Short Attention Span: Fad Diets, Healthcare Heroes and Black Lives Matter

As part of my work I'm occasionally asked to perform public speaking on various topics. This week it was heart health. Inevitably at the end I'm asked about some sort of fad diet, these days it's usually keto or fasting. The answer is always the same: to focus on sustainable changes. Usually the latest fad is overly restrictive and people fatique of the rules and giving up their favorite foods and revert to their old ways until the latest new and shiny comes up. To be honest thinking about fad diets, telling people they need to be thin to be healthy and anything outside of finding a way to survive nearly 8 months into the COVID pandemic is a struggle. Since March my team and I have been scrambling to read the latest nutrition for COVID patients. Every day since about April we've had at least one, usually more, COVID patients we're trying to figure out how to feed. These patients are on high doses of fat based sedatives, proned (a fancy word for saying they're on their stomachs), intubated or on another breathing apparatas and occasionally on paralytics. The other day while I was on the COVID floor watching housekeepers clean rooms in full hazmat suits I was struck by how foreign this all feels and how while the rest of the world pushes to go back to normal for us that means more of this. Are we destined for this to be the normal forever? In the early days of COVID we had free food for all staff in the cafeteria after we closed our doors to families and visitors, we received large donations of flowers, salads, berries. Which was well meant and received but also there were large numbers of people without pay that likely would have benefited more while other than the ever present fear of how bad will this be our lives and pay had remained the same. And for those that were furloughed they weren't at work to benefit anyway. Work displayed a massive healthcare heroes banner out front and children drew pictures and sent cards. And then, as expected, about 3 months in that all went away. It was too heavy a burden for others to continue to carry or care about. The finanical resources had given out and people had lost the energy to care, they needed to go back to their own things. Which admittedly included 3 local fires, many many more statewide fires, children out of school, and their own job fears. But what we're left with is a heroes banner and very very tired "heroes". I would argue that perhaps the heroes bit is overstated. Likely the true heroes in this are the often mocked haven't left their house since March crowd. Or those that lost their income and still trooped on believing that others or even our government would find a way to provide support. But alas neither has quite come through. Quite like fad diet we have grown fatigued of rules and structure, our attention spans are ready to move onto the next thing that's being promoted and this year there has been a lot. In the midst of all of ths the Black Lives Matter movement arose and for a brief moment amid all the Instagram posts, the antiracism books flying off the shelves and marches it appeared as though our country was ready to make a true shift. And while protests continue and there continues to be work that needs to be done, it seems that again our attention has shifted away to the next thing. Leaing the work undone. Rather than spending money on the new shiny we need to be focused on caring for ourselves and the others around us. True and commited caring. For healthcare workers this is doing away with the glossy marketing of heroes work here and providing time off for workers to rest and heal, along with child care and schooling options. This should be across the board for those that have returned to work. For those that are not working there needs to be a care package that passes, not a short term bandage package but one that comprehensively cares for us for the duration of this pandemic and in preparation for future worldwide disasters. And finally we need to do the work of examining our own biases and those that are built structurally into this country's framework. School history classes need to include the less glamorous portions of our history including that the indigenous of this land still exist and our broken promises, Tuskegee and Central Park, and that the KKK didn't go away and we created equal rights for all but in reality they've continued to exist not just in the south but in California and everywhere in between. Be it fad diets, community care, or Black lives Matter commit yourself, rest and commit again. True change can only come if continue on when the work gets hard not give up when the moment and the spotlight passes.

Fiber for fox sake

I see you there with your standard American plate, all animal protein, starchy carb, and that frozen vegetable mix you're going to hide under your potato skin and push around your plate until it looks like you've eaten something.  I see you in the cafeteria with your lunch of french fries, chili dog and Coke.  May I suggest, before you tell me your next diet trend, that you try adding some fiber?

Fiber that wonderfully beneficial something that lowers your cholesterol, helps you feel full and controls your blood sugars and like vegetables we get woefully little of it.  The recommendation is for about 25-30g of fiber per day and we get about 12g.  (Probably because you're not eating your fucking vegetables).

There's two types of fiber the soluble kind that forms a gel and slurps through your digestive track it brings down your cholesterol, controls those blood sugars and help you go(to the bathroom that is).  Sources include oatmeal (beware of the coffee and oatmeal breakfast if you have plans that will keep you from a bathroom later), nuts, beans, and some fruits.  Insoluble on the other hand is more like a brush scrubbing things clean and also helping to move things along.  Sources include vegetables, whole grain, and nuts.

Side note to talk about whole grains:  whole grains are grains that still have all their parts.  White rice is just a PART of brown rice.  The starchy energy filled part (endosperm).The reason why brown rice takes so long to cook?  that tough FIBERy outside shell also known as the bran.  And then there's the germ where the B vitamins (the guys that help with using energy from fats, proteins, and carbs, help you create new red blood cells, keep your nervous system healthy, and prevent birth defects), protein, fats and minerals are. All processed grains are missing the bran and the germ meaning you're missing a heap of nutrition.

