Obese? Canadian Docs Say It’s About Health, Not The Scale

I’ve worked with so many overweight and obese adults and children whose weight was seriously impacting their health: diabetes, hypertension, back and joint pain, the works.  But not all overweight people experience these problems.   Some overweight patients have told me they’re happy with their weight and don’t feel hindered by it.   

As a health professional, I know and see the risks of having too much weight.  But what about the overweight person who has normal blood pressure and lab values, a good quality of life, generally feels good.  They ask, “do I still need to lose weight?”

Not necessarily, say the doctors of Obesity Canada.  The Canadian Adult Obesity Clinical Practice Guidelines (CPGs), a two-year effort by the Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, was authored by over 60 physicians.  They reviewed over 500 published studies and a formed a consensus of both clinical and scientific issues related to weight gain.

These guidelines focus on health & quality of life,                      not “ideal weight”, as goals.

Why I Like These Guidelines

They state the facts:  Obesity is a complex chronic disease that predisposes a person to many disease conditions, including:

  • Hypertension
  • Type 2 diabetes
  • Gout
  • Non-alcoholic fatty liver disease
  • Numerous cancers: colon, kidney, post-menopausal breast, esophagus

They also admit that the causes of obesity are multi-faceted, and can include genetics, individual behavior, metabolic factors, and the person’s living environment impact a person’s weight.  I’d add social factors to this as well.

BUT – and this is just as important – they emphasized that managing it is not all about the number on the scale!  It’s just as much about overall health, quality of life, and lifespan.  Bravo!

One Size Fits ONE!

These guidelines push personalized treatment.  It’s the INDIVIDUAL’s journey, not the physician’s.  Yes, the medical pieces are important.  You can’t advise which road to take if you don’t know where you are.  After that however, being effective takes more: meeting each person where they are at that point in time, how they live, and what their own goals are.  That may include not wanting intervention right then. 

All hands on deck!

These docs admit they can’t do it alone.  Obesity has many causes and therefore needs many components of treatment and a multidisciplinary approach: 

  • Medical nutrition therapy (MNT): Eureka! The physicians of Canada recognize that personalized counseling from a registered dietitian-nutritionist (RDN) is critical!  It’s evidence-based but individually focused.   
  • Exercise: 30-60 minutes of “vigorous” activity on most days. No worries here – remember everything is individualized.
  • Use all appropriate tools: medication, if needed, referrals for cognitive behavioral therapy, even psychotherapy if needed, and bariatric surgery as a last resort.

It’s “Best Weight” Not “Ideal Weight”

“Ideal weight” may be an unrealistic goal for many, especially if they’ve been overweight for years.  That’s OK.  The goal should be better HEALTH first, and whatever weight you are when you’re doing healthy behaviors – whatever weight that is. 

Silver lining: Even losing 3-5% of initial body weight reduces your health risks.  Just do what you can. 

  QUALITY of life is everything!

Cut-To-The-Chase Takeaway

These CPGs don’t give permission to disregard the pursuit of healthy behaviors and lifestyles.  They focus on YOUR best health.  That means striking that sweet spot between doing what you need to do and not leaving out what you most enjoy.  It’s not the same for everyone, so have a chat with your doctor.   The goal is better health, and better QUALITY OF LIFE.  Obsession with the scale isn’t healthy! 

COVID-19 Got You Depressed? Could Probiotics Help?

Whether COVID-19 has you sheltering-in-place, quarantining, or just frustrated by not being able to have your usual life, lots of people seem a little down in the dumps, grumpy, and yes,  even “depressed”.  The “life sucks now” feelings are real, but different from true clinical depression, which can happen for no observable reason. 

Could “Bacteria” Improve Mood?

The right kind of bacteria – probiotics – just might help truly depressed people, even those who on antidepressant medication.  This just-published study reviewed clinical research on the impact probiotic supplements had on people formally diagnosed with clinical depression.  

Probiotics are what give Greek (& regular) yogurt that tangy taste. 

Probiotics are live healthy bacteria, found in cultured foods like yogurt, kimchi, and kefir.  These are different from PRE-biotics, which are various types of dietary fiber found in fruits, vegetables, grains, nuts, and beans.  Prebiotic fiber feeds the growth of probiotic bacteria in the gut.  

What The Results Showed

In the 7 studies that met the criteria for inclusion in the review, all found that probiotic supplementation “demonstrated a significant, quantitatively evident, decrease/improvement of symptoms and/or biochemically relevant measures of anxiety and/or depression for probiotic or combined prebiotic– probiotic use.”  Whether the studies used one strain of probiotics or multiple strains, the results showed improvement in reducing depression symptoms. 

Moreover, in one of the studies that also measured “quality of life”, it increased with supplementation but returned to baseline 8 weeks after the supplementation stopped.

Why Probiotics Helped

If something works, I always want to know WHY, and this paper suggests a mechanism for how probiotics might help depression.

The gut is known to be the center of our immune system, and when probiotics have been found to be useful, as they have with conditions like ulcerative colitis, it’s often because of their ability to reduce inflammation by suppressing the production of some annoying substances, called “cytokines”. 

The gut also is known to connect with the brain via the “gut-brain axis”, part of the central nervous system, so “food and mood”, or the notion that what’s happening in one’s GI tract could impact one’s emotional state has weight behind it.

The “Fine Print” 

It would be great to learn that just by having some yogurt, your mood would soar, but alas, reality must be acknowledged.  These studies looked at persons with diagnosed, measurable depression.  Those who got the probiotic supplements seemed to become less depressed, but those supplements contained higher doses of probiotics than you’d get from a cup of yogurt. 

