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. 

Tis the Season for Giving

Take a moment to think about being hungry.  How does it feel?  How do you fix being hungry?  Now imagine not knowing where your next meal will come from.  For millions of Americans that is a reality 42.2 million to be exact.  1 in 6.  I've been fortunate to never been hungry.  I've been hangry but not food insecure. Today I spoke about nutrition and budgeting at a Senior Nutrition Program here in Salinas. Having worked for a supplemental food program I was vaguely aware that there was a similar program for seniors.  For those of you not in the know, the Alliance of Aging's Elderly Nutrition Program is a grant-funded program created to improve the nutrition of the elderly as well as create new social opportunities.  Today participants also received donations from the food bank as well.  Not only does the program provide for in center meals, they also do home delivery and a Senior Farmers Market Nutrition Program which gives seniors a one-time financial incentive to shop at Farmers Market.
I want you to imagine for a minute that you are 70 years old.  You have some health problems.  You're unable to drive far and you're living on a limited budget.  What are your priorities?  Do you eat?  Do you pay bills?  Do you keep the lights on?  Just imagine.  Don't assume it can't happen to me I put money away and I have a family.  Just imagine, you're a senior, you're isolated, you count on this one meal a week and donations for food.  What would you want to eat?  What would you need to supplement?  Ok, hold that in your mind.  When you see donation bins this winter for the food bank, hold that in your mind. Imagine one step farther what would a nutritionally adequate meal look like.  What would you eat for dinner if you were to eat your healthiest meal?  Hold that in your mind and Donate that.  Donate dried beans and low sodium canned beans, brown rice, whole wheat pasta, low sodium canned vegetables, Canned fruit in water or its own juice.  Donate dried fruit and unsalted nuts.  Don't use the food bank as a waste bin for the foods you don't want.  Just because they are poor they shouldn't "just be grateful for what they get."

Now for some startling statistics:
About 5,000 nutrition service providers together serve over 900,000 meals a day in communities all across the United States.
Monterey County Food bank feeds 1/5th of Monterey County with 6 million pounds of food.
34% of Monterey County residents are food insecure.

I remember the day I learned why WIC only goes until age 5 for kids.  That is when school lunch programs pick up.  Hunger is an issue that spans across all age ranges.  It's personal and many times you don't know who around you is or has suffered from hunger. Seniors and children are most likely to suffer from hunger issues.  Don't let America's obesity epidemic fool you into thinking that hunger is not an issue.  I remember when I first went to work for WIC thinking that hunger did not look like what I thought.  The unfortunate reality is that low nutrition low-cost foods are readily available while low-cost nutrient-dense foods are not so much.   As so many call for us to come together, I will add my voice to the call.  Be good to one another this holiday season and every other day think of those less fortunate than you.

Grocery Shopping Tips

Start by making a list and making sure you’re not hungry before you go.  Shop the perimeter of the store searching for Choose mostly foods (bread, cereal, produce, dairy) vs food products (fruit snacks, diet soda, cheese spread), with a short ingredient list. Keep the 3-3-300 Rule: 3g Saturated fat, 3 g fiber or more, less than 300 mg Sodium (140mg or less is even better). Avoid aisles you don’t need to go down.

When you reach the produce aisle make sure to include something from each color group and remember you need 5-9 servings per day.  Fill in the gaps with canned and frozen produce to keep costs down.  Just remember to look for low sodium vegetables and fruits packed in water or its own juice. In the meat aisle be sure to include fish twice a week- this can be canned. Otherwise choose lean meat:

Beef: flank steak, sirloin tip, eye of round, top round, tenderloin, top loin, rump roast, extra lean ground beef.

Poultry- white meat without skin.

Pork: tenderloin, center loin, Canadian bacon. 

Keep in mind you lose about 25% with cooking so to get a 3 oz portion buy 4 oz.

In the cereal aisle look for the first ingredient to be a whole grain.  Check the nutrition facts for at least 3 g fiber, less than 5% sodium, and 10g or less sugar. Similar rules apply to the bread aisle. Look for whole grain as first ingredient, as much as possible buy breads with 3-5g fiber per slice and 5% or less sodium. Fruits vegetables make the best snacks try them with hummus or nonfat yogurt (by itself or plain yogurt mixed with low sodium seasonings for vegetables). Choose whole grain, low fat snacks. Use caution with protein bars-check sugar. Always check serving sizes.

