Monday, November 5, 2012


[Note:  this post, to preserve patient privacy, was saved in my "drafts" folder for an entire year. I sat on publishing it, but I am going to, because I think it is worth commenting on.  No names have been given, and hospital location will remain anonymous.]

Today has got me thinking.

I love my job. I love people...talking to them, helping them, figuring out what we can do to make them just be able to go poop. (It took me about 2 days in clinical dietetics to realize that poop is first and foremost on everybody's minds, and understandably so)

I've also come to realize that nutrition is about more than calories, protein, fat, carbs...those are just the "semantics." The real push behind the shove, when it comes down to it, is motivation.

Very little of nutrition consulting is providing information. Yes, tube feedings and parental nutrition require knowledge. Yes, calculations for patient charts require some judgment calls. Yes, lab values are reflective of medical phenomena that need detecting.

But more than all those fancy calculations and lab detections...people need motivation.

What gives motivation?

For most of us, nutrition doesn't get high on the priority list until our bodies give us a wakeup call...maybe Type II Diabetes, heart disease, swelling...the signals are not in short supply

Sometimes, these symptoms are awesome motivators. I'm so thankful for that "I'm gonna go get 'em" response that seems to make patients almost rebound off their hospital beds in a newfound pledge to "steer free of sodium," "lower the fat," "limit the carbs," "stock up on produce!"

But sometimes...sometimes that motivational "tick" is more elusive.

A young patient admitted with uncontrolled Type I Diabetes. He is in acute renal failure, dehydrated, blood glucose through the roof, beginning signs of peripheral neuropathy. In ten years he may be an amputee, may be blind, most certainly will be on dialysis. Heart problems set in, as his weight has dropped to that of the average ten year old.

All of these symptoms are a result of uncontrolled diabetes.

Cherry on the top: same age as me. Down to the exact ol' month.

I figure this will be good...from one youngin' to another, we can talk blood glucose monitoring, we can put together a meal plan...we can do this. None of those awful things are going to happen, because today we're going to talk about preventing them, and that will be that

Wakeup call...

..He does not care. Every day I get elderly people that are so excited and ready to make changes to add a few more years to their lives, but this young, beautiful person, full of life, does not care. I don't know if he doesn't get it...if he just doesn't like me...

I offer to recommend another dietitian. I try the scare tactic with pictures of scary AV fistulas (internal hookups for dialysis machines) and gangly amputations related to uncontrolled diabetes. If I'd thought singing and dancing would do the trick, I'd have karaoked on the spot.

Nothing. I am politely thanked, and the handouts are left on the table, where they will absolutely be politely discarded.

Days like this I don't feel so big in my lab coat. I know all the facts, but I still have so much more to learn about motivation.

What motivates you to make healthy decisions?
Working in a hospital motivates me. I love the people I encounter throughout the day, and I love leaving my job every day with a renewed gratitude that my health, for now, is intact.

Peace, Love, and Veggies,

Sunday, November 21, 2010

Thanksgiving Carb Control

I received the following question from FOODPICKER.ORG:

"My husband was diagnosed with diabetes as few months ago and has been working hard to lose weight and control his blood sugar. Each year we have a family gathering for thanksgiving that includes lots of food (large turkey dinner with all the trimmings and assorted pies & cakes for dessert). What are your suggestions to ensure my husband doesn't overeat but also does not feel deprived this thanksgiving?" -Martha T.

The most important part of holiday blood sugar control is a commitment to plan ahead, so sit back and relax! The rest is all in the details.

Blood sugar control strategies vary depending whether or not your husband is on insulin.

If your husband is on insulin to control his blood glucose levels:
Insulin doses are prescribed based on a pre-determined estimation of carbohydrate servings. These recommendations vary amongst individuals. He should review the amount of carbohydrate servings covered by his insulin injections, and try to match his Thanksgiving meal to his insulin dosage. If he is unsure of recommended carbohydrate servings per meal, he should consult his doctor or a Certified Diabetes Educator (CDE).