So before you say I'm gonna go buy that box of cereal with 28 g of fiber per serving lets talk the real stuff.  Those little gut bacteria of yours (you know the ones that make beans musical) are used to you current eating habits so before you get all crazy lets shop your own cabinet.  Go look at your cereals, breads, tortillas, pastas, rices that you already have and see how many grams of fiber there are (it's there under the Total Carbohydrates).  Then add 3 g of fiber to every other day until you're getting all those benefits.

Here's how to do that:
add in one more serving of fruit
add in one more serving of vegetables (you're still eating that one serving every day right?)
find one of those low fiber things you're running low on and replace it with something with at least 3 g of fiber
Add more beans
Eat some oatmeal

And get your fiber for fox sake.

Learning to duck

From 2007 to April 2016 I ran 4 half marathons, 5 mud runs and more 5 and 10Ks than I can remember.  I have a box full of medals, a fistful of bibs and more scar tissue than is probably reasonable.  I'd drag myself out of bed at 530 AM after sleeping in my running clothes.  Rise and shine and run.  Put in 2 miles and then head out after work to put in 3-4 more.  Weekends I'd run 4-6, depending on what I was training for more.   I wish I could say I remembered each one.  The special ones, NIKE and Giants, and Bay to Breakers I do.  The rest are a mishmash of asphalt and portopotties and teenagers holding cups. In the midst of this I won a belt buckle showing my horse.  I have another box of ribbons.  My life was a schedule.  Run MWS ride TTHSS.  Friday rest day (I suck at rest day). Riding was my safe place, running my meditation.  They anchored me to the earth.
In all my years of running I never learned to be a good runner.  3 trips through Team in Training no one ever pulled me aside and said you lock up your left side to keep that shoulder in place thats why your IT band hurts.  5 trips through PT for IT bands, dislocated cuboids, locked up SI joints, malrotated hips.  What I learned was to endure.  That even when your body was screaming you moved on.  In the midst of it I'd find myself sitting on my horse unable to do anything but sit on her and rope the dummy because my hip flexors screamed.  I'd fall asleep on the couch at 7pm.  Or wake up in the middle of the night with everything from my hips to my ankles screaming with nothing that gave any kind of relief.  And then she got cancer.  My safe place my favorite thing became the thing that I would lose.  For years I had wanted to run the Oz race and for the first time during training I would find myself standing in the middle of the hill unable to find anything to make me keep going up even at a walk.  And not wanting to go to the real world back at the car so I'd just stand there.
I hated everything. The structure the grind and when I lost her I quit. I let go of the anchors that held me. I quit caring.  I quit running.
Or maybe I started...Running kept me grounded because of the self talk and the pushing it was the one break in my head and suddenly there was no break and there was no safe.  It was just me and I ran from it.
My friends called it my step up year.  New horse, applied to school.  They talked about the phoenix and how she rises from the ashes.  Put I couldn't get out of the ashes.  I just sat there in the darkness.
And so I entered 2017 more out of shape more unme than I'd ever felt.  My professional life was a nightmare of drama, my academic future was yet unknown and I felt adrift, uncomfortable and alone. Running taught me that even while you're counting the miles the focus has to be ahead.  I fell into a Pilates studio that specialized in rehab.  We discussed my everything and once a week she helped me rebuild.  And I had to laugh.  Once a week!  I used to be a die hard that barely rested a day and here I was making it to exercise once a week.  I'd try to walk the same trails I used to run and I'd end up frustrated remembering what was. Once a week turned into twice a week which turned into a walk before plus an hour of pilates.  I went to yoga.  I remembered how to breathe.  I struggled with the darkness.  I found a little bit of strength.  In the midst of the fear and the dark I learned to fight.  Not in the emotional sense in the punch and block and duck Krav Maga sense.  I got punched in the face.  I lived.
The lesson it seems is that in life you will find people who will punch you in the face.  And you will find people who will help you find your strength.  That's not an if you are lucky.  You will find them.  Or they will find you.  The key is learning when to duck.
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Hydrate for Heaven's sake

What is the highlighter colored beverage in your hand?  Are you actually drinking a soda with your name on it because it had your name on it? Listen, folks, I get that the marketing geniuses over at Gatorade have you pretty well convinced that your 30-minute foray to the gym to jog on the treadmill while watching Ellen qualifies you as an athlete. And Coke well they're coca cola they've been making soda an addictive beverage since it came on the market but what are the real facts about hydration?

• Fluid is important, it keeps you sharp, can perk you up like a wilting flower for that 330 meeting with your boss.  But some tips to keep in mind:
• Ditch the sugary stuff- extra calories- extra weight
• Limit the caffeine 
• If you're going to be working out for an hour or more try a beverage with added sodium
• Monitor your urine color- clear to pale yellow means you're well hydrated.  If you're looking at fluorescent or school bus yellow march yourself to the nearest water fountain and have a drink.
• Do yourself and the environment a favor and bring a reusable bottle along.  You'll always have a drink and you won't kill a whale with you wasteful plastic.

