Sunday, November 5, 2017


November is Diabetes Awareness Month®.  The theme this year from the American Diabetes Association is #ThisIsDiabetes - "Whether you're living with diabetes, caring for someone who is, or you're fighting to stop it, there's a hero in you.  One in 11 Americans has diabetes.  So put on your cape and take a stand."  It's a month to draw awareness to the disease as well as to call attention to those at risk.

I taught a class last week called "Dining Out and Diabetes" in Spanish, "Comer Afuera y la Diabetes".  Ironically no one in class had diabetes, so I shifted my focus of class to discuss what diabetes was and more so how to prevent it (what I prefer anyways).  One lady in class mentioned she was too scared to go in and have her levels checked.  She kept asking a lot of questions but yet didn't know what her numbers were.  Bottom line she's like so many others out there:

Approximately 84 million American adults - more than 1 out of 3 - have prediabetes.  Of those with prediabetes, 90% don't know they have it. 

To me that's a staggering statistic and the reason why we have National Diabetes Awareness Month®.  Experts say a "diabetes tsunami" is coming our way.  Why are the numbers SO high?  One of the main reasons is that  of adults (and  of children) are overweight or obese, not to mention we're couch potatoes - binge watching TV is the new norm, sadly.  Type 2 diabetes develops because the body is resistant to insulin.  Insulin acts like a key that allows sugar to enter the cells, where it can be burned for fuel or stored for later.  However, in some people, the key struggles to open the lock.
This puts the pancreas into overdrive - to compensate for this insulin resistance the beta cells have to pump out more insulin just to keep up.  Over the years the beta cells wear out.  When this occurs this is when the blood sugar levels fall into the "diabetes" range.  Americans are headed towards this breaking point because of a couple of reasons:  we're gaining weight at alarming rates (due to portion sizes, sugary beverages, and less exercise) and because of age.  Beta-cell failure occurs more rapidly with age.  

I read an article this week that discussed this issue - of needing to know your numbers, yet doctors are not communicating how important it is to make a change once you've been diagnosed with prediabetes.  "Prediabetes doesn't trigger much of a fuss in the doctor's office.  A lot of healthcare professionals see the numbers are in the prediabetic range and simply tell the patient that their numbers are high.  They should go home and exercise and eat less."  Many patients I saw (at my previous job that were referred by their primary care doctors) had NO idea what their numbers were and and/or why they were even being referred - many knew they needed to lose weight, but stated they had NO idea of their blood sugar levels.  Now in the doctors' defense the patients may have been told this, but in the education/prevention world we call this the "Charlie Brown effect".  They get their diagnosis and then all they heard was "whaa whaa whaa whaa".  The truth is you're going to have some doctors that are more proactive than others.  I encouraged all my patients to be their own advocates and one, know their numbers and what they mean, and two take preventative action with their nutrition.  One other good piece of advice is to see a specialist if your numbers are in the prediabetes range, an endocrinologist.  They specialize in endocrine disorders.  If you have heart disease you see a cardiologist - so why wouldn't you see an endocrinologist if you have prediabetes?  Back to the numbers and what they mean:
If you have a fasting blood sugar drawn (eight-hour fast) and the numbers fall in between 100 - 125 mg/dL this signals that you have an irregularity in your blood sugar levels, impaired glucose tolerance.  A diagnosis is not made from one blood sugar level, however, you should have your A1c level checked.  The A1c level is a 3-month average of your blood sugar levels.  This will give a better picture of what is going on (as well as the ability to diagnosis if your blood sugar levels are normal, prediabetic, or diabetic).  If the A1c level falls in between 5.7 - 6.4% this is considered prediabetes.  6.5% and higher is diabetes.  This is the first place I start with patients, in understanding their numbers.  Diabetes works on a continuum - it cannot be reversed (contrary to what people may say), however it can be controlled.  The first step is knowing your numbers and if they are in a range of concern, begin to make changes in order to offset/prevent developing diabetes.  

How can we lower the risk of developing type 2 diabetes?  How can we help control type 2 diabetes if one already has it?  There was a whole study focused solely on preventing type 2 diabetes - Diabetes Prevention Program.  Here's what the findings said along with other helpful tips to help prevent diabetes:

-The best way to dodge diabetes is to lose weight (or not gain) extra pounds.  Losing 7-10% of your current weight can cut your chances of developing type 2 diabetes in half.

-Do at least 30 minutes of brisk walking or other aerobic exercise every day.  Include strength training two or three times a week as well.  Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose.  Limit the time you spend sitting at work, at home, or in between.  

-Limit sweets, especially sugar-sweetened drinks.  The sugar you sip may add flab more than the sugar you chew.  Liquid calories don’t seem to lead to satiety and it’s easy to take in a large amount, easily.  Think your drink! 

-Fill up half your plate with vegetables and only a quarter with (preferably whole) grains.  Whole grains don’t have a magical nutrient that fights diabetes and improves health.  It’s the entire package – elements intact and working together – that’s important.  The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose.  This leads to lower, slower increases in blood sugar and insulin.  As a result, they stress the body’s insulin-making machinery less, and may help prevent type 2 diabetes. 

I also wrote a whole blog post last time about how to choose healthier carbohydrates - they're not all created equal.  Read about it here.

-Replace saturated fat and trans fats with unsaturated fats to lower the risk of heart disease.  The unsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.  Trans fats do just the opposite.  Trans fats are found in many margarines, packaged baked goods, fried foods in fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. 

Baptist Health South Florida, my current employer, is finishing up a year-long program that implemented the Diabetes Prevention Program - education, support, changing lifestyle habits - all in an effort to prevent Type 2 diabetes.  We'll be starting another program in January.  If you or someone you know has prediabetes and is looking for help and support and is ready to implement change, comment below so I can refer you to get signed up for the program!  You must live in Miami.  A year might sound like a long time, but it takes time to implement change and undo habits that you've had for a lifetime, all in an effort to help prevent diabetes.  It'll literally be a life-changing program.