In the dairy aisle choose nonfat of 1% for family members over 2 years old or unsweetened dairy alternatives if you prefer.  Check the sugar content of your yogurt.  Look for added sugars. Yogurt will have naturally occurring sugars from lactose (milk sugar).

                                    Regular: 15-16g

                                    Greek: 6-9g

                                    Icelandic: 6g

Subtract these numbers from the sugars listed in the nutrition to get the grams of added sugar.

Remember that a good diet is about overall diet quality; make sure as you reach check out that the the majority of your cart is healthy real foods.  Avoid last minute temptations of breads, candy, and sweetened beverages while standing in the checkout line. 

Thriving

I'm taking a coaching class because while I feel like I've got a pretty decent grasp on the nutrition stuff sometimes imparting this knowledge is questionable. This week we had a session on thriving and I'm starting to understand why Kaiser has grabbed onto that as their mantra. How do you know you're thriving? What are the top 5-10 things that make you feel like you're thriving? Can you pay attention to this for the week, month, year and store these moments up? I know for me it is hard to identify. I know that moment I first meet a patient in rehab I light up. I want to hear their stories and see what I can do to help. I know when my mare learns something from me and I think "now we're a team!" But 8 more things? That's tough.

Take a moment and take stock of what is going well in your life. Then think what life would look like if you were thriving. Compare the two maybe think about some goals you can make to get to thriving. For me this is terrifying. I lost my mare this year, and my boyfriend left and work had a strike. The world feels so uncertain to me as I prepare to go to grad school that I just want to say I get it. It's safe here in the I don't want to make plans because they fail. So even if your one little step is to take note of what makes you thrive,do that until you feel able to take the next step. And maybe once you've got that you can say maybe this week I'll try doing a little more of x.  Until you've got yourself a few goals to work on. Baby steps. 

Thrive: to develop well or flourish

Go forth and flourish my dears.

Meal planning

1. Start by taking stock of what is in your pantry, fridge and freezer.  Use this as the basis for this week’s meals. 2. Check your calendar.  Mark days and/or meals when you know that you will need left overs or to eat out. 

 3. Choose recipes with similar ingredients and that you may already have.

          Google and Allrecipes.com can help you search for recipes that include     items you already have on hand.

     4.Be strategic in your planning.  If you     are only going to the store once in the week, plan for root vegetables and heartier fruits later in the week, and berries, leafy greens and quick spoiling items earlier in the week.  

5. Plan for snacks.

6. Make a grocery list based on what you will need.

     7. Try to keep in mind what you eat most often while you are making your list.  It may help to have extra microwaveable brown rice or wild rice, canned low        sodium beans, frozen vegetables and fruits on hand for easy to prepare meals.  

    8. When you get home prep items:

          Cut up vegetables for quick.     snacks.

          Remove tops of carrots and beets so they last longer.

9. Keep recipes with your meal plan to make thing easier during the week.

10. If it helps try keeping track of your favorite recipes.

           Group these by main entrée.       

          Mark items that you can eat for more than one day.

11. Freeze individual portions of left overs.  These can be quick lunch or dinner    options.  Remember to date and label what they are.

12. Some people find it easier to batch cook on the weekends and store things in single serve containers to eat throughout the week.

13. You can meal plan by week and just buy what you need for the week, or plan for the whole month and take advantage of buying in bulk.

 

                

A review of the numbers

Cholesterol is a waxy substance made in the liver that is found almost everywhere in the body.  It makes up cell membranes, bile to break down fat, hormones and as transporters.  Some cholesterol is needed for good health but too much can mean disaster.  Of primary importance for the heart patient is LDL cholesterol.  This is what is known as bad cholesterol and is by far the most important number to change for heart health. LDL carries the majority of the cholesterol in the blood.  LDL is designed to take cholesterol to cells that have run out.  In the ideal situation this cholesterol is used to repair membranes or make hormones, but if it is not needed LDL builds up in the bloodstream causing plaque buildup.  For every 1% reduction in LDL cholesterol you reduce your risk for developing heart disease by 2%.  For most individuals LDL cholesterol values should e less than 100 mg/dL but for those at the highest risk of heart disease the recommendation is less than 70 mg/dL. To learn more about your risk score visit:  http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp

