Monday, August 29, 2016

How To Navigate the Supermarket


Patients always tell me that they’re lost when it comes to shopping in the supermarket.  They want a list of what to buy.  I started a pantry in my office of products to have a discussion with patients about what to buy and what to look for when shopping (I have yet to make a handout).  It can seem overwhelming at first, but I tell my patients, “start with replacing one item at a time” – this way the changes can happen slowly.   The truth is, good nutrition starts with smart choices in the supermarket, just remember, NEVER go to the store hungry – that should just be obvious.  Here are a few general rules to get you going:

The process starts even before you head to the grocery store.  Have a PLAN! Plan your meals for the week – which meals will you make at home, what’s for lunch – and plan your list to shop from.  This may seem obvious, but the truth is planning helps to avoid the pitfalls of stopping on the way home from work for take-out (because there’s nothing at the house to cook.) It’s easy to fall into this trap, believe me.  So first a few rules of navigating the supermarket and then some products that are my go to staple items to have in the house. 

Spend most of your time in the produce section.  This many times can be one of the first areas that you encounter when you enter the supermarket.  Choose a rainbow of colorful fruits and vegetables.  The color reflects the different vitamin, mineral, and phytonutrient content of each fruit or vegetable.  Fresh is best!  Aim to have 5 to 9 servings of fruits and/or vegetables a day.


Breads, Cereals, and Pasta – choose the least processed foods that are made from whole grains.  Regular oatmeal is preferable to instant oatmeal (not to mention preferable to all the flavored instant oatmeals out there as well.)  Any patient in my office knows that I think cereal is one of THE worst foods out there.  It’s a high load of carbohydrate with virtually little protein.  I truly don’t have one boxed, cold cereal to recommend – and patients try to get me to tell them one.   Oatmeal is a cereal and that would be the only one I would recommend (but even then you need to add protein to it via nuts or nut butters to help keep you fuller longer). 

Bread, pasta, rice, and grains offer more opportunities to work whole grains into your diet.  Choose a whole-wheat bread or pasta, brown rice, farro, quinoa, barley, freekeh – there are so many grains to choose from.  The goal is to make at least half your grains whole.  Experiment and see which ones your family likes and remember that there are many ways in which to prepare them.  This is my favorite way to eat quinoa, Sweet Potato Quinoa Cakes.

Meat, Fish, and Poultry.  The American Heart Association recommends two servings of fish a week.  Salmon is one that many people like (if you’ve found the way to cook it just right – Honey-Glazed Salmon) and it’s a good source of omega-3 fatty acids.  Be sure to choose lean cuts of meat (like round, top sirloin, and tenderloin), opt for skinless poultry, and watch your portion sizes!

Dairy/Non-Dairy Milk Substitutes – Make sure to choose plain yogurts as much as possible.  This is an area that in the next year when nutrition labels are updated, we’ll be able to see how much added sugar is really in the yogurt.  My recommendation, buy plain as much as possible and add your own fruit in, along with cinnamon, and vanilla.  In regards to the milk substitutes, i.e. almond milk, etc, make sure to choose unsweetened.  These too will have a lot of added sugar and the goal is to keep our added sugars to a minimum.

Frozen Foods.  Frozen fruits and vegetables (without any added sauces) are a convenient way to help fill in the produce gap, especially in the winter.  Whole-grain waffles, frozen vegetables (picked right after harvesting), frozen fruits, and even pre-cut vegetables (think onions, green peppers) that can help out with minimizing steps for cooking!

Canned and Dried Foods – Keep a variety of canned vegetables, fruits, and beans on hand to toss into soups, salads, pasta, or other grain dishes.  When possible, choose vegetables without added salt, and fruit that’s been packed in its own natural fruit juice.  Here in Florida we’re in the midst of hurricane season, so it’s always a good thing to have a few of these canned food items on reserve, just in case.  A few other items to have on hand as they are just staples to have in your pantry, canned tuna, nut butters (the natural kind – think one ingredient, peanuts!), olive and coconut oil, and assorted vinegars.

Remember, it’s been said many times before, but the truth is, shop the perimeter of the store.   This is where the fresh fruit, vegetables, dairy, meat, and fish are usually located.  Avoid the center aisles as that’s where most of the processed/junk food lurks. 

Choose “real” foods, 100% whole-grain items, with as little processing and as few additives as possible.  This can be a goal that you are working towards.  Yes, they do make “whole-grain goldfish” crackers, but remember we’re trying to limit as much as possible some of the additives and preservatives.  So while they might be trying to make these crackers a little healthier the truth is they still shouldn’t be a staple item to have around.

Stay clear of foods that have cartoons on the labels that are targeted to children (think of that cereal aisle – cartoon characters everywhere, not to mention all the sugary type cereals are right at the kids’ vantage point from the grocery cart!)  If the junk food is available kids will eat it, so if you don’t want your kids eating junk food, don’t have it in the house.  Sounds simple, but it is one of the biggest complaints I hear from parents to which I respond, “who buys the food for the house?”  This is definitely a discussion to have with the whole family.

Avoid foods that contain more than five ingredients.  This is getting hard to do at times, but it’s a good rule to try and follow.  This year as I’ve been trying to make everything homemade there are a few items that I do still buy (bread, crackers) and I try to use this rule – So if it does have more than 5 ingredients I at least try to buy something that I can pronounce all the ingredients!  Center for Science in the Public Interest (CSPI) has a good list to double check if it’s an item that is safe – Chemical Cuisine.

So now we’ve come to the part where I’ll recommend a few items for you all to have as staple products to have in your pantry.  I by no means am endorsed by these companies, I’m just helping to guide you as you make your way through the supermarket. 

The first item is beans.  I am a vegetarian and these are my go to for protein (and complex carbohydrates).  Whole Foods sells these both in the can and in the box (I didn’t have any in the box – need to pick up!) and they have just one ingredient: garbanzo beans.  No additives or preservatives and no added salt!  Not to mention that in the can they run $.99 and in the box they’re $1.69 – cheaper than I’ve seen anywhere else (when you take into consideration the health benefits of no salt and no additives – not to mention I didn’t have to cook them!)  I have these on hand ALL the time. 


