Thursday, December 16, 2010

Why You Should Pack Vegetables in Your Kid's Lunch

Don't forget the vegetables!
 Many parents tell me that they do not pack vegetables in their children's lunches. My mother never packed vegetables in my lunch. I can't say that I would have eaten them had she packed them, but I enjoyed snacking on vegetables at home as a kid. When you think about what is served for lunch in restaurants, typically vegetables are absent. It is common to see sandwiches and fries or chips with a small fruit or kale garnish. When I eat lunch with my daughter at school, I notice that children who bring their lunches often have sandwiches, juice pouches, pretzels or some sort of crunchy snack food, and maybe some fruit or a cookie. Vegetables are MIA. Perhaps we're not used to eating vegetables at lunch daily so we don't put them in our kid's lunches. Perhaps we're concerned that our kids won't eat them.

As parents, we teach our kids many things. One very important thing that we teach them is what they should eat to gain the energy and vitality to become contributing members of society. Kids push back against our recommendations. That is the nature of being a kid. Does that mean that we stop making recommendations?

When it comes to packing vegetables in our kid's lunches, why do we hesitate? Is it so bad if our kids throw away a snack bag of vegetables? The lesson that you teach by offering vegetables at lunch is that they should eat them. I think this lesson is more important than a little bit of food waste (believe me, kids throw away more than their vegetables). This is part of the learning process. What is the worst thing that could happen by not offering your children vegetables at lunch? They could grow up not eating vegetables regularly, choosing instead a diet filled with processed foods which can cause them to suffer from one or more of the many chronic diseases associated with diet.

Here's how you can encourage your kids to eat more vegetables by packing them in their lunches:

1. Discuss with your children the types of vegetables that they enjoy eating. Choose those vegetables to pack in their lunches.

2. Offer variety. Even a favorite vegetable can get old if eaten every day. Try cauliflower, cucumber, cherry tomatoes, baby-cut carrots, bell peppers, broccoli, green beans, mushrooms, zucchini, radishes or sugar snap peas. All of these vegetables are good raw. Many kids seem to prefer raw vegetables over cooked vegetables.

3. Offer a little bit of dip to make eating vegetables more enjoyable. Use a mini container and fill it with a small amount of ranch dressing, hummus, tzatziki, or other dip.

4. Start young. By the time your kids are ready to go to school, they are old enough to be eating vegetables daily at lunch.

5. Start small. Begin by offering a small snack bag of vegetables. Hopefully by the time your kids reach high school, they'll be eating a larger sandwich bag filled with vegetables.

6. Talk with your kids at home about what they ate for lunch. Ask them if they ate their vegetables. If they say no, gently encourage them to eat their vegetables (there are lots of good reasons for your kids to eat vegetables, an important reason is that you love them and want them to thrive).

7. Never give up. By offering vegetables to your children at lunch you are setting an example about what they are supposed to eat.

I have my own challenges in getting my children to eat their vegetables. My 13 year old daughter has been sick too much already this school year and I point out to her that she skimps on much of the healthy foods that I serve her. I'll keep trying because it is that important.

Sunday, December 5, 2010

The Enigma of Blood Sugar Control

My son has type 1 diabetes. I've blogged about our struggles with this disease before. My son would love for me avoid sharing our personal experiences with respect to him, but I'm on a mission to better understand how diabetes is controlled and to help other diabetics in the process.

To me, the expression "blood sugar control" seems like an oxymoron. It is elusive at times and often we are left scratching our heads as to why our son's blood sugar becomes high or low (even though I'm a dietitian and my husband is a physician). Diabetics, especially teenagers, can take these values personally and may feel like they have failed in managing their health. There are so many factors that affect blood sugar. Understanding why blood sugar becomes high or low is very complicated. Lately, I feel like we've been chasing our tails and I need to know more about diabetes to help my son understand more and manage his disease without excessive emotion.

As I educate myself, the nuiances of blood sugar control are becoming more apparent. I have decided to post a "pearl of wisdom" on my Facebook page daily to reinforce the concepts that I am learning and to share that knowledge with other diabetics or those responsible for caring for a person with diabetes. I invite your comments, experiences, and knowledge on this topic here on my blog as well as on Facebook and Twitter. I'm hoping to impact hundreds of people and create an online comminuty of diabetics sharing their experiences and wisdom. Please pass this on to your diabetic family, friends, and coworkers. To your Health!

Tuesday, November 30, 2010

Kids in the Kitchen

My daughter enjoyed cooking at a young age

My youngest daughter turned seven at the end of September. One of her birthday presents was a "real" cooking kit with kid-sized cooking utensils. She has been asking me to cook with her since she got it. My response to cooking with my kids is mixed. As a dietitian, I'm thrilled that they have an interest in preparing food. I see a great opportunity to teach them about the healthy foods that we all need to eat more often. As a mother, I'm hesitant to cook with them. I'm so tired of cleaning up messes all the time and the surest way to a messy kitchen is to have your kids cook. I have come to realize that the kitchen is my area of control. Unless I'm cooking with a clone, I prefer to cook alone. Despite my need to feed and nurture with food, I'm not the most nurturing person the kitchen. I watch commercials of parents cooking with their kids and wonder why I'm not as happy as those parents seem when I am cooking with my kids.

