The Health Pyramid- Nutrition Part 2

The Invisibly Empowered Health Pyramid

PART TWO: NUTRITION

When Nutrition Starts Showing Up in Your Health

In Part One, we talked about what actually happens to food after you eat it.

We followed nutrients through the body and looked at why your brain, heart, muscles, bones, blood, immune system, gut and hormones all care about what is on your plate.

Now I want to talk about what happens when those systems aren't consistently getting what they need.

Or when they're consistently getting more than they need.

Or, and this is important, when you're eating the nutrients your body needs but something is interfering with your ability to absorb or use them properly.

Because nutrition isn't just about weight.

Actually, I think that's one of the biggest mistakes we've made when talking about food and health.

We step on a scale and somehow decide that number tells us whether we're well nourished.

It doesn't.

Someone can live in a larger body and be deficient in important nutrients.

Someone can live in a smaller body and have high blood pressure, high cholesterol or insulin resistance.

Someone can eat an incredibly balanced diet and develop a deficiency because of a medical condition affecting absorption.

Someone can look perfectly healthy and have lab work telling an entirely different story.

You cannot look at someone and know their nutritional status.

So let's take weight off center stage for a minute and talk about what's actually happening inside the body.

Your Body Is Constantly Trying to Keep You in Balance

Your body is incredibly good at adapting.

If you miss one balanced meal, your body doesn't fall apart.

If you eat birthday cake, your pancreas doesn't submit its resignation.

If you go on vacation and eat differently for a week, you haven't destroyed your health.

Our bodies are designed to handle variation.

The bigger concern is usually patterns over time.

What happens when the body repeatedly doesn't receive enough energy or certain nutrients?

What happens when it repeatedly receives considerably more energy than it uses?

What happens when our overall eating pattern consistently contains too little of the things that support health and too much of the things associated with greater health risks?

That's where nutrition can start showing up in our health.

And it can show up in ways you may not immediately associate with food.

When You're Not Getting Enough

When most people hear the word malnutrition, they picture someone who doesn't have enough food.

That's certainly one form of it.

But malnutrition is broader than starvation.

A person can have inadequate overall energy intake, inadequate protein intake, or a deficiency in one or more specific vitamins or minerals.

The effects depend on what is missing, how severely it's lacking, how long it has been happening and the individual person.

Possible consequences can include:

• fatigue and weakness

• loss of muscle mass

• impaired immune function

• slower wound healing

• changes in hair, skin or nails

• problems with bone health

• anemia

• neurological symptoms

• changes in mood or cognition

• impaired growth in children

• hormonal or reproductive changes

• reduced physical performance and recovery

And here's the important part.

You don't necessarily have to be eating very little food for this to happen.

You Can Be Overfed and Undernourished at the Same Time

This is one of those concepts I wish everyone understood.

Calories and nutrients are not the same thing.

Calories describe energy.

Your body absolutely needs energy.

But meeting your energy needs doesn't automatically mean you're meeting all of your nutritional needs.

Imagine someone eating plenty of calories every day but very little fiber, fruits, vegetables, legumes, whole grains or other nutrient rich foods.

They may have plenty of energy coming in while still falling short on particular vitamins, minerals or fiber.

That's why looking at nutrition exclusively through calories or body weight misses so much of the picture.

You can consume enough energy and still not consistently give your body everything it needs.

Iron Deficiency and Anemia

Let's start with a common example because it demonstrates this beautifully.

Iron helps your body make hemoglobin, which allows red blood cells to carry oxygen.

If your iron stores become depleted, you can develop iron deficiency. If it progresses far enough, you can develop iron deficiency anemia.

Possible symptoms can include:

• fatigue

• weakness

• dizziness

• headaches

• shortness of breath

• difficulty concentrating

• reduced exercise tolerance

• feeling cold

Now imagine that person doesn't know they're iron deficient.

They're exhausted, so they drink more coffee.

They're too tired to exercise.

They're frustrated because they're sleeping but still don't feel better.

Maybe they start blaming themselves for being lazy or unmotivated.

Meanwhile, their body is dealing with an entirely different problem.

And iron deficiency isn't always simply caused by "not eating enough iron."

Blood loss can cause it.

Pregnancy increases iron requirements.

Certain digestive conditions can affect absorption.

Other medical circumstances can contribute.

The symptom is fatigue. The reason behind the fatigue can be completely different from what we assume.

That is the Health Pyramid in action.

Vitamin B12 and Folate

Vitamin B12 and folate are also important for normal blood cell production.

Vitamin B12 is particularly important because deficiency can also affect the nervous system.