The bottom line and the good news about diabetes:  you're not destined to get diabetes if you practice prevention.  Keep your weight - and especially your waist - under control, and spend more time on your feet than on your seat!

The key to healthy eating is balancing your plate - protein/carbohydrate/healthy fats - and aiming to include LOTS of non-starchy veggies to fill you up with fiber!  Delish, healthy food!

Sunday, October 22, 2017

Carbs and Cravings

Carbohydrates aka carbs - Most people LOVE them.  Maybe they love them too much, it is what most plates are filled with these days.  Just take a look around and you'll see people overeating carbs.  So why would one remove them from their plate completely?  If the promise of weight loss was there would it be worth it?  Low-carb diets are and have been popular throughout the years for this very reason...weight loss.  Is this the right way to go?  Will this help curb one's craving for these carbs?

Truth bomb - low-fat and low-carb in the long-run show little success.  So, what is successful?  Cutting back on the processed, refined carbs that are creating the crave for why we want them in the first place.  I've said this a repeated number of times on this blog, but it bears repeating again.  NOT ALL CARBS ARE CREATED EQUAL.  I apologize for the all caps (screaming), but I think people need to understand that there is a different physiological response when we eat certain carbs.  When people say they feel that they are addicted to sugar, you better believe them.  It's a literal feel good response when you eat certain foods and all of that correlates to your blood sugar response.  The unfortunate?  Sometimes you don't always feel so good and your body emits symptoms to let you know it's not responding as well as it should - that poor pancreas can't keep up.

So before you stop reading my article, hear me out.  There is nothing wrong with eating a pasta meal.  I have Italian blood in me, I eat pasta.  What's the problem most times with pasta?  I said it earlier and it is one of the problems with carbs in general, not only are we eating the unhealthy carbs but we are also eating them EXCESSIVELY.  While I'm picking on my pasta, think of any culture and it tends to be carb-laden.  Here in Miami we have a mix of many Hispanic cultures.  When I used to get diet recalls, many times it was black beans, white rice, yuca, plantains, and meat.  Carb/protein, carb, carb, carb, and protein.  Carb-bomb waiting to go off.  And virtually no non-starchy vegetables thrown into the mix, unless you want to count Iceberg lettuce and we're not playing that game.
It's easy to overeat carbs...

Processed = A Problem                                                                                                                      You've heard your doctor say eliminate all things "white".  He's referring to those processed carbs - white bread, cereal (sugary or regular - sorry not sorry - I cannot nor will not recommend a cereal to you to eat.  Worst.Food.Ever!), white rice, white pasta.  Why?  Again, our bodies are amazing machines if we fuel them the right way.  Give them this kind of fuel (because that is what carbs provide, fuel) - it will produce a rapid rise in blood sugar, wherein your pancreas has to respond and produce insulin in order to cover all that circulating glucose (sugar).  The pancreas cannot continue covering all our overeating.  It just can't.  Add in genetic risk factors, and this is why we're seeing a rise in prediabetes, and hence diabetes, not to mention metabolic syndrome and heart disease.   And here's the kicker of it all, the more processed, refined carbs you eat, the more you CRAVE.  That's right - you're on a roller coaster ride, literally.  You want that feel good rush, making it almost impossible to get off the ride (and oddly enough you don't want to - you crave it).  Remember what I said, our bodies are these amazing vessels.  They respond with what we give them.  It's our job to fuel up and fuel the right way.

One difference with refined versus whole grains is the fiber.  Fiber literally slows down digestion and thus the blood sugar response.  When you're eating a processed, refined carbohydrate, it is literally "fast-acting" energy, which is not much different than sugar (your body doesn't know the difference as it is breaking these down for energy for your cells).  White bread or any other processed carb will bread down into glucose very quickly which again raises blood sugar rapidly.  The opposite occurs with the slower-digesting carbs - beans, whole wheat bread, quinoa, etc. - the longer it takes to digest and break down into sugar, in part due to the fiber that they contain, the slower the response in blood sugar occurs.  See the picture below for a depiction of the breakdown.    The rapid spike from the processed carbs often leads to a crash or if you're like most people, you try to avoid that and you start the cycle all over again and eat.

Sugary drinks wreak havoc on blood sugar response

Insulin                                                                                                                                                      I believe there are many reasons why people say they have cravings - taste, PMS, stress, etc.  But when we look closer at carb cravings your body kicks in to try and restore your blood sugar, it senses the urgency and it responds.  But here's the problem.  Processed carbs cause more insulin secretion.  When you have this cycle:  eat processed carbs, blood sugar rises rapidly, insulin quickly follows (again the body is doing it's job), which directs incoming calories into the liver, muscle, and fat cells.  Here's the kicker, only fat cells have a limitless ability to store calories.  If after a short time of  eating your meal the glucose circulating is low (you're out of available fuel), this leads to hunger all too soon after you've just eaten.  Breaking this down - if fat cells get too much energy, there's not enough to fuel the brain.  The brain is constantly watching the calories in our body.  If/when it sees that the calories are low, it sends the message and triggers you to feel hungry and create those all too famous cravings.  This is a vicious cycle that goes on and on, ultimately leading to weight gain.

Kick the Crave                                                                                                                                      I'm not of the mindset of all or none, but I've heard people say that they've gone cold turkey with the processed carbs to help themselves with cravings.  Then they will add the healthy, complex, whole grains back into the mix.  I say the key is to minimize your intake of processed, refined carbs and have the majority of your intake be healthy, whole grains.  However you're able to do so, get going.  Here are a few helpful tips to remember:

Include WHOLE grains - brown rice, whole wheat pasta, quinoa, etc.  And while you're including whole grains, begin to monitor your portion size.  To give you perspective, 1 cup of pasta = 45g of carbs - that would be the amount an adult female could/should have at a meal.  Yes, 1 cup of pasta will seem like none, but remember it's not just the source of carbs that's the problem it's also the amount that we're eating.  We need to be more mindful when it comes to carbs.  When we've included the healthy carbs in a portion controlled amount this has the biggest impact on blood sugar - keeping it steady and in better control (no more crazy roller coaster ride) which in turn helps manage those so-called cravings.

