So the other night I was watching this
awesome documentary on clean eating hosted by Dr. Giles Yeo, a Nutritional
Biochemist, that was aired on BBC a few months back. Here is the link for your viewing pleasure if
you are interested (http://www.dailymotion.com/video/x599rzw). Whether it was the concept of pleomorphosis
or wheat as being one of those “bad,” foods to avoid, he debated many of their
claims from a scientist’s perspective. There is so much misinformation about
diet and health out there. For instance,
I had recently heard about a documentary entitled, “What the Health,” which
made an outlandish claim about eggs being more hazardous than cigarettes. For that reason alone I don’t think I can
stomach watching it. So many fad diets
and pseudo truths are being circulated related to health. The clean eating movement does emphasize some
positives when it comes to health. For example, it promotes cooking your meals,
as well as, increasing consumption of fruits and vegetables. But there are some negative aspects that can
overlap with the message making it more difficult for the lay person to differentiate
from right and wrong. Many times they
rely on their personal convictions when deciding to follow a certain diet
regimen which could steer them wrong unfortunately. Hopefully, with the increasing visibility of
Dietitian’s, we can expand our message for better eating based on more sound
June 29, 2017
The Diabetes Council has a great website you can peruse to find information on managing diabetes. I myself have contributed to this great site! If you have been following my twitter account then this link may be somewhat familiar to you: https://www.thediabetescouncil.com/50-registered-dietitians-share-diabetes-diet-lifestyle-tips/
The following links to a more recent article that provides excellent advice when trying to motivate patients to lose weight. Although I did not write it, many of the techniques discussed I try to utilize with my patients seeking weight loss:
Favorite Lecture's from Nutrition Event's I Have Attended Over the Past Year
I know, I know I have been MIA for the past year or so! Did not update my blog whatsoever!! Doesn’t mean I wasn’t out and about in nutrition world. I’ll give you a brief highlight of my favorite lecture from the three different events I have attended since updating you last.
1.) Robert Wood Johnson New Brunswick’s Second Annual Nutrition Symposium
- Back in March of last year, my co-workers and I attended this event which had some interesting talks on retail dietetics, holistic nutrition and supplementation. Of all the talks I have to say I enjoyed Dr. Shawn Arent’s the most. His lecture entitled, “The Psychology of Supplementation,” discussed the performance enhancing effects of caffeine, the positive’s and negative’s of St. John’s Work usage, Omega 3 fatty acids benefits for mood disorders and ADHD, Gingko Biloba on cognitive function and Creatine. Of all the supplements listed above, the information provided regarding Creatine was most exciting of all. Creatine has been found to have neuroprotective benefits for those suffering from traumatic brain injury. In fact football players who take Creatine are able to recover from concussions much more quickly than those who do not take the supplement. Creatine’s ability to cross the blood brain barrier and it’s association with increased brain oxygenation has proven to be helpful in combatting fatigue and with those suffering from Huntington’s Disease.
2.) Today’s Dietitian Nutrition Symposium in Orlando, Florida
-Yes, I traveled all the way to Orlando, Florida back in May to be part of this event! And I even got to visit Disney for the first time ever while I was there!! There were lecture’s I attended on communicating nutrition messages properly to the public, updates on the new dietary guidelines, as well as Olive Oil!! Of all the talks I listened in on, I must say the Olive Oil talk by Dr. Janet Bond Brill was very eye opening. I never realized this but Olive Oil is actually the most widely consumed fruit juice in the world. Why is that? Well Olive’s are drupe fruits and the oil is actually the juice that is extracted from the olive. There is so much adulteration of olive oil’s apparently. When reading the products label it is important to look for a product that has been processed and packaged in one location. The bottle should be dark and try to stay away from pomace oil. Extra Virgin Olive Oil is best.
3.) GNYDA Annual Health and Wellness Event in New York City
- Once again, I took the train into the city to attend this educational event. I thoroughly enjoyed the speaker Laura Lagano, MS, RD, CDN Co-founder of the Holistic Cannabis Network. Some interesting factoids she provided were that Marijuana has only been illegal in the United States for the past 80 years. Prior to that it was used as medicine. In the UK, during Queen Victoria’s time, women actually drank Cannabis tea to relieve menstrual pains. She discussed how it works through the bodies Endocannabinoid System (ECS) to relieve pain and other symptoms. The ECS is also said to help promote homeostasis in our bodies. The use of medical marijuana has been found to help many conditions like seizures but more research is needed. Many of it’s stated benefits are anecdotal.
March 29, 2015
The 5th Annual NYC Vegetarian Food Festival
Apparently, as I was informed by my friend and fellow RD,Ms. Melissa Mirota, there is an annual Vegetarian conference in NYC and shethought we might as well check it out. Of course I joined her in attending part of the 2 day event which was heldon March 14th and 15th. If you can imagine a hippie FNCE conferencewith only vegetarian/vegan food products, that promoted animal rights andspirituality, had a kiddie play area, psychics, an actual blow out bar and somecanine friends roaming around, that’s basically what it was. They also had a myriad of speakers withinteresting topics. I did sit in on twolectures, one by Rich Roll a top notch lawyer turned vegan Ultra Marathoner/author/motivationalspeaker and Johnathan Balcombe who spoke about animals and their feelings. They were interesting, not what I expected,but still worthwhile nonetheless. Therewere some physicians, nutrition scientists and public policy speakers my friendand I thought would be interesting to hear but our time limitations preventedus from doing so. Anyways, back to theexhibitors….
Harlem Grown was there promoting their inner city projectsto help encourage healthy eating amongthe youth of the area. They teachhydroponic gardening techniques to the kids and were looking for volunteers tohelp out and learn as well. Some of thevegan deserts were fantastic! From icecream to pies, I was quite impressed with the taste and texture of many of theproducts on display. I especiallyenjoyed the pie samples by, “This Pie is Nuts.” There were stands that advertised brands of olive oil, like Kastaniaolive oil, which were imported from Greece. Many of them had strong delicious flavors that kept you begging formore. OM botanical’s were also on handgiving demonstrations of their skin care line. Their products are said to be gluten free, vegan and eco friendly. Jyoti natural foods had a tasty sampling ofsome of their Indian style recipe’s made with their products. I could go on forever telling you about mytaste adventures but I won’t as I am sure you want to also hear about these lectures I attended.
As I mentioned earlier, I heard Rich Roll speak about hisexperiences going from a coach potato lawyer and turning his life and healtharound by not only going vegan but participating in these Ultra Man Marathon’s thatare run in Hawaii. As disappointed as Iwas in not hearing more about his vegan adventures as he was pursuing hisathletic endeavors and improving his life, I still enjoyed his highlymotivational talk about how he overcame so many obstacles in pursuit of ahealthier lifestyle. In the process hewas also promoting his book, “Finding Ultra.” The other speaker, Mr. Johnathan Balcombe, discussed various animals andillustrated how they had feelings that we should be cognizant of. What really struck me during that session wasthat fish, yes, actual fish like to be touched and massaged, much likedogs. Who knew! And then he showed a photograph of thisperfectly shaped mandala that was madeby a puffer fish in the sands of the deep ocean to attract a mate. Another astonishing fact that he dispensedwas that sharks actually like humans, even more so when you massage them. No offense to our fish friends, not trying tosound awful, but this knowledge did not deter me from consuming fish, or encourageme to get cozy with sharks.
February 7, 2015
GNYDA Health and Wellness Conference 2015
So a couple ofdays back, I journeyed off to the yearly GNYDA Health and Wellness Conferencein mind numbing cold weather. I suspectthe weather kept a few home since, at least as far as I could tell, the roomwas a bit emptier than previous years. Thetalks provided enlightening insights on the association between skin and acne,the re-emergence of blenderized tube feedings, as well as reinforced conceptsabout the benefits of exercise. Overall, I would say, it was worth the trip.
Jennifer Burris,MS, RD, a doctoral student at NYU with multiple dietetic certifications gave usa glimpse of her research into acne and nutrition. The incidence of adult acne has increasedover the past 20 to 25 years. Thiscondition, although not life threatening, negatively impacts emotionalhealth. Acne can be attributed to anumber of factors including but not limited to stress, environment anddiet. Current research on theassociations between diet and acne are inconclusive but certain foods can aggravatethe condition. Sugary foods, fruitjuice, and surprisingly fat free milk have been shown to be some of the worst culprits. Low glycemic diets and omega 3 fatty acids appearto possibly be helpful in cases of moderate to severe acne. The link between milk consumption and acne isunclear. Researchers aren’t sure whetherit’s the fat, carbohydrate or protein in the milk which is associated withexacerbating the condition.
Dr. Jordan Metzl,a sports physician, emphasized the importance of exercise as preventativemedicine. He stated today’s youth are expectedto live 5 years less than their parents. His prescription for exercise as follows: 30min/day for 5 days of theweek starting off with low intensity workouts and increasing intensity as thebody becomes stronger. He alsoencouraged yearly fitness goals.