Depending on severity and duration, B12 deficiency can cause symptoms such as fatigue, weakness, numbness or tingling, balance problems, cognitive changes and other neurological symptoms.

Some people don't consume enough.

But again, absorption matters.

Vitamin B12 absorption requires several steps involving the stomach and small intestine. Certain gastrointestinal conditions, surgeries and medications can interfere with that process.

So telling everyone with low B12 to simply "eat better" would completely miss the point.

Sometimes food is the issue.

Sometimes absorption is the issue.

Sometimes medication is involved.

Sometimes we need medical investigation.

Your Bones Can Be Quietly Affected

Bone health is interesting because you usually can't feel your bones becoming weaker.

There isn't necessarily an alarm going off saying:

Excuse me, we could use some calcium, vitamin D and protein down here.

Bone loss can occur quietly.

Adequate calcium and vitamin D are important for bone health, and protein, magnesium, phosphorus, vitamin K and other nutrients also play roles in maintaining normal bone structure and function.

Over time, inadequate nutrition combined with other risk factors can contribute to reduced bone mass and increased fracture risk.

This becomes particularly important as we age and during and after menopause, when hormonal changes can accelerate bone loss.

Bone health isn't something we should start thinking about for the first time at 70.

The foundation gets built much earlier.

Your Muscles Need to Be Fed Too

Muscle isn't only about looking toned.

Muscle helps us move, maintain balance, support our joints, perform daily activities and remain independent as we age.

When the body doesn't receive adequate energy and protein, especially over extended periods, muscle tissue can be lost.

Age adds another layer because adults naturally tend to lose muscle mass and strength over time.

This is one reason adequate nutrition and resistance exercise become so important as we get older.

Muscle is not vanity.

Muscle is function.

Being able to get out of a chair.

Carry groceries.

Climb stairs.

Catch yourself if you stumble.

Lift your suitcase.

Play with your grandchildren.

Maintain independence.

Suddenly protein and strength training look a little different when we stop viewing them exclusively through an appearance lens.

What Happens When We Consistently Take In More Energy Than We Use?

Now let's look at the other side.

Your body is designed to store energy.

That's a good thing.

If humans had needed food every few hours throughout our entire evolutionary history, we probably wouldn't be here.

When we repeatedly consume more energy than our bodies use, some of that excess energy can be stored, primarily in adipose tissue.

Body fat isn't inherently bad.

We need it.

Adipose tissue stores energy, cushions organs, provides insulation and produces hormones and signaling molecules.

The issue is that chronically carrying excess adipose tissue, particularly visceral fat around internal organs, can be associated with metabolic changes and increased risk of disease.

This is where we start hearing terms such as:

• insulin resistance

• type 2 diabetes

• high blood pressure

• abnormal cholesterol and triglycerides

• metabolic dysfunction associated steatotic liver disease, often called fatty liver disease

• cardiovascular disease

These conditions don't develop simply because someone ate a cheeseburger.

Health doesn't work like that.

We're talking about patterns, risk factors, genetics, activity, sleep, stress, hormones, medications, age and many other variables interacting over time.

Nutrition is one piece of the puzzle.

A very important piece.

But still a piece.

What Is Insulin Resistance?

This is one of those terms everyone hears but not everyone understands.

When we eat carbohydrates, many of them are broken down into glucose.

Glucose enters the bloodstream.

Your pancreas releases insulin, a hormone that helps cells take up and use or store glucose.

Insulin is not bad.

You need insulin.

The problem occurs when cells become less responsive to insulin.

Your pancreas may initially compensate by producing more insulin to help keep blood glucose within an appropriate range.

That's called insulin resistance.

Over time, if the body can no longer compensate adequately, blood glucose levels can rise and eventually reach the range of prediabetes or type 2 diabetes.

This doesn't happen because someone ate dessert one night.

And carbohydrates themselves aren't a disease.

Genetics, body composition, physical activity, sleep, age and other factors can all influence insulin sensitivity.

Again, context matters.

Type 2 Diabetes

Type 2 diabetes develops when blood glucose remains chronically elevated because the body isn't using insulin effectively enough and eventually may not produce enough insulin to meet its needs.

Over time, high blood glucose can damage blood vessels and nerves.

That is why poorly controlled diabetes can affect so many different parts of the body, including:

• heart and blood vessels

• kidneys

• eyes

• nerves

• feet

• wound healing

Nutrition is an important part of preventing and managing type 2 diabetes, but I want to be very clear about something.

Diabetes is not a moral failure.

People do not deserve disease because of what they ate.

Genetics matter.

Age matters.

Environment matters.

