Sunday, August 24, 2014

Meatless Monday

I get this question all the time, “Why did you become a vegetarian?”  The answer is actually pretty simple.  I have never enjoyed the texture of meat (chicken, turkey, tuna, pork, you name it!).  I have a distinct memory as a kid of chewing the meat (so it looked like I was eating it) and then spitting it out in my napkin.  Our dogs weren’t allowed in the house, otherwise I would have been feeding the evidence to the dog!  I always tried and attempted to eat meat, but the moment there was a hint of gristle or the chewing was taking too much effort, I was done.  When I got to college and entered into the field of Nutrition I realized I didn’t have to eat meat to get all the vitamins and minerals that meat provides, I knew I could get them from alternate sources.  And so began my slow transition to becoming a vegetarian.  It took a few years because let’s face it food is a part of social interactions.  Many bbqs took place where I would cave in and just have a hamburger because everyone else was.  Or maybe Chick-fil-A’s chicken nuggets were being served at an event and that was one way I didn’t mind chicken.   But then in 2005 that’s when everything changed.

We had just returned from my brother’s wedding in St. John’s.  My dad hadn’t been feeling well most of the trip so he went in for a check-up.  The next thing I know he’s at the cath lab getting a couple of stents placed.   I was in shock and disbelief!  I knew that we had heart disease in the family, but I also knew that we ate healthy overall.  It was in that moment I made my decision.  I had been contemplating it for a while now, this whole going vegetarian thing.  Now it made all the more sense.  Eliminate the majority of the saturated fat from my diet so that I could avoid any health implications later in life.  Easy.  I had the nutrition background to know what foods to eat and in what portions to get the vitamins/minerals that I’d need.  Let the science experiment begin!

Cooking for myself was easy.  Granted I had to learn how to cook tofu so that it had flavor, but overall preparing my meals had been easy in this whole transitioning over to being a vegetarian.  The hard part?  Eating out or going to functions where meat would be served.  Over the last few years I’d say that restaurants have gotten better in their menu selections, but back in 2005 the variety was quite limited.  Basically you’d get vegetables with a grain and that was it.  Salad was always an option if you were still hungry.  They just weren’t getting it – I needed protein!  I started carrying (and still do) nuts wherever I go.  The dietitian in me needs the balance of carbohydrates, protein, and fat, otherwise I know I’ll be craving/hungry for food within an hour.  It’s just the way the body processes food.  Call it my security/back-up plan, I know I’ll always have protein with me.

Just in the last couple of years I’ve actually started to include seafood.  So I am now technically called a  pescatarian.  While I don’t include seafood often, this way  I have a back-up plan at places/functions that might serve seafood.  It’s still not my favorite and I’m quite picky when it comes to what I will actually eat.  My mom made a salmon recipe a couple months back that was so good that everyone that thinks they don’t like salmon needs to try this recipe (it was THAT good).  However, I still travel with my handy portion-sized nuts, just in case.  It’s almost been 10 years since I’ve been a vegetarian (pescatarian).  I think that for anyone that cooks it’s important to find new recipes so that you don’t continue to do repeats and end up being bored with food.  It’s the same with being a vegetarian, you have to keep coming up with new and inventive ways to work with beans, tofu, and other plant proteins.  So if you’ve been thinking about having a meatless meal during the week and weren’t sure where to start, I have a few recipes to get you going.  I started out with the chickpea when I was first starting to do more bean recipes.  It’s a mild flavored bean and it pairs well with a lot of other flavors.  (If you’re wondering which bean packs the most nutrition in a ½ cup, just remember in everything, variety is the spice of life.)  Chickpeas are nutrient dense and in only a ½ cup there are 5 grams of protein, 6 grams of fiber, and just 2 grams of fat.  The following are a few recipes that might help you get started.  

Linguine with Zucchini and Chickpeas – I’ve shown this recipe before, but it’s so simple and delish, I have to share it again.  I stumbled across it on Real Simple’s website a few years back.  It’s great for a weeknight when I’m not sure what to eat and there’s an extra zucchini in my fridge.   Simple and nutritious.