Tempeh is made from fermented soybeans & contains lots of probiotics, plus protein & fiber!

Probiotic foods and supplements may not be useful mood-boosters if you’re just having a down day, but there are plenty of reasons to eat foods that naturally contain probiotic bacteria, like these:

  • Yogurt, including Greek yogurt
  • Kefir
  • Kombucha
  • Tempeh
  • Miso
  • Kimchi

Look for “Live and Active Cultures” on yogurt and kefir labels, to be sure they contain useful amounts of probiotics. 

“Live & active cultures” guarantees a high amount of probiotic bacteria.

These being dairy foods, they also have a whole lot of essential nutrients we need, especially calcium and potassium, to help fill gaps in most people’s diets.

The main ingredient in kimchi is cabbage, and it’s fermented soybeans in tempeh, so they both have PRE-biotic fiber, too.  Heads up, if you’re sodium-sensitive: Miso and Kimchi can be loaded with sodium.  

Is there a down side to getting probiotic bacteria?   So far, there doesn’t seem to be, especially if you get them from food.  Getting some probiotics daily though, gives you the most benefit, and the study found this as well: depression returned when the probiotics stopped. 

Even if probiotic foods don’t lift your mood, you can definitely feel good about adding some healthy foods to your eating style!

Food Is Medicine…But Some Restrictions Apply

Did Hippocrates really say, “Let food be thy medicine and medicine be thy food”?  Probably not, but he often gets the credit for it.  At any rate, using food for medicinal purposes has been done for years, by your doctor or registered dietitian-nutritionist (RDN), or maybe grandma.  It’s also been the stuff of quackery and unproven hypotheses forever.  Elderberries, anyone?  They’re a good food, but there is no evidence they’ll cure COVID.  And we speak today of food, not supplements.

Quackery aside, here are some foods that have been used to treat various conditions:

  • Chicken soup! From Dr. Grandma, given for colds, flu, and “anytime you don’t feel good.” 
  • Prunes – the original “laxative.”
  • Milk – to calm an acid stomach.
  • Coffee and tea – both contain caffeine to jumpstart the morning (bonus: they’re both loaded with antioxidants)

These foods helped in acute conditions, but taking the next step, could food actually be “prescribed”, like medicine, to treat chronic conditions, such as heart disease, diabetes, hypertension, and stroke?  These diseases may not be diet-caused, but they’re all definitely diet-influenced. We know that eating an unbalanced diet long-term can eventually take a toll on health.  It’s also clear that a lifelong healthful diet reduces your risk for chronic conditions.

Credits: Junan Sonin, Sarah Kaiser, CC 2.0
https://www.flickr.com/photos/juhansonin/14406031184/in/photostream/

 

But…A “Prescribed Diet”?

By definition, it’s a diet that’s personalized for YOU with YOUR chronic condition.  Just as a medical diagnosis can require specific medication, diet-influenced chronic conditions require specific “diet prescriptions”. 

The idea of prescribed diets is gaining traction, because of emerging evidence that such diets can improve health outcomes AND lower health costs. 

This 2019 study looked at whether medically tailored meals for chronically ill persons would impact admissions to hospitals and skilled nursing facilities.  The meals were delivered in “ready-to-eat” form to persons with a variety of chronic conditions who also had various environmental or other barriers (social, income, inability to shop or cook for themselves), placing them at nutritional risk.  The meals were customized to the medical needs of each person, but also incorporated food preferences whenever possible.  

Results?  Huge.

After two years, those who received the medically tailored meals experienced:

  • Nearly HALF the hospital admissions.
  • 72% FEWER admissions to nursing facilities
  • Health care costs reduced by 16%.

Delivering tailored meals is costly, and not everyone needs or wants that approach.  In addition to medically tailored meals, a recent analysis in the British Medical Journal also noted other programs that take a broader approach in order to have a wider reach:

Medically Tailored Groceries

These are for people with chronic diseases like diabetes and cardiovascular disease, who can prepare their own food, but are food insecure.  Specific groceries items are customized by a nutrition professional, usually an RDN, and picked up by patients at a central location, such as a clinic or community center.

The results? 

  • Better adherence to medication.
  • Better blood glucose control in diabetics.
  • Better intake of fruits and vegetables, lower medical costs!

Photo credit: pxfuel.com

Produce Prescriptions

 

Sounds gimmicky but it’s solid.  Healthcare providers distribute vouchers or debit cards for free or discounted produce to food insecure persons with chronic conditions.  They redeem the vouchers at any store that accepts them.

The results? 

  • Better blood glucose control in diabetics.
  • Reduced excess weight, fewer antibiotics in children.
  • Better consumption of fruits and vegetables.

The “Catch”

Most of the research on prescribed diets isn’t very granular, so we don’t know exactly what’s producing these improvements.  Is it the total food package?  Individual foods?  Was it just because they were able to get, and eat, more fruits and vegetables?  Or more nutrient-rich protein foods? 

These unknowns can be problematic, because it opens the door for all manner of charlatans and quacks to tell you they “know” what foods you need to eat to prevent or treat these conditions.  In these programs, food was given out directly or vouchers were provided that limited purchases to the intended foods.  

What if you’re food secure but still have these chronic conditions, what are YOUR options for a ”prescribed diet”?

Credit: Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Medical nutrition therapy (MNT) is your best option, and it’s provided by an RDN – not a trainer, coach, or “wellness expert”.  MNT from an RDN customize your dietary plans, focusing on YOUR foods for YOUR needs, taking into account your food preferences, your food culture, and food budget.  It’s not a new skill for RDNs – it’s exactly what they’ve ALWAYS done, and they have more training in the field than anyone.  Bonus: most insurance plans cover some amount of MNT.