Next item – some of the breads I have on hand:  I’ve been buying the Ezekiel bread (or the Trader Joe’s version of Ezekiel bread) otherwise known as sprouted bread.  Sprouted bread contains the whole grain (or kernel, or berry) of various seeds after they have been sprouted.  I’ll then rotate back and forth between the English muffins from Trader Joe’s or the Eureka brand bread – they have a few versions of flavors varying the nuts/seeds.  My goal is to make my own bread but until this point I haven’t had much success – I might just have to break down and buy a bread maker.  Until then, these are a few breads I rotate through.


Canned items – Salt (sodium) lurks in most canned/boxed items.  I always opt for the unsalted version.  My palate has adjusted and I season with other spices/herbs that I have on hand.  People often tell me that I must like bland food.  I often challenge myself to make a dish have flavor with all the spices – believe me when I tell you, you won’t even know it’s missing once you start cutting back.  The recommendation for sodium is just 2,300 mg (roughly 1 teaspoon) and Americans are far exceeding that recommendation.  Here are a few items that I use, canned/boxed, that are unsalted if I can’t make it homemade or find fresh.  This brand of vegetable/chicken/beef stock comes unsalted.  Normal brands carry 2,400 mg of sodium in a box.  This brand only has 600 mg for the whole box!  It’s still loaded with flavor.  This spaghetti sauce is my go to sauce (don’t tell my mom I don’t make it homemade!)  Brands can range for a ½ cup to have anywhere from 250 mg – 850 mg of sodium.  Gia Russa’s brand has just 15 mg of sodium per ½ cup.  It may lack sodium but it does not lack flavor!  Last I always have some canned or boxed tomatoes around – while it’s summer now and the tomatoes are in season, it’s always good have to some extra tomatoes on stand by (to throw in a soup or dish with real tomatoes). 


Grains – I’ll admit it.  I’m a snob when it comes to brown rice.  Regular brands in the grocery store just don’t cut it for me.  I’ve had the real deal and that comes from the Chinese supermarket.  Once you’ve had the real stuff you won’t go back – not to mention when people tell me they don’t “like brown rice” I explain that they probably haven’t had a good experience with it and that makes sense.  I rotate through my grains when I make grain bowls and I always have a few around – whole wheat couscous, farro, barley, and quinoa.  And with my pasta I have all whole wheat versions – be it the orzo in the picture, rice noodles, or just regular pasta.


In the summer I’ve been having a homemade muesli that I throw together.  It allows me to have the rolled oats but not cooked – it’s too hot for oatmeal in the summer in Miami.  So for breakfast I rotate and have the muesli or my whole grain bread (with nuts butters) – what can I say, I’m a creature of habit.  I save the eggs for the weekend!  Akmak is my go to cracker.  Super flavorful and perfect for cheese and crackers, hummus and crackers, or whatever you fancy.  I’ve even had it with a little ricotta cheese, tomato, basil, and a drizzle of vinaigrette – delish!


So there you have it.  A round up of sorts of how to navigate the supermarket.  I know it can seem overwhelming.  Part of the reason is that there are so many new products being introduced yearly.  I definitely can’t keep up with all the new items.  Manufacturers are producing what they think you the consumer want.  See the above rules to help you solve that problem – stay away from the center aisles, otherwise known as packaged and processed junk food.   Problem solved. 


Sunday, August 14, 2016

Kids Eat Right™


Kids Eat Right™

“August is Kids Eat Right™ month.  Kids Eat Right™ month focuses on the importance of healthful eating and active lifestyles for kids and families.  It’s a time to highlight the role that everyone plays in ensuring a healthy future for our nation’s children.”
As a Registered Dietitian I help teach parents and children how to eat healthy and learn the important role that nutrition plays in their growth.   It’s all well and good to know what your child should eat, but getting the food from the plate to their stomach can be a challenge.  It may not seem like the thing to do, but letting kids have some control is the way to go. 


Here are 10 tips for parents:
Parents control the supply lines:  You decide which foods to buy and when to serve them.  I can’t tell you how many times I’ve been in the grocery store and see parents cave to buying food just because their kids are whining and they don’t want them to make a scene.  You have the control over what comes into the house.  What’s available is what kids will eat.  I’m not here to say that kids shouldn’t have a few treats, but if the majority of what you’re buying is crap, odds are they’re going to go for the food that in theory looks/sounds more appealing.  It’s all in how it’s presented though.  I’ve always said that healthy food can taste good.  It has to have flavor otherwise no one will want to eat it, yourself included.

Kids decide if and what to eat.  From the foods you offer, kids get to choose what they eat or whether to eat at all.  Yes, this means they can walk away from the dinner table (once everyone else is finished) without having eaten.  But, because you control the food, it also means that they won’t have the option of opening a bag of chips and using snacks to fill the dinner void.   You’re not going to please everyone every night with what’s for dinner, the key is to offer variety and have some foods that the kids recognize and like.  What might be more important is getting the kids involved in the meal prep, not only for understanding the importance of nutrition but also for helping them to learn how to cook as well as expanding their repertoire as far as eating.  I’ll never forget the time when we made homemade pesto at the school I taught at.  We had an organic garden at the school and the kids really were able to see farm to table in motion.  They were hesitant at first to try a green leaf aka basil.  But the minute they saw it blended up with parmesan cheese and nuts they were able to see it transformed into something that maybe, just maybe they’d eat.  Bring on pasta and they were in (because who doesn’t like pasta?!)  Getting kids involved in the meal prep is important, not only for them but also for the parents – it helps take some stress off of having to think of every meal for the week.  The odds are higher that they’ll try it if they’re involved in the process.


