On the nature of addiction

June 12, 2014 at 12:22 pm | Posted in Conditions, Ethics, Media, Opinions | 2 Comments

This is going to be a complex post in which I will make a certain very uncomfortable admission that I’ve never made in public before. For that reason it might ramble slightly. Bear with me.

First of all, news today that the European Court will rule on whether obesity is a disability. I have some thoughts about that.

Obesity isn’t a disability. People become disabled because they are obese. Disability is the symptom, not the cause.

Take that one step further though: Obesity is also a symptom. It’s a symptom of addiction; addiction to over-eating, and specifically to sugar.

See, this is why we have angry fat acceptance activists like “This Is Thin Privilege” (I’m not providing a link, because they’re honestly borderline psychotic and I don’t need the aggro) and the like; pointing out to an obese person that their obesity is a problem is exactly the same as pointing out to a junkie or an alcoholic or a gambling addict that they have a problem – Until they’re ready to accept it, all you’re going to get in return is anger and denial. And some of them will never be ready to accept it.

Obese people aren’t disabled, they’re addicts.

And here’s where it gets really messy:

If a patient comes in to my care having seizures from alcohol withdrawal, maybe with a case of hepatic encephalopathy, then we can dry that patient out. We can give them benzos to control their seizures and withdrawal, we can give them IV Pabrinex to save their liver, we can get that person back on their feet, and we can say with complete honesty: “You cannot drink alcohol ever again, or it will kill you”.

How do we say that to a food addict? “You can’t eat ever again or you’ll… Oh… Wait… Never mind”.

See, abstinence is EASY. Alcoholic? Don’t drink. Heroin addict? Don’t take heroin? Smoker? Don’t fucking smoke.

It’s a piece of cake. Honestly.

Know what’s hard? Moderation. Tell somebody with an addiction that they can have just a little bit of what they’re addicted to? They’re ADDICTED to it. One drink will become twelve really quickly. That’s what recovering food addicts have to deal with: They can’t just avoid their addiction entirely. They have no choice but to have a little bit of their poison, at least three times per day, ever single day.

Quitting booze and cigarettes is easy. Getting slim is a bastard.

And I know this for several reasons. Firstly, I smoked (heavily) for thirteen years and quit without incident the first time I seriously attempted to. Secondly, I am a recovering fatty. My BMI is 32, and it’s not because I don’t exercise, it’s because I eat too damned much sugary, high calorie food. I’m doing my best to moderate it, but it’s bloody hard. Thirdly, and this is where I make an uncomfortable admission, I have an alcohol problem. If I’m drinking, then brother I am DRINKING. I am addicted to alcohol. I am an alcoholic. I’ve never said that before. Feels weird. But good.

But I can cope with my alcohol addiction. Really, it’s not difficult at all. I either drink nothing whatsoever (the default state of being for the last few months), or if I drink at home I buy four 330ml bottles of beer and no more (never any spirits, and oh my God do I miss single-malt Scotch whisky). When I’m out and exposed to unlimited booze, any of my friends will tell you: I drink. I really, really drink. Which is why I don’t go out very often.

The problem is, none of these strategies work for food addicts. You cannot abstain from food entirely. Neither can you have a house in which there is no food (not and maintain a marriage anyway). I guess the challenge for the 21st century is to find a way to break the addiction. Methadone for sugar.

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Farewell Unreasonable Faith

April 24, 2014 at 9:13 am | Posted in Media | 2 Comments

Today I’m feeling a little melancholy. Yesterday, the long and protracted process that is the death of a blog became complete.

Unreasonable Faith was started by Daniel Florien in 2008 as an outlet for his thoughts and feelings about his deconversion from evangelical Christianity. Unfortunately, life kind of overtook Dan and he had to step away from it sometime in 2011 – But fortunately Vorjack was there to pick up the ball, and he did a great job of writing engaging, thoughtful entries about religion, scepticism and history. Do go and read his back-catalogue. It’s well worth it.

And then there’s me. The Angry Nurse – Custador, as I was known there. UF was never my blog, it was Dan’s and then it was Vorjack’s. But I’ve been writing posts for it for almost the entire time it’s been up, only stopping about a year ago out of frustration at the hundreds and thousands of fruitless hours I was putting in to try to keep their forum useable. The repeated blog migrations saw the bulk of my back-catalogue of writing mislabelled as written by “Fatemeh”, and brought it to Patheos (which paid for the bandwidth but has a crappy interface). Then Patheos introduced the Disqus commenting system for all of its blogs (and if you think it sucks as a commenter, then try being the poor sod that has to use it as an admin). I miss the UF forum most of all; it was a thriving, buoyant community, and its death by spam-bot signalled the final death-knell of the whole enterprise for me. So without even a goodbye, I stopped posting on the blog and gave up on the forum entirely.