Finally, JuliaDriggers, RD, LDN,CNSC a clinical dietitian at the Children’s Hospital ofPhiladelphia talked about the use of blenderized tube feedings. This was an eye-opener as I (as well as otherRD colleagues of mine) thought they weren’t in use anymore. These feedings aren’trecommended for patients with multiple food allergies or areimmunocompromised. There are food safetyissues associated with implementing such feedings. Supposedly there are feedings on the marketby commercial distributors made with real foods. Real food and Liquid Hope were two of thebrand names mentioned during the meeting. Liquid hope is not for use with children. There are two types of feedings that can bemade: thick and thin. Thick feedings generallyhave higher caloric density (>30cal/ oz), are thick and pasty in consistencyand have minimal free water. They areused in patients with reflux, volume intolerance or have undergone nissenfundoplications. Grains, sugars,cornstarch, or infant cereal are used to thicken formulations. Thin feedings are used in patients’ withformula intolerance, oral aversions, or delayed oro-motor skills. They typically are between 20 to 30cal/oz andare moderately free in water. Recipe’sfor these formulas can be found in, “Homemade Blended Formula Handbook,” byMarsha Dunn Klein, Med, OTR/L and Suzanne Evans Morris, PhD, CCC. Most homemade blenders would not beacceptable for making blenderized tube feedings so thought must be put into thetype of blender to purchase.
November 8, 2014
Chocolate and Cardiovascular Health
(Originally published on a Sodexo Blog)
Chocolate is a food that is loved and adored throughout the world. It provides comfort while imparting a delectable taste that makes one question its’ health promoting properties. Researchers had observed that the Kuna Indians of Central America consistently maintained a healthy blood pressure throughout their lives (1,2). They attributed this to the fact that they drank three to four cups of a chocolate drink per day. As such, chocolate, particularly dark chocolate, has been looked at for the purpose of promoting cardiovascular health (1). It is said that even a small drop in blood pressure in the hypertensive patient can bring forth positive changes in cardiovascular health(1).
Flavonols are the chemical compounds found in cocoa beans that catalyze the production of endothelial nitric oxide which is responsible for this decrease in blood pressure. These phytochemicals are found in plant based foods like apples, beans and tea in lower concentrations than is present in chocolate. The higher concentration of flavonols in chocolate impart the medicinal properties associated with this food. Furthermore, the density of flavonols in chocolate products is dependent on the processing methods used. Naturally, dark chocolate is higher in flavonols than is milk chocolate (1,2).
A meta-analysis review of 20 different short term studies (approximately 2 weeks in duration) found a significant drop of 2 to 3 mm Hg in blood pressure. This decrease was noted only in individuals less than 50 years of age. The results of the studies are questionable due to their short duration(1). One study that included young healthy people found that consuming 8g of dark chocolate (>70% cocoa) over a month improved vascular functioning(3). In another review of the health benefits of chocolate a study lasting fifteen years was discussed. The afore-mentioned study involved men between the ages of 65 and 84 years of age and found those that consumed cocoa products regularly exhibited lower blood pressure(4). The authors of these reviews suggest more longer term studies for the purpose of arriving to definitive conclusions on the health attributes of chocolate. It is also stated that many of these studies have been funded by producers of chocolate products which therefore causes one to question the positive findings (1,4).
Improved cardiovascular health is only one of the benefits of consuming chocolate that is cited in scientific literature. Other benefits of chocolate consumption include, but are not limited to, relieving stress by increasing serotonin production, weight management and maintaining oral health. Despite evidence suggesting chocolate as a health promoting food, moderation in intake should still be exercised(4). A single serving of a dark chocolate bar every day should be enough to quell your chocolate cravings and promote wellness.
1.) "Effect of Cocoa on Blood Pressure." Review. The Cochrane Library 8 (2012): 1-81. The Cochrane Collaboration. Web. 5 July 2014.
2.) Latham, Laura S., Zeb K. Hensen, and Deborah S. Minor. "Chocolate-Guilty Pleasure or Healthy Supplement?" The Journal of Clinical Hypertension 16.2 (2013): 101-05. Web. 5 July 2014.
3.) Pereira, Telmo, Mariana Vilas Boas, and Jorge Conde. "Dark Chocolate Intake Improves Endothelial Function in Young Healthy People: A Randomized and Controlled Trial." Caridiovascular System 2.3 (2014): 1-6. Web. 5 July 2014.
4.) Latif, R. "Chocolate/cocoa and Human Health: A Review." Netherlands: The Journal of Medicine 71.2 (2013): 63-67. Print.
June 16, 2014
Part 2: New Jersey Dietetic Association Annual Meeting
Vicki Koenig, MS, RD CDN, a Nutrition Consultant to individuals and food companies spoke to the attendees of the annual New Jersey Dietetic Meeting about the usage and benefits of probiotics. She reviewed some of the history behind the use of probiotics. The 1908 Nobel Peace Prize winner in the field of Medicine and Physiology, Mr. Elie Metchinkoff is said to have discovered the connection between probiotics and health. According to Ms. Vicki Koenig, he observed that Bulgarians lived a relatively long and healthy life which he attributed to their consumption of cultured food products. In fact, Lactobacillus bulgaricus is named after the Bulgarian people. Lactobacillus, found in the small intestine and Bifidobacteria which inhabits the large intestine are two of the major genera of probiotics noted for their health promoting properties. Some benefits of the use of bacteria are as follows: improved digestion, lower cholesterol, decrease in allergies and eczema, as well as improvement in the utilization of carbohydrates and proteins. Contraindications to usage of probiotics are GI bleeding and a immunocompromised system. The quantity of “good” bacteria in the gut is said to decline with age. Specific strains should be sought after for certain conditions, therefore, there is no one probiotic fits all according to the speaker.
During the poster session there were some interesting pieces of research by Dietetic Interns that were being exhibited. I will share some tidbits of research from this years College of Saint Elizabeth Dietetic Internship crew.
1.) Dietetic interns Andrea Ficarra, Alicia Henning and Victoria Kuebler completed a meta analysis review of studies relating to GI disease and nutrition. Current evidence does not strongly support the use of probiotics in the treatment of IBD, a low FODMAP diet for treating IBS, or a gluten free diet in caring for diarrhea prominent IBS.
2.) Another meta analysis review was completed by Jenna Graziano and Gabrielle Guiliano to investigate the impact of zinc supplementation on hepatic encephalopathy and wound healing. There appears to be a possible benefit of zinc supplementation with hepatic encephalopathy but researchers are not clear on dosage and whether other therapies should be implemented. Improvement of wound healing was noted whether the patient was zinc deficient or not when receiving supplementation. Data on this matter is inconclusive at this point.
3.) Finally, Lindsay Dolashewich reviewed the research between weight control and antipsychotic medications. Long term adherence of 6 months or more to a diet and exercise program showed improvement in weight control and metabolic abnormalities.
There was much more information that I wish I had the time to share with you!! But, I hope you enjoyed the information I did have time to share!
May 30, 2014
Part 1: New Jersey Dietetic Association's Annual Meeting
A couple of weeks ago I attended the annual New Jersey Dietetic Association’s meeting held on May 14th at the Imperia on Easton in Somerset, NJ. For the most part I was manning the Scholarship Fundraising Raffle table making sure everything was going well with that part of the event. Given my duties, I wasn’t able to attend any of the lectures, but , I was still able to gather some information that I hope some of you may find enlightening.
Ms. Jennifer Stein, MS, RD, a Dietitian with St. Barnabas Health Care discussed, “The Nutritional Management before and after Weight Loss Surgery.” She went over current weight loss treatment modalities, as well as, the evolution of weight loss surgery and nutritional guidelines associated with the surgeries. Over the years, weight loss surgeries have morphed into what she termed, “metabolic surgeries,” that are done laparoscopicaly and single incisions with shorter hospital stays. The following table gives a break down on the different surgeries she discussed during her talk:
Restrictive vs. Malabsortive and Restrictive Procedures Restrictive: Gastric Band Sleeve Gastrectomy Weight loss: 40 to 50% of excess body weight >50% excess body weight Metabolic/hormonal None Improved diabetes, decreased changes : hunger due to hormonal changes Nutritional Deficiencies: Most likely not Vitamin B12; ? others Risks/Complications: Band slippage, prolapse, weight regain Leaks, strictures, weight regain Other: high calorie foods slip through
Malabsorptive/Restrictive Procedures: Duodenal Switch Roux-En-Y Gastric Bypass Weight loss: >70% weight loss 60 to 80% weight loss Metabolic/Hormonal Changes: Hormonal changes decrease hunger Same Nutritional Deficiencies: Fe, Fat soluble vitamins Vit B12, Fe, Ca, folate Risks/Complications: Dumping, leaks, ulcer Same
Preoperative care involves diabetes management, smoking cessation and making sure the patient has realistic expectations. Encouraging exercise, providing protein and MVI, calcium and vitamin D supplementation is also advised. Postoperative care requires a gradual advancement of the diet. The first week should be clear liquids, second should be full liquids, the third and fourth week is puree before the final week when the patient can advance to solid foods. The only difference is found with the duodenal switch diet which extends to 9 weeks and between the fifth to eighth weeks, the patient is on a semi-soft diet. All patients undergoing bariatric surgery should have the following supplements: MVI, calcium citrate, vitamin D and biotin. Patients who underwent the duodenal switch surgery should also receive fat soluble vitamins.
Ms. Cynthia Lowen, a Medical Scientific Liaison with Nestle Health Science, gave a talk entitled, “Nutritional Support of the Critically Ill Patient with Obesity.” She discussed how obesity, despite it’s associated physical and metabolic derangements, is often missed as a diagnoses. Other points she talked about were the prevalence of diabetes and nutritional insights into improving outcomes for the critically ill obese patient. Obesity is currently recognized as a disease associated with a multitude of comorbidities and has behavioral, genetic and environmental causes. Obese individuals are susceptible to protein energy malnutrition due to increased protein breakdown which leads to a reduction in lean body mass. Hypocaloric or permissive underfeeding is advised for critically ill patients whose BMI exceeds 30. 11 to 14kcal/kg of actual body weight with protein requirements of 2g/kg IBW for class 1 and !! obesity (BMI of 30 to 39.9) or 2.5g/kg of IBW for class II obesity ( BMI of >40). Interestingly, she notes that studies have found that providing approximately 8g of leucine a day to critically ill patients can help maintain lean body mass and improve glycemic control. She states low carb, high protein feedings can have the same effects. Fish oil is also said to help with outcomes for critically obese patients.