Quit the “clean plate club”:  Let your children stop eating they feel they’ve had enough.   Parents may want the efficient eating and clean plates, but that is not how kids operate.  And that is a good thing.  Kids, especially younger ones, are able to respond to their hunger cues.  When they’re hungry they eat, when they’re not hungry they don’t eat.  If you as a parent are able to respect your child’s hunger cues, your child may well be on the way to a healthy and enjoyable relationship with food.  Now if only some adults could cue in on their hunger cues…


Start them young.  Food preferences are developed early in life, so offer a variety of foods in a variety of forms.  Yes, kids go through phases where all they want to eat is a grilled cheese on repeat, aka known as a food jag, but don’t get frustrated or force them to eat, this will not solve the problem.  Introduce new foods slowly.  Children are new-food-phobic by nature.  Taste buds have to get used to a flavor before the kids actually begin to like the taste.  It can take as many as ten tries before a child accepts a new food.  10 tries!!  Talk about needing patience.  Keep offering, without forcing, and your child might end up liking broccoli.  Here are a few alternative ways to offer broccoli:




Drink calories count:  Soda and other sweetened drinks add extra calories and get in the way of good nutrition.  Kids need water, water, and more water – it helps to quench their thirst and won’t fill them up at meal time, as opposed to sugary drinks like juice or soda (& yes, juice is just as unhealthy for you as soda – don’t be fooled!)

Put sweets in their place.  Occasional sweets are fine, but don’t turn dessert into the main reason for eating dinner.  If parents are using sweets as a reward, the sweet treat can become the goal, making dinner just something to get through on the way to the finish line.  These practices can create unhealthy eating patterns instead of resolving them.   


Kids do as you do:  You ARE a role model.  Eat healthy and your kids will follow.  Children pick up on adults’ attitudes about food, so be aware of your approaches to eating, too.  Don’t expect a child to try a variety of foods if you regularly eat chips for dinner.  If you view food as a collection of unwanted calories, your child may adopt a similar outlook.  Instead, turn mealtimes into a pleasurable time – talk about your day while eating together as a family. 


Bite your tongue.  As hard as this may be, try not to comment on what or how much your kids are eating.  Be as neutral as possible.  Your job as a parent is to provide food that is balanced; your kids are responsible for eating them.  If you play food enforcer – saying things like “Eat your vegetables” – your child will only resist.  No one wants a fight at the table.

Make mornings count.  Most families don’t eat enough fiber on a daily basis, and breakfast is an easy place to sneak it in, whether it’s with oatmeal or whole grain toast.  Or, do what I do and make-up batches of whole-grain pancakes that can last all week (I am a kid at heart J).  For a batch that serves 6 (2 pancakes a piece), sift together ¾ cup all-purpose flour, ¾ cup whole wheat flour, 3 Tbsp. sugar, 1 ½ tsp. baking powder, ½ tsp. baking soda, ½ tsp. salt.  Next mix 1 ½ cups buttermilk, 1 Tbsp. vegetable oil, 1 large egg, and 1 large egg white.  Combine the liquid ingredients with the dry ingredients and there you’ve got your homemade pancake batter!  If you want to make up extra, they freeze well too!

Turn off the TV, computer, tablets, and phones:  You’ll also turn off the advertising and mindless snacking.  Distracted eating is becoming more and more common as we are so busy in our day to day lives.  Make sure to turn off all electronics and focus on your meal.  The other day after running with my friend we were sitting and enjoying our coffee and her son came in from watching morning cartoons.  He walked right in and asked for “Froot Loops”.  I looked at her and I tried not to laugh.  He’s 5 years old!!  Talk about the power of advertising.  He walked right in asking for what the TV advertisement showed him to eat.  I’m not sure what the ad showed and what its contents were.  But what I do know is that kids are young and impressionable.  Kudos for the Froot Loops ad working but shame on them as well for marketing to kids an unhealthy food.  (He wasn’t eating breakfast at the time, but it was on during early morning Saturday cartoons).  Turn off the electronics and focus on your food, help kids learn from an early age, no distractions while eating.

Kids Eat Right™ month is designated as August every year, however, every month and every day paves the way for kids to eat right.  Teaching children healthy eating habits that ensure that they’re getting the nutrients that they need starts at a young age.  Getting kids to eat healthfully doesn’t have to be complicated.  Variety, Balance, and Moderation along with a little patience will help kids eat right and you’re on your way!

Sunday, July 31, 2016

Half Crazy or Full on Crazy?


½ Crazy or Full on Crazy?

My friend and I have discussed running a full marathon now for a while.  We even signed up for the Miami ING a few years back with the intent to do the ½ marathon and then find a destination run for the marathon.  Injuries happened and we postponed the race till the next year.  My friend was still injured in 2015 and so I ran the ½ marathon by myself.  The running a marathon discussion is happening again.  We’re both approaching a semi-big birthday, ahem, age is just a number though really ;) and so we’ve revisited the idea again of “it’s now or never”.  A little background if you please:

I started walking with a group in 2007 to meet new people.  I had moved back to Miami from San Diego and thought I needed to get active and find some exercise I didn’t mind doing.  I had heard of this group of people that would get together early Saturday mornings and run or walk.  I had never run before in my life, so I thought that I would simply walk.  The walks became something I would look forward to.  We had a core group that would always meet and when I say we’d walk, we’d walk.  8 miles was the long distance of the day – we were supposed to do our shorter walks during the week to be able to do the long walks on the weekend.  I’ve always walked fast and 8 miles really didn’t seem that long when you’re talking about everything that goes on with each and every walker.  And that’s when the discussions first started that I should do a marathon.  I only fathomed half marathon at that point.  So sure enough we all started training.  We pushed to do 11 miles (some did the full 13 miles as practice) but I wanted to do the full 13 on the actual race day.   Sarasota, March 2008, I completed my first ½ marathon – 13.1 miles – I felt so great I even did a cartwheel over the finish line (there’s a picture somewhere to prove it).  After I returned the following Saturday the other walkers now began the discussion of, “What next?”  Would we do another ½ marathon or would we go for the full now?  Many of the walkers told me that if I had trained for the ½ then it was the best time to continue on for the full.  I took the challenge on.  What did I have to lose, right?  From March to May I trained and I trained a LOT!  I even was able to go out to San Diego (the destination I picked for my marathon!) a few times as my nephew was turning one.  I thought what better way to check out the race course and train in the elements.  It just all seemed to line up (in my mind).  I even after one of my trips kept my suitcase out since I was going to be going back so soon – I thought it was not only motivation but also a reminder for inspiration.  Little did I know that 10 days before the race I would stub my toe on that said suitcase.  Who does that??  This girl does, that’s who!  I went to the doctor and the doctor said the toe was not broken, but they did advise me NOT to walk in the marathon.  I told myself if the toe wasn’t broken then I was walking in that marathon.  I had to after all that training and time spent.  My dad has this famous saying in our family, “You gotta be tough if you’re dumb.”  I kept hearing his voice say this over and over.   I knew I’d be tough and overcome.   