Being aware of my flaw, I have been trying to overcome it and have been pleasantly surprised at how helpful my kids can actually be in the kitchen (hold on a minute while I adjust my blinders)! My two older children each had to plan and prepare a meal for a seventh grade class. I was impressed at how conscientious they were to choose a healthy menu and how much pride they had in executing the whole meal themselves. Of course, they came to me for guidance, but they did all the chopping, cooking, and cleaning. What a great school project! I now find myself focusing on the "teaching moments" that I have with my kids in the kitchen. Put the caps back on containers and put them away when you are finished using them. Don't lick your fingers, but if you do, you must wash them (we wash our hands a lot in my kitchen). Completely disassemble the blender when you are washing it, including the rubber seals. By focusing on what I can teach my children as we cook I am creating my kitchen clones, but I'm also teaching them about food safety, healthy eating and how to be more efficient while cooking.

I've had a few food-related surprises with my kids recently. This past Thanksgiving weekend, my seven year old daughter took an active part in preparing one of the many meals that my family serves during this time. She helped her grandma prepare for a dinner party and was there every step of the way from grocery shopping, cooking and setting the table. She even served herself Brussels sprouts at the meal and ate them all! My middle child and oldest daughter has gotten in the habit of making me and my husband breakfast. We are often awakened on a Saturday or Sunday morning to the smell of brewing coffee. This past month she didn't even ask us to take her to the mall later that day! Finally, my son, who is the first born, completely surprised me when he told me that he was joining the cooking club in high school. I can't tell you how proud I am of that, especially when he mentioned that many of his friends don't see the value of cooking when you can get prepared foods on any street corner. These are my sweet rewards for allowing my kids to make a mess in our kitchen! The mess is such a small thing compared to the lifelong skills you teach your children by allowing them to cook. I'd love to hear your stories about cooking with your kids. Perhaps some of them have gone on to become chefs, teachers or scientists. The skills learned from cooking can be used in many ways.

Tuesday, November 23, 2010

5 Healthy Tips for Your Best Holiday Season Yet!

Keep your healthy habits through the holidays
'Tis the season for overeating and inactivity, but it doesn't have to be. You've worked hard all year to change unhealthy habits and now it's time to run the gauntlet of holiday parties and coworkers bringing cookies and treats to work. If you can make it through the holidays unscathed while practicing your healthy habits, you are truly a new person. Here are five tips to keep you focused on having a happy and healthy holiday season.

1. Be positive. Positive emotion is necessary for behavior change. To flourish, we should exhibit three positive emotions for every negative emotion. Flourishing is like navigating a sail boat. Negative emotion is your rudder and positive emotion is the sail that soars high into the air. Your sail should be three times as high as your rudder to keep you on course. Of course, you need both a sail and a rudder to navigate. The trick is to have enough positive emotion to balance the negative. We typically focus too much on negative feelings, so lighten up and be positive. You can track your emotions at Emotions change daily, so track yours often. It might help you focus a little more on the positive aspects of your life.

2. Catch up on your ZZZ's. During the holidays, most people overstuff their days and weekends with activity and short change sleep. Adequate sleep is vital for health. Lack of sleep is a risk factor for diabetes, heart disease, obesity, accidents and it lowers your immunity. You may have to resist the urge to be a party animal, but getting enough sleep will ensure that you enjoy your celebrations to the fullest. Allow at least one day a week to catch up on your sleep. You might have to delegate some holiday shopping or cooking, leave a party early once in a while, and resist the urge to stay up late watching TV, playing video games, etc.

3. Keep moving. The best way to avoid weight gain over the holidays is to move daily. Face it, we are made to move and without movement we couldn't survive. Preserve your regular exercise routines as much as possible. If you notice that you can't exercise as much as you used to, wear a pedometer and track your activity as daily steps. The goal is to log at least 10,000 steps a day which is equivalent to walking about five miles. I did this last year between Thanksgiving and New Year's. It was a great way to keep moving. When I noticed that I was short of my goal, I would take the dogs for another walk (god for the dogs as well as me) or take an extra lap in the mall while shopping. Taking a walk after a larger meal is also helpful. The artery clogging effects of one high fat meal can literally be visualized. Fortunately, so can the health promoting effects of one bout of activity. So get up after your meal and take a walk!

4. Maintain your weight. Most people only gain about one pound over the holidays, but that one pound hangs around long after the holidays are over and is often joined by more pounds the next year, and the next, and the next... Setting your sights on weight loss may be too difficult at this time. The goal should be to maintain what you've already lost. You have to measure this somehow. I encourage my clients to weigh themselves daily. You will notice small changes in your weight that you can equate to your eating and exercise habits. If you notice a weight increase in one day, examine what you ate earlier. If you ate a meal in a restaurant, chances are the meal was excessive in calories, fat, and sodium. You can make corrections in your eating and activity and work to bring your weight back to where it was. If you don't measure, you won't know to correct. Before you know it that one pound will be sitting on your hips or mid-section and will be hard to lose.

5. Be thankful.  There is so much flurry around the holidays that is is easy to forget what they are about. Enjoy the time that you are allowed to be with your family, friends, colleagues and coworkers. Humans are social beings and having a supportive community around us is one of the best ways that I can think of to be happy and healthy. We bring the burden of the season upon ourselves. It is within our power to lighten that burden with humor, love, kindness, thoughtfulness, friendship and thankfulness.

I wish you the best holiday season yet!

Saturday, November 20, 2010

Do Your Food Values Make You an Elitist or an Oddball?

 I can't help but feel a little odd!
 Sometimes I can't help feeling odd, a little eccentric and different from most people. I'm consumed with passion for being a dietitian and spreading the message of how much better life can be when we eat healthy foods responsibly, exercise regularly and get adequate sleep each night. I think about food all the time. It's not odd to think about what you do in your profession, even when you're not working. I feel odd because of the blank stares I get when I tell people I'm vegetarian. I feel odd when there is nothing for me to order in a restaurant except a salad or processed veggie burgers. I feel odd when I won't let the server in a restaurant refill my children's beverages, except with water. I feel odd because I suggest that people cook more meals at home using fresh ingredients rather than serving Tyson chicken tenders. I feel odd because I won't eat the foods that many other Americans will eat. Does that make me an elitist? Am I perceived as thinking that I'm better than others because I won't eat fast food? The truth is I'm not an elitist and I've been known on occasion to buy fast food for my children, albeit the smallest meal and beverage that I can buy. But feeling odd because of my food values is a feeling that I can't seem shake.