Stay tuned for some more from New Jersey Dietetic Association’s 2014 Annual Meeting!!
March 23, 2014
St. John's Wort Effect on Drug Efficacy
One of the most studied herbs with regards to drug interactions is St. John’s Wort. It can be effective in treating mild, moderate and major depression. Considering many patients who undergo organ transplantation or suffer from HIV and cancer suffer from depression, they many feel inclined to try out St. John’s Wort to treat their mental affliction thinking it to be harmless. Well, “natural” doesn’t always translate to harmless especially if you are undergoing medical therapy for a variety of medical conditions and there is a potential for an herb-drug interaction. A decrease in drug efficacy is one of the many ways St. John’s Wort can interact with medications. St. John’s Wort is comprised of many phytochemicals from flavonoids to napthodianthrones. More specifically there is a phloroglucinol derivative called hyperforin that negatively impacts the pharmacokinetics of certain medications causing a decrease of the drugs plasma concentration in the system thereby disrupting it’s therapeutic potential. St. John’s Wort preparations with hyperforin concentrations of greater than 1% are often seen to exert negative effects on drug efficacy with certain medications.
The isoenzyme CYP3A4 is part of the family of enzymes (otherwise known as cytochrome P450) that are involved in drug metabolism. CYP3A4 with or without the ATP transporter P-glycoprotein when present as substrates of certain medications are involved in decreasing plasma concentration of these drugs. These medications include anticoagulants, beta blockers, immunosuppresants, hormonal contraceptives, anti-retrovirals, anti- cancer, and HMG Co-A reductase inhibitors among others. A cascade of events that effects the genome when hyperforin interacts with a medication causing CYP3A4 and/or P-glycoprotein to be induced results in decreased drug efficacy.
One of the most studied of these interactions with St. John’s Wort involves the immunosuppressant drug cyclosporine. This medication is given to organ transplant patients to help prevent rejection of the organ. Cyclosporine is substrate of both CYP3A4 and P-Glycoprotein. Additionally it has a narrow therapeutic range which also helps encourage the herb-drug interaction. When St. John’s Wort is taken with cyclosporine it has been observed that plasma concentration of the medication is decreased and dosing adjustments were required. This is shown to be reversed with discontinuation of St. John’s Wort supplementation.
Mannel, Marcus. Drug Interactions with St John’s Wort. Drug Safety. 2004;
Zeping H, Xiaoxia Y, Paul C, et al. Herb-Drug Interactions: A Literature Review. Drugs.2005; 65(9): 1239-1282.
Izzo A, Edzard E. Interactions Between Herbal Medicines and Prescribed Drugs: An
Updated Review. Drugs. 2004; 69(13): 1777-1798.
Borrelli F, Izzo A. Herb-Drug Interactions with St John’s Wort (Hypericum
perforatum): an Update on Clinical Observations. AAPS Journal. 2009; 11(4):
Wang X, Li J, Su Q, et al. Impact of the haplotypes the human pregnane X
Receptor gene on the basal and St John’s wort-induced activity of cytochrome
Hiromitsu I, Tsutomu K, Kimiko T. The recovery time-course of CYP3A after
Induction by St John’s wort administration. 2008; (65) 5: 701-707.
Mueller S, Peszynska J, Uehleke B, et al. The extent of induction of CYP3A by St. John’s Wort varies among products and is linked to hyperforin dose. Eur J Clin Pharmacol. 2006; 62: 29-36.
Mai I, Bauer S, Perloff E, et al. Hyperforin content determines the magnitude of
The St. John’s wort-cyclosporine drug interaction. Clinical Pharmacology and
Therapeutics. 2004; (76) 4: 330-340.
Nowack, R. Review Article: Cytochrome P450 enzyme, and transport protein
mediated herb-drug interactions in renal transplant patients: Grapefruit juice, St.
John’s Wort- and beyond! Nephrology. 2008; 13: 337-347.
Murakami Y, Tanaka T, Murakami H, et al. Pharmacokinetic modelling of the
interaction between St. John’s wort and ciclosporin A. Br J Clincal Pharmacol.
2006; (61) 6: 671-676.
February 23, 2014
Part 2: GNYDA Health and Wellness Conference 2014
Apparently Diabetic research has come a long way in the past few years and enabled the innovation of novel new pharmaceutical therapies per Dr. Joyce Vergili’s talk on, “Diabetes Medications Update for Healthcare Professionals.” She went over the different metabolic defects that are associated with diabetes and the therapies that are available. It so happens that we only had two classes of drugs for diabetes between 1950 and 1994: Sulfonylureas and Insulin. In just the past few years we have had an influx of new medications being approved by the FDA for treating Type 2 Diabetes. Metformin remains as first line therapy as long as none of the following contraindications are present: CHF, renal or hepatic impairment. In addition to insulin resistance and declining beta cell function, she discussed other newly discovered metabolic defects and the types of therapies that have been invented as a result of this new information. The majority of the newest drugs developed combat what she referred to as the, “Incretin blunting effect.” The two incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) are secreted from the small intestine when food is ingested. As diabetes progresses, these hormones are decreased along with insulin. Incretin is involved in the stimulation of insulin production and inhibition of glucagon secretion. Moreover, these proteins are degraded by the enzyme dipeptidyl peptidase-4 (DPP-4). In response the following two classes of drugs have been developed: DPP-4 inhibitors (oral medications) and GLP-1 Receptor Antagonists (injectable medications). The other metabolic effect she discussed that has yielded newer therapies is the increased renal glucose threshold. The normal renal glucose threshold is around 180 mg/dL but increases to approximately 200-250 mg/dL in type 2 diabetes. The sodium glucose co-transporter-2 (SGLT2) transports glucose into the kidney for glucose reabsorption into the bloodstream. When maximum capacity of glucose is reached in the kidney the excess is excreted into the urine. As such the following SGLT-2 inhibitors were developed: Canaglifoxin (Invokana) and Dapagliflozin (Farxiga).
Finally, Toby Amidor MS, RD blogger for the Food Network gave us a rundown on what can help draw readers to your blog and why we should blog. To sum up what she said, she encouraged a website that included lots of photos, was not too lengthy (between 250 to 600 words max) and with a little dose of fun. She also emphasized the importance of blogging for the Dietetics professional. After all, Dietitians are the food experts and we are competing with non food experts dishing out nutritional advice in the blogosphere. She pointed out statistics that showed that the majority of Americans trust food blogs and their recommendations. Granted there are many successful food bloggers out there that do not have the education Dietitians have when it comes to food and nutrition, this can be problematic. This point makes it even more important for Dietitians to start blogging, and doing so in a way that attracts readers attention and combat misinformation on the internet related to health and nutrition.
February 7, 2014
Part 1: GNYDA Health and Wellness Conference 2014
This past Saturday (thankfully devoid of the snowstorms and bitter cold we have been experiencing more often than not lately) the GNYDA Health and Wellness conference was held at the University Settlement located in New York City’s Lower East Side. In years past, it was held at the Cornell Campus of NY Presbyterian Hospital. Nonetheless, the conference continued its’ legacy of inviting quality speakers exposing attendees to varied areas of Dietetics, as well as, providing an excellent networking opportunity. This years’ event included presentations about integrative nutrition, blogging, and an update on diabetes.
First up was Dr. Jaime Schehr, ND, RD, CDN, a Naturopathic Doctor (a.k.a ND) and Dietitian who practices Integrative Nutrition in New York and Connecticut. It should be noted that an ND is recognized as a primary care provider in 15 states (by the way, NY is not included in that list). She differentiated between MNT, Integrative Medicine and Integrative and Functional MNT in the following ways:
-Integrative Medicine is the synergistic integration of traditional natural healing and modern medicine to promote health and wellness and not just treat the symptoms.
-MNT is reducing risk of complications from already diagnosed conditions like diabetes and high cholesterol.
-Integrative and Functional MNT is focused on the overall health and wellness of the patient by promoting diet and lifestyle modifications.
A healthy gut is the foundation of good health according to Integrative Nutrition practitioners. Intestinal permeability, which can be negatively impacted by stress, can lead to immune compromise and “stimulate hypersensitivity responses to food and components of gut flora.” She discussed a situation where a patient of hers had not experienced symptoms of celiac disease until she underwent a stressful period in her life. Food sensitivities, more often than not, can be detected via elimination diets. Using eliminating diets are less costly than having the patient undergo blood testing to determine the offending IgG and IgE food antibodies. Dr. Schehr also described a 4 step gut restoration program that involved Removing foods/medicines that may be harming the gut, Replacing nutrients, digestive enzymes, etc. that may be lacking, Re-inoculate healthy bacteria with the use of pre and probiotics, and finally the last step is to Regenerate using dietary supplements and/or modifying the diet. Some diets she briefly mentioned are as follows: the anti-inflammatory diet, anti-candida diet, FODMAP diet, Blood type diet, and alkaline diet. She encouraged dietitians to learn as much as possible about dietary supplements as we are seen as the experts in this area, regardless of the lack of formal education we get in this area. She suggested a site called Emerson Ecologics which RD’s can join for free as another resource to learn more about Integrative Nutrition.