My brother dropped me off almost exactly at my corral.  I was early but race ready – I had made homemade “energy” bars and had my fruit leather and water all ready to go.   Trained and ready.  I chose the Rock-N-Roll series for my race because I knew at least every mile I would have some form of entertainment.  26.2 miles is a long way and since I was walking I wanted to make sure others would be around as I was still walking!  I would say it was mile 9 or so I got a rock in my shoe.  Of all the things to happen during the race – I had not trained for that.  It had formed a small blister – I took my shoe off and saw it – the medic tent told me they could take me to the end and I didn’t have to finish the race or I could continue on.  Once again, my dad’s voice popped in my head, “You gotta be tough if you’re dumb.”  I figured if the stubbed toe didn’t stop me, what more could 17 miles do to an already formed blister?  They bandaged me up and off I went.  During my race there were signs everywhere from the Team In Training groups and others as motivation:





And there were even running Elvēs (that’s right, that’s the plural of Elvis) for entertainment.  Over 100 Running Elvēs were at my marathon – I’m not sure how they were in uniform and wig running in the heat.  San Diego in June normally has a marine later in effect till late morning, early afternoon.  The day of my marathon, it burned off at 9 am.  I had the worst sun burn ever!  San Diego was a great destination run.  And more than that, I had my family at the end – talk about motivation.  At mile 20 though I think you hit this wall (at least I did) and all I could think was there were 6 MORE miles left.  I look back now and it was a mix of adrenaline/heart/sheer will to get me through to the end.   Completing a marathon is like no other feeling that I can describe – you hear people try to describe it, but until you experience it you never know how you will react.  I was caught up with emotion and was just overjoyed to see my nephew (and the rest of the family)  I had done it, blister and all, 26.2 freaking miles.  6 hours and 10 minutes.  I always say I actually walked 27.2 miles – because where they made my brother park his car was definitely another mile or two – talk about cruel! 

Returning from the marathon left me with the “where do I go next” feeling with my exercise regimen.  I had just walked 26.2 miles, would I start running now?  I had never run before and never thought I could run.  I wasn’t sure what was next.  My friend Felix helped me start running.  We did intervals:  run 1 minute walk 4 minutes, until we worked up to run 4 minutes and walk just 1 minute.   I’ve been doing intervals ever since.  I have Felix to thank for introducing me to running and believing I could run.  Over the years I went from running literally barefoot on the beach to running with the minimalist type shoe (since I no longer run on the beach). 



4 years ago I broke my foot, the 5th metatarsal, the good old Jones’ fracture.  I didn’t break my foot from the minimalist shoes, but from running in the rain in flip flops – cue dad’s favorite phrase J  It took a long road to recovery after breaking my foot to even begin to run again.  After having running taken away, I knew the minute I could run again I would run.  Injuries are able to teach you a whole lot.  I never take for granted being able to work out.   A year and a half after breaking my foot I completed a half marathon (when I thought I’d be never able to run again)



Talk about an emotional roller coaster of a run that was!  It was November in Puerto Rico – no one was going to be pulling a PR (personal record) in PR (Puerto Rico) that was for sure.  After the first light rain shower passed over there was this rainbow and I stopped to take a picture:



I tried to savor every moment of that race, not caring what my time was like.  Finishing felt like such an accomplishment – thinking back to breaking my foot and thinking would I ever be able to do what I so loved?  Incredible moment for sure.

And that leads us to the present moment.  To run a marathon or not?  My running partner Marcela has never walked or run a marathon.  We’ve run a half marathon together and I know it’s on her bucket list:  run a marathon.   She’s downloaded the running schedule and is determined.  I’m training with her and tomorrow will be our official first day of training.   Say what?   I said after the first time around I’d never do this again??  Here's what I do know.  Marcela is my running partner. Through thick and thin, we're training for this marathon.  Marcela will be able to have that same feeling I had years ago - she'll be able to describe it to you one day.  Here’s to training and here’s to learning things along the way! 

Sunday, July 17, 2016

Extreme, Strict, or Simply Passionate?

Extreme, Strict, or Simply Passionate?

Summer in Miami is always hot and humid.  This past week it’s been extra hot since there haven’t been any of the afternoon rain showers to “cool” things down.  Not to worry, this week rain is expected every afternoon.   So now it will be a little steamier instead of just hot.  I’m not complaining, just stating the facts.  I wrote a blog about Hydration to help people stay hydrated.  All over social media sites, i.e. Twitter, Instagram, others are posting about hydration as well.  The truth is water is the best hydrator.  I teach a class at work, a general nutrition class, and the question always comes up, “What should I drink?  Crystal Light? Coffee?  Tea?”  My answer is always water and will always be water.  Sure I know it’s boring (to some people) but the truth is when you’re thirsty it’s the drink that will actually quench your thirst.  Eating fruits and vegetables can help as well as many of them have a high percentage of water. 