Access to nutritious food matters.

Sleep matters.

Movement matters.

Medications and medical conditions can matter.

We can talk honestly about modifiable risk factors without blaming people for being sick.

Blood Pressure and Sodium

Sodium is another nutrient with a terrible public relations department.

Your body needs sodium.

It helps maintain fluid balance and is involved in nerve and muscle function.

The problem isn't that sodium exists.

The issue is that many people consume more sodium than recommended, much of it coming from packaged, prepared and restaurant foods rather than the salt shaker alone.

Higher sodium intake can contribute to higher blood pressure in many people, particularly those who are salt sensitive.

And high blood pressure matters because over time it places additional strain on blood vessels and organs and increases cardiovascular risk.

But there's another nutrient involved in this conversation that gets far less attention.

Potassium.

Potassium is important for normal cell, nerve and muscle function and plays an important role in blood pressure regulation.

This is a great example of why nutrition shouldn't always be about what we need to remove.

Sometimes the question is:

What aren't we getting enough of?

Cholesterol and Triglycerides

Here's another place where nutrition advice became overly simplistic.

For years, people heard:

Fat makes you fat. Fat is bad. Cholesterol is bad.

The reality is more nuanced.

Your body actually makes cholesterol because it needs cholesterol for cell membranes, hormones and other important functions.

Triglycerides are another type of fat found in the blood and are used to store and transport energy.

Problems arise when certain blood lipid patterns are associated with increased cardiovascular risk.

Diet can influence those patterns.

So can genetics.

So can diabetes, thyroid conditions, body composition, physical activity, alcohol intake and other factors.

Different types of dietary fats can also affect cholesterol differently.

Once again, the answer isn't:

Never eat fat.

It's understanding the bigger picture.

Your Liver Is Processing More Than You Think

Your liver is basically the multitasking employee who never gets to clock out.

It processes nutrients.

Stores glycogen.

Produces bile.

Helps regulate blood glucose.

Processes medications and alcohol.

Makes important proteins.

And does hundreds of other things.

Excess fat can accumulate in the liver, leading to what is now called metabolic dysfunction associated steatotic liver disease, or MASLD.

This condition is closely associated with metabolic risk factors such as insulin resistance, type 2 diabetes and obesity.

The fascinating and slightly scary part?

Fatty liver disease can exist without obvious symptoms.

Someone may feel completely fine while changes are happening internally.

This is why health is so much more than how someone looks.

Your Gut Will Let You Know When It's Unhappy

Sometimes nutrition problems aren't silent at all.

Your digestive system may be extremely willing to submit a complaint.

Low fiber intake, inadequate fluids and certain eating patterns can contribute to constipation.

Very rapid increases in fiber can cause bloating and discomfort.

Food intolerances may create symptoms.

Certain gastrointestinal diseases can interfere with digestion or absorption.

The gut microbiome is also influenced by what we eat.

A varied diet containing fiber rich plant foods can provide substrates used by different gut microbes.

But here's where we need to avoid turning gut health into another wellness competition.

You do not need seventeen powders, a detox tea and a $14 probiotic soda to have a gut.

Your body already came with one.

What About Our Immune System?

Adequate nutrition supports normal immune function.

Protein, vitamins and minerals all participate in immune processes.

Severe deficiencies can impair immune responses and increase susceptibility to infection.

But again, there is an enormous difference between correcting a deficiency and taking huge doses of something because the bottle says "immune support."

More is not automatically better.

Some supplements can be harmful at high doses.

Some can interact with medications.

Some nutrients compete with one another for absorption.

Food and supplements aren't interchangeable, and supplements aren't automatically harmless because they're available without a prescription.

Can Poor Nutrition Affect Mental Health?

Nutrition and mental health are connected, but this is another area where we need to be careful about oversimplifying.

Your brain needs energy and nutrients.

Deficiencies in certain nutrients can cause neurological or psychological symptoms.

Blood glucose changes can influence how some people feel.

Hunger can absolutely make people irritable.

We've all met hungry me.

She's delightful.

But depression and anxiety are not simply caused by eating the wrong foods, and someone should never be told they can cure a mental health condition by changing their diet.

Nutrition can be one factor supporting overall brain health.

It isn't a replacement for appropriate mental healthcare.

Sometimes the Problem Isn't What You're Eating

This deserves its own section because I think people living with chronic illness hear "just eat healthier" far too often.

You can eat nutrient rich foods and still develop nutritional problems.

Why?

Because eating is only Step One.

Your body still has to digest, absorb and use those nutrients.