I have more to say! So stay tuned for the second part of the GNYDA Health and Wellness Conference 2014!!!!
January 18, 2014
Family Based Treatment: An Approach Towards’ Treating Eating Disorders in Adolescents
A recent issue of SCAN’s Pulse (the newsletter for the Sports, Cardiovascular, Wellness and Nutrition DPG group) published an article about eating disorders by Ms. Kerri Heckert, MS, RD, a Dietitian at the Children’s Hospital of Philadelphia. Eating Disorders (or ED’s) are notoriously known to be difficult to treat. A recent Huffington Post article on Family Based Treatment (otherwise known as Maudley’s approach) cited that sufferers of anorexia are overwhelmingly young females which range in age from 12 to 26. Even more alarming was that anorexia is known as the, “deadliest of all mental health conditions.” In the diseases early stages, adolescents coming from loving homes with parent’s who are not overwhelmed with their own mental health issues can benefit from Family Based Treatment or FBT.
The primary goal of FBT is to transition these adolescents from a malnourished to a well nourished state. This is done in a series of 3 phases with 15 to 20 therapy sessions over the course of 9 to 12 months. Parents are educated on the severity of the medical conditions attributed to the eating disorder. Not much consideration is given to the cause of the disease, rather the effort is placed on weight restoration. Through the process of overcoming the illness, the hope is that the patient will gain the appropriate insight to prevent regression.
The first phase of the illness usually requires the adolescent to stay home from school with her parents for approximately 2 weeks. During this time, the child’s meals are constantly supervised by the parents who are involved in every step of the child’s meal planning. Additionally the parents are asked to compassionately encourage the child to eat and reinforce the idea that it is a necessary part of life. The second and third phases increase the child’s autonomy during meal times and eventually the majority of the weight required for the patient’s age and height is gained. Studies have shown success with adolescent’s suffering from anorexia but limited yet promising evidence have been reported with Bulimic’s as well.
Heckert, Kerri. "Family Based Treatment: Getting Parents Involved in the Outpatient Treatment of Eating Disorders." SCAN's Pulse 33 (Jan. 2014): 12-14. Print.References
Pearson, Catherine. "Maudsley Method For Anorexia Treatment Puts Parents In Control Of Their Child's Recovery." The Huffington Post. TheHuffingtonPost.com, 19 Sept. 2013. Web. 18 Jan. 2014.
IFT 2013: Part 2
Next up, I attended a meeting on hybrid sweetener systems where they discussed new approaches to sweetening foods to help combat the obesity epidemic. They are noticing that customers are demanding “better and healthier” food products. Dr. Walters of Rosalind University of Medicine and Science started off the talks by stating that soft drinks have been linked to the obesity problem. He noted that the sweet taste receptor was identified between 2001 and 2003. According to the lecture, it has been found that combining different sweeteners together in a product formulation actually increases the sweetness and they suspect it has to do with different molecules affecting varied sites on the sweet taste receptor. The speakers had discussed a new sweetener called Talin by Naturex. Talin is a sweetener derived from a West African fruit called katemfe according to the companies website. It is low in calories and when combined with Stevia it improves the taste profile. Stevia usually has a bitter aftertaste to it but when it is combined with Talin you find a smoother and more pleasant sweetness. Later on, I attended an educational session entitled, “Nutragenomics and Angiogenesis: How Food Influences the Common Denominator in Health.” Angiogenesis helps maintain a healthy physiological state but when it is not in balance, it can lead to health problems like obesity and cancer. The speakers noted that dietary intervention can suppress these processes and discussed the gene mechanisms involved.
There was a talk given by Mr. David W. Robson, Head of Energy and Environmental Foresight with the Scottish Government that I sat through entitled, “Food, Water, Energy Nexus: Surprise is Inevitable, Being Unprepared is Not.” He stressed the importance of starting to prepare for the inevitable calamity that is to hit mankind in the coming years due the effects of climate change on food, energy and water. It was noted that climate change impacts economic, food, global stability and biodiversity. Environmental, social and technological changes require that we increase centrality of resources to human security, national prosperity and social well being. The perfect storm which can stress physical and biochemical systems and these now fragile systems can amplify issues of equity according to Mr. Robson. He predicts that water scarcity and stress would occur in 2025. Additionally he expects a globally integrated market for fresh water in 20 to 30 years. Water, he reported, is currently traded like wheat and its’ consumption is doubling every 20 years.
Overall, I enjoyed my experience at IFT. I was able to network with fellow RD’s and even had the chance to speak with the President of the Academy of Nutrition and Dietetics, Dr. Ethan Bergman. There was talk of the possible expanding role of supermarket RD’s in healthcare as Obamacare gets underway due to the fact that more American’s will be insured. It was also exciting to visit the city of Chicago and experience it’s grandeur. The Taste of Chicago, a food festival held once a year was a feast for the senses and was walking distance from where I was staying. The food industry doesn’t have the cleanest reputation when it comes to promoting health and wellness. They have a long ways to go to improve upon that, which appears to be their goal. Given the global food culture, the food industry will continue to play an important role in feeding the global population. From attending their events, it is my understanding that they are aware of the harmful effects of the western processed diets on health. Traditional whole foods were touted as health promoting. It will be interesting to see what the future holds with respect to the food industry’s response to the coming food crises and the current obesity epidemic.
August 4, 2013
IFT 2013: Part 1
A little less than a month ago I attended the Institute of Food Technologists (IFT) annual meeting and food expo in the beautiful city of Chicago. The event focused on the impending food crises and changing the food industries image as the facilitator to the world’s health woes, particularly with regards to obesity. Talks were given by prominent scientists, physicians and political scientists with regards to these issues. The keynote speaker was Dr. Fareed Zakaria, CNN correspondent and political scientist, who gave a positive spin on the unforeseen challenges to the global food supply due to climate changes and how that is going to affect the food chain and distribution economically and politically. He emphasized that, as always, a solution will be found and he used examples of previous recessions and how America managed to survive. But of course, scientists will be at the forefront in resolving this issue. There were educational track sessions on topics relating to food and nutrition, food laws, food microbiology, as well as food safety and defense. I also attended their educational excursion to the Illinois Institute of Technology (IIT) where we were given a tour of their clinical nutrition and innovation labs. Their food expo floor was inundated with food ingredient companies trying to sell their products based on their application.
The trip to IIT’s clinical nutrition lab was interesting and insightful. The dietitian/ lab researcher we met actually drew blood from the study participants as warranted. Before this I did not know that dietitians actually performed such duties in this line of work. They also had a room which looked like a physicians exam room where some investigative work was done. There was of course a prep room and an instrumentation room where blood samples were processed. At the conclusion of our tour we were given strawberry smoothie samples and were asked to distinguish between the one made with real strawberries and the one made with the artificial version. We also visited the innovation labs and were led towards a microbiology laboratory where they were showing us their work on biological polymers and their applications with food products.
I attended several interesting food and nutrition track educational sessions during the event which I will go into some detail. First, it was such a delight to listen to Dr. Kaplan from the University of Calgary speak about, “The Role of Nutrition in Mental Health,” as her talk was entitled. She emphasized that traditional diets (such as the Mediterranean diet) promoted mental health while the western processed diets increased the rate of anxiety and mood symptoms. One particular study she discussed involved analyzing individuals 3 day food records and noting that those with increased vitamin and mineral intake had improved mental functioning scores. During her talk she quoted Margaret Mead by stating that “it is easier to change a man’s religion than the way he eats,” to prove her point that since American diets are deficient in whole foods that supplementation may be necessary. She also stated that although the brain is 2% of our body weight that it occupies 20 to 50% of our metabolic demands. Finally she discussed studies involving vitamin and mineral supplementation and improved mental health. But, she did stress that whole foods were best! Dr. Markus, a professor at the University of Maastricht gave a discussion on, “Food, the Brain and Stress Resilience.” He stated that the balance between situational demands and personal preferences/abilities determined our wellness. Stress, he added, “is the mental and physical energy to keep this balance.” When individuals are in a bad mood they usually crave carbohydrate rich foods. Increasing intake of tryptophan has been shown to improve mood. He went on to discuss how this knowledge could help enhance food effects and thereby help with curbing obesity.
To be continued with highlights from the rest of my IFT 2013 experience!
May 12, 2013
Current Food Trends
Increased exposure to exotic foods and the awareness of how food impacts health seem to be the driving forces in what is trending now in food. In the April issue of, “Food Technology,” magazine A. Elizabeth Sloan, President of Sloan Trends, Inc. discussed how American’s are eating in her article, “Top Ten Food Trends.” The American demographic has been changing quite a bit especially over the last few decades. Family meals are not so much the norm anymore as even those who live in classical family unit situations are eating their meals at separate timings. Modern day busy lifestyles have much to do with this change. Dining out, especially for millenials, is becoming much more of a treat than it used to be. And consumers are seeking fresher food items to prepare at home.
Traditional American fare is losing its’ grasp as taste buds are expanding. Consumers are seeking more exotic flavors to satiate the appetite. They are looking towards world cuisine, as well as, artisanal foods to “upgrade” typical American foods like hamburgers, potato’s and beans to name a few. Additionally, trendy ways to prepare foods such as sous vide and liquid nitrogen chilling are being sought in restaurants to add a punch of flavor to foods. Frozen dinners are no longer in vogue as Americans who are eating alone at home are seeking freshly prepared or chilled meals.