I spent some time yesterday reading through my own back catalogue of blog entries for UF. There are about 150 in all (if you include the ones I wrote as “Guest” and the ones misattributed to “Fatemeh”).

That doesn’t represent the same investment of time and effort that Vorjack put in, or that of the emotion that Dan put in. But it was still a lot of my time. I’ll always be grateful to Dan and the UF community for giving me a place to expose my own thoughts to a mass audience and have them seriously scrutinised; I’ve changed an awful lot as a person thanks to some incredibly smart people patiently ripping my posts to shreds and carefully explaining why I was wrong. I’ve also met some people in the strange internet world who I’ve never met in real life, but who I nevertheless consider to be good friends.

So for anybody from UF reading this, goodbye and good luck. The old UF days were good, and I’m sure I’ll always miss them.

Peace, out.

On “Health at Every Size”

August 31, 2013 at 10:55 am | Posted in Conditions, Media, Opinions | Leave a comment

Oh boy. I don’t think I’ve ever written a post outside of the realms of aggressive atheism that I knew before I even started was going to be such flame bait. That said, I will try to keep this sensible and not bash any particular demographic. My goal here is to state facts, not to tease obese people. I’m even going to add a disclaimer: I am a chubby fat-ass. Oh yes. But I’m not kidding myself about the impact that has on me.

Health at Every Size (HAES), from their own website, ”acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors ”.

That’s a good goal, and it’s one you have to approve of. Getting anybody to be healthier is a good thing; getting somebody who’s very unhealthy to be healthier is even better. So I don’t want to take issue with that. But I really do take issue with some of the methods it advocates and the messages it sends. I’ll get on to those in a moment.

So: Who invented Health at Every Size? A lady by the name of Linda Bacon (save the jokes, people), who to be fair holds a lot of qualifications in a lot of disciplines. However, while she does have a PhD in physiology she’s not a medical doctor, and that makes me a little wary of putting too much weight in her opinions about something as important (and medical) as obesity and overweight. It’s also interesting to note her list of peer-reviewed published works: Not extensive, and nothing in any of the big, high-impact journals. She calls herself an ”internationally recognized authority on weight and health”, but honestly I see nothing in her public profile that backs up that assertion, and I’m cautious about people who proclaim themselves to be internationally recognized. If it’s true, they shouldn’t need to say it themselves because other people are saying it for them – I read widely in medical and care journals, and until I started looking at the HAES website, I’d never heard of Linda Bacon.

The HAES website lists three principles that I want to talk about.

First: ”Accepting and respecting the natural diversity of body sizes and shapes.”.

Yes. Totally with you on that. We do come in all shapes and sizes, and it is nobody’s place to make judgements about an individual’s weight. There is a huge amount of body dysmorphia in the Western world, mostly thanks to media depictions of absurdly “perfect” (I use the word guardedly) bodies, faces and teeth. Anybody who doesn’t look like Beyonce or Brad Pitt* is made to feel like they’re inferior, not good enough, second class. And that’s a bad thing. So I have no bone to pick with this point at all.

Second: ”Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.”

…Aaaaand then again, there’s this one. Oh boy. How much is wrong with this one? First of all, Western diets (particularly among poorer demographics, who are also – non-coincidentally – more obese) mostly use fat and sugar as flavours. It’s a general rule of thumb that any processed food proclaiming itself to be low in fat is likely to be high in sugar, and any processed food proclaiming itself to be low in sugar is likely to be high in fat. The problem with fat and sugar (particularly sugar) is that they are incredibly calorie dense and are digested and absorbed by the human body very, very easily. A tablespoon of sugar contains 45 calories and no nutrients whatsoever except pure carbohydrate, and your body will absorb all of those calories immediately. On the other hand, a large bowl of salad will come in at less than 50 calories, not all of which will be absorbed by your body, and a shedload of micronutrients that a healthy body really does need.

The reason that this is such a problem is that sugar triggers the pancreatic feedback response, dumping insulin into your body. Insulin does two things in this context: First it enables cells to absorb glucose in your blood quickly and easily so that your sugar levels (which have already risen rapidly at this point) drop rapidly back down, and it stimulates your body to store fat. That’s right. Sugar makes you fat. It also has an addicting effect; when the sugar rush is followed by the sugar slump, your body wants more sugar. And that’s more high-density calories that your body just does not need.

The “Too Long; Didn’t Read” version of this is: Processed foods and beverages are addictive, calorie dense, habit forming, nutritionally crap, and don’t satiate hunger. They trigger a pleasure response, but it takes way, waaaay too much volume of them to fill your stomach and satisfy your appetite.