This feeling of being odd became overwhelming when my thirteen year old daughter asked me to buy a birthday present for a friend. As we drove to Wegmans, my daughter told me that she wanted to buy her friend's favorite chocolate which happened to be Hershey's. I recently wrote a blog post on my views about Hershey's and have banned Hershey products from my house in lieu of fair trade and organic chocolate (elitist?). I apologized to my daughter that we would not be buying her friend's favorite chocolate. As a thirteen year old will do, she pushed back exclaiming that four bars of chocolate wouldn't make a difference to the world. An argument ensued and ended with my retort that she was asking me to be a hypocrite. We entered the store and proceeded to buy several bars of fair trade and organic chocolate. I went home feeling the burden of my values. I disappointed my daughter and felt like I didn't "fit in" in a world where trading commodities and making money was more important than human life, protecting the environment, or any other value that is different from popular opinions.

Even though the pendulum of popular belief with respect to food is swinging in my direction, I still feel the burden of my beliefs heavy on my shoulders. In a world where the majority of adults are overweight and greater numbers of children are becoming overweight and obese, I'm hopeful that the choices I make in small measure will influence others, who in turn will influence even more people. But then I I a food fascist (sic)?

I asked my daughter if she told her friend that I wouldn't allow her to buy Hershey's chocolate. She did and her friend enjoyed the fair trade chocolate that she gave him. I felt a little vindicated when she told me that another friend replied, "Oh yeah, I know about Hershey's. They stink!" Perhaps I'm not that odd after all.

Monday, October 18, 2010

Hungry? The Quest for a Healthy Body Image

Hungry by Crystal Renn discusses how a young woman working in the modeling industry develops an eating disorder under the pressure to be thin to get work and how she conquers it through her own will and determination. Renn tells the story of her transformation from an unhappy, hungry and unsuccessful model to the successful, internationally acclaimed, confident and happy plus-sized model she is today. Renn serves as an inspiration for size acceptance to women everywhere.

There are many campaigns promoting healthy body image from the Dove Campaign for Real Beauty to Fat Talk Free Week, a campaign to promote the end of body-centric comments which can have a negative impact on body image and possibly lead to eating disorders. With the fashion industry, it seems that changing the focus from thin to healthy is an uphill battle.

I interviewed professional model and registered dietitian, Maye Musk, MS, RD, about the modeling industry and how she navigates her role as both a model and a nutritionist. Musk's comments are candid and humorous. She states that health and the health of  models are not truly important to the fashion industry. Clothes are made in one size and the models must fit into these clothes. Somewhere along the line someone decided that clothes look better on smaller models. Musk defines these finer boned models as "freaks of nature." This is her humorous way of stating that very few women naturally have the body type to wear the clothes that are being designed. "The clothes are made for skinny 12 year old boys,"  she says. To get a chance to model these clothes, young models starve themselves. "You can see the muscle wasting on the arms and thighs. The models are truly emaciated."

In her nutrition practice, Musk counsels ballet dancers, actors and models, many of whom are trying to obtain this unrealistic ideal. She counsels them on the value of good nutrition and how beauty relates to it. She states that "general good health provides the energy to model." That energy in turn translates the model's movements into a beautiful work of art. The movement of a healthy model in clothing has the power to captivate, so that even a still photo is dynamic. To model, Musk claims, one needs to look fabulous. The amount of fat doesn't matter.

The modeling industry has adopted the minimum healthy Body Mass Index (BMI) for its models which is 18.5 kg/m2. BMI is a mathematical equation and is defined as weight in kilograms divided by height in meters squared. Despite this, Renn was encouraged to maintain a weight of 95 pounds on her 5'9" frame, a BMI of 14 kg/m2. Renn's body revolted from her abusive eating and exercise habits and she began to gain weight despite them. Her metabolism downshifted so much that she could gain weight while still eating very little. The outcome for many women in this situation is death, but for Renn, her ambition is what I believed saved her. Her desire to live and succeed were strong and she took plus-sized modeling by storm.

Thanks to the efforts of Renn, plus-sized modeling is taking on a new status, but it still has a long way to go. I find it ludicrous that "plus-sized" is defined as anything sized 8 or greater. The average American woman is a size 14. That's the world of fashion and Musk doesn't foresee it changing very much any time soon. American women walk a fine line between overweight and health. Many of us are overweight and do not engage in healthy eating and exercise habits. It doesn't help that we have an unrealistic ideal to be compared with. As a health practitioner I would not define Renn as overweight. I'm hopeful that her efforts will encourage American women to be the best and healthiest that they can be.

Saturday, August 14, 2010

A Quickie in the Kitchen

I love to cook, but lately I haven't had much time for cooking. This bothers me to no end because food and healthy eating are my profession. Apparently, I need to listen to some of my own advice. We can all benefit from some quick suggestions for getting a healthy meal on the table. Here are some tips that help me to prepare healthy meals for my family in a hurry.