Conditions that can interfere with nutrition or absorption include certain:

• gastrointestinal diseases

• inflammatory conditions

• pancreatic disorders

• liver or biliary disorders

• surgeries involving the stomach or intestines

Medications can sometimes affect nutrient absorption or metabolism too.

Blood loss can create deficiencies.

Hormonal changes can affect nutritional needs.

Pregnancy changes nutritional requirements.

Age changes our bodies.

Illness changes our bodies.

So before we blame someone for a deficiency, we need to ask a better question:

Why is this happening?

Then There Is Access

I don't think we can have an honest conversation about nutrition without talking about this.

Eating well isn't equally easy for everyone.

Healthy food costs money.

It requires access.

Sometimes transportation.

Often time.

Sometimes a kitchen.

Sometimes the physical energy to cook.

Sometimes enough time between two jobs to actually sit down and eat.

Someone living in an area with limited access to fresh foods isn't making the same choices as someone with three grocery stores and a farmers market nearby.

A single parent trying to feed children after working all day may be making decisions based on time, budget and what their children will actually eat.

Someone with chronic illness may not have the energy to prepare an elaborate dinner.

Nutrition advice that ignores real life isn't very useful.

I don't want this series to be about perfection.

I want it to be about doing the best we can with the resources, bodies and lives we actually have.

When Should You Pay Attention?

One symptom doesn't diagnose a nutritional problem.

But persistent changes deserve curiosity.

Things worth discussing with a healthcare professional can include:

• unexplained or persistent fatigue

• unexplained weight loss or significant weight change

• ongoing weakness

• dizziness or shortness of breath

• numbness or tingling

• persistent digestive problems

• frequent constipation or diarrhea

• unusual hair loss

• slow wound healing

• recurrent anemia

• abnormal blood glucose

• abnormal cholesterol or triglycerides

• high blood pressure

• unexplained changes on laboratory testing

• concerns about restricted eating or difficulty getting adequate nutrition

The goal isn't to read this list and diagnose yourself with twelve things before lunch.

Please don't do that.

The goal is to recognize that our bodies give us information.

Sometimes we need to listen.

And This Is Why I Don't Like the Phrase "Eat Better"

What does that actually mean?

Eat less?

Eat more vegetables?

Get more protein?

Increase iron?

Decrease sodium?

Get more fiber?

Eat more calories because you're underfueling?

Eat differently because you have diabetes?

Adjust something because you have kidney disease?

Address a gastrointestinal problem because you aren't absorbing nutrients?

There is no single answer called:

Eat better.

Nutrition should be individualized.

And before we change everything about how someone eats, it helps to understand what problem we're actually trying to solve.

The One Small Yes

This week, I want you to do something that has nothing to do with changing your body.

If you have recent routine lab results available to you, look at them.

Not to diagnose yourself.

Just become familiar with your own health information.

Do you know your:

• blood pressure?

• blood glucose or A1C if it has been checked?

• cholesterol and triglycerides?

• iron or ferritin if you've had a reason to have them tested?

• vitamin B12 or vitamin D if your healthcare provider has checked them?

You do not need every nutritional lab test simply because it exists.

And please don't start ordering random tests because you read a blog.

The point is simply to become an active participant in your own healthcare.

If something has been abnormal, ask what it means.

If you've been experiencing persistent symptoms, ask whether nutritional status could be one piece worth considering.

If everything looks great, wonderful.

Keep supporting your body.

One small yes doesn't always mean changing something.

Sometimes it means understanding something.

From Surviving to Thriving

There was a time when I thought being healthy meant looking healthy.

I don't anymore.

I've learned that you can look perfectly fine while something inside your body is asking for attention.

I've also learned that our health isn't a report card on how disciplined we've been.

Bodies are complicated.

Genetics matter.

Illness matters.

Hormones matter.

Sleep matters.

Stress matters.

Movement matters.

Access matters.

Nutrition matters.

And all of those things interact.

That's why I don't want you finishing this article afraid of food.

I want you more curious about your body.

Your body isn't asking you to eat perfectly.

It doesn't need you to fear carbohydrates, eliminate every food you enjoy or own a refrigerator that looks like an influencer organized it.

It needs nourishment.

It needs enough.

It needs balance.

And sometimes it needs us to recognize when something isn't working and ask for help.

In Part Three, we're going to leave the doctor's office and head back into real life.

We're talking about hunger.

Cravings.

Blood sugar.

Energy crashes.

Why you're suddenly willing to fight someone for a cookie at 3 p.m. 😂

And most importantly, how to start understanding what your body may actually be asking for.

Because the more we understand our bodies, the less we have to fight them.