If your husband is not on insulin:
Controlling carbohydrates is still a healthy strategy to prevent high blood sugar. The recommendation for males with Type II Diabetes is 4 to 5 carbohydrate servings per meal. For a detailed list of common carb servings, click here. Avoiding high-fat foods also becomes especially important for people with Diabetes, as these people are at greater risk of developing heart disease than people without Diabetes.

Common Thanksgiving carbohydrates include:
  • Bread
  • Potatoes
  • Yams
  • Stuffing
  • Corn
  • Cranberries (most contain huge amounts of sugar)
  • Desserts
High-fat foods to avoid may include:
  • Gravy
  • Butter
  • Baked goods
  • Fried foods (including fried turkeys)

The good news is that Thanksgiving offers plenty of healthier options for your husband to indulge! To feel satisfied, encourage him to load up on fiber and lean protein- hit up that veggie tray and grab some turkey!

Remember, carbohydrates do not have to be eliminated, just controlled. By choosing his favorite traditional foods to count into his daily servings, he should be able to enjoy his holiday in a healthy way!

Hope this helps, Martha. Happy Thanksgiving!

Peace, Love, and Veggies,

Monday, November 8, 2010

Less Legs for Lower Cholesterol

Don't get me wrong- when it comes to showing a lil' leg, I'm in. Sometimes my only motivation to get my booty to hot yoga is knowing that I will be able to do the entire thing sans pants, letting my gams run wild in the hot, sweaty room amidst a sea of other exposed thighs and calves...

Ahem. Anyways.

What the title is referring to is the legs on our food. When it comes to choosing foods with lower cholesterol content, the trick is to look for foods that are a little less leggy.

This trick applies to just about every animal out there:
  • Shrimp, Crab, Lobster: Multi-legged (is it bad I don't know how many?) Highest cholesterol
  • Beef, Pork, Dog (?): 4 legs. Higher cholesterol
  • Chicken, Turkey: 2 legs. Lower cholesterol
  • Fish: no legs. Lowest animal source of cholesterol!
  • Vegetarian, non-animal foods: no legs! Eat em' up!

Moral of the story: Evidently there is such thing as "Too much leg." But never in hot yoga.

Peace, Love, and Veggies,

Sunday, October 31, 2010

Avoiding the Afternoon Head-Bob

Jim from writes:

"I have diabetes and work long hours. I usually eat lunch at my desk while working. I'm struggling with what I can have for lunch. Could you give me some tips on what to pack for lunch at work?"

I hear you, brother. The typical sack lunch (sandwich, chips, juice) is almost totally carbs. Beyond spiking your blood sugar, this will result in only temporary energy. Ten dollars says your head will be doing the "I'm Just Resting My Eyes Bob" by 2:00 pm.

A good lunch needs to have necessary nutrients to keep you going all day. The important fuel components to look for are fiber and protein.

Good fiber sources include fruits, veggies, nuts, or seeds.

Protein sources include dairy, grains such as quinoa, beans, eggs, meat, or nuts/ nut butters.

Three of my go-to quick lunches include wraps, soups, and salads:

  • Wraps- See more about my favorite quick and easy wraps here.
  • Soups- Canned soups can work well- just look for the lower sodium versions. When evaluating which soup to choose, look for one that contains lots of veggies, lean protein, and minimal carbs. These can be found by comparing the nutrition facts on the back label. My favorites are Veggie Chili, Black Bean, and Lentil Vegetable.
  • Salads- I'm not talking "bird food," I'm talking a good, hearty salad! Start with a base of lettuce or spinach, add a protein like chicken or an egg, and then get crazy with the veggie toppers. The sky is the limit. Also try experimenting with beans or 1/2 c brown rice tossed in to your salad for extra staying power.
Pair a wrap or soup with a salad, or the salad with a fruit, and you have yourself the perfect lunch to give you the cutting edge at work.

If you have been instructed to self-monitor blood glucose by your doctor, you will still want to do so before and after eating. If blood sugar is low, keep a yogurt, fruit cup, or string cheese on hand for an added single-carb serving "boost."