Food consumers are looking towards fresher food products as they associate that with healthier eating. They are steering away from foods with chemicals, pesticides, antibiotics and are leaning more towards certified organic food products. Foods grown and harvested in the states are also preferred over imports. Wording on labels that are making an impression with consumers are as follows: “cage free,” “grass fed,” “heart healthy,” “100% whole wheat,” “unprocessed,” and “preservative free.” Consumers are also interested in foods with herbs, botanicals, prebiotics, vitamins and minerals in order to improve or maintain good health. Products with ingredients that improve circulatory health, enable weight management, enhance muscle strength and help regulate blood sugar are in demand. It is said that mothers are even more inclined to seek foods deemed healthier based on freshness, safety of consumption, and nutritional value.
As a whole, these insights are comforting to hear especially when you listen to the horror stories of Registered Dietitians of years past who have struggled to have whole wheat bread and fruit on the school lunch menu because parents thought their children would starve with such items on their lunch meal trays. It appears that Americans are waking up to the face that food is the best medicine which is the realization that encouraged many to pursue careers as dietitians. Hopefully this trend will grow as American’s begin to realize prevention is better than the cure.
A few days back, the Greater New York Dietetic Association (GNYDA) held their annual Health and Wellness Conference at the Cornell Campus of NY Presbyterian Hospital. The event featured updates on advances in critical care nutrition, motivational interviewing techniques and how to develop a nutrition communications business. I had the pleasure to attend this event so that I can share some insightful information I gathered during my time there.
Motivational interviewing requires engaging the client, focusing on a desired behavior change, evoking reasons why habits that need to be altered, and a plan of action. For this portion of the conference, Ms. Shelley Mesznick, MA, RD, CDE, CDN a dietitian in private practice for a number of years now, expanded on her knowledge of this technique she uses to assist her clients with lifestyle changes. Engaging and building rapport with clients is necessary to help win their trust and confidence in the services you are providing for them as they go about the arduous path towards change. OARS is an acronym for an effective counseling skill she reviewed that can be of great assistance to outpatient dietitians for the purpose of promoting dietary changes. OARS stands for the following: Open questions, Affirmations, Reflective Listening, and Summaries. In utilizing this skill you are actively listening to the patients story, reflecting on what is being said thereby clarifying the intended meaning of the speaker, and being empathetic to the clients needs. In discussing affirmations, she described them as words of understanding, appreciation, or even a compliment like, “that was a great suggestion!”. She also reviewed the 6 stages of change (precontemplation, preparation, contemplation, action, maintenance, and termination) noting that humans are at varying levels of change on any given day and that dietitians should capitalize on those days when their client exhibits a higher degree of readiness. She also advises to ask open questions and limiting self disclosure to moments where you feel it can be helpful in assisting patient towards goals. Having a conversation with a client should not be the same as talking to a friend. Creating achievable goals, a plan to reach them and scheduling follow ups to monitor their progress is important throughout the counseling process.
Second up were the cofounders of C & J Nutrition, Ms. Stephanie Clarke, MS, RD and Ms. Willow Jarosh, MS, RD who met at Tuft’s Nutrition Communications graduate program. The focus of their presentation was the business of nutrition communications. They discussed tips on pitching queries and stressed the possibilities of networking in this business. When developing a piece for a magazine, they suggest reading 3 to 4 recent back issues to make sure you do not replicate anything they have recently done. You must pitch the story to the editor 3 to 4 months before it is to be published. When contacting editors, communication should be short, sweet and to the point. Starting a blog and guest blogging is a great way to start. Additionally, defining your skill set, creating a logo and creating business cards for networking purposes are necessary components of developing your brand. You can also consult companies with regards to nutrition marketing, social media, etc. Thinking out of the box is key to success in nutrition communications. The speakers noted that they consulted a fashion brand on how to market nutraceuticals in their products.
Finally, Dr. David Seres of Columbia University Medical Center enlightened us on some myths regarding nutrition in critical care. First off, he disputed the use of albumin as a marker of “malnutrition.” He stated that low albumin levels are related to a redistribution of the protein which gets the signaling molecules to call out to the white blood cells. Hypoalbuminemia is a good indicator of severity of illness. As always, it still stands that enteral nutrition is superior to parenteral nutrition in critical care nutrition, as long as the gut works! He reports that even patients with severe pancreatitis can be fed via NG or NJ routes successfully. Dr. Seres pointed out that gastric feedings have been shown to increase pulmonary immunity in mice. Regarding aspiration, he stated that everyone aspirates and the best ways to avoid pneumonia is to follow proper head out of bed protocol, monitoring for dysphagia, noting abdominal distention and gastric residuals in excess of 500cc. Early enteral feeding promotes better outcomes in critically ill patients but feeding a patient too early could lead to disastrous outcomes like refeeding syndrome. When is it too early to initiate feedings? It is when a patient is not well resuscitated or perfusing well. Some ways to determine whether these criteria are being met are checking lactic acid levels, pulse and urine output. Parenteral nutrition should be used when there is gut failure and the patient is severely malnourished or requires TPN for greater than two weeks. Short term PPN should only be used, “… to resolve refeeding abnormalities when central line is delayed.” There is a greater complication rate and cost with the use of parenteral nutrition versus enteral nutrition. Some other myths regarding nutrition support in critical care that he disputed were as follows: diabetic tube feeding formulas improve blood glucose control, protein restriction in renal failure, and presence of bowel sounds for diarrhea.
January 21, 2013
The Practice of Dietary Supplementation
There is much truth in Hippocrates words, “food is thy medicine,” but sometimes, a little dietary supplementation can be of benefit in preventing and treating some medical conditions. It is also advocated by the Academy of Nutrition and Dietetics that there are times when dietary supplementation can be deemed beneficial in patient care. Recently, the DPG group Dietitians in Integrative and Functional Medicine held a webinar entitled, “The Science, Art and Practice of Dietary Supplementation.” The speaker during the event, Ms. Mary Beth Augustine, RD, CDN is a Senior Integrative Nutritionist with Beth Israel Hospital in New York. She shared her knowledge and expertise in choosing supplements wisely and appropriately to help enhance patient care. Of utmost importance it is necessary to seek dietary supplements that are safe and reliable.
The FDA defines a dietary supplement as any product that is taken by mouth and contains a dietary ingredient that supplements the diet. The dietary ingredient can be a vitamin, mineral, herb, amino acid, metabolite or enzyme. The world of dietary supplements is not strongly regulated by the FDA which can pose problems for consumers. Luckily, there are resources and techniques that can be used to locate the best quality dietary supplements available for your patient. Additionally, some companies voluntarily partake in the FDA regulatory auditing system called Current Good Manufacturing Practices (cGMP) where their products are subjected to testing for quality, identity, strength and purity. It should be noted on the dietary supplements label that it undergoes such testing. If the vendor does not provide such testing for it’s products, you may present them with a sample audit form that they may fill out to your qualifications. Integrative Medicine-A Clinicians Journal or ICMJ pieced together such a form that can be used for this purpose. It is also beneficial to obtain proof of evidence for product, raw material and stability testing of the supplement. Another venue to investigate is consumerlab.com which analyzes these substances in their laboratory and reports their findings on their website.
Ethical considerations are especially important in deciding whether to recommend a supplement or not. Would the supplement cause more harm than good? With the high costs of supplements, is it justifiable to recommend such a product to your patient? Of course, it would be prudent to review evidence based medicine information on dietary supplements you are considering recommending. The Natural Medicine comprehensive internet database provides a wealth of information on different herbs/botanicals from uses to safety considerations. They also provide knowledge on the scientific evidence supporting or disputing the uses of the herb for medicinal purposes. Ms. Mary Beth Augustine did encourage attendees to not solely rely on the western scientific analytical method of deciding whether a supplement would be appropriate or not. She notes that, “practice based wisdom,” is also an essential tool in the decision making process. Also, the patient should be actively involved in deciding on supplement usage. As the speaker noted, there is a paradigm shift in the way health care practitioners are relating to their patients. Patients’ are becoming more involved in the decision making process. Therefore, it is suggested Dietitians review the research and discuss findings with their clients and allow their clients to make the final decisions on what to take or not to take.
In educating patients on the different dietary supplements that may be useful for their medical condition, it is always important to stress that there is always an assumption of risk no matter how safe the dietary supplement appears to be. For instance, it was previously thought that St. John’s Wort was very safe to take but it has recently been found to interact with protease inhibitor drugs. It is also necessary to provide start and stop dates. An example given during the webinar was a patient who had been taking vitamin B6 supplements for years and developed neuropathy leaving practitioners to question whether it was excess vitamin B6 or diabetes that resulted in the patient’s condition. It is advisable to start with the lowest effective dose for a supplement and increase as tolerated/needed. And when documenting dietary supplement usages, do not use words like treat or diagnose such language is intended for physicians only. Structure and function claims are better suited for documentation of these medicinal products by Dietitians. For instance, “feverfew _______(optimizes, enhances, supports, aids, maximizes) treatment of migraine headaches.” Overall, dietary supplementation can be a useful addition in a patient’s medical treatment plan. Diet changes should always be the first step in the process and dietary supplements can be added as deemed appropriate. It is essential that safety, purity and integrity of the product be confirmed and specific brand names associated with these supplements should be provided to clients. It is also the Dietitians responsibility to adequately educate the patient on the risks involved with the supplement and document appropriately.
November 26, 2012
Citicoline: Supplement for the Brain?
Citicoline is a novel nutrient with the potential to treat a variety of neurological dysfunctions. It is already being prescribed by physicians in some countries to help treat such conditions. Citicoline is well absorbed via oral and IV administration. It can also be obtained through a variety of fresh food sources. Either way it crosses the blood brain barrier and is broken down into cytidine and choline. Cytidine is necessary for the formation of nucleotides and both are required by the structural components of neuronal cellular membranes.