1. Plan Ahead: This means actually thinking about what you can make for the week.
  • Find Recipes: I usually go to my favorite healthy eating website, Eating Well. There are many wonderful recipes here that can be made in less than an hour. This can be necessary if you're coming home after a long day. You can search for new, quick, healthy and delicious recipes to add to your grocery list or you can search for recipes with ingredients that you have on hand. I recently found a recipe for Spiced Eggplant-Lentil Salad when I searched for recipes using eggplant. Yes, I still have to go to the store for some fresh ingredients, but I'll be using up the eggplant that has been sitting in my refrigerator for the past week.
  • Three Meal Rule: I usually plan to cook three new meals a week. This way I'm not overwhelmed by planning a whole week of meals. I make extra to have as another meal or to take leftovers for lunch. You can recycle leftover food and create new meals. Leftover meats and vegetables can be used to make casseroles, stir-fries, salads, stews and soups.
  • Make a Grocery List: Part of the planning process is making a list. This helps you get through the store faster and can minimize less healthy impulse purchases.
2. Stock Your Pantry and Refrigerator/Freezer: Buy healthy staple foods that make it easy to prepare a quick meal. These are foods that you may eat more regularly and that you can use in recipes such as:
  • Healthy breakfast cereals
  • Low fat dairy and dairy substitutes (fortified soy, rice and almond milk and cheeses)
  • Low fat and low sodium lunch meats
  • Lean meats and meat substitutes
  • 100% whole wheat bread
  • Fresh and frozen fruits
  • Fresh and frozen vegetables
  • Canned tomato products
  • Canned beans (legumes)
  • Brown rice (quick cooking varieties are available)
  • Whole wheat pasta
  • Herbs and spices
  • Olive and canola oil
  • Vinegars
  • Sauces (Many of these are high in sugar and sodium and should be used sparingly to enhance the flavor of meals. Some of my all time favorite sauces come from the Texas-based company D.L. Jardine's)
  • Broths (chicken, beef, vegetable and no-chicken broth, which is a vegetarian broth that has a chicken broth flavor)
3. Shop: To make quick and healthy meals you need to have healthy foods on hand. This means that you have to go to the food market. I'm not as well organized as one of my nutrition mentors who only needs to shop once a month (now that's a well stocked kitchen!). I usually plan one large shopping trip a week (usually on a weekend or in the evening when the number of shoppers is less) and another smaller trip mid-week. A good rule to follow for mid-week shopping is to get only the things that you really need such as some fresh produce and milk. If I have to shop for more items after work, typically we'll be eating grilled cheese sandwiches for dinner. I don't have time to shop and cook after work.

4. Learn How to Use a Knife/Food Processor: One of my jobs in my family as a kid was making salads. I dutifully cut vegetables using a paring knife as my mother instructed me. This was a chore and took longer than I wanted. I hated being asked to make a salad. It wasn't until I worked for a caterer in college that I learned how to correctly use a knife. What a difference choosing and using the correct knife makes! Cutting vegetables quickly and efficiently can actually be fun! This is probably the most important skill for cooking (remember to keep your knives sharp!). Food processors are also available for quickly cutting up vegetables. I tend to only use mine if I have a lot to chop as cleaning it is sometimes a bigger chore than chopping. And if you are really in a rush, you can use bagged chopped vegetables. It's always good to have options!

5. Utilize Your Kitchen Helpers: My mother was clearly doing this when she would ask me to make salads. Your kitchen helpers can set the table, wash dishes, and stir the pot for you. A great principle to follow is anyone who eats should help with meal preparation and clean up (thanks goes to one of my dietitian colleagues for suggesting this).

6. Clean as You Cook: My husband actually helped me learn this. His job in his family was clean up. Clean up is so much easier when you clean as you go. While I'm waiting for something to cook, I'll wash a few dishes. I'm a much happier cook when my cooking space is uncluttered and clean.

7. Minimize Distractions: When you're tired after a long day, distractions can make you lose your momentum and the next thing you know you'll be ordering out for pizza. Don't sit down at the computer, don't turn on the television and don't pour yourself a drink until you have a head start on your meal. You may need to delegate other household tasks to the denizens who share the house with you.

8. Experiment: Try making up your own recipes. With practice you will figure out flavor combinations that you enjoy. You'll be surprised at some of the great meals you come up with. You'll also make a few duds, but don't worry, you won't poison anyone. I've had the experience of not liking some of my own creations, but my family seems to eat them anyway, and sometimes they like them even when I don't. I've probably instilled enough guilt in them to simply appreciate the fact that I am cooking for them. I think I'd appreciate an underwhelming meal if someone prepared it for me too.

9. Lighten Up: Sometimes it's OK to eat grilled cheese. You can make a healthy meal using all kinds of shortcuts as long as you balance it with fruits, vegetables and whole grains.

10. Enjoy: Sometimes we need little reminders about how to make quick work of meal preparation so that we can have more time to enjoy other things in life. Who knows, maybe you'll even be able to enjoy the process of meal preparation more, which will make you a happier person overall. Hopefully, you'll free up time to enjoy the other rooms of your house too.

Wednesday, August 11, 2010

A World of Oats

Guest blog post by Laura Williams

Oats are a gluten-free cereal grain and are the third leading cereal crop produced in the United States (after wheat and corn) and the fourth most important crop worldwide. They were once considered a weed, but are now a popular staple of the British Isles like Scotland, Ireland and Wales. The grain was introduced into the Americas in 1602 by a sea captain who planted them in one of the islands off the coast of Massachusetts. Today, nearly half of the world's oat crop--more than 4 billion bushels a year--is grown in the United States and Canada. Oat kernels look very much like wheat in structure with an outer covering of bran, which protects the starchy endosperm and the germ that sits at the bottom of the grain. Whole grain oats contain seven B vitamins, vitamin E, and nine minerals, including iron, magnesium, selenium, manganese, phosphorous and calcium. Oats are very high in protein, containing about twice the protein of wheat or corn. But the most important nutritional advantages of oats are the soluble fiber and the GLA (gamma linoleic acid), an essential fatty acid. The soluble fiber is what gives oatmeal its gummy texture; it also has many beneficial effects on health. Regular use of oats in the diet can be helpful for managing several medical conditions. They have been shown to help control blood sugar levels, which is beneficial for people with both type 1 and 2 diabetes; to reduce cholesterol levels, which may help prevent heart disease; and to reduce plaque build up in the arteries which may help prevent atherosclerosis.