And chances are, if you’re already overweight, obese or super-obese, the foods that you respond to hunger cues with and get pleasure from are foods that you really, really shouldn’t be eating.

On to principle three: ”Finding the joy in moving one’s body and becoming more physically vital.”

Or, as it’s otherwise known, ”Doing exercise and getting healthier, which as a side effect will cause you to lose weight”. Do I even need to add anything here? Of course better cardiovascular health through exercise is a good idea. Anybody who tells you otherwise is a moron.

Now I’m going to move on to some things that come from Linda Bacon’s own promotional website.

”MYTH: Fat Kills. REALITY: On average, ‘overweight’ people live longer than ‘normal’ people.”

How can I put this? It seems to me that this quote is misleading. It seems to me that a layperson probably doesn’t know the distinctions between overweight, obese, morbidly obese and super-obese. It seems to me that Linda Bacon might be deliberately using the word “overweight”, knowing that it’s probably the word most people in all of the above brackets would use to self-describe. It also seems to me that The New England Journal of Medicine (one of those big, high-impact journals I mentioned earlier) has published research which disagrees strongly with this point. It seems to me that a reasonably unbiased, well informed, outside observer might look at this point on Linda Bacon’s website and consider it to be very cynical and manipulative indeed.

Moving on.

”MYTH: Lose weight, live longer. REALITY: No study has ever shown that weight loss prolongs life”

Well this is just flat-out wrong. I can only charitably assume that Linda Bacon doesn’t know about Google Scholar, because it took me all of about ten seconds to find a study which evidences a link between losing weight and living longer. I assume that Linda has Athens access. Because I do. And there is more than one study that says the same thing.

”MYTH: Anybody can lose weight if he or she tries. REALITY: Biology dictates that most people regain the weight they lose, even if they continue their diet and exercise programs

(Emphasis mine).

And physics dictates that this point is utter bullshit. It’s really simple: Your body cannot create mass or energy out of nothing. Therefore, if calories in equals less than calories out, your body converts mass to energy to make up the difference. Conversely, if calories in equals more than calories out, your body converts energy to mass to store the excess. This is not rocket science. I would love to know what research Linda Bacon has to support her assertion here, because I guarantee you if there is any it’s based on self-reporting by study participants – Because people routineliny underestimate their own calorie intake by A LOT, while simultaneously overestimating their own physical activity levels.

I’d like to throw one more point in here before I close. Life expectancy is going up, even amongst high BMI populations. But that isn’t because high BMI is healthy; life expectancy is going up despite increasing BMI levels. The fact is, if you have a high BMI, your life expectancy is still much lower than it would be if you have a normal BMI.

The danger in the HAES movement lays in the fact that it’s impossible to take a general rule of thumb and apply it to a whole demographic. While it’s entirely possible to be both fat and healthy, it is very rare to be both fat and healthy, and everybody thinks they’re the outlier, the exception to conventional wisdom. The problem is, most of them are wrong.

The HAES movement is popular amongst what is known as the “Fat Acceptance Movement” (or self-styled “Militant Fatties”). This is a demographic that has already made up its collective mind to ignore evidence and reality in favour of confirmation bias.

That is a group of people who nobody is ever going to convince that they are harming themselves with their lifestyle choices. When their knees collapse and have to be replaced, when they’re on BiPAP at night so they don’t die of sleep apnoea, when they’re on mobility scooters to go to the shops, these are people who will insist that all of those things are coincidental, that they’re nothing to do with their weight. Ultimately, though, when they have a serious cardiac event twenty or thirty years before their healthy BMI contemporaries and lay dead on a mortuary table, they’ll still have been just as wrong.

*Disclaimer: I think she looks like a blow-moulded Barbie doll and he looks like a skinny manlette, but whatever.**

**Disclaimer 2: Yes, I just judged two people on their appearance. I’m a hypocrite. Deal with it.

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On Stafford, and Judgementalism

February 13, 2013 at 10:56 am | Posted in Media, Nursing, Politics | 2 Comments

I guess I can’t really blog about nursing and not mention the Stafford Hospital report. For anybody who’s been living under a rock, the tl;dr version is: Care was not good enough at the Stafford Hospital, and unnecessary deaths resulted.

Ouch. I can only imagine how nurses at that hospital feel right now. Frightened. Embarrassed. Defensive. Angry. Probably a cocktail of all those and more. But that report has been pored over and analysed and quote-mined to death; the only thing that I want to say about it directly is: The report’s author has already admitted that he was wrong to name the whole hospital as the problem, when in point of fact the issue was isolated to two wards – And he even narrowed it down to specific staff on those two wards.