I'd be honest in saying to avoid the sugary carbs in the beginning (again, I'm not an all or none person) but cakes, cookies, pies, candy, and any sugary beverages, yeah, I'd say eliminate at least for the first week - not only do they wreak havoc on blood sugars but they provide virtually no nutritional value.  Find a nice piece of dark chocolate or something that will in theory replace this but yet not be laden with sugar.

Include healthy plant-based fats at meals.  Fats take longer to digest which in turn helps stabilize blood sugar and cause less of a response  but they also help to keep you fuller longer.  Examples include nuts, nut butters, avocado, olives, oils, hummus, seeds, etc.  The key is to balance your meal - carbs, protein, and healthy fats, and not to be forgotten including non-starchy vegetables at as many meals as possible, i.e. kale, broccoli, spinach, tomatoes, carrots, cucumber, asparagus, and MORE.  They are what I like to call the fiber factor.  Fiber helps control blood sugar response (since you don't digest fiber it doesn't elicit a blood sugar response) but what it does do is help stabilize it as fats do and fiber also helps keep one fuller longer as well.  Get your fiber!

In summary, the goal is to include high-quality carbs - those that are minimally processed - at meals in portion-controlled amounts along-side protein, healthy plant-based fats, and non-starchy vegetables.  I've included pictures throughout to give examples.  Many times people will end up asking me at the end of it all, "what can I eat?"  There have been examples throughout to help you.  More importantly it's to show you that healthy can taste delicious, it all begins with a few small changes (and kicking some old habits maybe) to get you on the path of health and wellness and really put an end to those carb cravings.  You'll feel better.  Pinky promise.

Sunday, October 8, 2017

The Year Round Up

The Year Round Up

I turned 40 last year.  Call it a "milestone" birthday if you will, but the truth is that every birthday for me is a time to reflect and see what I can do better in the year to come - kind of like New Year's, only I think of each year as a new chapter, a new beginning.  So now that I am approaching 41 it's time to sit and reflect on the past, present, and future, the mark of my new year, my new chapter in life.  A lot has happened both personally and professionally - not sure how so much happened in just one year - but I'm here to tell you that I'm grateful and ever in awe of this so called life.  Here are a few things I learned/made a priority in this past year:

Self-care.  I know people say it's important but how many people are really practicing self-care?  I can't express to you how important it really is.  I'm not talking about a 4-hour day spa getaway once a month (although that would be nice), I'm talking about a simple 10-minutes to yourself each day (yes, I know that's hard for mothers of the world).  Make it a daily priority.  Yes, life is busy and at times it might seem like taking time for yourself is trivial when there is so much else to be done.  Well it's not.  It's actually one of the most important things you can do for yourself.  A few things I've been doing for self-care this past year (it depends on the day and how much time I have):  meditation, exercise, spending time in nature, manicures, & more.  As I said, it depends on the time I have, but minimally I've been meditating for 10 minutes to be able to sit still, center myself for the day before me, and remind myself to always come back to my breath.  My encouragement is to find a way to have your own self-care practice.  Giving back to yourself helps you give to others. (cliché but true).  
40 Roses for Each Year - Taking time to smell the Roses

Miami Marathon.  January 29, 2017 -- 5 hours 15 minutes in the cold, cold rain.  Weird weather day for Miami, but yes it was cold (in the 50s with rain is not pleasant).  My running partner Marcela and I had talked about running a marathon for years.  You can read about it here.   Little did I know how much the training was doing for me.  The thought of running for 26.2 miles straight can seem daunting.  But there is truth when people tell you that you get a runner's high.  All of my pictures from the marathon I have this ridiculous grin on my face.  It couldn't have been anything else other than a runner's high.   I think it was the culmination of all the training and there we were on that day and it was finally coming to fruition.  Talk about never being more proud of myself for having accomplished something.  I truly couldn't have done it without Marcela.  She pushed me to do something I didn't think I could ever do.  The training gives you the grit to know you can.  Beer on mile 22 might've helped just a little.   And knowing that you can overcome anything.   Training for this marathon forever changed me.  Whenever I think that I can't do something I remember back to all the hours I put into training.  Where there's a will there's a way.
Runner's High
After I completed my marathon in January I had a couple of back to back months with injuries (injured foot after the marathon, broken rib and then a broken toe because I'm just a clutz).  Add to that during this time period I was facing work stress without having the ability to workout.  I wasn't myself most days and I was walking around as if I was a different person.  I'm one of those people that will just keep things most times inside - I feel why share with others all this negativity?  My outlet normally is the exercise, so pair that with not being able to exercise, I was what you call a hot mess.  What turned it around for me?  The meditation helped some, but the bigger "elephant in the room" was that I had to take an inner look at what I wanted to do with my life (professionally).  I knew that what I was doing wasn't making a difference (most days) and I knew that I needed to be able to have a better work/life balance.  So I started looking for jobs.  That was one of the first things I knew I needed to do to improve the situation.  As hard as it is for change at times, making the decision to move on was what really turned it around for me.  

Doing What I Love and Loving What I Do

My job is going well.  Almost 3 months in and I'm loving what I do.  I've finally been able to find a better work/life balance.  I'm re-learning how to go and have fun.  Sounds silly maybe, but I had lost the ability to go and enjoy life.  I was always so tired I used my down time just to recuperate and get ready for the next week.  It's definitely been a transition, but one I'm welcoming.  I've already caught up with a few friends over dinner, enjoyed a concert, and even did yoga in the ballpark (something I've always wanted to do but never did).  I definitely work hard, but I'm learning that old saying, "work hard, play harder".  