Different forms of oats:

Oat groats: This is the whole oat grain, with only the outer hull removed. Oat groats are extremely nutritious, but they need to be soaked and cooked a long time. Oat groats are usually processed into one of the other forms below.

Steel-cut oats: Produced by running groats through steel cutters, chopping the groats into smaller pieces and creating a chewy texture. Steel-cut oats still contain the whole grain and oat bran, and are also very nutritious.

Rolled oats or old-fashioned oats: Steaming groats and then flattening them with a roller makes rolled oats.

Quick-cooking oats: Steaming and flattening steel-cut oats makes quick-cooking oats.

Instant oatmeal: Produced by rolling more thinly and steaming longer or partially cooking the oats. Instant oatmeal will also have salt, sugar, and in some cases artificial sweeteners added to it.

You can also grind rolled oats yourself to make oat flour.

Oats can be included in the diet in the form of oatmeal, cold cereals, baked products, granola bars, etc. Any way you include oats in your diet, you will still receive their beneficial effects.

Some recipes to try using oats include:



2 cups oats (quick or old fashioned, uncooked)

2 cups apple juice or apricot nectar

1-1/2 cups sliced fresh fruit (any combination of banana, peaches, nectarines or strawberries)

8 oz vanilla low-fat yogurt

2 T chopped nuts* (optional)

1 T ground flax seeds* (optional)

Preparation: Combine all ingredients except nuts and fruit; mix well.

Cover; refrigerate 8 hours or overnight.

Serve cold; add fruit and sprinkle with nuts, if desired. Refrigerate in airtight container up to 4 days

Oatmeal Raisin Cookies


3 cups old fashioned oats

1 cup flour

½ tsp cinnamon

½ tsp baking soda

¼ tsp salt

1 cup honey or maple syrup

¾ cup softened butter

½ tsp vanilla

1 egg

½ cup raisins

Preparation: Preheat oven to 375 F. lightly coat cookie sheet with vegetable oil. Combine dry ingredients and mix well. Mix honey/syrup, butter, and vanilla until smooth. Add egg. Blend in dry ingredients, mixing thoroughly. Stir in raisins. Place rounded spoonfuls of blended ingredients onto cookie sheet and bake for 10 minutes. Makes 50 cookies.

I made three batches of these cookies each using a different sweetener (1 each with honey, maple syrup, and sugar) and would definitely recommend using maple syrup.

Laura is a senior at Syracuse University majoring in dietetics and minoring in hospitality management. She hopes to become a Registered Dietitian. Laura has a passion for cooking and baking.

Monday, August 2, 2010

Diabetes From a Personal Point of View

The dates of some experiences can be imprinted on one’s memory for a long time. I don’t think I’ll ever forget the day that my son was diagnosed with type 1 diabetes at 8 years of age. He had been excessively thirsty for a few days, and was drinking a lot of water. A couple days prior to his diagnosis, I remember him coming home from school and telling me in amazement that he went to the bathroom twenty times that day! My husband and I scoured the internet looking for any other explanation than the one that we knew was most obvious. In medicine, they have a saying: If you hear hoof beats it’s probably a horse, not a zebra. This means that what is most obvious is most likely. In our case it was a horse, type 1 diabetes.

When I was a nutrition student learning about diabetes, I struggled to get my mind around all that was necessary to manage the disease. Diet, medication and physical activity are all very important in controlling diabetes, and none of it is simple. I am still learning how complex diabetes management is every day. My son is now a 15 year old athlete. He has risen to the challenges of diabetes better than many adults would have. He knows how important physical activity is for his blood sugar management, and after trying several different sports he found a sport that he loves, rowing. Diabetics used to be discouraged from participating in sports because of the risk of low blood sugar. Now, we view physical activity and athletics as an important part of keeping a diabetic person healthy throughout life. The advent of the insulin pump has allowed us to fine tune the delivery of insulin such that athletics is not considered as dangerous as it used to be.

Since my son has been diagnosed with diabetes on March 16, 2004 he has had several seizures related to low blood sugar, all of them occurring during sleep. He’s always recovered relatively quickly from them, and was alert enough to drink juice to bring his blood sugar back up. His most recent seizure on July 7, 2010 was different. By now, my other children are well versed in their brother’s diabetes management. My 13 year old daughter has helped me administer juice to her brother and witnessed the multiple daily finger pricks to check blood sugar and injections of insulin. On this warm day in July, she frantically called us at work to let us know that our son was having a seizure. I left for home grateful that she would be there to give him juice. While I was en route she tested his blood sugar and administered glucagon, a quick acting sugar to help raise blood sugar in unresponsive diabetics. When I arrived the situation had not improved. Another injection of glucagon failed to bring him around. I was relieved when my husband, a physician, arrived home to help, but nothing that we did brought our son back to his normal mental status. We called 911.

