriptions, is all about “Your Way of Life.” The second most popular is “Prevention Magazine: Love Your Whole Life.” “Shape Magazine: Shape Your Life.”

Is there something more to life than the physical shape of my body? I can’t seem to remember.

In truth, however, I didn’t realize just how bad it was until I learned about “pro-ana” communities and began studying them.

Pro-ana is short for “pro-anorexia.” As in: “We at Anorexic Diet tips blog publish the best pro ana diet plans and pro ana tips and tricks to lose weight fast and become anorexic,” explains AnorexicDietTips.com.

Groups like this have received little media attention—despite them being egregiously dangerous—but what’s just as horrifying is the fact that tips commonly found on the most popular pro-ana sites and forums are not so different from those found on Health.com, or any number of other “health” sites.

One Health.com article from earlier this year is titled “49 Ways to Trick Yourself Into Feeling Full.” It’s full of fun little tips like drinking water before a meal and chewing gum instead of eating. These are frighteningly similar to the tips found on popular threads from MyProAna.com, a pro-ana forum and one of the first websites that comes up when you google the term “pro-ana.”

“Drinking an entire glass of water before every meal fills your belly, so you’ll likely end up eating less than you otherwise would have. During your meal, taking sips in between bites will help slow your pace and eat less overall.” — Health.com

“I guess you all know water is your bestie. Drink AT LEAST 8 glasses of water, or a glass per hour … Have a sip of water between each bite, It will help you to fill up faster and won’t make you overeat.” —MyProAna.com

Even more alarming are the tips that rely directly on shaming yourself for eating.

“Watching yourself eat junk food triggers discomfort, since you’re suddenly very aware of the unhealthy choice. So if you’re seeking an easy way to boost your weight-loss goals, consider picking up a new decorative mirror for your dining room or kitchen.” —Health.com

“Eat while watching yourself in the mirror naked. How much are you able to eat now?” —MyProAna.com

A big part of the pro-ana “movement” is keeping strict track of everything you eat. Sound familiar? What “health” publication these days doesn’t advocate for keeping a food journal? Not that having a food journal is going to make you anorexic or is necessarily negative or predicated on self-harm, but the language these publications use is, again, alarming.

“The power of the food journal is that it keeps you accountable and makes you more aware. You are less likely to grab that piece of chocolate cake if you know you have to write down later and face the ultimate critic (AKA you),” says the website for the popular book “Eat This, Not That.”

How else can I shame myself for eating?

“There are many ways to track your progress, from basic approach to just weighing yourself every day to using various fitness tracking apps or using the wearable devices that can help you accurately count the number calories you are taking and burning,” echoes a pro-ana site.

People suffering from this devastating illness very often make a set of rules for themselves around eating, and make these rules stricter over time. This is a common feature of related eating disorders as well, which means that all together they affect at least 30 million people in the U.S. alone. This path leads to more death than any other type of mental illness.

At least one person dies every 62 minutes from an eating disorder. According to the Agency for Healthcare Research and Quality, “Hospitalizations for eating disorders in children under the age of 12 years old increased by 119% between the years of 1999 and 2006.” 50% of teen girls and 33% of teen boys “engage in unhealthy weight control behaviors” as of 2017.

Eating disorders lead to more death than any other type of mental illness.
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Pro-ana sites lean in to these self-imposed rules hard—and it’s this kind of attitude that leads directly to the disease, as victims become addicted to a dangerous sense of control.

You know who else talks about “rules” a whole lot?

“The 10 Rules of Weight Loss That Lasts” — Shape Magazine

“6 Eating Rules For Faster Weight Loss” — Prevention

“The 10 Rules of Weight Loss” — Runner’s World

“5 rules of fast fat loss” — Men’s Fitness

“5 Rules You Need to Follow if You Decide to Lose Weight” — Women’s Health Magazine

Yikes.gov.