Be passionate about what you love.  I’ve been told once or twice (okay maybe 100 times) I’m too passionate about nutrition.  I don’t even know what that means.  I just know that I went through a time where I switched careers and even when I wasn’t doing dietetics’ work I was always incorporating nutrition somehow.  Apparently I did know what I was passionate about and just needed some time away.   I will always be passionate about improving people’s health, it’s just in my nature and in my being.  And if being called passionate is wrong, I don’t want to be right.
Travel.  It’s the best education you’ll ever get.  “Nothing will teach you more than exploring the world and accumulating experiences.”  Last year for my 40th I went to Italy - Rome, Florence, and Venice.  I'll have to do a blog post about that sometime.  That was the first vacation I had in almost 10 years.  Long overdue.  I've always said it's more important to have stories to tell than stuff to show.  True story - I brought back a few gifts for people from my trip, but every time I went to buy something for myself, I always hesitated.  So much so, I didn't end up buying anything for myself.  I have a ton of pictures and I wrote a journal to help myself remember all my adventures.  It was definitely a trip to remember.  Now I need to start planning where to next!

Looks fake, but it's as real as it comes!
I don’t have it all figured out.  By no means am I trying to force my views or opinions on you and telling you how you should live your life.  What works for me, may not work for you.  And the truth is, I’m still trying to figure it all out – because some days it works and some days it doesn’t, even for me!
Here’s wishing that my 40s (as each year passes) will be as wonderful as my 20s but with added wisdom.  I am approaching my 40s with an open heart full of wonder and magic. 

Sunday, September 24, 2017

It's Fall Ya'll

It’s Fall Ya’ll
Time flies when you’re having fun?  I think that’s how the saying goes.  Or is it time is slow as molasses?  Truth be told it’s been a little of both these past few weeks.  Between the anticipation of Hurricane Irma, the clean-up post Irma, and then some family stuff going on, it’s been a little stressful these past few weeks.  I know that all these things shall pass, but while in the moment it can feel a little overwhelming.  I know for me it was all the build-up of the storm – a possible category 5 Hurricane hitting Miami – and to evacuate or not?  The back and forth between family members.  Yes, there was some stress.  While we were lucky here in Miami, Key West was hit more directly and Hurricane Irma was not even the cat 5 they were expecting.  To say the Keys is quite devastated is an understatement.  Then within the next week there’s word of Hurricane Maria – we do know here in Miami the possibility of hurricanes, it is hurricane season.  But we haven’t had a direct hit since 2005.  I don’t know that Miami would’ve been able to sustain a cat 5 – note to all the cities, keep up-to-date on cutting back your trees. 
Talk about some overgrowth of debris that shouldn’t have been.  All these natural disasters in general can create stress.  We’re having a few programs with Baptist Health South Florida this week, so check them out:

How to Talk to your Kids about Natural Disasters:

I’ll be going down on Thursday to Marathon, FL with a group from my team.  This is an opportunity for the community down in the Keys to come and get information on various resources that are available to them. There will be a free lunch provided and truth be told, I’ll be there just to listen to people’s stories.  It’s so important for people to be able to talk about what’s happened.  Let it all out and release the stress.  I’ve been wanting to get involved and give back to the community.  To the first of many…

NEWtrition Facts Labels

Last blog I wrote about the new nutrition label and talked specifically about the “Added Sugars” line Read about it here if you missed it.  This time I’m showing you just a few things from the ingredient list that can be misconstrued or misinterpreted.  It’s not as if there aren’t clues.  You just need to read the fine print, it’s why the food companies have lawyers (duh!)  Here are just a few tricks/marketing ploys to make foods sound healthier than they really are.  Hence confusion and hence why I’m writing about it.

“Unlock Your Coffee’s Latte Potential” – Yeah, you read that right.  To make a latte with just 6 oz. of coffee, you’d need a seventh of a can, which is about 9 tablespoons (not sure how you’re going to measure that seeing as you have to submerge the nozzle in the coffee).  That equates to 120 calories, 6 grams of saturated fat, and 4 teaspoons of added sugar or more depending on how many tablespoons you really end up adding in.  Last time I checked a latte was made with espresso and steamed milk.  This One Touch “Latte” is made with creamer – sugar, coconut oil, gums, artificial flavors, etc.  I’m all for quick and easy, but I know a certain company that makes an espresso machine that can give you the real thing in seconds.   And it isn't this product.  Just saying.

The complete cookie – I saw these the other day in a supposed health food store.  The company boasts that their cookies have 16g of protein.  So glad my cookie could provide me said protein. (I seriously hope no one is eating cookies to get their protein…oh wait, that’s why this product was created).  They call their product “baked nutrition”.  I call it adding protein (pea isolate, brown rice, and wheat gluten) but that doesn’t equate to nutritious cookies which is what they’re inferring.  Each 4 oz cookie has 360 to 400 calories (their label only lists half, but that’s a half a cookie and we all know you’ll be eating the whole thing).  These cookies are also baked with mostly white flour, sugar, and margarine.  Pretty sure as a dietitian I wouldn’t call that “baked nutrition”. 
Spinach Flavor Wraps – they market their product as having “no artificial flavors” but they don’t market their product as having no spinach to speak of.  Hmm.  Oh wait, that wouldn’t sell.  Not to mention people don’t like vegetables, so anything to make people think they’re eating vegetables and doing a good thing.  Infuriating.  There is some spinach powder added after the white flour and shortening but that’s just part of the other seasonings – garlic and onion powder.  And to top it off they add blue and yellow dyes to make the wrap green.   Here people are thinking they’re buying a green wrap for the spinach and all they’re getting are green-dyed wraps.  Pretty sure someone’s trying to pull the wool over our eyes.  Shame on you Mission.  Good thing I’m here to help.