So key points here:

• water is not boring.  If it is stop eating so much sugar and salt so you can actually taste your food.  Try La Croix waters or any other of the wide variety of flavored and carbonated waters on the market.  Flavor your own with some essential oils, herbs, lemon or other fruits.
• bring your own.  You'll feel better and mother nature will love you more and maybe she won't drop a tree on your house or something.
• check your pee
• light post it yellow= good
• school bus yellow =bad

Drink up

the reluctant dietitian

Nutrition philosophy

If you had asked me my nutrition philosophy several years ago it would have been something along the lines of everything in moderation, eat a variety of foods for health to fulfill your senses and tastes but after 6 years of working in a hospital my current nutrition philosophy is:
Eat a fucking vegetable.
Just one, every day, forever. Preferably not a potato in the form of a fry or a chip.
That's it.
There is no magical vegetable that I will tell you to eat although if you'd like me to assign you one off the top of my head I can. You there eat beets. They'll make you super healthy... make your eyes bright, your teeth white and child birth a pleasure. Plus for funzies if they're fresh they'll make your pee red. Eat a vegetable, preferably not the same one every day, ideally 4-5 servings a day, but at this point I'll settle on one.
We are fantastically terrible at eating our vegetables. Only 6% of Americans meet their recommended veggies per day. Most people only get less than 2 cups of fruits and veggies per day when it should be 4-5 cups per day, and when we look at who is meeting that, the numbers drop to 1% of adults getting their recommended amounts.
Now you can say I don't like vegetables but I challenge you: have you tried every vegetable ever in every possible way it could be prepared? No? Go find a new vegetable and try it in a new way. Purée that bad boy and hide it in your spaghetti sauce.
My challenge for you is to try, no actually do, eat a vegetable every day, for the next week, month, year... see how you feel. Heck get crazy try to hit that 4-5 cups a day. Tell your friends, start a movement... eat a fucking vegetable.

Batch Cooking

Batch cooking is a great way to eat healthy for those of us that are constantly on the go (ie busy nurses that work 12 hour shifts).  Prepare foods ahead of time on days when you have extra time and set it aside for busier days. Recipes can be as simple or as complicated as you like.  Think about things like prepping extra chicken breasts to use in salads and sandwiches, larger portions of quinoa or brown rice and large batches of vegetables. If you’re not much of a cook experiment with microwaveable sides such as brown rice or wild rice packets as a fast way to add healthy complex carbs and fiber to your diet. Bagged salads are a fast and easy way to make half you plate vegetables. And rinsed canned beans are an easy way to add vegetable protein.  

2015-2020 Dietary Guidelines

There have been a lot changes in the 2016 year, among them were the 2015-2020 Dietary Guidelines released January 7^th of this year.  The guidelines are reviewed every 5 years based on current research and are meant to help professionals create healthy diets.  New changes include guidelines on added sugar, caffeine, sodium and cholesterol.

                Added sugar is a growing problem.  The new guidelines recommend limiting added sugars to 10% of a person’s total daily caloric intake. For a 2000 calorie diet that is approximately 200 calories or 50 grams of sugar. Unfortunately at this time there is no way to easily identify how much added sugars are in foods.  In 2018 new food labels will listed added sugars separately from naturally occurring ones.  Until then check the ingredients for words that will identify added sugars such as honey, agave, molasses, and anything that ends in ose such as fructose. 

                Caffeine made an appearance for the first time in the guidelines as well.  The recommendation is for 400mg or less per day.  On average coffee has between 100-200mg, Breakfast tea contains 60-90mg, black tea has 30-60mg and green tea has 25-50 mg.  The guidelines don’t make any recommendations to consume caffeine merely that there are no increased risk of major chronic diseases at this level of intake.

                The 2015 guidelines loosened up slightly on sodium recommendations removing its 1500 mg restriction for African Americans and people over 51 years old.  However the recommendation stays intact for those with hypertension (high blood pressure), prehypertension and heart disease.

                Also removed from the guidelines is the recommendation to limit cholesterol.  The guidelines do continue to recommend replacing unhealthy fats (saturated and trans fats) with more healthy fats (unsaturated fats).   The recommendation remains to limit saturated fat to 10% of diet (remember for heart patients this is even stricter 5-6% or approximately 13g).  The recommendation for trans fats remains less than 1%.  Remember to check the ingredient list for these hidden fats with the words “partially hydrogenated.”

                These guidelines are used to shape the My plate (https://www.choosemyplate.gov/MyPlate-Daily-Checklist) which is a helpful visual representation of what these guidelines mean.  The fact remains however that it is difficult to think of these guidelines in terms of what an actual diet would look like.  Try to remember to make half of your plate fruits and vegetables shooting for at least 7 servings per day (1 cup raw/1/2 cup cooked), 3 oz of lean proteins, with the final ¼ of your plate whole grains. Use these updated guidelines to help you read labels and bring healthier foods into your diet.  And remember that more so than any one magic food it is overall diet quality that makes the difference.