Will hospital food ever get better?

New York–area chefs are working on the problem. More need to follow their lead.

Photo: rawpixel/pixabay
  • 23 New York–area hospitals are attempting to redefine hospital food by making it healthier and more exciting to prepare.
  • 20% of 208 hospital facilities surveyed featured McDonald's, Chick-fil-A, and Wendy's on their campuses.
  • A 2017 report published in JAMA found that almost half of deaths caused heart disease, type 2 diabetes, and stroke can be attributed to poor diet.

Boston's Children Hospital is one of the most well-regarded children's medical facilities in the world. It was fortunate that my ex-wife's teenage nephew lived in Boston. When he suffered a brain injury that nearly killed him eight years ago, the top-notch staff saved his life. People from around the world to bring their children to this facility thanks to its combination of expertise and equipment.

Yet what I remember most about the trip to visit him was the food. Here we were, in one of the best hospitals on the planet, and the cafeteria looked like a 7-11. Our options included muffins, cookies, potato chips, soda, and not much else. I was stunned that a place of healing would only offer visitors the products that bring many patients into its wings in the first place.

I shouldn't have been that surprised. I worked in the emergency room at another top institution, Robert Wood Johnson University Hospital, for two years while attending Rutgers. In fact, I lived in that same hospital for over a month after breaking my femur in 1986. I recall eating in the hospital as both an employee and patient. In both situations, what was provided was anything but healthy.

I'm not alone in this confusion. A recent Eater expose highlights the problem:

A Styrofoam cup of watery broth, orange Jell-O, blue Gatorade, low-fat vanilla yogurt, a juice box of wild berry-flavored Boost Breeze, a packet of Scandishake powder, and generic saltines, neatly lined up on a dull gray hospital tray: This was among my husband's first meals in over two months.

I remember the Jell-O, saltines, and juice well—I drank multiple plastic containers of grape juice every day for five weeks, not exactly the best option for an overweight eleven-year-old. America might be unique in this disregard for health, at least given this global survey of user-generated photos of hospital food from around the world. (Ok, Poland isn't looking so hot either.)

In America, obesity costs $147 billion per year, driving up our annual health care costs by 29%. A 2017 report published in JAMA found that almost half of deaths caused by heart disease, type 2 diabetes, and stroke can be attributed to poor diet. Why, then, are the places that address these diseases part of the problem? How do administrators get this very solvable issue so wrong?

As the NY Times reports,

Only 27 percent of American medical schools teach the recommended 25 hours of nutrition, and even then the content is mostly biochemistry rather than "practical" advice about diet.

This explains why doctors are often ignorant of nutrition, but does this problem persist in every facet of hospital bureaucracy? Not every doctor is clueless about this issue: In 2016, a nonprofit group of over 12,000 medical professionals filed a report about hospital food, stating that 20% of the 208 facilities surveyed featured McDonald's, Chick-fil-A, and Wendy's on their campuses. If visitors are getting shafted, just consider the patients:

The food served in regular hospital cafeterias often isn't much better; in the same 2015 report, PCRM [the Physician's Committee for Responsible Medicine] analyzed cafeteria menus and patient meal plans, and found that they often included processed meats and items high in sugar, salt, and cholesterol. Another study from 2012, published in the journal Academic Pediatrics, assessed the food offerings in 14 California children's hospitals, rating each hospital on a scale from 0 (unhealthy) to 37 (healthy). The average score was 19, and only 7 percent of the 384 entrees served were classified as healthy.

Fortunately, things are changing. A pilot program at a children's hospital in Ottawa includes red Thai curry, basil pesto with kale, and cod on the menu; the vegetables that chef Simon Wiseman cooks with are pulled from his garden. And, as the NY Times article above mentions, a move toward healthier food is happening at 23 New York–area hospitals.

Beyond serving healthier food to patients, there is an educational component to avoid patient re-admittance. Doctors are being trained to teach those under their care how to read food labels and understand what a carbohydrate is. They've even created a "food pharmacy" for discharged patients to return home with better nutritional options and are offering low-income patients the opportunity to return for free meals on a weekly basis.

Hospitals are stressful places, and humans are emotional animals. A few weeks ago, I sliced off my fingertip while cutting an onion. My wife, taking a nap, was startled when I ran into the bedroom, my left hand wrapped in a bloody towel. Two hours later, having received a tetanus shot after the cauterization of finger, it was obvious that the healthy dinner previously in preparation was not happening. We settled on burritos—true comfort food in Los Angeles—on the ride home.

We need our medical establishments to do better. Health care spending accounts for nearly 18% of America's GDP. That unacceptable figure is produced by an industry that keeps us returning by fostering bad dietary habits. At a moment when citizens really need medical professionals to educate them, they're failing miserably by feeding them the same crap that likely put them in the hospital in the first place. It's slowly changing, as one doctor in the NY Times piece noted, but the change is not coming soon enough.

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Stay in touch with Derek on Twitter and Facebook.


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The surprise reason sleep-deprivation kills lies in the gut

New research establishes an unexpected connection.

Reactive oxygen species (ROS) accumulate in the gut of sleep-deprived fruit flies, one (left), seven (center) and ten (right) days without sleep.

Image source: Vaccaro et al, 2020/Harvard Medical School
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  • Surprisingly, the direct cause seems to be a buildup of Reactive Oxygen Species in the gut produced by sleeplessness.
  • When the buildup is neutralized, a normal lifespan is restored.

We don't have to tell you what it feels like when you don't get enough sleep. A night or two of that can be miserable; long-term sleeplessness is out-and-out debilitating. Though we know from personal experience that we need sleep — our cognitive, metabolic, cardiovascular, and immune functioning depend on it — a lack of it does more than just make you feel like you want to die. It can actually kill you, according to study of rats published in 1989. But why?

A new study answers that question, and in an unexpected way. It appears that the sleeplessness/death connection has nothing to do with the brain or nervous system as many have assumed — it happens in your gut. Equally amazing, the study's authors were able to reverse the ill effects with antioxidants.

The study, from researchers at Harvard Medical School (HMS), is published in the journal Cell.

An unexpected culprit

The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

"We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

"Even more surprising," Rogulja recalls, "we found that premature death could be prevented. Each morning, we would all gather around to look at the flies, with disbelief to be honest. What we saw is that every time we could neutralize ROS in the gut, we could rescue the flies." Fruit flies given any of 11 antioxidant compounds — including melatonin, lipoic acid and NAD — that neutralize ROS buildups remained active and lived a normal length of time in spite of sleep deprivation. (The researchers note that these antioxidants did not extend the lifespans of non-sleep deprived control subjects.)

fly with thought bubble that says "What? I'm awake!"

Image source: Tomasz Klejdysz/Shutterstock/Big Think

The experiments

The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

"We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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