Perhaps worst of all is the way both the “health” industry and pro-ana movement demonize food. Some foods are okay to eat, but they’re increasingly hard to come by. It recently came to public attention that fat was thrown under the bus by the sugar industry for sweet, sweet profits.

As it turns out, you need fat to live — a fact you might forget if you spend too much time in a pro-ana forum. Or on WomensHealth.com. You know what else you need to live? Sugar. I know there’s a difference between “refined” sugars and “natural” sugars, but I know at least half a dozen people who have tried diets that cut out all sugars — even those found in fruits and vegetables.

Biochemist Leah Fitzsimmons doesn’t think this is a particularly good idea.

Glucose is a simple sugar found in the blood of all animals—without it we die. We need sugar to live. It’s the main source of energy for our mammal brains, and disruption of “normal glucose metabolism” is a root cause of a number of brain disorders. Sugar is literally brain food.

We need fat to live. According to a study in the American Journal of Clinical Nutrition, the healthy range for body fat content is between 8 and 33%.

Another recent study found that low-fat diets might be killing people. Oops!

We need carbs to live. Carbohydrates are our main source of energy. They come in many different forms, and guess what, we need all of them! Carbs have a number of essential functions in the body, including that glucose regulation we talked about earlier. Also, pooping.

We need salt to live. I have family members who went on a low-salt diet and ended up with intense headaches and constant thirst no matter how much water they drank. Turns out salt is essential for allowing our cells to absorb and retain water. Critically low levels of salt can put your body into shock and send you into a coma.

In short? Health is very, very, complicated. What’s good for one person might not work at all for another. Eating only bagels will likely make you feel like crap, but then again, so will eating nothing but kale. If “health” publications are actually concerned about leading people toward eating disorders, they need to read into some of these pro-ana and pro-mia (pro-bulimia) sites and forums and sit with their horror for a spell, then rethink their entire existence.

Because demonizing food and shaming eating is not healthy, it’s lethal.

By Vidya

I can distinctly remember a moment during one of those many (many) days in my first year of medical school when we were sitting in lecture and learning about a disease.

Before my professor described the mechanism of the disease, which involved inflammation of the blood vessels, he paused and cleared his throat. “I want you to know that you may see this disease referred to as ‘Wegener’s granulomatosis’ in textbooks or amongst colleagues. However, we as a profession have decided that we are not calling it ‘Wegener’s’ anymore. Because Wegener, it turns out, was a Nazi.”

He said this solemnly, and then proceeded with the lecture, referring to the disease by its new names. First, in the 2000s, “ANCA-associated granulomatous vasculitis” was used; now, it is often taught as “granulomatosis with polyangiitis” (GPA).

Medicine is rife with old eponyms — diseases or body parts named after their discoverers or researchers — that are beginning to be replaced by more logical names for practical reasons. (The term “rectouterine pouch,” after all, tells us more precisely what we are talking about than “pouch of Douglas”).

But this was the first I had heard of the entire medical profession deciding to change an eponym for the sake of revoking honor from someone whose actions were now deemed immoral. And, more than that, the name change accompanied a small but repetitive teaching of why there was a new name — actively passing on the unethical history that led to greater understanding of a rare disease.

When other diseases gained new names, we were typically allowed to use the original eponym and the logical name interchangeably. But here? We were being told: Don’t use this old name. This man was a Nazi, who used tissue from Nazi prisoners to make his discoveries. And this moment of reflection on the history of this disease’s name happened almost every time I was taught about GPA.

It happened again when we learned about “Club cells,” the dome-shaped cells with short microvilli which serve to protect the lining of our lung’s small airways. We were told that they were originally named “Clara cells,” after the man who first described them in 1937. But Max Clara, we were told, was a Nazi — and so the pulmonary physician community made a dedicated effort in 2012 to have a name-change take effect in January of the next year. They rolled out the change systematically: for two years, they would put “Clara” in parenthesis after “club cell.” After that, “club cell” alone would replace all mentions of the name.