I’m happy to say that my son has made a full recovery and the only lasing effect from this day was his inability to train athletically for about a week due to headaches from a lumbar puncture that was part of his hospital evaluation. We replay the events leading up to this day and try to figure out what contributed to it. I never expected my son to have a seizure that we couldn’t bring him out of. I now wonder if we should have been better prepared to understand how different the needs of a diabetic athlete are compare to other athletes and other non-athlete diabetics. I’ve since learned that to correct for a low blood sugar, a diabetic athlete can require twice as much carbohydrate as a non-athlete diabetic. I’ve also learned that dehydration can impact a diabetic athlete differently than a non-diabetic athlete. I never wanted to understand as much about diabetes as I do now. My experiences with my son have motivated me to learn as much as I can about this disease to help him and other diabetics, athlete and non-athlete alike, to take control of their lives!

Monday, June 7, 2010

No Free Refills!

I'm often asked by people if they can eat all they want of a certain food. Perhaps vegetables or fruit? What about diet soda? You're not going to like what I have to say, but there are no free refills when it comes to healthy eating. In fact the notion of "free refills" perpetuates mindless eating. There is and should be a limit to what we consume. By eating all that we want, we tend to overeat (think about the last time you ate at a buffet). Shouldn't we stop and evaluate our level of hunger before eating more?

Hara hachi bu is an Okinawan expression that means eat until you are 80% full. This was traditionally practiced by the Okinawans who were among some of the longest lived people on the earth. Their diet consisted mostly of  vegetables, whole grains, fruits, legumes including soy foods, fish and very little amounts of meat. Sadly, younger generations of Okinawans may not live as long as their elders because they seem to prefer a more western diet, with a nice helping of western diseases to boot.

As a 15 year old athlete, my son has a healthy appetite. I'm fortunate that he likes most foods and with a dietitian for a mother, he gets more than his fair share of vegetables, whole grains and legumes. He often desires second or third helpings. I'll ask him if he's still hungry before digging in a second time. His reply has often been, "well, I'm not full." I don't believe that fullness should be the gauge that we have had enough to eat, but rather absence of hunger. Fullness is the gauge that we have overeaten. This is food for thought in a world of overabundance. It takes real discipline to practice hara hachi bu when we are being bombarded by food advertisements that make us want to eat more with excessive portion sizes on every street corner. A mere 100-200 hundred calories a day extra can prevent us from obtaining weight loss, and over time promote weight gain. It's something to think about when you want to eat more because something tastes good, but you are no longer hungry.

To those who question why we shouldn't eat as many vegetables as we want, after all they are low in calories; I say sure, eat plenty of vegetables. Most people don't eat enough. But no food should be eaten unchecked. A recent article in the New York Times told of an 88-year-old woman who developed life threatening hypothyroidism from eating two to three pounds of raw bok choy daily for several months. She believed that it would help control her diabetes. Instead it suppressed her thyroid. This is an extreme example, but it shows that you can get too much of a good thing.

My challenge to you, try practicing hara hachi bu for a week. Be mindful about the food that you eat and stop eating when you are no longer hungry, but not full.

Friday, May 14, 2010

Diets Don’t Work? …Really?

Have you ever noticed how an idea gains popularity but the idea may not be true? Drinking eight cups of water a day is one such concept. It seems like a good idea, but there are many people who do fine drinking less and many people who need more. Another such idea is that diets don’t work. This is a common idea circulating within the nutrition community and one that I’m sure many “dieters” have also heard. The purpose of this idea is to move people away from the “dieting” mentality to encourage them to engage in healthy eating and lifestyle habits, and to become more aware of their bodily need for food. It also, unwittingly lays blame with the “diet promoting” community for the failure of dieting efforts.

As a practicing dietitian for 20 years I have to say that diets DO work! I’ve been witness to many people achieving their goals by following a specific dietary plan. The problem is that people can be limited by their ability to follow recommendations consistently. There are all sorts of reasons for this, too numerous to describe, but here are a few: emotional eating related to the need for comfort, lack of time to prepare meals due to social pressures, and medical problems (and medications) that change the body’s response to food.

Perhaps the first myth to dispel is that "diet" is a four letter word. It depends on how you look at it. The word “diet” as a noun describes a way of eating. All living creatures have a diet, ranging from the worms and bugs that birds eat to the broad variety of items my dogs eat – dog food supplemented with small rocks, twigs, shoes, undergarments and broccoli. Change diet into “dieting” and viola—it becomes a verb. This is how many of us are most familiar with the word. Dieting implies that we are doing something to change our eating regimen—not necessarily a bad idea. But when one “goes on a diet” they inevitable must “go off a diet” abandoning all the good changes that they previously made. It seems best to focus on the word diet as a noun to grasp the long term nature of what our commitment should be to a healthy diet. As long as we are living and eating, our commitment shouldn’t end.

Research conducted by the National Weight Control Registry showed that people can lose weight on ANY diet plan. So weight loss doesn’t seem to be the problem as much as weight maintenance. And weight is not maintained when the permanence of an eating regimen is not considered. As is the case with weight loss, there are many diets that are successful in improving other aspects of health. The Mediterranean diet is heart-healthy. The DASH diet lowers blood pressure, and has recently been shown to help prevent kidney stones. And there are many different diet manipulations that can improve intestinal function, reduce the risk of cancer, lower cholesterol levels and control blood sugar. Diets do work!

I agree with my colleagues who espouse the non-dieting approach, but don’t say that diets don’t work. Let’s go back to looking at the word “diet” as a noun and encourage each individual to choose the best diet to achieve and maintain their health.

Sunday, March 21, 2010

Can Vitamin D Protect You From the Flu?