When a Pharmacist Talks With a Registered Dietitian/Nutritionist….

Dr. Jessica Nouhavandi, PharmD, co-founder and co-CEO of Culver City-based Honeybee Health, asked me recently what it’s like to think like a registered dietitian/nutritionist, and a little about my approach to nutrition, food, and eating.  

When did you first start working as a registered dietician (RD)? 

I have been an RD since 1980, so I’m now 40 years in! I was in graduate school back then, working on my doctorate and working part-time as a “relief” dietitian, so I’d fill in on weekends and when they needed someone during the week. It was great because, as a relief, I’d be experiencing all the different hospital units: oncology, cardiac ICU, pediatrics, the works.  

What inspired you to become an RD? 

Nutrition science was my undergraduate degree. I always enjoyed learning how the body worked, and the more I learned about how truly complex it is, the more fascinated I became.  Plus, in a nutrition curriculum, you also learn about food science, not just nutrition. Food science focuses on food before you eat it. Nutrition is what happens once you put it into your mouth.  

How would you say your approach differs from other RDs? 

My approach has definitely evolved over the years, because I keep learning, but also because nutrition is such an evolving science. I came up in a health care setting where the patient was the focus, not the statistics. My kids and families aren’t often “typical,” or they wouldn’t be in our clinic. I always felt I had to dig a little deeper with my patients and their family lives, to see what might be contributing to the child’s nutrition issues. 

There is the “cut-and-dry” approach that focuses mostly on educating people about what to eat and what a balanced diet is. However, just focusing on education doesn’t cut it any longer. It’s about motivating people to make changes. The combination of education WITH motivation can have much more of an impact than education alone.

You have a strong background in pediatrics, including working with children with special needs. Could you please elaborate on your “meet them where they live” approach to working with these children and their caregivers on nutritional issues?

When it comes to changing diets and eating behaviors, you have to remember you’re treating the child AND the caregiver. Caregivers need to know they don’t have to make huge food and eating changes all at once. I also tell them how long they should expect things to take. For a child with autism who eats 5 foods, parents need to know that he may never eat the same way as everyone else, but if he can accept at least two or three foods in each group, that’s enough.  Even that may take a year, and the only thing they need to really do is be patient and be consistent. It’s about baby steps towards improving, not big leaps to perfection. It’s about helping meet the child’s nutrient needs and also helping the caregiver feel he/she is doing their best.

What other chronic illnesses can benefit from particular diets? Can you please elaborate on one example? 

Many kids with ADHD are on medication to help them focus at school and do their best academically. When medication is prescribed, it’s often quite helpful, but there are side effects, the most common being a poor appetite. For these kids, it’s so important to get a solid breakfast into them every day. It might be the only thing they eat until dinner, so it must do double duty if possible, with calories, protein, and micronutrients. Most importantly, I stress that, once it becomes routine, it’s much easier—it’s a learning process. 

You talk about myth-busting when it comes to nutrition. The spread of misinformation has been a big issue with COVID-19 as well. What changes would you like to see to the way health information is shared online? 

One very popular online thing is “immune boosters.” Foods and supplements may “support” the immune system, but only a vaccine will actually boost immunity. That’s what it’s designed to do.  All nutrients “support” immunity, but support is such a vague term that it’s almost meaningless.

There is so much “junk science” online that credible sources get diluted or even lost. Please, follow your doctor’s or medical professional’s advice. It’s easy to get sucked in by celebrities, sports players, or others with high profiles, who talk about what they do, but it’s a huge risk.  Hydroxychloroquine is a perfect example. People are desperate for a COVID-19 cure and this just won’t do it. And anything described as a “miracle” food or supplement should be passed by.  Period.  

Can you please “cut to the chase” and give us your top 5 pieces of advice for anyone struggling to live a healthier lifestyle during these tumultuous times?

Comfort food is perfectly understandable for the short term, but we’re in this for the long haul and we need to get back on track.  Here are some great ways to get started:

  • Protein matters! It comes in plant and animal forms, and unless you’re a vegan, get it from both animal and plant sources. Every meal, every day. 
  • MOVE! It’s absolutely safe to go outside and walk or be otherwise physically active. In fact, you should if you can as long as you wear a mask and keep your distance from others. If the benefits of physical activity were derived from a drug, it would be the most demanded drug ever. It’s not in pharmacies though, it’s in your shoes. Use them.
  • Best diet? Maybe it’s a screen diet. Cut it off at least an hour before bedtime and give yourself permission to do nothing. The world will spin without you and still be there in the morning. You’ll have missed nothing and improved your chance for better sleep.
  • Sleep is medicine, in my book, so for most people, no eating at least 2 hours before bedtime. You’ll have a better quality, deeper sleep when your digestive system isn’t working so hard breaking down food.  
  • Yes, fruit and vegetables are critically important, and there’s no substitute for them nutritionally. Frozen and canned are fine (canned beans should be in every pantry) and they last, but include fresh when you can, too. Summer fruit is unbeatable. Aim for at least 2 cups a day, total, but the more the better.

Anything else you’d like to add?

One thing people ask me about is if I’m a vegetarian or vegan. I’m neither. I eat everything and I don’t like wasting food. That said, people think you have to be strict about being vegan or vegetarian but you don’t. That’s a self-imposed thing, but being a “flexitarian” is perfectly fine.  Or just being an omnivore who sometimes eats vegan or vegetarian meals. It doesn’t have to be either/or. And I’m just glad dark chocolate fits all the above eating styles.