“Chickpea” Tuna – I did this recipe with kids once where I made actual tuna and then I made this chickpea version.  The kids surprisingly enough liked the chickpea version.  They made sure to let me know it tasted nothing like tuna, but regardless they liked it.  I used to make tuna this same way, where I’d mix in the craisins along with the celery, so maybe it just reminds me of back in the day when I did eat tuna.  Pair it with a hearty bread and it makes a great sandwich for lunch.

Sweet Potato and ChickPea Cakes – These are hands down delicious.  Maybe it’s the avocado salsa that really makes the flavors pop, but no one would know that there are beans in this recipe.  Don’t be scared to add the jalapeno in either!  

As I said before a lot of people think their meal isn’t complete unless there’s meat on the plate.  I get that.  But what I try and do is teach my patients that in anything it’s about portion control.  If you include meat for your protein source I’m fine with that.  Watch your portion sizes, make sure to include a healthy complex carbohydrate at your meal and of course, don't forget your veggies.  Balance, moderation, and variety are key in any meal planning.    

Saturday, August 2, 2014

Tip of the Iceberg

I always said that I would continue writing my blog if I had a topic that interested me and therefore the writing would just came easy.  Last week I was due to post a blog and sat down to begin writing.  I opened my computer up and the screen was cracked.  Apparently a new blog post wasn’t meant to be. (Funny enough I really didn’t have anything pressing to write about.  While I would’ve loved to rant about the new COKE ads, “Share a Coke with”, I knew I couldn’t write a whole blog ranting about how horrible soda is to our health.)   And then just like that the following week my next topic came to me. 

I have a lot of interesting discussions with my patients and this week didn’t disappoint.  I start off asking my patients why they’ve come to the education session and what their expectations are.  I have background information, i.e. bloodwork, diagnoses, etc. to know where to steer the discussion, but I like to make sure I’m covering topics that they feel are important.  This week felt like the week of prediabetes.  Some knew they had it while others did not – it makes it kind of hard to talk about a diagnosis when the people don’t even know they have it (yep, that’s why I ask for the reason for their visit).  While I represent just one clinic in America, the numbers are really startling.  One out of three adults have prediabetes.  90% of those that have prediabetes don’t even know that they have it.  Of those with prediabetes, 70% will develop diabetes in their lifetime.  Staggering. 

Experts say a “diabetes tsunami” is coming our way.  1 in 3 adults already have prediabetes.  Why?  One of the main reasons is that 2/3 of adults (and 1/3 of children) are overweight or obese, and we’re couch potatoes.  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. 

An article I was just reading this week even discussed this issue – “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.”  These clients I saw this week were referred to nutrition for education.  The only problem?  They had NO idea what their numbers needed to be and they weren’t sure when their follow-up was.  Granted some of 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 hear is, “whaa whaa whaa whaa whaa”.  Believe me I’m trying to see where/what the disconnect is.  Bottom line I try and teach my patients all about the numbers.  Even though you all aren’t my patients you need to understand your numbers as well.  If you get a complete blood count, a CBC, that has all your bloodwork, pay attention to the blood glucose level and here’s what the numbers indicate:

The cutoffs for prediabetes and diabetes depend on whether your blood is tested after an eight-hour fast or without fasting.  If your blood glucose is after an eight-hour fast, and your glucose is between 100-125mg/dL that is considered prediabetes.  If your blood glucose after the eight-hour fast is 126mg/dL or higher, that is considered diabetes.  This is the first place I start with my patients, in understanding their numbers.  Diabetes is a continuum.  It cannot be reversed (contrary to what people may say).  Our goal should be to make sure that people don’t get diabetes and if someone already has diabetes, the goal should be to keep our numbers within normal limits to help prevent further complications – diabetes can affect you from your head to your toes.

How can we lower the risk of developing type 2 diabetes?  How can we help control type 2 diabetes if one already has it?

-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.  (So glad I got rid of my 3-hour commute.  Phew!)

-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 intake 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. 

-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. 

The bottom line and the good news about diabetes:  it’s not inevitable.  Keep your weight – and especially your waist – under control, and spend more time on your feet than on your seat!