Warning: try to not make fun of "Head-Bobbing Bob." were there once.

Peace, Love, and Veggies,

Wednesday, October 27, 2010

Why your Vitamin Water may be a waste of money

I’ve been on a little blogging hiatus, tackling a research review monster instead. The culmination of this monster is a 1-hour presentation of my findings at a conference for MD's and RD's from Illinois and Indiana. Which lying.

The Topic: Innovative Research on Antioxidant Supplementation and Implications for Overall Health and Mortality

If I play my cards right, this topic should be featured on Cosmopolitan’s “Conversation Starters” page any time now.

Hopefully you'll find this as interesting as I have!

A LONG TIME ago, back in 1959, a scientist by the name of Harman conducted some research resulting in what he called
Harman’s Theory. Basically, he said human cells produce oxidants leading to cell damage, disease…and eventually mortality. (Wamppp wamp).

The way to combat these oxidants, then, is with antioxidants produced by the body and obtained through foods. According to this theory, antioxidants should directly decrease disease and mortality.

Fifty one years later, this is the reason behind a slew of supplements and food products on the market today advertising increased antioxidants. The market for antioxidant supplementation is huge, and not only in food. Women's beauty products are also formulated around the antioxidant theory. Use of antioxidants to prevent aging is an idea so ingrained in us, it seems like a fundamental truth-
antioxidants help us live longer. Right?


The problem with this idea lies in the fact that in study after study, antioxidant supplementation does not reduce disease, and does not decrease mortality. I’m talking HUGE amounts of studies, conducted for over 50 years now. It’s just not happenin’.

In fact, in people who smoke, antioxidant supplementation actually has shown an increase in cancer, cardiovascular disease deaths, and all-around mortality.

What does this mean?

It means that oxidants may not be the bad guys. If oxidants aren’t the bad guys, maybe antioxidants aren’t really the heroes of the show, either.

Yes, fruits and veggies make us healthier. That is proven and not changing. Girlscout’s honor.

However, nobody has ever proven that the antioxidants taken out of the produce, isolated, and eaten gives us the same good effects as the fruits and veggies themselves.

Current research is actually looking to completely dispel Harman’s theory, instead implying that oxidation is helpful in cells, and increased oxidation actually leads to a longer life and better health.

All a fancy way of saying:
Hardship makes us stronger. Something the scientist Kanye West published in his dissertation years ago.

This alternative theory would explain why:
  • Exercise (which increases oxidation) leads to a longer life
  • Periodic fasting (which increases oxidation) leads to a longer life
  • Antioxidant supplementation (which gets rid of oxidants) does NOT lead to a longer life, and, in some, increases mortality

More and more, it is looking like the secret to longer life may lie in eating less, rather than supplementing with more.

Upside: Your meathead neighbor investing in $100/month antioxidant drink deliveries is probably just paying for very, very expensive pee. Joke's on him :)

I would like to hear from you!
What’s your best Cosmopolitan Conversation-Starter?
Dispelling antioxidant theory honestly isn’t my only one. Another of my favorites for a crowded room includes: If you could/absolutely had to make out with one person you can see right now, who would it be? If the answer is not “you,” then no use continuing conversation... on to the next!

Peace, Love, and Veggies,

Tuesday, October 19, 2010

Raise Your Cholesterol! (Er...HDL)

Cholesterol can be baffling. Aren't there two types? Isn't some cholesterol good?

Yes indeedy, Cholesterol can be divided into two types:
  1. HDL (high-density lipoprotein)
  2. LDL (low-density lipoprotein)
Since protein is more dense than fat, the density of the cholesterol depends on the ratio of protein to fat in the cholesterol molecule. Cholesterol with a higher ratio of protein is higher in density (HDL), while cholesterol with a higher ratio of fat has a lower density (LDL).

LDL Cholesterol is the cateogry that has been linked with heart disease, earning its reputation as the bad cholesterol.