Dr. Jessica Nouhavandi, PharmD is the co-founder and co-CEO of Culver City-based Honeybee Health. Dr. Nouhavandi combines ethics, patient care and passion to create the ultimate patient experience. She earned her bachelor’s degree in bioethics and became a Doctor in Pharmacy from Western University of Health Sciences in 2011. Dr. Nouhavandi left her traditional retail pharmacy to start her own accredited online pharmacy, Honeybee Health, once she realized she could dramatically reduce medication costs for patients by cutting out industry middlemen such as insurance companies and pharmacy benefit managers. Honeybee Health now provides direct access to affordable, high-quality prescription medications to patients—without the need for insurance or coupons. You can read more about her and her company at www.honeybeehealth.com.

And The Survey Says: COVID-19 Changed How We See, Eat, & View Food

During “This Challenging Time” may people’s usual food concerns gave way to more immediate priorities: stocking up on staples like proteins, milk, canned goods and the like.  (Count me in – I bake our bread and I’m one of those who found it hard to find yeast and flour.)   Right after sheltering-in-place (SIP) began, our attention went towards all things comfort: in our food, our home, our down time, everything.

The International Food Information Council (IFIC) conducted their 2020 Food & Health Survey of adults, ages 18-80, in mid-April, during the pandemic.  More than 8 out of 10 of us changed how we ate and prepared food in response to COVID-19.  People under 35 made the most changes – but not all changes were good ones.

Here are other survey highlights about how we see food and health right now:

We’re eating better – or not

More than 1 in 5 say they’re eating healthier, but there’s another group, about 1 in 7, who felt they were making less healthy choices.

We’re cookin’!

About 3 in 5, were doing more cooking at home.  Not a surprise, since most restaurants were closed.  Grocery stores continued selling their prepared foods at a pretty good clip, however, so cooking at home still was still able to be avoided by some.

You can bet that people working from home and now forced to produce 3 meals a day, probably relied more on help from the prepared foods section of the supermarkets.  Supermarket sales in almost all sections of the store were way up.

Got kids?  You got snacking!

More than 3 in 5 (41%) parents with minor children were snacking more than they normally did, vs less than 3 in 10 parents with grown children.  With more kids at home all day, it figures that there will be more snacking going on, and parents serving snacks are probably more likely to join them. Even so, about 1 in 4 said they were now snacking multiple times each day.

What worries us more about food now? 

  • More than half had concerns about eating food away from home or eating food prepared outside the home. Roughly half of survey respondents were at least somewhat concerned about either eating away from home or food prepared away from home (take-out, restaurant deliveries, etc.).  This was somewhat more so for African-American and Hispanic consumers than for whites.
  • Put into simple language, people want to know if the person/persons who made this dish I brought home were careful about proper food safety when they made it.
  • “Food handling/food preparation related to risk of COVID-19” had never been asked in this annual survey, but it became the number 1 concern for consumers, knocking off the top 4 food safety concerns of 2019. On the home front, we’re also washing our fruits and vegetables more.

What worries us less?

  • Food-borne illnesses from bacteria.
  • Chemicals, carcinogens, and pesticides in food.

These were still concerns, but issues related to COVID-19 knocked them off most people’s “top concern” list.  It’s consistent with the huge increase in purchases of items like canned and frozen vegetables – foods that people know are safe and have a long shelf life.

Health vs. Weight: Which Matters to People More?

Health mattered a little more than weight but not much.  Most participants valued both equally, but women and overweight persons put slightly more priority on weight.

More “style” in our eating!

A consistent trend the past few years is following some form of eating style.  Nearly 3 in 5 persons reported trying some type of diet or eating style.  Top reason: to try and lose weight.

Top eating style for 2020?  Intermittent fasting.  It bumped last year’s “clean eating” from first place.  Keto/high fat dieting was third.

The survey offered hope, though. “Nearly 6 in 10 place more emphasis on their overall health now in comparison to how they made decisions a decade ago.”  Healthier weight will follow – another “two-fer”!

Cut-To-The-Chase Takeaway

We CAN and DO make changes to how we eat – if we’re motivated.  Let’s not lose sight of that.  Instead of our motivation coming from fear, let it be wanting to feel better. And knowing we deserve that.

From 9 Top Nutritionists: Positive Take-Aways From COVID-19

In a very short time period, COVID-19 turned how we live upside down.  We’re suddenly living, eating, and shopping differently than perhaps ever before. Has all this impact been negative?  I spoke with 8 nationally-known registered dietitian-nutritionists to get their take on what they think are the POSITIVES that might come out of the current pandemic, what they’ve learned, and a few noted what they’d like to keep from the whole pandemic experience.

Newfound Respect for Some Pantry Standbys

Amy Myrdal Miller hopes people “appreciate the benefits of canned fruits, vegetables, and beans and frozen fruits and vegetables. For too long people have believed ‘fresh is best.’  This points out the reality that canned and frozen foods offer nutrition benefits and convenience.”  If the increased demand for canned and frozen foods is any indication, this appears to be happening.

Neva Cochran agreed, noting that consumers returned to these foods as well as beans, beef, pasta, and others, “that are often mis-characterized as not being healthy or nutritious.”  Since the onset of the pandemic, she continued, “Concerns about buying organic, meat-free, non-GMO, all-natural, no added hormones, antibiotic-free and gluten-free have taken a back seat when people are concerned that there may not be enough food.”