I started thinking about this movement to change names recently in the aftermath of the violence in Charlottesville and the national dialogue on removing monuments. The scientific name changes above signal a systematic effort to remove honor afforded to those who did immoral, horrific things to other human beings in the name of country-sanctioned medical research.

As a medical student, I am proud of the profession for pushing this change and I welcome the continued mention of the change in our medical training — with little effort, it allows us the important benefit of remembering the unethical history of the disease’s discovery without honoring it.

The Statues Must Come Down

But with each of these instances, there is also a growing feeling of disparity in this remembrance.

I rarely encounter the same explanation or historical interludes prefacing some of the tests we use in medicine today, which were developed in the context of racial exploitation in our own country’s history — such as spirometry to test lung function, or the immortalized cell line of Henrietta Lacks.

Soon after I learned how to do a speculum and pelvic exam in medical school, I happened to listen to an NPR Hidden Brain story which detailed the work of surgeon James Marion Sims. Sims, the so-called “father of modern gynecology,” developed the first speculum out of pewter in the 1840s — it was not markedly different from the very same device we use made of steel or plastic today.

There is an important benefit of remembering the unethical history of a disease’s discovery without honoring it.
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He is also famous for perfecting and pioneering a technique using silver sutures to repair vesicovaginal fistulas—an opening between the vagina and bladder that could result from complicated childbirth, which caused women suffering and social stigma from urine leakage.

In 1845, Sims purchased slave women with fistulas and housed them on his property for the purposes of medical experimentation geared towards gynecological research. In his memoirs, he names three of the at least 11 slave women he kept to experiment on — Anarcha, Lucy, and Betsey — brought to him by their owners. For the next four years, he did a series of experiments on them without anesthesia.

According to physician-historian Vanessa Northington Gamble in the NPR story, “there was a belief at the time that black people did not feel pain in the same way.”

In her book Medical Apartheid, writer Harriet A. Washington describes how, when the subjects of Sims’ experimental surgeries screamed in agony while he cut them with a scalpel, his medical assistants would forcibly hold them down. According to her research, women would be awake and naked while he did the procedure, often with many male assistants or interested physician colleagues watching.

One subject of his experiments, Anarcha, underwent 30 surgeries before he figured out how to properly heal her fistula. After that, Sims did the procedure in clinics — with anesthesia — to heal white women with the same condition. He started a women’s hospital after he moved to New York in the 1850s, where he gained his reputation as a surgeon treating women’s gynecological issues.

He reportedly repaired the fistula of a European empress, and became American Medical Association president in 1876 and president of the American Gynecological Society in 1880. According to Washington’s research, Sims also used black infants as subjects for experiments, using scalp incisions to pry skull bones into new positions based on the false belief that their skulls closed prematurely and caused lower intelligence; he was not blamed or persecuted when the infants died.

Washington writes that eugenics provided a contorted rationale for Sims’ and others’ experimentation on slaves:

“Many researchers argued that blacks were so different from whites — less intelligent, much less sensitive to pain, possessing numerous physical anomalies as well as markedly different patterns of disease immunity — as to constitute a separate species. Given this supposedly vast biological chasm between blacks and whites, how could scientists logically infer results of medical experiments from blacks to whites?”

Throughout August and September I started to see more articles in the press about Sims beyond the NPR story; people spurred by the events in Charlottesville started to organize to protest the statues that exist in tribute to him. There is a statue of Sims across from the New York Academy of Medicine, on Fifth Ave and East 103rd St in NYC. The New York Academy of Medicine has released a statement that it supports removal of the statue, writing that it does not belong to the Academy or its property and is in the control of the Parks and Recreation department.

In August, the activist group The Black Youth Project 100 held a protest in front of the statue, with protestors memorably wearing bloody-appearing hospital gowns. The statue currently still stands, though in the aftermath of Charlottesville, New York City declared that it will be going through a 90-day review of “symbols of hate on city property,” and as part of that, the Sims statue was discussed at a public city hearing in late November.