In the event of neuronal cellular damage, as would be the case in ischemic stroke or other type of brain injury, the release of certain chemicals such as free fatty acids, glycerol, and arachidonic acid occurs. Additionally, toxic metabolites and free radicals are accumulated causing further damage to the brain. Supplementation with citicoline can help sequester this process. The methods which are known to be implemented for this effect include promoting the synthesis of acetylcholine, phosphoplipids, and halting the free fatty acid accumulation that can lead to more extensive damage. The phospholipids that are generated with the assistances of citicoline are required to maintain the structural integrity of the neuronal cell membranes. Studies have been conducted with mixed results regarding the benefits of citicoline on problems related to neurological dysfunctions. Some small animal and human studies have found beneficial effects of the afore mentioned supplement on conditions like Alzheimer’s disease, learning and memory,eye and mental health as well as appetite control. More studies need to be conducted to validate these results. Recently, the largest clinical trial conducted on the effects of citicoline on stroke was completed. Unfortunately the results were not promising as they proved that citicoline was not protective against the damage incurred following a stroke. Overall it is known to be a safe supplement to take for a period of 90 days. Safety of long term use has not been established.
Endres, Irfan, ND, and John R. Endres, ND. "Citicoline: A Novel Therapeutic Agent with Neuroprotective, Neuromodulatory, and Neuroregenerative Properties." Natural Medicine Journal 2.6 (2010): 11-24. Web. Kamel, Hooman, MD. "Citicoline Disappoints as a Neuroprotectant After Ischemic Stroke." Online posting. Journal Watch. N.p., 17 July 2012. Web. 26 Nov. 2012. <http://neurology.jwatch.org/cgi/content/full/2012/717/5>.
Laidlaw, Sarah H., MS. "Citicoline: A Promising Dietary Supplement for Preventing Cognitive Decline." Integrative RD 13 (2011): 32-34. Prin
November 13, 2012
Part Two: My FNCE 2012 Experience
Following the DIFM Pre-FNCE workshop, I attended the opening ceremony which included an address by keynote speak Mr. Dean Karnazes, an ultra marathon runner and successful businessman. One of his claims to fame was a three day non stop run that he was able to accomplish because of a unique ability to metabolize lactic acid in such a way that he does not get fatigued. Well, his story of perseverance and endurance was meant to inspire the nutrition professionals in attendance to take charge as they forge ahead in their careers. I also attended two networking events while I was there. The events were hosted by the Nutrition Entrepreneurs DPG and Renal Dietitians DPG. It was interesting to see what other dietitians around the country were up to and how they were going about enhancing their careers while having some fun. Finally there were all the wonderful lectures I had the pleasure to attend. Below I have outlined some of the major points that I felt were notable to mention of the things I managed to pick up while I was there:
“Calling All Food Bloggers: Stay in the Game” Toby Amidor Dana Angelo White
--- 70% of households cook their meals at home. --- RD's should be food blogging ---- Tweet at least once a day ---- Put up your blogs/tweets early in the morning as most people like to check their facebook/blogs early in the day. This will help drive traffic to your site. -- have a separate fan page on facebook for your blogs and advertise your posts on that page versus your own page
“Forewarned if Forearmed: Legal Use of Social Media” Debra King Stephen Stromberg
--- Do not give personal diet advice on social media forums. Take it off facebook and discuss in private. Even if they are friends!! -- Do not plagiarize and make sure you give credit to your sources.
“The Dollars and Sense of Telehealth: Designing Programs to Maximize Effectiveness” Mary Ann Hodorowicz, MBA, RD, LDN, CDE Joanne Shearer, MS, RD, LN
--Telemedicine and telenutrition are gaining ground. -- You can actually obtain reimbursement for online nutrition counseling but you have must contact the individual insurance companies. Some may only reimburse with the use of video conferencing. -- Make sure you contact whatever states you choose to take clients from for their rules and regulations regarding telenutrition services.
“Cancer Survivorship and Energy Balance: Going Beyond Obesity” Suzanne Dixon Lee Jones
--- The percentage rate of cancer survivors has increased in recent years. --- Improved fitness levels can improve survivorship further --- Your fitness levels decrease by 10% every decade normally --- Fitness levels decrease by 10% following 12 weeks of chemo in patient --- Mice studies have shown that when combining exercise with chemo treatments you have a marked decrease in the rate of tumor progression.
“Myths and Mysteries: Dietary Intake and Diabetes” Amy Campbell Osama Hamdy
--- There is no standard Diabetes Diet!! --- RD’s should individualize diabetic diet therapy --- High protein and low carb diets for the first two years is recommended (unless patient also has renal disease) --- Higher protein diets lower blood glucose lab values, improve cardiovascular health and any change in GFR is not significant. --- Change in GFR with diabetic patients is more related to sodium intake than protein.
FNCE (Food and Nutrition Conference and Expo) 2012 was held earlier this month at the Pennsylvania Convention Center located in the hub of Philadelphia. Thousands of Nutrition and Dietetics professionals from around the country traveled for the incredible educational and networking opportunities this annual event provides. The expo provided an opportunity for food companies, authors and organizations to showcase their products and services. Additionally, the expo lightened up the mood of the conference by giving out food product samples, gifts and prizes. My favorite was the stability ball that was gifted by Pepsico after you visited several of their booths and answered several questions relating to their products. They put a clever spin on the word PLAY which they used as an acronym for Protein Liquid Activity and You to promote physical activity and show how their products (i.e Gatorade chewables) can help in achieving optimum nutrition for physically active people. I jump started my FNCE experience by attending the pre-FNCE workshop entitled, “Integrative RD: Nutrition as Medicine Confronting Cardiometabolic Syndrome,” hosted by the dietitian practice group called Dietitians in Integrative and Functional Medicine (DIFM). Several speakers discussed a holistic approach to combatting cardiometabolic syndrome which is associated with central obesity, hypertension, high triglycerides, low HDL and elevated blood glucose levels. Dr. Mark Hyman, the first speaker of the event, discussed functional medicine as it relates to cardiometabolic syndrome. Functional medicine, according to Dr. Mark Hyman, views illness in the body as a systemic disorder and not as a disease. In relation to heart disease, he states that 90% of such cases can be prevented through lifestyle changes. Less than 1% of Americans are said to ,”…. fill the criteria for factors that are good for cardiovascular health.” And he noted that more people die from physical inactivity than from smoking. He also briefly spoke about how toxins and food can effect our DNA and thereby lead to illness or improved health. For example, high levels of lead in the environment can increase the incidence of stroke by 151%. The body as a complex system requires a non- linear understanding of its’ functioning which is vastly different from the linear thought processes that can be used to understand mathematical concepts. Dr. Mark Hyman also discussed how simple lifestyle changes can be more effective than medical treatments like Avandia or insulin which are said to increase the risk of death. He also discussed how fecal transplants have been shown to be successful for insulin resistance. Statins supposedly increased the risk of diabetes in patients per Dr. Hyman. Lifestyle changes are said to decrease the incidence of diabetes. Effective techniques to bring about these changes for overall improved health are food journaling and group therapy. Another technique called Emotional Brain Training (EBT) was described by Ms. Laurel Mellin, MA, RD, cPhD. According to Ms. Laurel Mellin, it takes one year to rewire your brain. Stressors in a child’s parents life can lead to faulty conditioning thereby causing unhealthy relationships to things like food. The first three years of life is crucial in this regard as that is when 70% of a child’s brain wiring takes place. This wiring leads to a persistent brain state that provides an emotional set point. The goal of EBT is to shut off the emotional drive and rewire the brain from stress to joy so that psychologically healthier choices can be made in relation to food or anything else. Registered Dietitians can obtain certification via an 18 month distance learning program. Information on this can be obtained at www.ebt.org. Ms. Kathie Madonna Swift, MS, RD, LDN discussed how sometimes normal isn’t optimal and that investigative work and clinical wisdom should be implemented by the RD in assessing the patient. Things are not necessarily clear cut because as mentioned before the biological system of the body is complex. And then finally, the last speaker Ms. Coco Newton, MPH, RD, CCN gave a brief overview of the nutrition focused physical exam and encouraged participants to examine the patient and to take mental notes of any physical observations and research any unique findings. She reported that waist to hip/waist to height ratios are better predictors of the risk of cardiometabolic disease than BMI. Here are a few of the many things she pointed out during her lecture: - The skin and liver have the same detox processes - Low Essential Fatty Acids can lead to impaired wound healing, dermatitis, and photodamage. - Some signs of vitamin B12 deficiency are vitilgo and hyperpigmentation. - Low Vitamin D can lead to Calcium and Phosphorous malabsorption causing rickets and osteomalacia. - Hypercalcemia can lead to calcification of kidneys - She also promoted the site nutritionfocusedexam.com as one resource to gain additional knowledge.