I've been on a recent kick of making chia jam.  I've made raspberry, strawberry, blackberry, and now blueberry.  I won't say which is my favorite, I'll leave that for you all to decide.  But it's the easiest homemade food item I make.  I understand it takes time to do, but the truth is you can control how much added sugar you add (or don't add) and that's the beauty of having things homemade, you have the control.  At least that's why I started the "all things homemade" kick awhile back.  When I made the strawberry chia jam the strawberries were SO sweet I didn't add any extra sugar (maple syrup in my case) because they didn't need it.  I used frozen blueberries this go around because berries are getting pricey at the store.  The frozen berries worked well (I doubted they'd work and thought they might be too mushy...but they worked perfectly!)  I'm not sure if the chia jam will look aesthetically pleasing using apples, but that'll be my next fruit to try.   Why the chia jam fix as of recent?  Let's just say that we're taking the butter off the toast and subbing the fat for the carbs due to some heart disease in this here family of ours.  I think the truth is in general you want to use moderate amounts of all foods.  But a certain family member of mine was found to be using WAY too much butter on his toast.  And due to recent occurrences we have switched from the butter to the jam for now.  Here's the simple recipe for easy chia jam with any fruit:
  • 2 cups fruit
  • 1-2 tablespoons lemon juice, to taste
  • 1-2 tablespoons sweetener or your choice (honey, agave, maple syrup)
  • 2 tablespoons chia seeds
Prepare the fruit as needed.  Remove stems, pits, seeds and skin as needed.  Chop large fruits into small pieces.  Berries can be left whole.

Transfer the fruit to a saucepan and set over medium heat.  Cook until the fruit breaks down and becomes syrupy, 5 to 10 minutes.  Mash the fruit with the back of a spatula or a potato masher, leaving it as smooth or as lumpy as you like. 

Off the heat, stir in 1 tablespoon of the sweetener of choice and lemon juice.  Taste and add more sweetener or lemon juice to taste.  Stir in the chia seeds. 

Let stand 5 minutes, until thickened. This won't quite reach the firm consistency of regular jam, but will noticeably thicken.  If you'd like a thicker consistency, especially with very juicy fruits, stir in more chia seeds, 1 teaspoon at a time

Transfer to a jar or other storage container.  Store in the fridge for about 2 weeks.  The jam will thicken further and become more set once completely chilled.  The jam can also be frozen for up to 3 months.  And if you'd like to get rid of the visible chia seeds, puree the jam with a blender or with an immersion blender.  

Voila.  Easy chia jam with any fruit.  No need to buy store bought jam anymore!

Prior to the storm and then the week after, I wasn't able to cook as much as I would've liked.  But there were things like getting power back and cleaning up debris that took precedence.  All the stress from the storm actually made me not want to cook.  It surprised me.  But suffice it to say, I'm back!  Cooking up a storm (ha, see what I did there...too soon for a hurricane joke?  Quite possibly, but laughter helps relieve stress!)   Since I've been back in the kitchen I've made two vegan desserts.  It always stirs up nutrition conversations with people - just because it's vegan doesn't mean it's healthy.  Truth.  I do try to experiment, not only to stay up on the latest trends but also to see how things taste.  Plant-based eating is on the rise.  The only thing I will say is that at times I don't like some of the replacement items - i.e. vegan butter, vegan cream cheese - and the reason why I don't like some of those items is because I often wonder if they're any better than an original product (with just one ingredient?)  I made a gluten-free vegan carrot cake for a co-worker's birthday last week: 

It was definitely enjoyed by all - I loved making the "flax egg" and having a cake turn out without having any eggs - nutrition science nerd.  If I had had more time I was going to try to make a cashew version of the "buttercream" frosting.  It used only real ingredients, no processed cream cheese.  I had so much extra frosting leftover from the cake, I made vegan cupcakes today: 

But I only made them because I wanted to make the maple caramel you see drizzled on top.  Currently it is 84° here in Miami, but it is fall ya'll.  Maple, pumpkin, and apple flavors here we come!  The cupcakes did not disappoint, but let's be real, cake is cake and desserts should be enjoyed in moderation - almost all are in my freezer (yes, cake products like bread freeze REALLY well).  It's just one way I can portion sweets out - and even though they're in the freezer I am able to manage and not overeat them (I've share this before but I include sweets here and there in order to avoid the tendency of many people to overeat sweets because they avoid them).  Don't worry I made real food this week also.  I even created my first veggie quinoa patty - stay tuned for the recipe this week!  Have a great week!

Saturday, September 9, 2017

September at a Glance

September at a Glance

It’s almost been two months that I’ve been at my new job.  Talk about time flying!  I mean it feels like it was just yesterday that I was starting to get adjusted to my new schedule, new co-workers, and new job duties.  To say that I have been happy is an understatement.  I'm doing what I love and loving what I do and I have amazing co-workers - really truly family oriented.  But I think one thing that stands out with my new job is the ability to control my schedule - I feel blessed.  I’m not dependent on a patient showing up late anymore and there’s no late night charting after the full slate of patients in a day.  I work my 40 hours a week (not 50 or 60) and again have the ability to work 6 hours one day if the next entails 10 hours – it’s all dependent on our programs and events happening for the week.  Planning and organizing is key – but I’m good at that (I’d like to think).  And the reason why I mention the timing part is that was what I’ve mentioned on the blog here and here – I wasn’t balancing my work and home life well at all.  How could I when I was consumed with work?  Not to mention my social life was effected.  I wasn’t practicing the very thing that I would tell my patients and I was walking around stressed out – not good for my health and unfortunately not good for my co-workers at the time.  The transition to the new job has been good.  I’m doing what I love – teaching nutrition in a group setting.  Just last week I did a supermarket tour.  Everyone came with such great questions and being right there where all the products are really made it hit home with some of the participants about how to make the healthier choice.  Call me a nutrition nerd, but how fun!  I love passing on the message of how to eat healthy and learn to decipher what products to buy.