Gratitude was also expressed.  “I’ve never been more grateful for all these non-perishable options – and the farmers who bring them to my table,” said Nicole Rodriguez.  “Whether it’s a simple box of raisins with my daughter during ‘home school’ snack time, cottage cheese topped with a pre-portioned serving of cling peaches, or frozen berries heated up as a makeshift jam,” she said she has a deeper appreciation for fruits in all forms.  As do I, including fresh fruit!  (See my Cut-To-The-Chase Take-Away below for more!)

Isolation – The Good Part

Photo credit: Andrea Piacuadio, pexels.com

Some found appreciations that had nothing to do with food or nutrition.  Chris Mohr’s normal schedule has him on the road constantly.  Being grounded (literally!) has been an unexpectedly positive experience for him, his wife and their two daughters.  “I love the increased level of connection among us.  We’ve each grown closer because we’re not socializing, traveling for work or anything else.  And I will work really hard to keep that up once we are ‘released’ from our homes”.  Probably something we all might focus on.

Having a less structured schedule during isolation has allowed Karen Ansel some freedom.  She’s found that she can do things “at times of day that mimic my body’s natural energy flow instead of when I’m “supposed” to do them.  I’ve been spending a lot of time spinning my wheels trying to be productive at the wrong times of day.” While she realizes all this may change when isolation is relaxed, “normal” life resumes, she does want to maintain take some of this new-realization.  “I do plan to really try to follow my body’s internal energy cues as much as possible.” 

Teachable Moments

If your kids show an interest in cooking, all the at-home time is great for getting into the kitchen with them to practice.   Toby Amidor, author of numerous cookbooks, has found it’s allowed her to, “Cook with my kids in the kitchen and actually see how my girls can cook without me in the kitchen.”  She sees how much they’ve learned from their mom, adding, “Now we are focused on further developing their cooking skills into more complex dishes they want to learn to cook.”  Sounds like “teacher” and her students have both learned something.

Rosanne Rust loves that people are sharing more time with their families in general, but including in the kitchen. “Teaching the kids how to bake, or working together at home, is a win-win for both the parents and the children. Even if at times it seems stressful.”  Good point.  If you’re new to teaching your kids cooking skills, start with goof-proof, entry-level skills: boiling an egg, baking a potato, steaming a vegetable.  Baby steps here!

As a retail dietitian (as in supermarket), Leah McGrath thinks many have gained a new appreciation for how hard supermarkets and restaurants work to make sure there is food available to us.  “Perhaps we won’t forget to take a moment when we’re shopping for groceries or eating out to remember that with a kind word, a smile or, when appropriate, a generous tip.”  Active on social media (@InglesDietitian), she’s using the #QuarantineKitchen hashtag.  “I think many have surprised themselves with their culinary creativity and ingenious substitutions to make meals for themselves and their families.  Necessity is the mother of invention!”

Beyond teaching cooking skills, food has always been part of family culture, too.  Notably, our isolation has occurred during Easter and Passover periods.  Christine Rosenbloom sees this isolation as, “An opportunity for kids and families to learn to cook and bake.  Teaching kids family heritage through foods and sharing treasured recipes,” is something she recommends during all the enforced down time.

I hear that.  Growing up, we celebrated what we called “regular” Easter (the one recognized nationally) and “Greek” Easter (the Eastern Orthodox one, which usually falls on a different Sunday).  This year, I did my part by making this braided Easter bread, like my Greek grandmother made, pictured here. (I hope she’s lenient – I reduced the amount of anise seeds by half and added some nuts – personal preference!)   

Cut -To-The-Chase Take-Away:

I join my colleagues in valuing all those pantry staples people have forgotten or dismissed.  They are – and always were – safe and nutritious to eat.  BUT…SO IS FRESH PRODUCE! 

Moreover, farmers need your help!  Many are plowing under or discarding perfectly good crops because of lower demand by consumers too afraid to handle and purchase fresh fruits and vegetables. 

You CANNOT get COVID-19 from food.  Why?  I explain it to you backed by facts!) in a previous post here.  So, when you do shop, buy fresh, too.  Remember – farmers aren’t “first responders”, they’re CONSTANT responders, through all.

COVID-19: 5 Steps To Make Some Lemonade Of It ALL!

Amid a pandemic like COVID-19, the hysteria seems to build and change by the hour.  Businesses are shut, so are many workplaces and offices.  Gyms, malls, anything even slightly optional, not happening.  We don’t know when things will return to normal but the world isn’t ending either.  In fact, there are some real positives for our lifestyle and our health that can come from all this disruption.

Positives?  From COVID-19?  Yes.  The disruptions are forced upon us, but everyone’s at the same place.  Let’s work it.  Here’s where I see the lemonade from “sheltering in place”:

Everyone. Slows. Down.

Less pressure to get all the errands done and on time.  Indeed, none of us can “do it all,” because so much of “it” has been cancelled!  There is also no rushed commute, no traffic snarls, no morning scramble to get kids to school, no mad dash after work to meet friends or get home to make dinner, and fewer errands to run.