In certain situations, i.e. outside work, exercise, of course some form of carbohydrate replacement may be necessary, however, those are not the day to day examples for everybody.  Again, read the post for more information.  What’s come up more recently in class though is the question, “well what about juices and smoothies?”  This is where the debate always begins.  I try to keep it simple in class because I have a short amount of time and there are many other topics to cover.  The short answer?  Drink water.  And then the questions always begin, “but I thought smoothies were healthy?”  Believe me this is a trend that I wish would end.  Unfortunately it’s been around for a while and is only here to stay to continue to confuse people.  Smoothies have now progressed to smoothie bowls – so now not only are we having a smoothie full of carbs but we’re now loading them up with additional foods on top that contain carbs, carbs, and more carbs.  I try to explain to patients that in general the preference is to eat and chew your food – this takes time and allows for overall slower digestion (your body breaking the food down and receiving all the nutritional benefits, i.e soluble and insoluble fiber, vitamins, minerals.  When you blend the fruit up, the blade does destroy some of the fiber (kind of like doing the chewing for you), bypassing this critical step in digestion.  Furthermore, it not only “pre-chews” the food for you but you then have no buffer to slow digestion down – the end result being a larger load all at once for your liver to respond to.  Yes, smoothies have some fiber in them, so they’ll help in cleaning your intestines out (but that’s the role of the soluble fiber).  Smoothies are just like drinking a sugary drink – at least in how your body responds to them.  NOT recommended.  People always follow up in class by saying that they only do “green” smoothies, so only vegetable containing just to be clear.  9 times out of 10 when people are asked what they put into the smoothie at least one fruit is thrown into the mix.  The minute the fruit is thrown in it is now contributing sugar (carbs) to the mix, not to mention that the load of some of those green veggies (or even carrots and beets) now due to their volume can also elicit a response.  Here’s an article a few years back where Dr. Robert Lustig explains it a little more eloquently than I do - We don't mean to ruin smoothies



I’ve been told in class that I’m a little too strict in my thinking on juices and smoothies.  I like to think of myself as an educator that’s passionate about what she does.  I’m not always going to tell you what you want to hear, that’s for sure – this registered dietitian does NOT give her stamp of approval on juices or smoothies.  Smoothies and juices are a way for people who may have never eaten vegetables to begin to incorporate some vegetables into their diet.  I used to do it all the time for my nephews with spinach – but in my concoction I always added greek yogurt or some peanut butter for some protein and fat – and that was to get my nephews to see that spinach didn’t always contribute a flavor so they’d be more willing to eat something green.  Sure every now and then smoothies and juices might be able to fit, but they shouldn’t be a daily thing.  The bottom line is that people need to eat and chew their food to get the full benefits and help their body process food in a normal manner.  Over the last 2 ½ years while working at the Diabetes Research Institute, I have had an occasional sweetened alcoholic beverage, where before I used to have them all the time.  I’m more conscious of my food and drink selections now.  So call me “extreme” or call me “strict”, I prefer to think of myself as passionate about educating and teaching people about nutrition.


This then leads me to my next topic that always seems to come up in class.  The question is always asked of me, “What can I do to improve upon in my eating habits?”  I guess as a dietitian they see me as having it all together and again think I’m a little extreme when it comes to eating healthy.  But the truth is we are all at different stages of where we need to improve upon.  And while I might be farther along the path, there is always, and I mean always room for improvement.  I strive to practice what I teach and be an example – I believe that’s how people are able to learn.  But more than that, I try to implement what I do teach to see if it’s practical.   If I’m asking people to do something, then I’ll trial it out first.  Who am I to tell someone to go and do something – easier said than done.  Here are a few things I’m currently working on:

I’ve been making meals that contain 45g of carbohydrates – Is it possible to only have 45g and stay full for 4 hours?  What do meals look like with only 45g of carbs?  I’m part Italian and 1 cup of pasta = 45g of carbs, that’s a tough one - but that’s exactly why I’m trying it out.   

 I work with both Type 1 and Type 2 diabetes.  I teach overall general nutrition for all, but in regards to Type 2 diabetes, the focus is on the quality and quantity of the carbs at each meal (again, this is taught to people with Type 1 diabetes too, but typically I’m teaching them to match the insulin to their carbs, a little bit of a different approach).  Quantity of carbs is critical when it comes to blood sugar control as you want to limit the load at any one meal (and aim to distribute the carbs throughout the day).  Which brought me the idea of having meal examples of 45g of carbs for patients to see real life examples– 

So what’s the verdict?  Does 45g of carbs at meals keep one full?  YES – when they’re balanced with lean protein and non-starchy vegetables.  You HAVE to add in lots of non-starchy vegetables to the mix, otherwise you will  load up on carbs and more carbs – believe me, I used to do it!  When meals are balanced – carbs, protein, and healthy fats, we’re able to fuel and sustain ourselves.  Carbs are your preferred source of fuel, however, they do digest quite quickly and will not sustain you for a long period of time.  Enter the lean protein and non-starchy vegetables (that are full of fiber – which also helps to keep you fuller longer) – it sounds cliché, but it’s the truth:  variety, balance, and moderation are key when it comes to planning meals.  When I look around at many cooking websites, they’re not always balanced.  This message is then passed on to people as to what looks like an appropriate meal, when in fact there might be something missing or it might not be adequately balanced.    You know the whole zoodle craze?  They were created to lower the load of carbs at meals, they were NOT created to omit carbs at meals – which is what is often depicted.  So enters my pics, to illustrate healthy balanced meals with real life food that people will want to eat.  I’ve just started taking the pictures, but I think it’s something that I’ll continue doing – now I just need a catchy hashtag J

I’ve been making everything homemade!  While this may not be realistic for everyone, remember these are the things I’m doing to improve upon for myself.  My most recent items I’ve made:  homemade bread, pico de gallo, salsa, chimichurri sauce, blue cheese dressing, and those are just a few!  I will be the first to tell you that my bread making skills need improvement.  So any tips that you can send my way, I welcome.  I don’t have that much space in the kitchen, but I’m thinking a bread maker might be the way to go.  There have been many failed attempts – whole wheat bread, pizza dough, “cheeze-it” crackers, unfortunately none have made it to the “taste test” stage for people to experience.  I’ll get there, eventually.  That’s my project and I WILL keep improving.  I have to! 