What Really Happened In Charlottesville

Yet another statue stands on the statehouse grounds in Columbia, South Carolina, Sims’s home state, with an inscription commending him for “treating alike empress and slave.” Columbia mayor Steve Benjamin said in an interview in August that the Sims statue is the most offensive one to him of all the statues on the grounds, and that it “should come down at some point.”

Kwoya Fagin Maples, creative writing instructor at the Alabama School of Fine Arts, helped to organize a protest in front of the statue that took the form of a poetry marathon, to show support for the hastening of its removal.

“There have been no preparations, to my knowledge, for it to actually happen. I suppose the protest was a way to support the mayor’s words in hopes that it would move us closer to giving the eleven or more women he experimented on retribution. I think the monument should contain images of the women he used for his discoveries. Personally, I think his image should not be the focus of the monument, if there at all.”

In September, Nature published an unsigned editorial originally entitled “Removing Statues of Historical Figures Risks Whitewashing History,” in which it argued that names or statues (specifically pointing out Sims) should not be removed but instead supplemented with additional plaques or “equally sized” monuments commemorating their victims:

“Sims was far from the only doctor experimenting on slaves in 1849, despite the fact that the abolitionist movement was well under way in the United States. And his achievements saved the lives of black and white women alike. But some historians argue that his experiments could have been considered unethical even for his time.”

The original article was met with strong backlash in many publications and on social media. Nature changed the title of the piece to “Science must acknowledge its past mistakes and crimes” with some content changes, and with an editor’s note apologizing for the original article being “offensive and poorly worded.”

A few weeks later, Nature editor-in-chief Philip Campbell published an apology statement in the journal:

“Removing such statues or other memorials does not erase these individuals or their acts from history. Beyond that fundamental error in the Editorial, the arguments throughout the piece — including an inappropriate framing of the example of J. Marion Sims — and its overall tone were naive and unintentionally served to reinforce the insidious notion that women, people of colour and minority groups do not have a place in science. This notion is wrong. We did not recognize how destructive the overall Editorial was and the effects that it could have.”

When I read about this saga in Nature, I remembered Wegener and Clara again. Why propose to build an “equally sized” monument to stand alongside the existing one, when one could build an entirely new monument altogether? In her NPR interview, Dr. Gamble proposed that his subjects Anarcha, Lucy, and Betsey be depicted instead. “I think what the inscription would say is ‘Betsey, Anarcha, and Lucy, the mothers of modern gynecology.’”

Apart from teaching medical students like me about the history behind the modern practice of gynecology, learning about the experimentation by Sims also brings up important conversations regarding the ability to consent.

In the Journal of Medical Ethics in 2006, physician L.L. Wall argued that “Sims’s modern critics have discounted the enormous suffering experienced by fistula victims” and that, based on Sims’ own writings, his original patients were “willing participants in his surgical attempts to cure their affliction.”

But can any people considered property actually consent? And would a woman truly “consent” to 30 surgeries without anesthesia? The argument is fallacious, dangerous, and openly ignores the intent with which Sims purposefully bought black women for his experiments, not to mention the eagerness of slaveholders to have their slaves returned in better condition for physical labor.

Can any people considered property actually consent? Would a woman a truly ‘consent’ to 30 surgeries without anesthesia?
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While Sims had been criticized by contemporaries as early as 1858 (by African-American surgeon Daniel Hale Williams, according to Washington), Wegener kept his Nazi ties secret for decades. He had joined the Nazi Party in 1932 and it is speculated that he participated in Nazi medical experimentation.

The American College of Chest Physicians awarded him a “master clinician” prize in 1989, a year before his death, but rescinded it after his secret Nazi past was discovered 11 years later through the work of two physicians researching his life in preparation for an intended celebratory article. Sims, for his part, experimented on living women — further exploiting their already harrowing reality of exploitation, using eugenics-based logic to give them no pain medication.