Avoid Going Nuts & Enjoy The Extra Time 

It’s time to get to things you’ve been putting off – especially the “me” things that help clear our heads and bust our anxiety.  Some options to consider: 

  • Move it!   No marathons, just get out and walk.  It’s still OK, even if you’re under “shelter-in-place” orders.  You’re not under house arrest, so get on your sneakers and walk as briskly as you can, staying at least 6 feet from others.  About 100 steps a minute – done outside or inside – is considered a “brisk” pace and that’ll get you a mile for every 20 minutes of walking.  Or ride a bike, dance to a video, or do online yoga!  Exercise is well-known as a great mood lifter. It clears your head, gives you a mental boost, and makes life more manageable.  Make it part of your “me” time.  About that marathon though, check out this story of a guy in France who ran the distance of a marathon on his 23-foot balcony!
  • Give yourself a 30-minute “organizing” task. The task may take longer, but spend 30 minutes a day doing it.  That might be de-cluttering your home office desk (the bane of my existence), cleaning out a closet, gathering clothes and knick-knacks to donate, or going through the pantry to throw out expired condiments and food.  You can do it at a leisurely pace and end up with so much extra room!
  • Do fun stuff. Got a hobby you never seem to have time to do?  It’s time, and make it a priority.  Aim for an hour a day here, too.  I hope you make it a habit you’ll continue, even after this all passes.
  • Family meals are back!  Make these a priority, too, and make them last at least 30 minutes.  No technology at the table, just re-acquaint with conversation and socializing.  Some of the best memories of my childhood were sitting around the dinner table with parents and grandparents.  We’d talk about everything: the meal, friends, goals, you name it, and everyone was welcome to participate.  To me, it’s what a family meal should be, but make your own family meal style you’ll enjoy.
  • Rediscover the joy of cooking!  It’s WAY more enjoyable when you’re not pressured.  You can finally get to making those recipes you’ve collected but never got around to trying.  No cookbooks? No problem.  There are tons of great sites online.  Try www.beefitswhatsfordinner for starters.  It’s my go-to resource for all things beef, and their recipes are excellent and don’t require a degree from Le Cordon Bleu.    Check out Dr. Keith’s Pot Roast recipe.  I’d never cooked one before and adapted a NY Times recipe.  Turned out to be lean and the best pot roast I’d ever eaten!  The prep doesn’t take very long, you just have to be home for a few hours.  And since you’re home anyway, enjoy the aroma and eat the reward – and it stretches for more than one meal!

CHOCOHOLICS REJOICE! It’s Healthy(ish)! Here’s the Evidence!

I love chocolate, particularly dark chocolate.  I make no apologies, and the more I learn about chocolate and the cocoa bean, the more I realize no apologies are needed.  It’s no joke, cocoa has health benefits.  Indeed, if I ruled the world, dark chocolate would be a deductible medical expense. 

Perhaps the science isn’t quite sufficient to justify chocolate as a deductible medical expense, but it ain’t junk food either.  There’s enough info on Theobroma cacao to warrant treating it with respect.  

What Makes Chocolate “Healthy-ish”?

Chocolate is loaded with antioxidants.  It contains flavonoids, a group of phytochemicals with anti-inflammatory powers and benefits for the immune system.  There are several subgroups of flavonoids, such as anthocyanidins that give foods like Concord grapes and red cabbage their purple color, and flavones, found in celery and bell peppers.  It’s the  flavanols however, that give chocolate (and other foods like tea and blueberries) it’s healthful properties.

So, What’s Chocolate’s Impact On Health?

Improved blood flow: This review of the research studying the combination of eating cocoa flavanols and doing aerobic exercise improved cardiovascular risk factors and vascular function (read: improved blood flow).  Cocoa helps reduce blood pressure by relaxing the walls of the blood vessels, improving blood flow, not only to the heart, but also to the gray matter of the brain.  This doesn’t mean eating a candy bar will make you a genius, but there may be bennies from eating some dark chocolate regularly.

Cholesterol benefits: Cocoa consumption seems to raise the HDL cholesterol (the good form) and reduce the “LDL cholesterol” (the bad one you want less of).  It works best when your total cholesterol levels are high.

Reduces “oxidative stress”: In a just-published systematic review of 48 studies on cocoa, the researchers found that cocoa consumption “plays an important role in the human metabolic pathway through reducing oxidative stress.”  Oh, bring it on.  

What’s oxidative stress?  It’s caused by “free radicals”.  Free radicals in your body can “nick” or damage the cells in arterial walls, making it easy for plaques to adhere and build up, clogging arteries. Cocoa consumption seems to help prevent free radicals from forming.  Ever taste rancid oil or nuts?  You’re tasting “oxidized” food damaged by free radicals.

Adapted from Tuenter, et al.

In the Mood

In this review of studies that looked at chocolate, mood, and cognition, the authors developed a “mood pyramid”.  They placed more general mood benefits from the flavanols at the bottom, since these are benefits associated with flavanols in other foods as well.  Secondary mood benefits appear to come from the caffeine-theobromine combination in chocolate. 

More specific is a possible dopamine effect from a substance in chocolate called salsolinol.  This is emerging research, but the hypothesis is that salsolinol may play a role in the impact of chocolate on mood.  Just how much chocolate you’d need to eat is still unclear. 

The Fine Print

Yes, there is some.  Some of the research found benefits from low intakes of chocolate, as little as 7.5 grams.  Other studies used significantly more however, up to 100 grams a day and produced good results.  (How do I sign up?)

These cocoa flavanols are NOT present in all chocolate foods.  Read labels: if it says, “cocoa processed with alkali” you can pretty much forget getting any flavanols.  This form of cocoa is also known as “Dutch-processed”.  The process makes cocoa appear darker (see photo) and taste a tad less acidic but it blows the antioxidant content to smithereens.  Some chefs and bakers prefer this type of cocoa for recipes.  I do not.  Give me the lighter powder on the right.  I like my flavanols, thanks.