Eat more non-starchy vegetables!  As a practicing vegetarian (technically a pescatarian as I will eat seafood every so often) there is some irony to this.   How do I not eat more vegetables, am I right?  Over the last two and a half years I have been working to improve upon this.  I’m the first to admit I had been loading up on carbs – it’s easy to do as a vegetarian. 

So now for meal prep I’ll roast lots of veggies up to include throughout the week.  It’s always the missing part of anyone’s meal most times.  This addition to my meals has helped me to cut back on the amount of carbs I was eating.  (Sure, I have a normal working pancreas that will secrete insulin when I need it, but the truth is that there is a family history of diabetes in my family and I am aging – no need to overwork my pancreas any more than I need to!  I’m all about prevention!)  Additionally I’m trying new vegetables I might never have tried before – Gai Lan (Chinese broccoli) is now a staple in my kitchen -  Also I’m trying to get a variety of colors within the vegetables that I’m trying – it’s hard to find different blue/purple hues of vegetables – purple carrots and purple cabbage are now mixed in on a rotation.  I still need to find a way that I’ll enjoy eggplant – I think it’s the texture that’s not my favorite.   So even me, the dietitian has problems eating more vegetables!

Decrease the frequency of desserts.  I love sweets – I often joke, “this dietitian eats dessert!”  I pride myself on saying that I have them in moderation and in portion controlled amounts, but the truth is they were starting to become a little too frequent.  So just in the last couple of months I have been cutting back.  I do make desserts, but I’ll share more of them now, so that I’m not having them daily.  I eat them in portion controlled amounts when I do have them and now the frequency is less.  They were starting to creep in as a daily ritual.  As part of the process of lessening the frequency I do still have a piece of dark chocolate daily – a nice 70 to 80% dark chocolate.  Not too sweet, but it still gives me the idea that I’m having “dessert”.  The portion has never been the issue, it’s more the frequency.  I teach my patients that desserts are meant for special occasions (and rightly so!)  Every day is not a special occasion.  I knew I needed to cut back and I have. 

Mindful eating – Breakfast and dinner are typically easy for me to be mindful about what I’m eating- I have time and it’s at my house.  Lunch, not so much.  Most days you’ll find me eating my lunch quickly at my desk.  Not super mindful at all.  This is definitely an area where I struggle and am honest in saying so.  The one thing that I have done is aim to leave the building for 10 minutes at lunch time.  I’ll go for quick walk around campus (even in this heat!) without my phone and try to practice a walking meditation.  This has been helpful.  So, while I’m eating rather quickly I do feel the walk outside helps.  I just need to figure out if eating outside and not walking would help me to be more mindful?  I wish in an ideal world I could do both.  Again, a definite area to improve upon. 


Remember, it’s important to constantly strive to improve – the moment you get too comfortable is when we start to inch back into our old ways.  While I’ve always eaten healthy, I too have room to improve – the desserts are a prime example of me becoming too comfortable and starting to eat them too frequently.  I really do try to practice what I teach and hope that others can see this is a lifestyle, it’s not just a one-week fix to lose weight – it’s all about establishing healthy habits, one at a time, to last a lifetime! 



Sunday, July 3, 2016

June in Review


Time flies.  How is it July already??  It’s been a month since I last wrote a post and life has been busy.  I saw a picture on social media the other day that summed up a few general wellness principles quite well: 
Sounds simple enough, but why is it always so hard to put some of these principles into actual practice?  Life.  It’s stressful!  We’re moving at a really fast-pace, we don’t slow down and like the quote says, we don’t “listen to our body.”  It’s easy to say, listen to your body.  But, knowing and doing are two separate things.  I’ve found that stress for me is the trigger to making poor eating selections, overdoing myself, as well as losing my cool at times.   This weekend I’ve taken time for myself, meditated, slept in, and worked some (more on that later).  It’s just what I needed after a month of non-stop on the go craziness.  A few things from this past month:

Four weekends a year we do a special program at work called Mastering Your Diabetes.  It’s a program geared towards people with Diabetes (insulin management).   With a multi-disciplinary team – nurse educator (CDE), dietitian (CDE), physician, and psychologist – our aim is to:

·       Optimize patients understanding of how their insulin works

·       Improve the decision making regarding the timing, dosage, and administration of their insulin dose for their insulin needs

·       Assist in identifying patterns in blood glucose management (with the use of continuous glucose monitoring – CGM)

·       Reduce risk for hypoglycemia and hyperglycemia

The month of June we have one geared towards kids and their families.  To say this 4-day program is life altering is an understatement.  I always go in to the program knowing that I will be teaching a lot of information to the kids and their families – carbohydrate counting, general nutrition for growth, etc – but the truth is I always come out having gained so much more from the kids themselves.   We did a section one day where the kids had to say one positive thing about having diabetes, one negative thing, one thing they’re grateful that their parents do for them, and one thing that’s annoying that their parents do.  The kids ranged from ages 8 – 16 in our group this year.  For this section though I had the younger kids, ages 8-11.  What they all had in common is that they wanted people to see them as normal children that didn’t have some label that comes with “diabetes” on their forehead.  Sure, they know they’re special they said and that they have to “think like a pancreas” but they’re normal kids that hate needles and want a cure for type 1 diabetes, like yesterday.   One child that especially touched my heart this time around was a child from Guatemala (he came especially for our program!)  When going around the circle, his fear is that his sister will have diabetes and his one thing that he was grateful for was that his parents buy him the things he needs to manage his diabetes.  At age 11, to be so reflective and able to see how supportive his family is for him and yet to be so thoughtful that he doesn’t want his sister to experience what he has gone through (even knowing that he is okay at the end of the day).  Okay, I’d say cue the tears, but I didn’t want to cry in front of the kids and get my ugly cry on in front of them!  So, I bit my tongue – maybe not the best strategy, but the kids knew their comments were getting to me – one came up and gave me a hug.  4 intensive days of teaching kids and their families how to “manage their diabetes” that not only changes the participants but changes us (the healthcare professionals) for the better.  Completely life-changing.