Stay tuned for the second part of my FNCE experiences………
Cranberry is a fruit that can be useful in preventing bacterial infections, managing cholesterol, wound healing and with cancer. The Native American peoples were well aware of the health promoting and healing properties of the cranberry fruit which is indigenous to the North American region. Dr. Amy B. Howell, an associate research scientist at the Marucci Center for Blueberry and Cranberry Research at Rutgers University in New Brunswick, NJ wrote an article in the recent issue of the Dietitians in Integrative and Functional Medicine (DIFM) newsletter entitled, “Health Benefits of Cranberries-It’s not just UTI’s anymore!” where she discussed this subject. She also lectured on this same topic at the 2011 Food and Nutrition Conference Expo (FNCE) DIFM breakfast meeting. And of course, as she further explains, the potent phytochemicals found in the fruit are responsible for it’s health promoting properties. According to Dr. Amy Howell, the phytochemical known as polyphenolic proanthocyanidin (PACs) is responsible for preventing bacterial adhesions that lead to UTI’s, stomach ulcers and oral health issues. The PACs found in cranberry are unique to those found in foods like grapes and chocolate because of its’ distinct type of chemical linkage that disrupts the bacterial adhesion process which is the first step towards infection. As such, these PACs work differently from antibiotics as they do not kill bacteria and therefore bacteria is not apt to form resistance against these chemicals. Regarding dental health, even advanced cases of periodontal disease benefitted from cranberry extract per Canadian researchers as reported by Dr. Howell. Apparently cranberry has a powerful effect on bone formation in periodontal disease. The combination of phytochemicals found in cranberries may prevent cardiovascular disease (CDV). In one study noted in Dr. Howell’s works, participants consuming a little over 8oz. of a low-calorie cranberry drink containing 27% of pure cranberry juice over a 12 week period showed a significant increase of high density lipoprotein levels (HDL) in overweight men. Higher HDL levels are typically associated with reduced risk of CVD. Cranberry is also suspected to exhibit anti-carcinogenic properties as some research has suggested a reduction of tumor growth and protection against cancer. To benefit from the healing nature of cranberries, Dr. Howell makes the following recommendations regarding cranberry products: 1.) When seeking cranberry supplements, look for those made with whole cranberries and carry the United States Pharmacopeia (USP) or Good Manufacturing Process(GMP) stamp of approval on the packaging. 2.) Cranberry drinks should containing at least 25% of 100% cranberry juice. 3.) Approximately 1 cup/day of sugar sweetened or a low calorie cranberry cocktail drink is beneficial. 4.) 2oz. of 100% pure cranberry juice added to other juices to improve taste can be used as an alternative to cranberry juice drinks.
Howell, Amy B. "Health Benefits of Cranberries-It's Not Just about UTI's Anymore!" Food and Nutrition Conference Expo Dietitians in Integrative and Functional Medicine Breakfast. San Diego Convention Center, San Diego. 26 Sept. 2011. Lecture. Howell, Amy B. "Health Benefits of Cranberries-It's Not Just UTI's Anymore." Dietitians in Integrative and Functional Medicine 14 (Sept. 2012): 49-51. Print.
August 19, 2012
Dietary Management of some Cancer and Cancer Treatment Related Issues
-Increase the intake of foods high in B-complex vitamins, vitamin C, protein and iron. Long term supplemention of Iron is discouraged. Small meals every few hours is advised. Aversion to foods/Anorexia/Cachexia/Colder Food Preference -Appetite stimulants and small feedings throughout the day are recommended. If patient finds food to have a metallic taste, using plastic utensils, ginger ale and/or mint may help to mask that. Try different seasonings. If patient is found to have an aversion towards meat, encourage consumption of poultry, fish, legumes and dairy products. Cleansing the palate with baking soda and water or salty water before meals may help. Nutritional supplements to help increase nutrient intake can also be used. Some patients may better tolerate colder food items. Dental cavities -Being extra diligent about good oral hygiene, avoidance of sweets, and the use of sodium fluoride three times a day is recommended to help prevent cavities in cancer patients. Constipation -Increasing fluid and fiber intake as well as getting extra fiber into the diet can help. Hot drinks and milk (if tolerated) are said to be helpful as well. Diarrhea -Patient should be encouraged to limit consumption of the following items: sorbitol, sugar substitutes, caffeine, carbonated drinks, and foods which are fatty, acidic, gas forming or spicy. The patient should be monitored for development of lactose intolerance due to the illness or associated therapies. If patient is lactose intolerant, dairy products should be avoided. Foods which may be helpful for those suffering from diarrhea include potato’s, skinless chicken, rice, and eggs. Nausea/Vomiting -Bland foods are recommended for patients experiencing nausea. Also small meals throughout the day and drinking fluids between meals can be helpful. Extra hydration is also advised prior to and following chemotherapy treatments. If patient is vomiting, following the episode patient should sip liquids every 10 to 15 minutes. Additionally, “flat” carbonated drinks can provide some relief.
Escott-Stump, S. Nutrition and Diagnoses-Related Care. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins:2012.
August 12, 2012
MNT of Head and Neck Cancers
The grouping, “Head and Neck Cancers,” is descriptive of the cancers found in the following areas: esophagus, lips, mouth, salivary glands, pharynx, nasal sinuses and lymph nodes. Diets low in fruits, vegetables, zinc, folate and selenium, as well as, obesity and tobacco use predisposes individuals to these cancers. General symptoms of this type of diagnoses include voice changes, dysphagia, or persistent lump or sore throat that will not heal on it’s own. Chemoradiotherapy ( a combination of chemotherapy and radiation) treatments are usually employed in the treatment of head and neck cancers. The chemotherapeutic drugs Cisplatin, Carboplatin, and/or Taxol along with radiation is usually given over several weeks. This type of therapy can lead to conditions like mucositis, odynophagia, and dysphagia which make it difficult to eat and therefore obtain the required nutrition to deal with these illnesses. As such, the expertise of dietitians and speech pathologists in providing supportive care is invaluable in improving patients quality of life.
Prior to treatment, an RD should evaluate the patients nutritional status. The main goal of nutrition therapy is to limit weight loss and help to prevent malnutrition. It is highly recommended that these patients have a PEG feeding tube inserted prophylactically to help meet patients nutrient needs without disruption to the treatment plan. Before the onset of treatment, patients are encouraged to gain weight via a high calorie and high protein diet. As treatment progresses and symptoms resulting in poorer oral food intake take into effect, PEG feedings should be implemented to assist in meeting nutritional needs. Tube feedings high in omega 3 fatty acids and arginine are recommended. When and if food is being consumed orally, it is advised that patients follow a soft bland diet plan. To help encourage oral food intake, fluids should be consumed between meals. High calorie and high protein nutrition supplements are recommended to improve nutritional intake. As the treatment progresses, diet consistency will need to be downgraded to liquid or pureed consistency as required. Eventually patients diet will be advanced as tolerated to soft and then to regular. Patients should visit the speech pathologist before and after treatment is completed. In so doing, patients will be educated on, “compensatory swallowing strategies,” as well as electrical stimulation to improve swallowing as needed post treatment.
Cheek, B. Scott, MD, Eric Nadler, MD, MPP, Caroline Nickel, MS, CCC-SLP, and Andrea Nguyen, MS, RD, CSO, CNSC. "Head and Neck Cancer: A Multidisciplinary Approach to Treatment." New Frontiers in Oncology Symposium. Texas, Dallas. 27 Apr. 2012. Lecture. Escott-Stump, S. Nutrition and Diagnoses-Related Care. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins:2012
July 10, 2012
Nutritional Intervention in Cancer Cachexia
Cancer Cachexia is a wasting syndrome that over half of cancer patients will experience. Some of the symptoms of cancer cachexia include weight loss, loss of appetite, early satiety, changes in taste, ascites, and dry mouth. There are two forms of this syndrome, primary anorexia cachexia and secondary anorexia cachexia. Primary anorexia cachexia is directly related to the disease process while the latter version is a consequence of other factors not directly associated with the disease such as chronic infection, inadequate food intake, and impaired absorption of nutrients among other things. Treatment measures are mainly to improve quality of life and reverse the condition through early detection, nutrition counseling, exercise, medications and treating the secondary causes as well as taking care of their emotional well being. Patients have been shown to benefit from dietary counseling in treating cancer cachexia. When assessing the patient it is important to review the patient’s medical history, medications/supplements taken, weight changes, dietary intake, labs, bioimpedance analysis, skin fold thickness, mid arm circumference, and DEXA scan. Pertinent labs in the nutritional assessment of the patient include transferrin, retinol binding protein, albumin and prealbumin. Patients should be encouraged to consume nutrient and energy dense foods. High calorie nutrition supplements are also beneficial in treating this condition. Exercise can help build lean body mass in these patients. For patients with very poor appetites, appetite stimulants like megace, medroxyprogesterone, and prednisolone can be effective in improving oral intake of food. Nutrition support may be warranted in situations where oral intake is not adequately meeting the patient’s nutritional needs. Enteral tube feedings, as always is the preferred method of administering nutrition support if the patient is agreeable to such methods of nutrition support and if the patient’s condition exhibits no contraindications for enteral tube feeds. In cases where enteral tube feeds are contraindicated (ex. bowel obstruction, malabsorption, etc.) parenteral nutrition is preferred. There is some evidence that omega-3 fatty acid supplements may improve appetite and hinder growth of tumors. Additionally, growth hormones, testosterone, melatonin, cannabinoids and thalidomides have shown that they may be beneficial in combatting symptoms such as weight loss and lack of appetite but these benefits have also not been established. Reference:
Granda-Cameron, Clara. "Cancer Cachexia." A Guide to Oncology Symptom Management. Ed. Mary P. Lynch. Pittsburgh: Oncology Nursing Society, 2010. 65-89. Print.