NEWtrition Facts Labels

In May 2016, the Food and Drug Administration finished its overhaul of the Nutrition Facts labels, giving larger companies a July 2018 deadline to put them on packages.  Not trying to talk politics here, but in June the Trump administration postponed the deadline (ugh).  However, some companies have updated their labels even with Trump’s postponement (woohoo)!  Here is a new label to see what’s different:
The new labels distinguish between natural and added sugars.  This will be an eye opener for some in seeing how much sugar they are actually taking in.  The recommended amount is just 6 teaspoons/day (~25g) for women and children and just 9 tsp/day (~36g) for men.  It can get confusing at times, but the truth of the matter is that we need to start cutting back on our total amount of sugar – start by adding up how much you are currently consuming with the intent to cut back.  Yogurt would be your first area –
Trader Joe’s avocado-citrus – has 12g of added sugar (that would be half my days' worth) in a 5 oz. cup in addition to 3g of naturally occurring milk sugar, lactose.  My advice, opt for plain yogurts and add in your own fruit to have naturally occurring sugar provide the sweetness.  Remember the intent is to start where you are at and begin to cut back.  Yogurt, a seemingly "healthy" food loaded with sugar.  Glad the added sugars have now been added to the labels.

Quaker Orchard Peach Oats – You might think you’re doing well eating oatmeal, when in fact you’re eating ½ your day’s added sugar ladies!  The orchard peach flavor has 13g (3 teaspoons) of added sugar.  Gah!  4g is from the actual peaches and that’s why the total shows 17g.  I’m here to tell you that yes, I know adding in some sugar or maple syrup will make it taste better and maybe you are doing better by eating oatmeal than before when you were eating pancakes and syrup in the morning.  Point taken.  But it’s astounding to me how much they add in to these products and now are having to out themselves.  As an educator, my hope is that as people become more aware they can begin to now lessen the amount they are taking in.  Try doing your own overnight oats – here's a recipe example here - it's a simple ratio, equal oats to equal milk.  Just be careful with the sweetener you're using, aim to use as little as possible and add in fruit to naturally add the sweetness.  Flavor combinations are endless!

Izze sparkling grapefruit juice – Not to confuse you, but let’s face it, it is confusing.  Their exact words from their website –
70% pure fruit juice and a splash of sparkling water. That’s it. No added sugar, no high-fructose corn syrup, no preservatives, no caffeine, and no evil sciency chemical concoctions. Because at IZZE, we believe juice should be pure with a splash of sparkle.”  
Juice is juice (I don’t care that they diluted it with water).  This 12 oz. bottle has 29g of sugar from apple, white grape, orange, and grapefruit juice.  No juice sugars don’t count as added sugar, but the truth?  No one needs to drink juice even if advertisers say you should and it looks natural.  Sorry not sorry.  Eat a piece of fruit and get the added benefit of fiber in your diet.
Kind Fruit/Nut Delight bar – has 4g (1 teaspoon) of added sugar.  For a nut/fruit bar, that’s actually not too bad.  3g is coming from the actual fruit – they’re using an added sugar to help the nuts and fruit bind together - a better grab and go option.  Just be careful with some of the KIND bars as they do use palm kernel oil to help them bind - this particular “Fruit and Nut” bar doesn’t but many of their other products do. 

Keep in mind the FDA is basing the Daily Value on “added sugar” to be 50g.  The American Heart Association recommends what I stated earlier – 6 tsp/day (25g) for women and 9 teaspoons/day for men – way less than the FDA’s recommended amount.  This is one area I would not recommend looking at the percentages for – definitely look at the grams of added sugar and aim for as little added sugar as possible.

My new job title is “Wellness Dietitian”.  The department I work for is called Community Health and I do just that – educate out and about in the community.  But it bodes the question what is wellness?  It’s a more commonly used term within different health professionals, but within nutrition what is it really?  How are you well with nutrition?  The dictionary definition of wellness:



the quality or state of being healthy in body and mind, especially as the result of deliberate effort.


an approach to healthcare that emphasizes preventing illness and prolonging life, as opposed to emphasizing treating diseases.

I’ve always wanted people to prevent diseases rather than have to treat them (after the fact).  I think sometimes I live in a nutrition la la land.  But the truth is many times people don’t change their eating habits until after they’ve had a diagnosis made.  So back to this wellness definition, recently people have been talking about how to connect all 6 dimensions of wellness – physical, social, intellectual, spiritual, emotional, and occupational. 
The other night I did a presentation where I talked about the “Hunger Fullness Scale” I think this is a good example of combining different components of wellness – are you actually hungry?  Are you eating because you’re bored?  Anxious? Or are you simply eating out of habit?  All of this pertains to one’s nutrition and why we eat, but the truth of the matter is we need to hone in on our actual hunger cues (the physical sign) where we sometimes don’t pay attention to.  We do often eat based on our emotions (the emotional) even when we know better (intellectual).  And sometimes we’re eating just because others are eating (social).  Nutrition can get complicated.  Many people “live to eat” rather than “eat to live”.  We should be mindful (spiritual) of this in helping ourselves to have nourishing meals that sustain us and provide us the nourishment we need.  It doesn’t always work this way, but that’s the goal and what we should aim to do.  My yoga teacher recently wrote an article on what “wellness” means - Seven Simple Rituals for Creating Wellness in Your World
I think the definition can be intermixed and it’s still evolving, but the truth of the matter is that in order for us to be mind-body-spirit connected, we really need to know ourselves and be present in the moment (as much as we can).

September is National Childhood Obesity Awareness Month - The statistics are startling.  1 in 6 (17%) children in the United States are obese.  Children with obesity are at a higher risk for having other major chronic health conditions and diseases - asthma, sleep apnea, type 2 diabetes.  They also have more risk factors for heart disease:  high blood pressure and high cholesterol.  Children with obesity are also more likely to be bullied and teased more so than their normal weight peers.  This can lead to social isolation, depression, and lower self-esteem.  Children with obesity are more likely to be obese as adults.  This can lead to lifelong physical and mental health problems - type 2 diabetes, heart disease, and many types of cancer. 

Childhood obesity is influenced by many factors:  eating and physical activity behaviors, genetics, metabolism, family and home environment, and community and social factors.  Obesity may also be influenced by:  too much time being inactive, lack of sleep, lack of places to go for physical activity, lack of access to affordable, healthier foods. 