HDL, on the other hand, is known to help protect against heart disease. There are also some studies suggesting it may lower cancer incidence. i.e...good cholesterol

While many cholesterol articles focus on lowering your LDL, a focus on raising HDL levels is just as important. That being said, today I want to discuss two ways to RAISE YOUR CHOLESTEROL! (HDL, that is)

The first, I think you will like:
Moderate alcohol intake has actually been shown to raise HDL cholesterol levels, decreasing risk of heart disease. Moderate means no more than 1 glass/day for women, or 2/day for men. Wine is an especially good choice here, since it also contains antioxidants. Pour 'er up and sip er' down, my friend :)

The second:
Results from a study published in the Journal of Nutrition showed that an increased consumption of omega-3 fatty acids is associated with reduced LDL levels. Omega 3's are found in fish, as well as flaxseed, walnuts, soy foods, and green leafies.

Another way to increase HDL is to improve your blood triglyceride levels...a fancy pants way of saying eat less hydrogenated and saturated fats. Dark chocolate, green tea, and vitamin D (good ol' sunshine) have also been linked with higher HDL levels.

Eat chocolate covered walnuts over a glass of wine, and chase with a walk in the sun. Now that kinda healthy livin' is right. up. my. alley. :)

Peace, Love, and Veggies,

Monday, October 18, 2010

"The Talk:" Serving Sizes

In life, there are a few conversations we dread. For instance...

"I don't think we should date anymore."
"I might have very accidentally used your toothbrush."
and the oft-dodged... "Why are the doggies giving each other piggy back rides?"

Right up there on the list....THE SERVING SIZE TALK.

I know how this topic feels. It feels all, "They say eat healthy, I'll eat healthy. But THEN they want me to eat healthy PLUS measure my peanut butter and it's STICKING TO THE SPOON and I'm HUNGRY and RAAAARRRRR!"

At least, this is how it sometimes can feel to me. If it does not feel like this to you, please forget you read the previous statement.

I've learned to preface this talk with a promise:
Yes, large portions of even "healthy" foods can undo your health goals.
Yes, there are some foods that you can eat and eat...measuring cups be damned!

For the foods that require a little more portion attention, I have a few standard visuals I use:
  • 1, 3 0z serving meat= about the thickness and size of a deck of cards
  • 1 serving cheese = 1 oz, or about four dice stacked
  • 1 serving ice cream, pasta/rice = 1/2 c. Think tennis ball.
  • 1 serving potatoes = 1/2 c, or about the size of your computer mouse (okay, so that one is stretching)
  • 1 serving margarine= 1 tsp= 1 dice
  • 1 serving peanut butter= 2 Tbsp= ping pong ball

Meat, dairy, carbohydrates, and fats/oils are really the food groups requiring attention to portion size. Beyond that, I've always lived by the theory that nothing bad ever came from filling up on greens and veggies. Produce packs fiber, antioxidants, and phytonutrients, yet is low in calories. When it comes to these, the more we eat, the better!

This theory can be especially helpful when applied to eating our favorite meals that may be high in carbohydrates (spaghetti!). Don't ditch that meal! Portion yourself a reasonable amount of spaghetti. The trick is...stick with your original judgment on portion size. Resist the urge to go back for more. If you're not quite satisfied, eat, eat! Fill up on a fresh salad, or a big ol' side of steamed/lemon peppered veggies. Follow with a fruit for dessert!

Alright. We did it. We had "The Talk." This calls for a glass of wine, lickety-split.

I'm curious to hear about your portion size habits. Do you pay attention to portion size? Are there certain foods you avoid because your portions tend to get massive? Peanut butter is my big one (couldn't have guessed, right?!). I've found that it's better for me to avoid altogether. Instead, I buy the peanut flour from Trader Joe's, and reconstitute with a little water and salt (a trick I learned from Emily). Delicious, good source of protein, and lower in fat/calories. Because there are a few monsters that just can't be tamed...


Peace, Love, and Veggies,