July 8, 2012
Summary of the, "American Cancer Society Guidelines on Nutritiona and Physical Activity for Cancer Prevention"
According to nutrition research scientists and the American Cancer Society, a substantial percentage of newly diagnosed cancer cases could have been prevented with proper attention to food choices and living a more physically active lifestyle. Guidelines set forth by the American Cancer Society for cancer prevention encourage maintaining a healthy weight, consuming 2.5 cups of fruits and vegetables a day, limiting intake of alcohol, tobacco products, red meat, processed meats, and refined grains should considerably reduce an individual’s risk of becoming a cancer victim. The information presented in this blog will discuss some of the American Cancer Society’s recommendations. The predisposition of overweight and obese individuals to cancer is due to alterations in metabolism that effect hormones, immune functioning and inflammation. Levels of obesity have stabilized in women and youth but are on the rise for adult men. Increasing physical activity and limiting caloric intake are encouraged to help with weight loss efforts and chronic disease prevention, including cancer. For adults, it is recommended that they partake in 150 minutes of moderate activity (examples given are: mowing the lawn, walking, dancing) or 75 minutes of intense activity (examples include jogging, martial arts, soccer) a week. Children are encouraged to partake in at least 1 hour of activity each day. Three days out of the week should be allocated for more intense physical activity for these youth. Exceeding these recommendations for all groups could be even more beneficial to health and well being. A 50 to 100 calorie a day reduction of intake from foods should prevent weight gain according the American Cancer Society. Decreasing caloric intake and making an emphasis to eat more plant based foods can help reduce risk of cancer. High fat and sugary foods/beverages should be minimized. Consumers should be aware that just because a food product is labeled as, “nonfat” or “low in fat,” does not assure that the item is low in calories. Increasing fiber through consumption of whole grain bread, pasta and cereal products is encouraged. Additionally, red meat and processed meat products should be limited because of their association with mutagens and carcinogens. In preparing meat, poultry, and fish meals cooking methods such as frying and charbroiling should be avoided. Instead, it is advised that you bake, broil or poach these food products to limit exposure to mutagens and carcinogens like nitrosamines and heterocyclic amines. Processed meats have a stronger correlation to disease risk. These meats are preserved in using nitrates which can lead to disease causing mutations. There is an established link between alcohol and certain cancers and therefore it is advised that men drink no more than 2 drinks a day and women drink no more than 1 drink a day to minimize the risk. If you do not already drink, it is advised that continue to abstain. One alcoholic beverage serving is equivalent to 12oz. of beer, 5oz. of wine or 1.5 oz. of 80 proof distilled spirits. Food contaminants can unintentionally affect our food supply that can indirectly or directly make metabolic alterations that may result in cancer. Some of these include antibiotics or hormones injected into animals, bisphenol A or phthalates that are found in packaging, heavy metals and a fungal toxin called aflatoxin produced by Aspergillus flavus. It is also unclear whether or not organic foods are effective in decreasing cancer risk. For now, the American Cancer Society feels that the evidence is inconclusive and that food recommendations are effective if followed using either organic or conventional food products.
Recently, Bridget Swinney MS, RD, LD, an expert on prenatal and child nutrition, gave a talk entitled, “ You Are What Your Mom Ate: The Prenatal Nutrition Environment and It’s Effect on Long Term Health.” I will relay much of the information presented during this talk via this blog post. She discussed some of the impacts that improper diet and environmental insults can have on the fetus. Women of child bearing age, especially those planning on eventually having children, should eat properly to ensure the health and well-being of any future offspring should they become pregnant. High risk pregnancies can result from improper nutrition and lifestyle choices (i.e. alcohol and or drug use, sedentary lifestyle) prior to the woman becoming pregnant during the first trimester. Visual and cognitive deficits can result from improper distribution of omega 3 and omega 6 fatty acids in the diet as well as low levels of DHA. Additionally, preeclampsia may come about due to improper intake of Mg, Ca, Vit D, Zn, folate, and vitamins B6, B12, D. Inflammation and bone density are also the result of inadequate nutrient intake. Whether the woman is undernourished or excessively nourished, the unborn child has an increased risk of diabetes, hypertension, metabolic syndrome and future weight problems. She defined excessive nutrition as having the following four criteria: generally overweight prior to pregnancy, exhibiting excessive weight gain, high blood glucose and imbalance of a macronutrient. Overweight expectant mothers are more likely to have gestational diabetes, a 60% increased chance of having a child with autism, children with high body fat, among other health issues. Those woman who suffer type 1, type2 or gestational diabetes have an increased likelihood of giving birth to a child with macrosomia which also predisposes the child to health problems later on in life. The criteria used to define undernourished expectant mothers are as follows: being underweight, not able to gain adequate weight, nutritional deficits, and issues with delivering nutrients to the fetus. The undernourished expectant mother will have a smaller placenta which makes it more difficult to pass on nutrients to the fetus. Endocrine Disrupting Chemicals or EDC’s (i.e industrial chemicals, BPA, phthalates) can be harmful to the fetus. These chemicals can lead to low birth weight, obesity, reproductive issues, diabetes as well as cancer. High fat meats and skins of poultry and fish should be avoided as they store many of these industrial chemicals. Heavy metals in the environment can also lead to spontaneous abortions, birth defects and learning problems in children. The fathers diet and lifestyle choices also affect the health of the offspring. Environmental toxins, alcohol, drugs and inadequate antioxidant intake can all affect the quality of the sperm. Having a diet high in fiber improves glucose tolerance and decreases the risk of gestational diabetes according to Ms. Bridget Swinney. She also encouraged lean beef, more specifically the “BOLD” diet or Beef in Optimal Lean Diet which encourages lean beef intake and plenty of fruits and vegetables, whole grains, nuts and beans. She also notes that adequate dairy intake can increase placental weight and reduces the incidence of preeclampsia. To summarize her recommendations, having a nutrient rich diet, obtaining protein from a variety of sources, having a proper balance of macronutrients in the diet, including dairy with probiotics in the diet, consuming healthy fats like DHA, and monitoring weight before and during pregnancy and exercising for at least 30minutes daily should benefit expectant mothers in their goal of having a happy and healthy pregnancy. Check out the link posted below detailing the Institute of Medicines guidelines for weight gain during pregnancy! http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Resource%20Page%20-%20Weight%20Gain%20During%20Pregnancy.pdfYou can also check out Bridget Swinney's websites at www.eatingexpectantly.com and http://www.healthyfoodzone.com/
A few months back I went to an interesting lecture on sports nutrition given by Dr. Felicia Stoler, DCN, MS, RD, FASCM. She is a fellow RD and Exercise Physiologist who has been featured in various media outlets and has a book out called, “Living Skinny in Fat Genes.” She is a strong proponent of meeting your exercise/sports nutrition needs via foods rather than supplements. For one, there is limited regulation on supplements and secondly, with regards to protein supplements for athletes, most can (and probably do) consume adequate amounts from the foods they eat. To optimize athletic performance, nutrition helps but training and getting adequate rest for an event is key. An athlete requires fluids and electrolytes for hydration, carbohydrates for fuel (which can also come from candy), protein for repair, and vitamins and minerals for health. To properly hydrate yourself in preparation for an athletic event requires that you do not rely on the feeling of thirst to determine when you drink water, as it is not a reliable indicator of when you should drink. Sports drinks can be useful when exercising for greater than one hour. They not only rehydrate you but also provide necessary fuel. These sports drinks should consist of 5 to 8% carbohydrates, contain sodium, and consumed when exercising greater than one hour. The following is a breakdown of some of the nutritional tips Dr. Felicia Stoler gave to encourage top athletic performance: 1.) Have the athlete create a food log to determine what diet regimen works best for that athlete. 2.) The athlete should weigh him or herself before and after exercising to determine fluid losses (or if too much fluid has been consumed). 3.) 2 hours before an event/training - Drink approximately 17 oz. of water - Consume a well chewed solid food meal 4.) 1 hour prior to event/training semi liquid or liquid meals are allowed. 5.) 10-15 minutes prior to and during exercise drink 8 to 10 oz. of water. 6.) After 90 minutes of exercise, 8-10 oz. of a sports drink should be consumed every 15 to 30 minutes. 7.) Following exercise, consume 20-24 oz. of water for every pound lost. 8.) During the important 2 hour recovery period, make sure you have a snack consisting of a 4:1 carbohydrate to protein ratio. (examples she gave were chocolate milk, turkey and cheese with apple slices and pretzels, and tuna on whole wheat).
May 14, 2012
Dietary Guidelines for Americans 2010
The expanding girth of Americans has prompted governmental agencies such as the USDA to step up it's efforts in combating obesity. On January 31st of 2011, the USDA and HHS released the updated Dietary Guidelines for Americans 2010. A few months back, I attended a lecture on efforts in communicating and promoting these guidelines by Dr. Richard Post, Deputy Director of the USDA's Center for Nutrition Policy and Promotion. He noted that the focus of these guidelines is to tackle the obesity epidemic
Americans are knowledgeable on how to eat well, they just need guidance in navigating portion control and caloric intake according to Dr. Richard Post. To help out, tools such as those found under choosemyplate.gov were developed. The site helps out with everything from food journaling (which is an effective weight loss tool) to meal planning. And, of course, MyPyramid was replaced with the now famous MyPlate for it's simplicity in assisting with consumers food choices on a meal by meal basis. Games, aprons and other visual tools are being implemented to reinforce healthier dietary habits on the American population.
Caloric balance (calories taken in vs. those expended via physical activity) and choosing foods that are nutrient dense are focal points of these guidelines. Eating more seafood, choosing lower fat dairy products, increasing whole grain consumption and limiting sodium intake are encouraged. I would like to point out that eating healthy should not only be about weight loss. No matter what your size you need to eat well to maintain your well being at it's optimal level.
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