How can you as a parent help prevent obesity and support healthy growth?  There are many things parents can do to help their children achieve a healthy weight and maintain it.  
  • Be aware of your child's growth.
  • Provide nutritious, healthy foods in place of foods that are high in added sugar and fat.  Aim to serve more fruits and vegetables at meals - even if they kick, scream, and cry when veggies are being served.
  • Make sure water is available and limit sugary beverages (sodas, teas, punches, juice, etc.)
  • Help kids get active - this could be helpful for parents too!  Aim to have them move more.
  • Be a role model.  When you're eating healthy meals and snacks, they will too!  If you're not eating vegetables, odds are they won't want to.  Try to find a new veggie each week to prepare and trial.  Keep in mind it might take up to 10 introductions (or more!) before a child will be willing to try a new food.  Be patient & keep experimenting!
Veggie Transformation - Broccoli Stems -
The goal is to raise awareness in regards to childhood obesity.  Start where you are at and aim to implement healthy habits, one at a time.

September is also officially National Yoga Month.  It's a national observance designated by the Department of Health & Human Services designed to educate people about the health benefits of yoga and to inspire a healthy lifestyle.  If you've never practiced yoga, I invite you to try. 

Yoga is unique because you connect the movement of your body and the fluctuations of your mind to the rhythm of your breath.  Connecting the mind, body, and breath helps us to direct our attention inward.  Through this process of inward attention, you can learn to recognize your habitual thought patterns without labeling them, judging them, or trying to change them.  You become more aware of your experiences from moment to moment.  The awareness that you cultivate is what makes yoga a practice, rather than a task or goal to be completed.  Your body will most likely become much more flexible by doing yoga, and so will your mind.

Writing my blog a day early - one because I have the time and two because we are bracing for Hurricane Irma here in Miami.  While this week has been one of anticipation, stress, and preparation, the storm has ultimately moved west.  We will get tropical storm/hurricane strength wind and rain from the bands of the storm (so there may be power outages), but we are not getting a direct hit or "the big storm" of the century as had been expected.  While I am grateful for this shift in the storm's path, I do not wish this storm on anyone.  We just saw the devastation from Hurricane Harvey and now are all waiting to see the wrath of Irma.  Prepare as much as you can (evacuate if necessary) and stay safe, Florida!

Sunday, August 20, 2017

Not Sponsored. And Definitely Not An Ad...Just here to educate

I debated on whether or not to write this post.  Some dietitians will agree with me and some will obviously not.  That’s the beauty of opinions. So here goes…Recently the trend has been for food manufacturers to have food bloggers promote their products.  On the pictures the food bloggers will write #ad #sponsored so it’s well apparent that they are promoting a product.  This is the state of social media these days, hashtags help promote.  Add that to a popular food blogger and people are out buying their products.   The food manufacturer’s win and win big $$.  How much are the food bloggers paid?  I don’t know and I really don’t care.  What I as a dietitian care about is for people to be healthy. And let’s be honest all these products that are being promoted are not healthy.  Food bloggers are not all dietitians, so I don’t hold it against them to know any better.  And as I said, if you see your favorite food blogger making a yogurt parfait with some sugar laden yogurt (or whole-milk based yogurt), you are going to go buy that product.  You want to make exactly what the food blogger is making.  I’ve been there – if it looks good, I’m immediately at the store buying the ingredients.  Yes, I’m addicted to cooking and baking and all things food.  But the product endorsement these days is now involving dietitians.  Yes our underpaid selves are now accepting sponsorships from questionable products.  I’d love to say that all dietitians are picking healthy products/brands, but the truth of the matter is they are not.  I scroll through enough Instagram pictures to know that I do not have sugar laden yogurt in my refrigerator.  It’s a mixed message when you promote that and people believe it is something they should go eat.  So when does it cross the line between profiting yet promoting health?  This is just one of the reasons why I think dietitians should be paid more as a profession (the age old debate)…maybe then we wouldn’t have to get sponsorships.  I’m all about preventing disease, but in the nutrition world that’s an ideal world to live in.  People do not think about prevention, but rather start paying attention once there is an illness.  I hope through my blog I’m able to show people that healthy can taste delicious…I think my pictures are proof.
As a dietitian, patients ask me all the time, “what product should I buy?”  I try to stay as impartial as I can be – educate the patient as to what key words to look for on the label and from there be able to choose whichever brand that may be.  Because at the end of the day they are not always going to have you (the dietitian) in their back pocket.  Teaching them how to make these decisions is critical, because let’s face it the supermarket is overwhelming.  I forget the stat at how many new items come in to the store on a weekly basis, but it’s hard even for me to know some of the latest products.  Enter, teaching how to read the label to patients so they can now make the better choice.  My co-worker leads a “Navigating the Supermarket” tour here in Miami (and I’ll be doing them soon too!) but it’s inevitable that the question comes up “which brand should I buy?”  Education is key in making the healthier choice.  Re-directing the patients to be able to see that they now can read the label and make the best choice for them (and their family).  It’s empowering.  Peanut butter really should only list as the ingredients, peanuts, salt, and that’s it.  Yes, that’s it.  I don’t care what brand you buy, but the bottom line is anything else added in is either sugar or an unhealthy trans fat that no one needs.  It’s hard to navigate with all the marketing strategies and not feel like you’re being deceived.  I get it.  Just know that they do want you to buy their product – “double fiber” bread I see you.  We’re all working to improve how we eat.  Figure out what your goals are (as they are different than mine) and begin to change one thing at a time and build as you go.  It won’t seem so overwhelming that way.  Promise.
The following are products that I use in my kitchen – no I am not sponsored and these are not ads.  It’s just what I eat.  And while this might seem like a product endorsement, I like to see it as I discussed, a teaching moment.  Read on to see what I say about the items and again, forget the brand, buy whichever brand you want that fits the bill of what I describe.  Because in Florida the brand might be Publix, where in California it might be Ralph’s or Kroger’s. 
Whole Grains.  Oats.  Quinoa.  Bulgur.  Farro.  Sorghum. (featured in the picture, but there are more grains – wheat, rice, spelt, buckwheat, couscous and more!)  They are all different varieties of grains.  But are they whole? It can get confusing when you’re at the store.  Are they added in with spinach powder or inulin (extra fiber) or are they just one ingredient on the label?  I’ve been challenging myself recently to rotate the whole grains that I’m eating.  I get in a rut and eat brown rice on repeat.  The truth is that half of your grains should be whole.  And with those grains, there should be a variety.  That’s the goal anyways.  Aim to find some whole grains you are able to include and stray from the enriched grains – think white flour that’s been stripped of the vitamins, minerals, and fiber, that they then try to add it back in.  If you’re not into quinoa, that’s fine.  The idea is to find a few whole grains to incorporate into the mix and lessen the amount of enriched grains we are eating.  P.S. if you’re not into quinoa, try this recipe and then let me know if you’re not into quinoa.
My absolute favorite way to eat quinoa!