Chocolate isn’t calorie-free.  Solid bars have about 150-170 calories per ounce.  I keep it to a max of 2 ounces a day, but an ounce of good chocolate, at 170 calories, makes for a rich snack or even a lower-calorie dessert.  Fair enough.  Cocoa powder however, is low in calories and the most concentrated source of cocoa flavanols, so use it to make your own hot chocolate.  I sweeten with stevia or a no-cal sweetener to minimize added sugar calories, and often add some cinnamon or other spice (smoked paprika is a favorite of mine).   

Get a high — in percent cocoa.  The most benefits are seen with chocolate that has at least 70% cocoa solids.  Not a problem for me, but it takes getting used to.  Go gradually!

7 Nutrition Myths These Dietitians Are Busting

When people learn I’m a registered dietitian/nutritionist (RDN), they almost immediately start venting their frustrations about food issues. “Every day it’s another thing you can’t do or eat.  One day a food is good for you, the next day it’s bad for you.”  Since confused consumers make no changes, I always try to bust their myths and misinformation.

While consumers may be confused about food fads, RDNs are not.  They’re fed up with them.  They’re trained to spot hype, fads, and myths around a blind corner and it annoys them to no end. I asked some RDNs who have particularly good communications skills to tell me which popular nutrition fads really grind at them.  Here’s what they said:

Carbo-phobia!

Mindy Hermann, MBA, RDN, said straight up, “I wish people would stop thinking carbs are the devil.”  She’s had it with a near universal demonizing of these essential macros. 

Sure, most people eat too much added sugar, but she’s right that all carbs seem to be lumped together, whether it’s whole wheat bread or soda.  “Today it’s keto, yesterday it was Paleo, so many others before,” she said.  “I’m tired of all the iterations of high-protein, restricted carbs.”

Plant “Milk” Deserves No Halo

Nutritionally, plant-based diary alternatives just can’t hold a candle to the nutrition in real milk, according to Salge Blake, EdD, RDN, FADN, professor of nutrition at Boston University and the host of the hit health and wellness podcast, SpotOn! In addition to being a dynamite protein source, “Cow’s milk is chock full of vitamin D, calcium, and potassium, three nutrients that many Americans are falling short of in their diets.”  Dairy alternatives only have these nutrients if they’re added, and they often aren’t.  Unfortunately, says Salge Blake, “plant-based milks may also contain added sugars, adding calories and no additional nutrition to your glass.” 

Salge Blake also sees the affordability of real milk as a win-win.  “When it comes to your wallet, plant-based milks can be at least twice the price of cow’s milk.  For the nutrients and the money per gulp, you can’t beat low fat or skim dairy milk.”  If you’re allergic or vegan, soy is the closest alternative.  Be prepared to pay though.

Stop Kicking The Canned Foods!

Shari Steinbach, MS, RDN, spent years working directly with consumers as a retail dietitian in supermarkets, is fed up with canned foods getting dissed when they offer so many advantages:

  • Sustainability: “90% of cans are recycled and they can be recycled indefinitely.” Linings are safe, with 90% containing none of the controversial BPA.
  • Convenience: They have a long shelf life and that helps prevent wasted food and wasted food dollars.
  • Nutrition: “You can cut 40% of the sodium in canned beans and veggies just by rinsing and draining them,” Steinbach says. Since 9 in 10 people don’t eat enough vegetables, “Canned beans and tomatoes count,” towards scoring enough of this critical food group, and are a, “convenient, nutritious way to balance your diet.”

Want her recipe for quick, veggie-loaded, chili using canned ingredients?  “Here’s a favorite simple chili recipe that I made this week”:

  1. Brown 1 pound of lean ground beef;
  2. Drain and add 2 cans of chili-seasoned beans and 2 cans of undrained diced tomatoes.
  3. Season to taste with cumin or chili powder. “Serve with a green salad and whole grain crackers. Enjoy!”

Don’t Panic If It’s Not Organic

That’s advice from Leslie Bonci, MS, RDN Owner of Active Eating Advice, who is fed up with food elitism.  I see her point.  I spent decades working with low-income families who will never be able to afford organic food.  They shouldn’t worry.  They can still put delicious, nutritious food on the table. 

“What do we even mean when we say clean?” Bonci says, because “clean eating” has no definition.  That leaves every definition up to whomever is spewing it and that’s a perfect recipe for consumer confusion, fear, and doubt.  Instead, Bonci favors creating “an enabled table where foods of all price points have a place.”

White Foods Are Bright Foods!

Liz Ward, MS, RDN, Author of Better is the New Perfect is bugged by all the attention given to putting “only the most colorful fruits and vegetables on your plate.”  Forget colors, she says.  “Instead of worrying about what types of produce are “best,” simply include the types you like, no matter how pale,” Ward advises.  Besides, white, brown, and tan produce, such as mushrooms, cauliflower, potatoes, and bananas, are just as worthy as their brighter counterparts,” are loaded with nutrition.

“And while we’re at it, can we stop shaming starchy vegetables, such as corn, potatoes and peas? They are packed with nutrition and starch is a form of energy.”  It’s true, these foods are hugely important to so many food cultures and have sustained people for thousands of years.  Empty calories they most certainly are not. 

One Diet DOESN’T For Everyone?  Seriously?

“The nutrition belief that I hope goes to its final resting place in 2020 is that a single diet plan, or way of eating, is right for everyone,” declares food anthropologist and nutrition communications consultant Robyn Flipse, MS, MA, RDN.  Looking ahead, Flipse feels personalized nutrition, not fad dieting, holds the most promise in the years ahead.  

Leah McGrath, MS, RDN, corporate dietitian for Ingles Supermarkets, couldn’t agree more.  “It seems like every year we have a new ‘hot’ diet,” she says.  “However, just like our fingerprints,  we should want to and  deserve to individualize our eating plans.” 