But even more important is the fact that, though Sims practiced 100 years before Wegener and Clara, American assumptions based on false theories of racial difference are still held by some physicians today.

A study last year from the University of Virginia found that a substantial portion of white medical students and residents surveyed believed that black people are biologically less sensitive to pain; in their results, 40% of first and second-year medical students and 25% of residents thought blacks have thicker skin than whites.

American assumptions based on false theories of racial difference are still held by some physicians today.
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One aspect of knowing the history of American medical experimentation is also understanding and empathizing with the views of black patients who continue to endure bias today. My medical school classmate Shelley Thomas is passionate and outspoken about working towards racial justice in health care, and was one of the classmates I interviewed for this article.

She cited acceptance of intrauterine devices (IUDs), a form of long-acting contraception, as one of many examples of history informing patient skepticism. “There are so many populations that are skeptical of IUDs. Some people think, ‘she’s not looking at the statistics, this is just lack of education,’ without knowing the history of forced sterilization,” she explained.

“When you’re talking about putting something inside of a black woman that will stop her from having kids for 5–8 years, the history is there, and without knowing that history, we can make a lot of assumptions about why people are so hesitant about a lot of these different forms of medical advancement.”

When I worked as a clinical research coordinator, my required online training included a section on research ethics that described the history of the Tuskegee trial. Wouldn’t it make sense to require us to preface our learning about, say, the speculum exam with a lesson about the man behind the device?

I often wonder why these histories don’t already exist in medical curricula; why I come across it almost solely in the lay press. I interviewed Dorothy Charles, a classmate a year ahead of me who is an organizer for the national White Coats for Black Lives movement.

“It would be a great to have syllabi on this in medical school,” she said. “We need medical students to learn these social justice issues in medicine, and be educated about the racial history and myths in medicine.”

She suggested having people who are experts in these topics teach it — not necessarily physicians, but instead social scientists or historians. Some might argue medical school is not the place for medical history, but as both Charles and Thomas pointed out to me, then why comment on the Wegener’s name change at all?

How Medical Schools Are Failing The LGBTQ Community

And, Thomas added, “when we don’t address it and don’t talk about it, now you’re having a child whose pain is being ignored because a resident that has gone through our medical education system thinks that black children don’t experience pain the same way that white children do.”

(Studies show that black children are less likely to receive appropriate pain medication as compared to white children, even for a condition such as appendicitis.)

I wonder if having increasing black representation at academic medical centers would push the process of learning about and introducing stories like that of Sims into medical curricula. In an article in the Journal of Urology in 2011, two urologists write that while lay journalists and historians have increasingly studied and critiqued Sims’s surgical discoveries and accomplishments, “relatively little mention is found in standard urology textbooks or journals.”

“Medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.”

The authors found that urological textbooks referred to Sims repeatedly as a surgical innovator in their sections on vesicovaginal fistulas. Though a more recent edition of a urological textbook did have a paragraph on the controversial ethics of his practices, it concluded with: “It is generally believed that Sims was trying to enhance the lives of these women and was in concert with accepted mores.”

Before inpatient rounds one morning earlier this year, Thomas gave a short presentation on GPA, which one of her patients suffered from. “GPA used to be called Wegener’s, but they changed the name — I have some thoughts about that, which we can talk about later,” she said. After the presentation, her resident asked her about it, and we had a short discussion as we walked to the first patient room about the issues with changing some names in medicine while continuing to honor others. But these conversations are difficult to initiate as a medical student who is constantly in the position of being evaluated by our superiors.

I hope that one day, across medical schools, before we are even allowed to do a pelvic exam, we are given the context of Sims and his experiments.

“Just like you do with Wegener’s, give that little one slide about the complicated history here,” Thomas told me. “I think that begins the process of honoring these women who suffered.”