Statin drugs such as Lipitor or Crestor, block the creation of cholesterol in the liver itself. However,  statins alone while continuing an unhealthy lifestyle may not be enough to protect you. In fact research has shown that diet itself may be able to induce similar actions to statin drugs without side effects.   While this doesn’t mean you should stop taking your statin it does mean you should consider making some diet changes. Try the following diet strategies to decrease your LDL cholesterol:

Increase your intake of beans, oatmeal, apples, barley and prunes to increase your soluble fiber intake.  These foods can help reduce the absorption of cholesterol into your bloodstream as well as help flush them out of your body.  Shoot for 5-10g or more soluble fiber per day.  1.5 cups of cooked oatmeal provides about 6 g fiber.  For best results try steel cut oats or oat bran.

Try a handful (1.5 oz) of almonds, hazel nuts, peanuts, pecans, pine nuts, pistachios and walnuts every day.  Be sure the nuts aren’t salted or sweetened and watch the portion size as these guys carry a lot of calories.

Decrease animal products (including butter) and replace with olive oil.  Shoot for 2 tbsp per day.  Instead of spreading butter on your bread, dip into olive oil and vinegar, use olive oil for salad dressings or to prepare fish and vegetables. 

Look for foods fortified with sterols and stanols which will block the absorption of cholesterol.  These can reduce bad cholesterol by 5-15%.  Some foods such as wheat bran, wheat germ, peanuts, olive oil, beans, corn, Brussel Sprouts and almonds naturally have plant sterols and stanols.  Because it is hard to get enough from foods alone, some food companies have started fortifying foods such as orange juice and margarine with them as well.  Some brands to look for include Benecol, Take Control, and Minute Maid. 

Eliminate trans fats from your diet.  These sneaky fats raise your bad cholesterol and lower your good cholesterol.  Because food companies don’t need to list them on food labels if they contain less than half a gram you will need to check the ingredients list under the food label for “partially hydrogenated oils” to completely eliminate these from your diet.

Hand trick

Over the last few weeks I've been using a calorie tracking app to see how much I've been eating. The results have been enlightening to say the least. As we age our metabolism slows and what you've always eaten can suddenly be too much. I noticed the first dip around 25 and here at 32 I'm noticing it again. Calorie tracker apps are a great way to check in with what your current intake is and can make you think twice about that second handful of nuts (or two scoop sundae at Baskin Robbins). But while having a conversation with a friend I found out that tracking portions can be difficult if you're not used to measuring portions. As a general rule of hand:

3 oz of meat or chicken is about the size of the palm of your hand ( and yes that's what you should be eating per serving)

A cup is the size of your fist

An oz is about the size of the meaty part under your thumb

A tablespoon in the size of your thumb

And 1-2 oz of nuts or dried fruit should fit into your cupped hand.

We're all somebody

Nepal

I never expected to go to Nepal. It wasn't on a life list. In fact 8 months ago I probably couldn't have found it on a map and then, 5 months ago I found myself on a plane there to do humanitarian work. There are not enough words to tell you about the experience, but it filled my heart and it changed my life. When I was preparing to go the two predominate things I was told were: you're going to get sick/worms/parasites/die there and the people are the most amazing, generous and kind souls you'll meet. Only one of those things happened. Anyone that has been to Nepal will tell you that the place is magic. But the people there are what makes it truly special. And now those kind souls have been through a terrible tragedy and I feel so heart broken and far away. Most of all I want to know what I can do. More than anything I want to get over there and do something but I know the best thing I can do is donate. Please consider giving what you can https://campaigns.choicehumanitarian.org/events/nepal-earthquake-support/e49165

I went to Nepal with CHOICE, they're an amazing organization doing what they can and have people on the ground. In the meantime, Nepal you're in my heart.

Namaste

Cardiac Rehab Corner #2: Spring into Good Health

Every New Year about 45% of Americans make New Years’ resolutions, but only 8% of people actually keep them.  Now is a good time to check in with those resolutions.  Did you make any? Have you kept them?  What is standing in your way?

Take this as a moment to evaluate your progress.  Big changes take patience and little steps add up. March is National Nutrition Month so it is a perfect time to focus on your health-related goals.  Some goals to consider:

Move more- build up to 30-60minutes per day as long as your doctor is okay with you exercising.  Carve out some time every day.  Change your mind set.  It’s not wasted time, it’s time to take care of you and build up a healthy heart and body.  This doesn’t have to be a big chunk of time either.  Think about parking a little further, taking the stairs instead of the elevator, if you live near town walk to the store or the post office. Build exercise into your daily routine.