Keeping with the theme of whole grains.  It’s hard to find a whole grain cracker in the store.  Period.  Here’s one that I recently found that doesn’t taste like cardboard.  I would love to say that I make my own crackers, but the truth is I need something quick sometimes.  These have been in the rotation.  I love their picture they added on the front for a balanced snack – cracker for the whole grain, cheese for the protein, and some fruit for some more carbohydrate, but hey it’s still balanced.  I use ricotta cheese sometimes with tomato and basil with a drizzle of balsamic vinegar.  And when I’m really in a pinch a simple smear of a nut butter does me just fine.  Here are a couple other crackers I also have in the rotation, you know for variety.

Here is another cracker that has been around for awhile now and Trader  Joe’s just recently surfaced with one that’s quite simple as well – where they mixed in seeds, they are quite delish as well.    Simple, minimal ingredients, that’s what you’re looking for.  Challenging when it comes to crackers, but the goal is to aim away from anything with “partially hydrogenated oils” – while that does provide flakiness to a cracker it also provides trans fat and that is not dietitian approved.
I have recently been making my own bread and have been successful (and didn’t think I would be!)  But as back-up sprouted breads are my go to – again forget the brand, think sprouted bread.  So what is sprouted bread?  They are made from whole grains that have been allowed to sprout – germinate before being milled into flour. Enzymes are released during the sprouting process, which breaks down proteins and carbohydrates – this helps aid in digestion and is helpful in absorbing nutrients.   As there are no preservatives added in they will get moldy.  I keep mine in the freezer and use as needed – the perk of bread in general, it can be frozen!
I eat nut butters daily.  I rotate which nut butter that I’m eating to get a variety, not only for flavor, but also for different vitamins and minerals.  These are my standard nut butters in my rotation.  I recently made my own nut butter and that was similar to the mixed nut one I recently found at Trader Joe’s.   I also splurge occasionally on a walnut butter that is divine.  I have tried pecan butter as well, but found it to be quite bitter – I’m not sure if the jar I got was already rancid?  But it was definitely not my favorite.  I’ve wanted to make my own and recently got a new food processor, so I’m thinking I’ll need to try it.  This recipe has some cinnamon and vanilla, maybe that will help with the flavor – update:  I did make it and it was delish.  I’ll admit I added just a teaspoon or so of maple syrup.  Yes I know that is added sugar, but there’s something about the pecan that leads to a little off flavor.  The cinnamon helped, but it still wasn’t right.  Next time I’ll try vanilla instead of the maple syrup, but in all honesty I had the control over how much maple syrup I added in and it was barely any at all for how much I made, and yet just the right amount to remove the bitterness.  Score for a new nut butter in the rotation!
I eat canned beans.  There I said it.  People often look to me as a dietitian and question why I don’t make my own beans.  Real life answer?  Have you ever made a pound of dried beans?  Do you know how much it makes?  As a single person, canned beans work just perfectly.  For quantity and not to mention allowing me to have a variety.  These canned beans are cost effective, BPA free, and bonus?  They have NO added salt.  That’s right, NO added salt.  If companies can make the beans without salt then why aren’t more companies doing this since most times canned products are uber loaded with salt?  There are more options these days – just the other day in the supermarket tour I saw three other brands that had NO added salt.  Less sodium is starting to catch on and companies have responded.  The whole rinsing the beans to take some of the sodium off is a good notion, but I think it’s best to start with none (as these beans are) and as you begin to build your meal you have more control over where the sodium comes from (in my humble dietitian opinion).  The other thing recently I’ve been experimenting with is the liquid from these chickpeas.  It’s called aquafaba.  It’s gaining ground in vegan baking.  I did it just the other day where I whipped the aquafaba as if they were egg whites with a little cornstarch and folded it into my cake batter
While you can’t see the inside of this beaut, the aquafaba definitely provided a level of lightness to this cake (and without having any off tastes – I knew what you were thinking – leftover bean residue?!  No off flavor, I promise – just ask my friends!)
So canned beans are definitely a viable option and can be deemed healthy.  Just watch the sodium content and aim to go “No Added Salt” if possible.
If I were a sparkling water fan, these would be one I would drink.  (I’ve heard La Croix makes a few good flavors as well, but these actually have some actual fruit juice in there!) There’s just something about the bubbly that makes me burp…so, yeah, sparkling water isn’t my jam.  Hydration is key in the summertime and  patients tell me all the time how “water is boring”.  For me, water is life and I have NO problem drinking plain old boring water.  But I do understand how people want something other than water and something that doesn’t contribute too many calories.  This would be an option. 
My job as a dietitian is to educate people on how to make better food choices with the ultimate goal of helping people become healthier.  It’s a hard job to do with so many food options available., not to mention sifting through all the marketing confusion, i.e. "No Cholesterol" - when it never had any cholesterol to begin with.  As a dietitian I don't want to be a part of the confusion.  Promoting a product and being sponsored by a food company might seem like a good way to bring in a few extra dollars to some, but to me that only creates even more confusion for the consumer.   I'll continue doing #TasteTestTuesday and showing different products on the market that are #dietitianapproved.  Keep in mind, I'm not being sponsored and it's not an ad, it's just me doing my job as a dietitian, promoting health and awareness.