My chronic illness made it impossible for me to have both a menstrual cycle and a life.

“Maybe I should stop my periods.”

It wasn’t something I had ever before considered and I had, in fact, wondered if there could be potential, unknown, long-term ramifications when friends of mine stopped theirs. I had never considered my periods an inconvenience or gross or annoying; in fact, I had liked the rhythm of them. The times I had been on birth control I resented how it made me feel divorced from my body.

When I asked this question, I was sitting in my doctor’s office, nine months into antiviral treatment for chronic fatigue syndrome, 11 years after starting treatment for Lyme disease. The previous year had been hard. Though I had been significantly healthier than I’d been in a long time and had started running again, working hours that were closer to full-time and going out with friends, every month, in the week before my period, I collapsed.

In these weeks, I felt ragged, frayed; the simple act of my body functioning with regulatory actions felt like too much of a drain. My life required too much of me in these weeks and I’d stumble through work, cancel plans, and do as little as possible. I’d get cold and not be able to warm up again, no matter how many burning hot showers I took; fevers would flash through me, but I never retained the heat and I’d collapse in a heap of fatigue, wracked with fevers and chills, muscle pain, sore throats, and mental confusion again. When my cycle was over, I’d be better than I was during the flare-up but worse off than I had been before my period. Every month, I’d take another step down in my health.

I always wonder how to describe a fatigue so profound it feels like a weighted shroud, especially as so many doctors have not believed me. This is not just being tired, it’s a fatigue of dangerous proportions that feels like an emergency in my body, threatening to take me down again. When I was finally diagnosed with chronic Lyme disease, I’d been sick for over 11 years — 11 years of doctors who refused to believe that I wasn’t just seeking attention, 11 years of worsening chronic fatigue and tick-borne illness. These are diseases that, when not addressed, become steadily more serious and more difficult to treat.

The Hidden Battle For The Rights Of Chronic Fatigue Syndrome Sufferers

When I was 24, I moved back in with my parents, deep into third-stage Lyme. My hairline had receded dramatically, deep purple rings dragged on my always bloodshot eyes, my skin had gone gray and papery. My body was wracked with so much pain it felt like simple daily use of my joints was causing them to degenerate. I wondered if I would be able to walk in three years. I couldn’t follow conversations, words had lost significance for me, I could no longer read. My inability to engage with the world mimicked that of my grandfather’s Alzheimer’s Disease. I was so tired that I hadn’t laughed in years.

A decade-plus of treatments has stripped me of most of the worst effects of CFS and Lyme (the symptoms often overlap) and returned me to living a life more fully than I had ever been able to before. But I still declined each month with my period, and never quite got back to where I had been before the decline. I was doing better than I had been before I started my antivirals, I told my doctor, but I felt that I would never be doing well — unless I stopped menstruating.

My doctor, Jennifer Sugden, N.D., had treated me for Lyme and CFS with a variety of different protocols, including hormone replacement therapies. But I’d never suppressed my periods before. I had always collapsed the week before my period, but I thought that this was one more thing that would resolve as I got better. Instead, it seemed that the hormone changes around menstruation would always be an Achilles heel.

This is a common experience among patients with Lyme and chronic fatigue syndrome and some other tick-borne illnesses. Dr. Sugden says that when she discusses Lyme and CFS within the medical community of Lyme-literate doctors, they talk about how “women are typically harder to treat and some women really decline before or with her period.” Jose G. Montoya, director of the multidisciplinary division of Stanford’s Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Initiative, concurs, saying that “this phenomena is really pronounced in some women. You don’t have to dig this [information] out…that is so clear in some cases, that the disease is significantly worse right around their menstrual cycle.” He acknowledges that “we will have to be treating women and men differently, there is no question.” (It’s important to note here that menstruation is not just a “women’s issue,” and can affect trans and nonbinary bodies as well.)