Eat more slowly-  pay attention to your body cues so you know if you’re really hungry and when you’re really full. Take the time to put your food on a plate and really experience the flavors and textures of what you’re eating.  Remember that it takes 20 minutes or so for your body to realize that you are full, so try to eat until you’re satisfied but not stuffed.

Try smaller portions-  start with less if you’re really hungry, you can always go back for more.  Keep in mind that half of your plate should be fruits or vegetables (you’re trying for 5-9 servings per day). A meat portion is about the size of the palm of your hand and a quarter of your plate should be fiber rich whole grains or other carbohydrates.  Drink more water.  Decrease your intake of high sugar/low nutrition beverages by cutting your portion in half, diluting your juice or eliminating them all together. 

Food is magic

Shortly after I went to work for WIC I gave up jam and juice. I prided myself on it.  “It’s wasted calories and sugar”  I’d boast.  “I only drink juice when I’m sick”.  And yet on days I hated my job, I’d stop and buy a piece of cake for two and eat the whole thing by myself, on the couch and call it dinner.  So in an attempt to reacquaint with food is magic I had a friend teach me to make jam.  We cut up apples and blood oranges and Meyer lemons and then threw them in a pot with sugar to brew.  We went for a walk, we caught up, we added some rosemary to the pot,  we talked about how hard it is to get together and talk and catch up and that once upon a time women gathered to do just this.  5 hours later we boiled some glass jars, funneled the marmalade in and reboiled the jars to get them to seal.  We tasted our creation and it was amazing.  It tasted like Christmas and friendship and work.  I think we often lose out when we forget the effort that goes into food. 

Reluctantly yours

Several years ago when I started blogging, I wasn’t quite sure why I was the reluctant dietitian but I was.  I felt it.  I love food.  I love helping people.  Health is important to me, so this path just felt like it fit when I was in school.  And, to be honest, I got an A in my first nutrition class.  But the more I learned the more I riled against it.  Nutrition takes the magic out of food.  Out of bodies.  You mean certain nutrients get absorbed in certain places? We’re going to spend the whole day baking cookies just so we can learn the effects of cook time, temperature, sugar, eggs, certain types of flour on the outcome? So I came out of school and took the first job I was offered.  Selling lettuce, nothing remotely related to nutrition.  And then I started talking to people about nutrition because that’s what happens when you have a nutrition degree.  So I came back to it.  Slowly, reluctantly.  It took me almost 5 years post bachelor’s degree to get into an internship then sit the exam to become a Registered Dietitian. Being a dietitian is hard.  Everyone knows something about food.  Your years of specialized training are often thrown aside for the quick and easy blurb by a certain tv doctor or anyone that has ever read a nutrition book or eaten.  And I am the first to say I don’t know it all.  I work as an acute care dietitian and in cardiac rehab this is what I know.  I don’t do sports nutrition (there’s a book on my nightstand I mean to read every time I run a half marathon). Or anything involving guts, gluten free or allergies. I'm moderately helpful when it comes to Diabetes. But as I stood in Target last night searching for a tortilla that didn’t have hydrogenated oils, it occurred to me that very few people in my age range are doing the same.  Being a dietitian makes grocery shopping take forever, on some subconscious level you’re almost always surveying what you’re eating, what others are eating, or what the food choices are.  I recently came across a book called Intuitive Eating By Evelyn Tribole MS, RD and Elyse Resch MS, RD and it resonated with me.  We are often called the food police as dietitians but I have to disagree. We are food lovers, food supports, promoters of GOOD food.  And not just food that is good for you but food that nourishes you.  That will make you feel better and be better.  If you are unfamiliar with the idea of intuitive eating it is the idea of reconnecting with what I’d like to call your inner toddler or your inner teenager. Do away with the voices that tell you you’re good or bad for eating one way or another.  These are moral judgments, you are not bad if you like to eat bacon, particularly maple bacon on Sunday at brunch with your girlfriends.  Eat what you want in the anounts you want. Think of food as part of your life experience.  Nourish your body and really listen to it.  How does it feel after you eat fast food or a bowl of fruit?  What are your energy levels like when you eat certain foods?  How does your skin feel? Your hair grow? Do you feel hungry?  Really hungry like the only things that will fix this is food hungry or are you bored, depressed, angry, or feeling social?  And on the other side of that how do you know that you are done eating?  What are your cues that you are full?  Take some time to get back in touch with you.  All too often I feel like our culture treats food as a burden. What I was initially afraid of becoming a dietitian was that I’d enjoy food less.  Growing up in an apple orchard filled with blackberry bushes and pear trees and friends in trees, I celebrated the seasons by coveting the newly budding apples, crawling all over the blackberry bushes for squishy finger staining berries. I knew where my food came from. It came from the top of that tree there the one we called the carousel or the tree by the road. Apple season was my favorite we'd wait all year for it to come. Store apples pale in comparison. So I work hard to eat locally and in season so good tastes like food. For a long time knowing what to eat and how felt like a burden, there was too much pressure to eat right all the time, to be the leading shining example, but food is just food and all I really want to do is help people feel better. So this year I’m trying to reconnect myself and my patients (and you) with the magic of food.