Vitamin D, termed the sunshine vitamin because it is produced by skin exposed to sunlight, has been in the news a lot recently. We are well familiar with the need for vitamin D to develop strong bones, but a rash of recent studies show that vitamin D also functions as an important regulator of immunity. Vitamin D deficiency is seen in many immune-mediated diseases such as Crohn’s disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and asthma. Vitamin D deficient states have also been theorized to increase susceptibility to infections. Because vitamin D is mostly obtained from sunlight, blood concentrations of vitamin D decrease in the winter months, a time when influenza infections become more widespread.

A study released ahead of publication in the American Journal of Clinical Nutrition is one of the first clinical trials to report that vitamin D supplementation in school-aged children can decrease the incidence of influenza A. In this study, a randomized group of 334 children in Japan were given either 1200 IUs of vitamin D or a placebo over a four month period (December 2008 trough March 2008). The study showed a significant decrease in influenza A infection in the children who took vitamin D supplements. Vitamin D increases the production of antimicrobial proteins that inhibit some forms of the influenza virus, and vitamin D’s anti-inflammatory properties may also lessen flu symptoms.

Some of the study results were not as distinctly positive. A decrease in incidence of influenza B was not seen in this study. Various strains of flu have different mechanisms of infection within the body, and some may be more resistant to the effects of vitamin D. Children with asthma did not show a decrease in the occurrence of flu, but it is thought that asthma suffers are more prone to infection overall. Interestingly, the study showed that there were significantly less asthma attacks in the vitamin D supplemented group. Flu incidence was not decreased in the first month of supplementation; previous studies have shown that vitamin D supplements need to be taken for three months before blood concentrations reach a steady value. Therefore the optimal time to begin vitamin D supplementation would seem to be before the start of flu season. The skin loses its ability to make vitamin D from sunlight beginning in mid fall. Flu season typically peaks in November and April. Thus it has been recommended to supplement vitamin D from October through April.

Clearly, more research needs to be done to determine whether or not vitamin D supplementation can prevent the flu in larger, more diverse populations. We know that senior adults are more susceptible to influenza. Vitamin D requirements are also increased in this population as older skin is less efficient at making vitamin D. Overweight or obese individuals have also been shown to have low levels of vitamin D; one study showed that 1 in 3 women and 1 in 2 men were deficient in vitamin D. Though it has not yet been definitively determined that vitamin D supplementation prevents the flu, supplementation with up to 2000 IUs of vitamin D has been shown to be safe, and emerging evidence suggests that it may indeed help to prevent infection with some strains of the virus.

Monday, March 1, 2010

National Nutrition Month® 2010: Nutrition from the Ground Up

This March celebrates the thirtieth year of National Nutrition Month® whose purpose is to focus attention on healthy eating and physical activity habits to promote health and wellbeing in the American population. It’s difficult to compete in the current food environment with the message of health. You most likely won’t see any TV commercials or advertisements online or in print. But the message for this year resonates; “Nutrition from the Ground Up.”

I asked my family what this meant to them. This year’s theme brings to mind acres of plants growing in the sunshine with various shades of green and gold as far as the eye can see. My six year old daughter thought of butterflies. My mind met hers in a field of strawberry blossoms in May with butterflies fluttering in the air. The thought of foods grown using sustainable practices that are good for the environment and good for us comes to mind. Such practices encourage the butterflies and the bees to pollinate the plants, which then allow the fruits and vegetables to develop. The ground provides the nutrients for growth. So “Nutrition from the Ground Up” means caring for the earth that produces an abundant harvest to nourish us.

Another concept for this theme is the idea of gathering or foraging for food. Mushrooms, nuts, legumes, and wild berries are gathered in forests, groves and meadows and can often be found near the ground (nuts historically were collected on the ground after falling from trees). The nutrients these foods provide are varied with myriad health benefits. Although we are not gathering and foraging for these foods ourselves anymore, we should include them in our diets routinely to reap the health benefits that they provide. A variety of nuts provide heart-healthy fats to prevent heart disease and stroke; they range from omega-three polyunsaturated fats in walnuts to monounsaturated fats in cashews, almonds and peanuts. Legumes (peas, beans, lentils, and soybeans) are a wonderful combination of soluble and insoluble fiber with a good dose of protein; they help to manage blood sugar levels, which can help in the management of diabetes. Foraging for food also includes a level of physical activity. This physical activity used to be our way of life, but is now so greatly lacking on any given day. We should wander the ground again in our pursuit of health and vitality.

Perhaps the deepest issue here deals with something that is hidden under the ground. Like an iceberg, there is so much more to discover underneath. The iceberg analogy is one that I commonly use when describing the science of nutrition: what we currently understand about the interplay of nutrients on our health is only a small part of the story. Most of it is vast and hidden from view, despite all of our science. Dedication and patience is required to learn about the wonders yet undiscovered, just the same as the dedication and patience we must have in the pursuit of our health goals, whether they involve weight loss or disease management. “Nutrition from the Ground Up” speaks of discovery; finding a carrot buried deep within the ground, discovering how nutrients impact our health, and finding that healthier and happier person within ourselves.

Ask what “Nutrition from the Ground Up” means to you and your family.

Monday, February 8, 2010

To Weigh or Not To Weigh

Should you weigh yourself every day? Good question! We used to teach restraint with the bathroom scale. We thought that it was better to weigh only once a week so that you could see your progress over time and not be fixated on the slight fluctuations that happen in normal weight management. Well, data from the National Weight Control Registry (NWCR) show otherwise. People who are successful losing weight and maintaining weight loss, weigh themselves daily. The logic is that if (or when) you gain a couple of pounds, you will correct for that gain with more activity or decreased food intake. This is an important skill to master in weight loss and maintenance.