So far, the research on ME/CFS has been meager at best and without a focus on female endocrinology. Stanford’s ME/CFS Initiative is currently recruiting subjects for a neuroendocrine study with women of child-bearing ages to hopefully give some answers on this subject. Eventually, Dr. Sugden says, “it wouldn’t surprise me if stopping periods becomes a part of protocol.”

So what is it about periods that can compromise some patients with ME/CFS and tick-borne illnesses so dramatically? Dr. Sugden points to an underlying problem: overworked adrenal glands. The adrenals produce cortisol, which regulates our circadian rhythm, and DHEA, which is the building block to produce estrogen and progesterone. “It’s having to produce DHEA on a cyclic pattern when the adrenals are not strong enough to produce it on a monthly cycle,” Dr. Sugden says about the monthly decline some people experience. “But when you replace the hormones and suppress periods, the glands can focus on healing themselves. You allow the adrenals to NOT produce DHEA and your body can produce cortisol at the rate it needs to.”

My doctor said it wouldn’t surprise her if stopping periods becomes a part of chronic fatigue syndrome protocol.

After three months of supressing my periods, I realized that I hadn’t had any extreme crashes in my health. While I wasn’t fully well, my health was steadier and I was incrementally getting better. Six months later, I was stable enough to start chasing dreams again. I packed up and moved to Mexico City, a place I’d been talking about moving to for years. I never did because I needed my family and my doctors close and I didn’t want to move abroad when I would have to live my life tight, watching to never do too much.

It’s been a year now and I live more easily than I ever thought possible. I’ve settled into my new home and language, work full time, and still have energy left over for friends, exploring, and climbing trips. In many ways, stopping my periods helped give me back my life.

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]]> https://theestablishment.co/the-troubling-power-of-nagging-e689829eb1cc/ Sat, 03 Dec 2016 19:00:09 +0000 https://theestablishment.co/?p=6495 Read more]]> I’ve given my boyfriend grief about his diet since we started dating. To give you a sense of his philosophy on food: the more butter the better; anything and everything that can should be fried; if you don’t think you need sugar on it, you’re probably wrong and it does.

In short, as a person who examines cardiovascular disease for her career, his eating habits drive me bonkers.

Naturally, his diet has been the basis for some of our more “heated debates.” One particularly memorable debate — where we were not using our indoor voices, shall we say — revolved around his beloved breakfast drink, orange juice. My boyfriend brings small cartons of orange juice to work daily.

My logic: Intake of excess sugar is associated with obesity (a risk factor for cardiovascular disease).

His logic: It tastes good.

My math: One serving size of your average Tropicana orange juice contains 22 grams of sugar; the World Health Organization recommends a daily sugar intake of 25 grams or less. This means his small carton of orange juice takes up 88% of his recommended daily intake.

His math: 25 grams -22 grams + one fun-size Butterfinger = sounds tasty.

At this juncture, I’d like to offer some science-driven fodder that illuminates both the importance of what’s often problematically referred to as “nagging,” as well as the truth behind the Great Orange Juice Controversy.

***

Not surprisingly, studies on behaviors in relationships have historically focused on heterosexual partnerships, so research is unfortunately limited. The studies that do exist reveal that, in essence, women do play a vital role in their male partner’s health behaviors. One can presume this has to do with the emotional labor expectations placed upon women, and the enduringly powerful societal influence of traditional gender roles.

One particularly illuminating cross-sectional study — Marital Status and Health Beliefs: Different Relations for Men and Women — examines the association between proactive health behaviors (such as receiving a flu shot, getting screened for colorectal cancer, receiving a mammogram, receiving a prostate exam, and receiving a blood test to monitor cholesterol levels) . . .

. . . and marriage.

What this study found was that married men were more proactive in their health beliefs than single men and more likely to utilize procedures that prevent illness or provide early detection of health issues. Oddly enough, this relationship does not exist for the female counterpart. Single women were found to be more proactive in their health beliefs than married women.