New Years Resolutions

The new year is approaching (4 more days left!?!) and as I prepare a class for cardiac rehab about weight loss I'm reminded about how many people try to start fresh in the new year.  This month has been a whirl wind for me.  I returned from Nepal the week before Christmas.  Fortunately my cookies were made and my presents were bought but between the jetlag and the return to work the only person I managed to cook for was a dear friend who lost her mom just 3 days before Christmas. I made her a chicken pot pie.  A good one with cream and butter that tasted like love and comfort.  And while I made it I laughed at how I couldn't help but "tweak" the recipe just a little.  Double the vegetables.  Add more nonfat milk, less cream.  White breast chicken meat only. Low sodium bouillon, no salt added despite the recipe calling for it.  It wasn't perfect.  Certainly not the healthiest thing I've made, but they loved it and that's what was important.  I feel all too often we try to make grand changes because we feel we have to change everything RIGHT NOW.  Why not ease into the new year by trying to make things just a little bit better?  Can you reduce the salt in that recipe just a little?  Change from 2% milk to 1%?  Change from white rice to brown rice?  Include just one more fruit or vegetable per day?  Little things add up.  They're accomplishable, sustainable and ultimately isn't that the goal?

Cardiac Rehab Corner 1

As a small portion of my real life job I work in Cardiac Rehab.  It's a nice break from the hospital and a chance to actually get to know people and feel like helping.  Recently I was asked to write a column for the newsletter. I thought I'd include it here.

 

With the days  turning colder, warm lunch and dinner options become more popular.  Heart healthy diet’s sodium restrictions make most soups out of the question.  Try this recipe from the American Heart Association as a hearty vegetarian lunch or dinner option.  Frozen mixed vegetables and low sodium broth and tomatoes keep the sodium low while the barley and kale boost the fiber to 5g per serving making this a good source of fiber.

 

Old Fashioned Vegetable Barley Soup

Serves 4  Serving Size 1 ¼ cup

Cooking spray

1 tsp olive oil

½ medium onion, chopped

½ medium stalk of celery, chopped

1 medium garlic clove, minced

14.5 oz canned, no salt added, diced tomatoes, undrained

1 ½ c frozen mixed vegetables

1 ½ cups low sodium vegetable both

1 c chopped kale

½ c water

¼ c uncooked, quick cooking barley

½ tsp dried basil, crumbled

½ tsp oregano, crumbled

1/8 tsp pepper

1 tbsp shredded or grated parmesan cheese PLUS

1 tsp shredded or grated Parmesan cheese

 

Lightly spray a large Dutch oven with cooking spray.  Add the oil, swirl to coat the bottom.  Cook the onion and celery over medium high heat until golden, about 3 minutes, stirring occasionally.  Add the garlic and cook for 10 seconds.  Stir in the remaining ingredients except the Parmesan.  Bring to boil over medium high heat.  Reduce the heat and simmer, covered, for 10-12 minutes, or until barley is cooked.  Ladle into soup bowls and sprinkle with Parmesan.

Calories: 129, Total Fat: 2g, Saturated fat: 0.5g, Cholesterol: 1mg, Sodium: 78mg, Carbohydrates: 24g, Fiber 5 g, Protein 6 g