And yet, on the basis of this report, nursing in Britain is going through what feels like a witch hunt. This isn’t a nice time to be living through, speaking as a nurse. The media cannot wait for us to screw up and sell more papers for them, and the government are eager to push any agenda which makes the NHS as-is look inferior, because they’re ploughing ahead with privatisation by stealth (if you doubt that, read the full text of the Health and Social Care Act, then come back to me) and want to minimise resistance from the general public.

What’s worse is, nursing can’t get a mention on social media without a barrage of comments from uninvolved lay-persons who think they know how to fix all of nursing’s woes. From dead reckoning, at least ninety percent of the people making such comments can be summed up as “Bring back Matron!”, even though Matron never actually went away in the first place. Personally I think that there is a small but very vocal minority of sexually deviant people who fantasise nightly about Hattie Jakes in a white tabard and starched cardboard hat, and who want to populate our hospitals with her.

My point here is this: Nursing is a profession that people have so little respect for (until they actually see us in action) that they feel perfectly comfortable with telling us how to do our work, in spite of their own absolute ignorance. Dunning-Kruger effect – They’re too stupid to know that they’re stupid.

Of course, in amongst the Hattie Jakes fans, there are always one or two comments along the lines of “my mum laid in her own faeces for hours!”. Actually, that’s a really good example to use because it’s so common and yet usually such obvious tosh. How would you know that your mother had been laying in faeces for hours unless you were actually there to see it? And if you were there to see it, why didn’t you nag somebody until they came and cleaned your mother up? Now, I’m not saying that anybody visiting a hospitalised relative should ever be in a position to have to provide care, but honestly? If I was visiting my elderly grandmother in hospital and nobody had cleaned her up after a few minutes and repeated requests? I would just do it myself. And I know that’s not really a fair generalisation, because I am a nurse, and cleaning poo from elderly people is very much in my job description, but I think the point remains valid.

People in general don’t seem to provide care for elderly relatives as much as they used to. There is a very sad tendency to expect the NHS and/or Social Services to do everything. And that really isn’t the point of socialised health and social care.

I have encountered my share of families who pick up on every single detail of their relative’s care, and get angry and upset and claim that it isn’t good enough even when it’s absolute gold standard. They’ve all had one common feature: Guilt. In general, it’s often the family of an end-stage terminal patient who’s been an inpatient for weeks or months, but whose family have never been to visit until the day they’re phoned and told that their relative is fading fast and now would be a good time to come and say goodbye. That’s the point when you know as a nurse that you’re in for a challenge, because the family are justifiably upset that their relative is dying, and they’re feeling guilty about not visiting while he/she was still actually conscious and able to interact with them. They lash out at staff, and it’s our job to take it and to never, ever judge them. We don’t know why they never visited, and it’s not our business.

It’s also our job to deal with patients who are confused and/or demented. I personally know four or five nurses and auxiliaries in the last year alone, who have been assaulted severely enough by dementia patients, to have needed time off work to recover. This is something that is poorly understood: If a person has dementia so advanced that they form no new memories and have few or no original memories, then as far as that person is concerned, they are always in a strange place, surrounded by strange people. A lot of they time they won’t even know who they are, let alone the people in blue who want to come and give them a wash. Fear and anger are natural responses to that, so sometimes as nurses we get physically assaulted. I’ll leave aside the issue of people who assault us because they’re just plain horrible people, because that is rare outside of the ED.

Now, I don’t want to play the martyr here. Honestly, I don’t; I think that’s a terrible and manipulative thing to do. Everybody who ever trained as a nurse knew very well that they were getting into a hard, physical job which comes with a lot of responsibility and very little financial reward. We all knew from the outset that we’d be working twelve hours without a break, often followed by four hours of unpaid overtime. We all knew that our home life would suffer for our choice of profession. We knew that we were going to get insulted, spat at, berated and punched.

We knew all of that. But we never agreed to be whipping boys and girls for every politician and bored journalist in Britain. And that, sadly, is what we are becoming.

If I get any message across in this post, I hope it’s this: On the basis of a report about specifically identified staff on two wards in one hospital, the government and media now seem to be on a mission to destroy the working reputations of more than a million clinical staff working across almost four hundred NHS trusts. They’ve totally ignored patient’s opinions (the last CQC survey showed that 91% of patients who responded rated the care that they received as excellent, very good or good), and they’re completely blanking the vast majority of clinical staff, particularly nurses, who deliver that excellent care against stacked odds.

So if you’re a nurse or an HCA or an NA or an AP or even (whisper it) a doctor, then hold your head up. The vast majority of your patients think that the vast majority of you are brilliant. And really, do any of us care what anybody else thinks?

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