In between working the weekend for MYD I’ve also been working to prepare nutrition curriculum for a 300-hour yoga teacher training (YTT) coming up.  My yoga teacher, Marianne Wells, developed a 300-hr YTT and with collaboration with medical and therapy professionals that will help yoga teachers deepen their knowledge, expand their skill level, as well as foster their evolution as yoga professionals.  I’m excited to be a part of this YTT and have been working hard on creating the curriculum for the Nutrition portion.  I’ll be covering some of these topics:

·       Carbs/proteins/fat – What is the right balance?

·       Nutrition in diet and disease & prevention

·       Vitamins/Minerals/Antioxidants – Is supplementation necessary or will my diet provide everything that  I need?

·      Nutrition Trends – Paleo/Atkins/Macros/Juicing – What’s the right “diet” I should be following, if any?

·      Mindful Eating – How to be mindful in a not so mindful world (technology/social media/work)

Simple requirements – that you’ve already had a 200-hour yoga teacher training prior to taking this 300-hour training & it’s highly recommended that you’ve been teaching yoga weekly at least one year prior to the training.  Again, I’m beyond excited to join Marianne in teaching what I love and am passionate about, Nutrition!  I’ve really been putting a lot of time into creating the curriculum.  I’ve still got more to go, but each weekend I put in hours dedicated to the curriculum and will be ready to go come November!  Any questions, let me know.  Check out Marianne’s website for more details as well:  Marianne Wells Yoga School - 300 hour Therapeutically-Oriented Yoga


In the middle of all of this I decided to try a few no-carb meals.  It’s a really popular trend – just check your Instagram, Facebook, Twitter feed and you’ll see any and all kinds of “noodles” that aren’t really noodles…  I’ve spoken to a few doctors (endocrinologists that I work with) and the thought is that every now and then a meal or two can be carb free.  I decided to try it and put the experiment to the test.  I borrowed my mom’s “spiralizer” and began to zoodle away:


I randomly spaced the no-carb meals so they didn’t fall consecutively and I made sure to include one or two meals prior to the days I would run.  What were my findings?  This is not science based, simply based on my personal experience:  I was hangry after these meals – so much so that I was definitely eating things that were unhealthy.  I was beyond irritable and my runs were the worst runs that I’ve  ever had (according to Fitbit analysis).  Maybe it was all mental?  This has and always will be my recommendations to people – EAT CARBS.  Eat healthy, complex carbs and in portion controlled amounts.  Quality AND quantity are important when it comes to carbs.  We are a carb laden society and need to cut back on the amount of carbs we are eating.  Period.  No need to eliminate them completely, rather include them in the right size portions – which when you see a cup of pasta you’ll think I’m kidding.  1 cup doesn’t look like much.  Believe me, overeating pasta is easy.  The key is to balance your plate with the right amount of protein along with non-starchy vegetables.   There won’t be any more experimenting with no carb meals.  I’m good.  I know my body and I listen to my body.  Healthy and balanced.  I eat carbs J
I finally was able to check out the new restaurant here in Miami called Grown.  It’s a fast-food restaurant created by Ray and Shannon Allen (former NBA player) that brings “real food, cooked slow for fast people, fusing a farm-to-table concept using organic, local, and nutritious ingredients in a fast-food setting.”  They created this restaurant Shannon says out of frustration.  She has five children, one child with Type 1 diabetes, and cooks healthy food at home, but like most families is busy and wanted an option to have on those nights when she couldn’t cook and needed to grab “fast-food”.  Enter her idea for Grown.  I knew I had to check it out – it’s only been open for three months already!  The menu is nicely laid out – they have the option to pick your protein, grain, vegetable, and then your sauce.  I chose to go with the salmon (as I will eat fish occasionally).  Literally ready in under 5 minutes, my dish came out:

Healthy food, fast.  Delicious flavor and quite convenient – they even have a drive through!  While it is a fast-food concept, just go in knowing that the price isn’t equivalent to other fast-food chains.  It is a little more pricey – you are paying for the local sustainability and organic food.  I haven’t eaten out in forever as I make my own food all the time.  But I do love their concept and understand her frustration – what do you get in a pinch that doesn’t compromise eating healthy?  Enter Grown.  Here’s hoping they expand and others will catch on to their concept.  If only I had the means to open a restaurant of my own…hmmm.

This past Friday, all I did was rest.  It was what my body needed.  This past month has been busy and at times stressful.  So I did just what my body told it to do – I slept in (even if it was only till 7:07 am, I slept in!), I did a restorative yoga class, I meditated, I took a nap (and I am not one to sleep in the middle of the day – but I was out cold for 20 minutes so apparently my body needed it!), and I did just a little bit of cooking – because I wanted to nourish myself with home-cooked food.   I know that in order to give to others I need to give back to myself.  I was running on fumes for the past week and a half and I needed to rest and restore.  We all do.  The wellness principles I mentioned at the beginning of my post are simple reminders to us all to slow down and tune in to ourselves.  On the days that were so crazy busy I found myself skipping my meditation time – when it was what I needed most!  I’m reminded that meditation can be little bits all throughout the day and this is what I’ve been practicing since Friday – one minute intervals of breathing, re-connecting, and resetting my intention – to not let stress overwhelm me and to know that there still may be moments of stress.  Breathing just helps me refocus and restart with a little bit of a different vantage point.  I’m not here to say I still won’t get stressed or overwhelmed, but I know I have the tools to tap into and help manage the stressful times.  I'm ready for you July!

Sunday, June 5, 2016

Summa-time!