Flipse continued, “The one thing we’ve learned from the decades of fad diet trends we’ve endured is that none of them have delivered on what they promised because they have all overlooked our metabolic differences.”  They also tend to be extreme, which is probably why people burn out on them. 

Flipse admits that we still lack the scientific tools to allow us to tailor nutrition to each person’s needs.  Unfortunately, when consumer demand gets ahead of the science, charlatans see an opportunity to market all kinds of pseudo-scientific gimmicks.

Plant-Based Doesn’t Mean Plants-ONLY

This one is mine.  I’ve written about it before and everyone in 2019 seemed to be jumping on this bandwagon.  Thing is, there’s no universal definition of “plant-based!” 

What it DOESN’T mean is vegan.  Eating a plant-based diet doesn’t automatically guarantee your diet is balanced or healthful, either.  Living on soda and chips is a fully “plant-based”, vegan diet.  And it ain’t balanced.  A huge salad with 10 different veggies, some nuts, and crumbled feta or parmesan cheese or a couple of ounces of beef or salmon is not vegan – but it IS plant-based.  Flipse put it best, “I tell people if 50% or more of what they eat is plants, then they have a ‘plant-based’ diet.”

Foodie Alert! Finding New Fruits & Veggies At NY Produce Show

If you want to know what brings out the “food nerd” in this registered dietitian/nutritionist, watch me at the New York Produce Show and Conference.  It’s the “trade show” for growers and distributors of all kinds of produce from all over the country and I jump for joy to attend. 

It’s all fruits and vegetables, but you get a preview of what will be happening for consumers in the months ahead, including many of the new varieties of fruits and vegetables that either haven’t hit the market yet or that are readying for national distribution.  It also give me a chance to speak with the growers themselves and learn what they’re hearing from consumers. 

A few highlights (not compensated — these thoughts are my own):

Convenience Rules 

Consumers like fruits and veggies but they don’t’ want to prep, slice, or peel it.  They want turn-key food, and produce folks realized they had to get on this bandwagon if they were going to get, and keep, people interested in buying and eating fresh produce. 

Everywhere in the exhibit halls were display cases featuring pre-cut “ingredients” like cleaned and ready-to-roast cauliflower and Brussels sprouts, chopped onions and peppers and of all manner of “stringy” veggies (think zoodles but with both winter and summer squash varieties).   

Then there were the new ready-to-eat “finger foods”, mostly cut fruits but there were some surprises.  “Watermelon stix”?  That’s right – watermelon cut in the shape and size of thick French fries!  No knives needed and ready for kids (and adults) to grab from the fridge.  I tasted them and was amazed at how crisp they were.  This owes to the value of plant breeding – new varieties are bred to lose less water when they’re cut and maintain the firmness of the flesh but still have the sweetness you’d expect from ripe watermelon..  They’ll come in both the traditional red and the newer golden varieties, both seedless.

New Varieties of Old (and not-so-old) Favorites

Koru Apples

Developed in New Zealand, grown domestically in upstate New York.  Jim Allen of New York Apple Sales explained that the Koru apple hits the trifecta – it’s good raw, cooked, or baked –yet holds its crispness without turning mushy or “floury”.

I’m a die-hard apple lover and I put this one to the test.  Jim gave me a Koru to take home and I kept it in my backpack for four days to see how it would hold up. When I bit into it I found it amazingly crisp.  A tart, yet sweet flavor with no astringency.  Thumbs up.  Bonus: the Koru has a smaller core, so you can eat more of it with less waste.

They’re available from October through March.  If you see them in your market, grab them. 

 

Honey persimmon

People have strong feelings about persimmons, especially the Hachiya persimmon, shaped like a huge acorn. It’s tricky to eat because it tastes best when it’s really soft, but some people are turned off by the almost gelatinous texture.  Eat it before then, when it’s firm, and it’ll pucker your mouth.  The Fuyu persimmon can be eaten hard, like an apple (it’s one of my favorite fruits and I’ve written about it here). 

At the show I tasted a “Honey persimmon”, a Hachiya variety from Brandt Farms in Reedley, California, that looks much like a traditional Hachiya but doesn’t require softening to eat it.  It’s absolutely delicious.  Dave Maddux of Brandt Farms described it as having a lot of mango notes with a hint of cinnamon and he was spot on.  Production was minor this year but Maddux said 2020 the honey persimmon will be busting out nationwide.  They’re a winter fruit, full of nutrients and antioxidants like potassium, vitamin C and carotene, have fiber and add some great variety to the usual winter fruits.  Don’t pass this one up.  Since they look like the regular Hachiyas, the Honeys will be bagged and labeled.

Brandt Farms also grows the Fuyu persimmon – also known as a “Sharon fruit” and – full disclosure – he gave me a bag of them.  We sliced them crosswise, thinly, spread them with goat cheese, topped with another slice, then rolled the sides in chopped almonds.  Guests at our holiday party went crazy for them.  Thanks, Dave! 

Eating the Dragon

Dragon fruit has been around for years in markets but a big push is on by growers to make them more mainstream.  Dragon fruit is related to the cactus family and the outside betrays a sweet, white flesh inside, studded with tiny seeds.  The taste and texture might remind you of a kiwi-pear hybrid.  Most common are the red ones, but now they share space with a yellow variety.  Nutritionally, it’s got game: a reasonable source of calcium, good fiber, and antioxidants (the red fruit has the same pigment that gives beets their color).  The only drawback: they’re a bit pricey.  But hey, they’re definitely worth trying.  I did, and I liked them.