The authors of the study say that the gender differential suggests that when men get married, their wives positively impact their health beliefs. The authors believe this positive impact may be in part because,“women initiate conversations about health care and the importance of health maintenance, thereby helping to improve their husbands’ health beliefs.” Essentially, as my boyfriend was quick to point out, we “nag our husbands.” And while this is a stereotypical notion that has been used to perpetuate dangerous gender stigmas, in truth, discussing health issues with a partner can lead them to seek essential preventative medical care.

An additional health economic study — Honey why don’t you see a doctor? — found that a man is 13 times more likely to see a health professional if their partner sees one. The reason for this phenomenon is thought to be because women remind their partner to go to the doctor for checkups.

This study goes on to say that this monitoring behavior may partially explain the phenomenon that “married individuals are healthier and live longer than unmarried people”; spousal influence on the promotion of healthy behaviors is thought to play a role in this increase in life expectancy. Feeling it was my duty to increase my boyfriend’s life expectancy, I decided to talk to him about his incessant consumption of orange juice.

The obvious result? We got into an argument.

Me: “I am going to throw all of those orange juice cartons off the balcony of this apartment if you don’t stop bringing those to work!”

Him: “I am going to throw all of this broccoli off the balcony of this apartment if you don’t stop nagging me about my morning orange juice! It isn’t unhealthy!”

Neither of us willing to concede, we both left for work. Huffing.

But I couldn’t let it go . . . I felt I had to prove him wrong. The minute I got into my office, I did what every good researcher does — I turned to science. I could almost taste the victory — sweet as O.J.! — as I began to scour empirical journals to find concrete evidence to back up my argument.

I knew the prior study — Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity — had found that excess consumption of 100% fruit juices in adolescents is associated with obesity and was determined to find a complementary study for adults.

And then, my day took a turn for the worst.

After scouring PubMed, I stumbled upon a peer-reviewed study that examined the association between 100% orange juice consumption and diet quality, nutrient adequacy and risk factors associated with cardiovascular disease. The researchers compared consumers of 100% orange juice to non-consumers in 8,000 adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003–2006.

My stomach . . . slowly dropped.

Linear and logistic regressions — predictive models that investigate relationships among dependent and independent variables — were run. Macro and micronutrient intake, diet quality, and various risks were assessed. The analysis controlled for energy (more commonly known as the much-dreaded calorie), age, gender, ethnicity poverty index ratio, and physical activity for body weight and body mass index.

And? Overall results found that drinking orange juice was associated with increased levels of vitamins and minerals (A, B6 and C in addition to folate and magnesium), better diet quality, lower body mass index, and lower cholesterol. Oh, I also discovered a 21% reduced risk of obesity in orange juice consumers compared to non-consumers.

So what exactly do these results mean? Drinking a usual intake of 100% orange juice (a little less than 1 cup) will not only not catapult you into cardiovascular distress or an early grave — it might in fact, improve your health.

Orange juice is frequently fortified with additional vitamins and minerals, which may explain why consumers were found to have had higher levels of vitamins and minerals. Additionally, the association with a better diet quality suggests that consumers are more dietary health conscious than those who are non-consumers. Based on these results, the researchers recommended including a usual intake of 100% orange juice as a part of a healthy diet.

Also based on these results? I 100% lost the argument with my boyfriend.

So what had my boyfriend unknowingly been doing right? Those little cartons of sweet orange nectar he religiously quaffs at work are portion controlled, 100% fruit juice, and do not contain additional processed sugars (which can in fact be detrimental to your health). Additionally, he was drinking orange juice, meaning these results do not apply to apple, grape, or other types of fruit juices, which may not have the same health benefits as our beloved breakfast beverage.

That evening, tail between my legs, I presented my research to my boyfriend, who had the very mature response of laughing hysterically and yelling “SCIENCE!” at the top of his lungs.

My weekend brunches now include two glasses for orange juice at the table instead of just one.