Hydration

Summer doesn’t officially begin until June 20th.  However, in the last week or so, here in Miami you can feel the heat and humidity.  I run early morning, 5 am, and it’s quite sticky and humid even at that time of day.  So, let’s suffice it to say it’s summatime!  And with summer comes the topic of hydration. 

Staying hydrated is fundamentally important to a successful summer exercise regimen, or any activity for that matter.  Your body is like a machine and it needs the fuel in order to function at a higher capacity. 


Let the engine run dry and well, you know the drill.  So what are the recommendations that experts tell us?  The key is to determine your individual fluid needs and learn to develop a hydration strategy based on those needs.  How much water do we need to drink?  The “8-glass a day” recommendation, is it really true? 

With the summertime, how does alcohol fit in with hydration?  There will be barbecues and holiday celebrations and alcohol is definitely part of the mix. 

Exercise and hydration – what should I be drinking to improve my workouts?   

Water itself is a simple substance, containing just one part oxygen and two parts hydrogen.  Yet every body cell, tissue, and organ, and almost every life-sustaining body process needs water to function.  Water transports nutrients and oxygen to your body cells and carries waste products away.  It moistens body tissues – mouth, eyes, and nose.  Water is the main part of every body fluid – blood, gastric (stomach) juice, saliva, and urine.  Water helps prevent constipation (by softening stools) and it helps cushion your joints.  Water, bottom line, is a critical and essential nutrient. 

How much is enough?

The oft-repeated recommendation for eight, 8-ounce glasses of water each day = 64 ounces, or about 2 liters, daily.  However, more specific guidelines from the Institute of Medicine (IOM) and the US National Academy of Sciences, suggest you should be drinking more – the food that we eat does help contribute to this total as you’ll see.  The experts state that healthy adults, between the age of 31 and 70, living in temperate climates (not the summer in Miami), should consume the following amounts:

·         Men:  125 ounces (3.7 liters) of water from all dietary sources – including drinking water, tea, coffee, and food

·         Women:  91 ounces (2.7 liters) of water per day from all dietary sources

Approximately 80% of our water intake comes from drinking water and other beverages, and the other 20% comes from food.  Assuming these percentages are accurate for most of us, the recommended amount would be ~9 cups for women and 12.5 cups for men.   Just like nutrition recommendations are individualized, these recommendations are made for the average population.  Keep in mind that specific needs and conditions will vary.  I’d be honest in saying, check your urine.  Our bodies are unique and amazing organisms, if we’d only listen to them.  Yes, thirst can indicate (in some) the need for fluids, but in some it indicates you’re already dehydrated.  When all else fails, check your urine.


As you can see from the chart above, “1,2, and 3” are well hydrated – pale yellow, almost clear.  Certain vitamins and foods (beets) can alter the color of urine, but in general this is a general guideline to use to help determine hydration status.  When my patients ask me what they should be drinking, the answer is always water and more water.  Yes, I know people think water might be boring, but try some infused waters to jazz it up.  Get in the habit.

Alcohol  - In regards to hydration, keep in mind that alcohol has a diuretic effect and promotes water loss, too.  This is important to consider while at the summer barbecues and holiday celebrations.  A good rule of thumb is when having one alcoholic beverage make the next one nonalcoholic – this allows your body to process the alcohol you’ve already consumed.  It’s always important to know how to pace yourself with alcohol.  Know your limits and be mindful when drinking.  A nice cold beer  may taste great in the moment and perpetuate the thought that more is better – but realize the after effects that come along with over consuming.  The general rule is to hydrate with 10 ounces of water for each ounce of liquor/4 ounces wine/8 ounces beer.  You’ll feel better in the morning and thank me J  (I’ll cover alcohol in another blog in regards to weight loss – today’s focus was simply on the role that alcohol plays in hydration).

Exercise and Hydration

When you exercise heavily, you lose water and salts in your sweat.  Gatorade has an advance over water because it added a number of electrolytes that are lost in sweat.  Sports drinks are packed with the electrolytes potassium, magnesium, calcium, and sodium to provide energy during intense workouts –as well as competitors such as Powerade, All Sport, and Accelerade.                                                       

Take a swig of an electrolyte drink, and you make sure your body doesn’t overheat.  You also give yourself an energy source – one that only serious athletes need.  For people engaging in exercise in a hot environment an electrolyte replacer can be a lifesaver.  Electrolyte drinks provide the body with fuel in the right quantities, so you don’t get an upset stomach.  And the carbohydrates, sodium, and potassium, help move fluid more quickly out of the body and into the muscles, where it needs to be during exercise. 

Read the label to determine which sports drink is best for you.  Ideally, it will provide around 14 grams of carbohydrates, 28 mg of potassium, and 100 mg of sodium per 8-ounce serving.  The drink’s carbohydrate should come from glucose, sucrose, and/or fructose – all of which are easily and quickly absorbed.  It shouldn’t be carbonated, as the bubbles can lead to an upset stomach. 

It’s important to drink plenty of liquids before, during, and after the activity.  A good guideline to use when preparing for an outdoor workout is to drink about two cups of fluid two hours before the activity.  That helps make sure you’re well-hydrated before you ever go outdoors.   

Then, during the activity, try to drink 4-6 ounces every 15-20 minutes to keep your muscles well-hydrated.   Drink something every 15 to 20 minutes, if possible.  Since that’s not possible in all sports, you may have to drink more before you exercise, so you have enough in your body.  Don’t try something new before competition.  That can be a recipe for disaster!  The body needs to get used to new fluids, so do it really, really, gradually.  (Think of that laxative effect and I’m sure you won’t go overboard for fear of the aftermath.) 

Last, drink up after you’re finished with your exercise.  If you really want to be precise, weigh yourself before you start exercising and again when you’re finished.  For each pound of water weight you lose, drink 20 ounces of fluid. 

So there it is.  A few tips to help you hydrate during the summer and all year long.  Get ready for this summer time heat and stay hydrated - water doesn't have to be boring!