Energy balance is maintained when energy intake is equal to energy output. But this equation is not easy to achieve, in fact, it probably is never achieved on any one day. The best that research has been able to show is within 50 to 100 calories of input or output. So there is never a day when we burn 2000 calories and eat 2000 calories. Maybe we burn 2014 calories and we eat 2115 calories. And the next day we burn 2354 calories (we exercised that day) and we eat 2274 calories. And that's how it goes. We need a tool to be able to measure the effect that this has on our body. The scale is such a tool. Whether you hate it or not, it can keep you honest about what you are really doing.

My recommendation to my weight loss clients now is to start with weekly weights until about five pounds are lost. Then it's time to weight daily. I know how much work goes into losing weight and I want my clients to be successful and not regain lost weight. The key with monitoring weight is to weigh on the same scale at the same time of day, wearing the same clothing (it is best to wear no clothing or minimal clothing). Write it down in your journal (because writing everything down increases your chances of success) and move on. At the end of the week go back and look at your weights and write a summary of your progress. It may go something like this:

Started the week at 155.6 pounds. Weight went down to 154.3 by midweek. Ate Chinese food for dinner at the end of the week and noticed that weight went up to 155.1 pounds. Probably holding extra water from all the salt in the restaurant meal
the night before. Finished the week at 154.7. Lost almost one pound this week.
Now, weighing daily is not good for people who struggle with eating disorders. If you are aware of disordered eating patterns, you will require both diet and psychological/behavioral therapy and you will have recommendations made by eating disorder specialists. The rest of us need to stop hating the scale. When we hate the scale, we hate ourselves. It's just a number that helps us measure progress toward our goal. We expect to see drastic changes in a short amount of time, but research again shows us that those who are most successful with maintaining weight loss, lose weight very slowly, 1/4 to 1/2 pound a week. So when the scale tells you that you've lost 0.4 pounds in one week, feel confident that slow and steady wins the race!

Saturday, February 6, 2010

The Value of a Training Buddy

My friend Linda hates to run. Linda and I train together. She told me this during one of our training sessions. I tolerate running, but can't say I love it either. I can manage one or two miles of interval running (preferring only one mile), but have never run long distances or entered any races. We train with another friend, Tim, who is a veteran runner. A while ago I decided that to continue to improve in physical fitness and to meet weight loss and management goals that people should continually challenge themselves. You have to do what you hate. So I made Linda run. She complained, but she did it. I wanted to quit too, but I did it also. We kept each other going. Tim kept challenging us and encouraged us to enter a 5K. We set the goal to run in the Jingle Bell Run in early December. We trained for a couple of months and we did it! It was a lot of fun! Our finishing times were not that great, but that wasn't our goal. While out shopping for new running shoes a while back, Linda expressed an interest in completing a 10K. OK, we can do that! We told Tim. Tim runs in a race almost every weekend during running season. Again Tim challenged us. How about running the Boilermaker 15K in Utica, NY in July? A 15K is a little more than we wanted to do, but I thought that we could do it (Linda was pulled along in this decision). We have plenty of time to train. Linda tolerates running now and is going out on her own. I think she even misses it when she can't get out for a run.

That's where Linda and I are right now. We're trying to get as much mileage under our feet as possible this winter. We spend two days training inside on the treadmill and as many days outside as we can considering the Rochester winters. Running long distances on the treadmill is agony. We'll run two miles and practice speed intervals on the treadmill. Linda hates this and doesn't see the point. Her 15 year old son tells her to stop complaining and to just do it. And she does. My goal is for us to complete the Boilermaker in 90 minutes. Ten minute miles seem easy for shorter distances, but we're running 9.3 miles. This is uncharted waters for us. Linda and I are now running five miles in an hour. This is beginning to seem easier to both of us.

Today, I met Linda in the bitter cold to go running. Sidewalks were not cleared and we had to run in the busy streets from time to time. We weren't sure how far we wanted to go today, but we both felt good during the run, despite not quite getting warm. We ran five miles, including a nice hill at the end of the run. Linda kept a good pace and we were both thrilled to be honked at by a gentleman driving by at the end of our run. Linda's goal now is to run six miles in an hour. That's a pretty good goal for someone who doesn't like running. I think Linda does like running now, she just doesn't love it! Hmmm...that sounds like another challenge.

Research shows us that when we engage in diet and exercise goals with other people our chances of success are greater. It's also important to set goals. Starting with small goals makes the challenge seem less difficult. But it's important to set new goals along the way, continually challenging ourselves. Humans are social and the camaraderie and encouragement that we receive from others can be tremendous. Conversely, others who do not share our goals can tear us down. Seek out those who will support you in your goals. I feel lucky to have Linda and Tim and the other friends who will be running and training with us! I'm really looking forward to putting many miles under my feet with good friends next to me!

Friday, January 29, 2010

My Stressed Out Entrance Into the Blogosphere

I consider myself typical; three kids, two cats, two dogs, a husband, a job, and volunteer work. I'm stressed out! Who isn't? I feel pretty equipped to manage my stress most of the time, though sometimes panic rears its ugly head. Stress can have a negative impact on the human body and coping strategies are necessary to maintain a level of productivity and vigor. For me, eating well and physical activity fit the bill. Getting a healthy meal on the table for my family after a day of work or setting aside time for physical activity can seem pretty daunting. Often, I think that we impose restrictions on ourselves to keep us from living a healthier life. We almost expect to fail, so we don't really try. Smoking cessation programs teach us that many people have to quit smoking several times to finally be successful. So, with failure comes success...eventually, if you never give up! Life is worth living fully with good friends, good food, lots of physical activity, and of course some stress. So, this is what my blog is about. Hopefully, I can navigate it like this picture drawn by my six year old daughter; with a smile on my face!