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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.

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.   

 

Food Fashions: Full-Frontal & Fickle!

It’s coming up on Fashion Week in New York and while that’s all about styles of clothes, foods come into – and go out of – fashion, too.  A previous post dealt with foods that nutritionists never thought would become popular, yet they did just that. 

Now think of the foods that were “in” — for a while.  I actually heard or read these comments recently:

  • “I’m so over kale, already.”  I read this comment by a former editor of a prominent food magazine. (Cauliflower is the new kale, if you’re wondering, but beets are gaining.)  
  • “Cottage cheese? What are you, like, 80?”  (This was said to me and no, I’m not 80 — but hey, nothing wrong with 80!)
  • “A baked potato?  A white one? Are you serious?”
  • “I don’t’ do bread.  All that gluten.  Quinoa is my thing.”
  • “She wants a Cosmo? No one drinks those anymore.”

All the above foods (excluding the Cosmo) are delicious and healthful.  They’re also “out of fashion” (including the Cosmo).  If this sounds a little ridiculous, read on.

Food Fashions Fade, Food Value Doesn’t

People may be “done” with kale, but is it less healthful than it was when it was “in”?  Of course not. It’s a superfood.  A baked potato is one of the best sources of potassium, even better than a banana, and has as much vitamin C as a tomato!  It always has!  Even so, all the buzz is that white potatoes are bad and sweet potatoes are a little better, but still a “starchy vegetable” to be eaten in minimal amounts. (Thanks, Harvard.)  

Fashion eating aside, the nutritional qualities of these foods have ALWAYS been there.  Whether it’s kale or cauliflower, or They’re as nutritious today as when they were first “discovered” by food fashionistas. 

Consider the following:

A healthful Russet Burbank white potato grown in Idaho!
  • Kale is every bit as good for you now as it was when you first tasted it.  It may even taste better now, since all that attention motivated chefs to develop inventive ways of eating kale.  Bravo.
  • White potatoes. Before you were told of their “horrors”, they were a staple food for millions of people from Paris to Poughkeepsie to Peru.  The nutrition they had is the nutrition they still have.  (Check out www.potatogoodness.com for a ridiculous number of facts and recipes. 
  • Bread?  It takes a hit for having “carbs” and gluten, which celebrities tell us are both bad (proof you should never get nutrition advice from celebrities).  Yet, it’s been a staple, indeed, the “staff of life” in many cultures throughout history.  Made with whole grains, it’s also loaded with fiber, vitamins and minerals.  It’s versatile, oh, and people like it. 
  • Cottage cheese?  PLEASE!  If you think it’s only for elderly ladies who lunch, experts disagree. registered dietitian nutritionist and exercise physiologist Jim White is one guy trying to set the facts straight about the value of cottage cheese. “If your goal is to increase lean muscle, mass try cottage cheese with a serving of your favorite fruit after a hard earned workout,” he says. He educates clients that a typical cup of low-fat cottage cheese boasts a walloping 27 grams of protein for those muscles, plus 200 mg of calcium to support bone health.

Sometimes fashionable eating can have benefits.  I love anything that gets people eating more veggies, yogurt, and whole grains of any kind.   But I get concerned that people strop eating these foods when the trend fades and the benefits also go missing from their diets, especially if they replace them with something less healthful.  (Example: plant-based “milks” are more hype than benefit.)

Cut-To-The-Chase Advice

Work it.  Let food fashions motivate you to try a new food.  If you like it, keep eating it!    If it’s nutritious and out of fashion, it’s still just as good for you as it was when everyone else was eating it to be “in.”  Never be intimidated about eating healthy food you like.

For 2019: Beets Go Big Keto’s “King” & “Ya Gotta Have A Gimmick!”

What kinds of diets do consumers want?  My previous post noted the top 3 diets – from a scientific standpoint – but nutritionists say consumers swap what’s safe and sound for what’s fast and flawed, preferring trendy diets like keto and intermittent fasting. 

Pollock Communications and Today’s Dietitian just released their annual survey of registered dietitian nutritionists (RDNs), this year totaling 1,342 respondents, who give their views of what’s tops to consumers. 

,Consumers’ fondness for flashy diets, like keto, is disappointing to RDNs like Dr. Joan Salge Blake, Associate Professor at Boston University and author of the textbook Nutrition and You.  She even says keto will have similar results in the marketplace with the drastic fat-free diets of the 90’s.  Back then, “We saw a plethora of non-fat cookies, (remember Snackwells??), ice cream, and candy products bulging in the supermarket aisles.”  Salge Blake predicts, “We are going to see Keto cookies, ice cream, and candy muscling out low-fat goodies down the supermarket aisles.” She reminds us that fat-free doesn’t mean calorie-free and too many calories of any type won’t help America’s waistline.  

Salge Blake concluded, “Haven’t we seen this movie before?   I think I know the ending.”

Consumers get it right – sometimes

You’ll see from the graphic above that consumers are liking some great foods!  Fermented foods are tops – again.  Good news for yogurt, kefir, kimchi (pictured), tempeh, and other foods that have the great anti-inflammatory properties fermentation often brings.

Other veterans to the list are:

Kimchi: a fermented food that’s tops for 2019
  • Avocados
  • Seeds
  • Nuts
  • Coconut products
  • Ancient grains (think farro and amaranth, among many others)
  • Exotic fruits (like lychees, horned melons, and dragon fruits)

The Newbies

Consumers are “beet”-ing a path to this delicious veggie and high time.  Beets are packed with both nutrients and flavor.  They’re also naturally high in nitrates, which can give a little boost  to exercise endurance. 

Blueberries, a newcomer?  Who’d have thought they’d ever been off the list?  Low in calories and among the best sources of antioxidants, I’d like to see people popping these somewhere into a meal or snack as often as possible.  Fresh or frozen, they’re fantastic. 

Disappointingly, kale got bumped from the #10 spot and replaced by plant-based “milks”.  The “halo” these beverages have is unfounded and kind of ironic, given that there is also consumer preference for “clean eating”, yet these beverages are pretty low in nutritional content, usually have little or no protein, none of the bevy of nutrients natural to real milk, and the only nutrients they do have are usually added. 

Ironically, there is very little of the identifying food in these drinks.  Only 3 or 4 almonds, for instance, are in a glass of almond milk.  Pretty expensive!  The foods these beverages are derived from are fantastic.  Eat almonds, rice, oats, and walnuts.  But milk is a far better beverage for nutrition.  One exception: soy beverages.  Soybeans are high in protein and for my patients who are allergic to milk or are vegan, it’s the closest equivalent.

Amy Myrdal Miller, RDN, president of Farmer’s Daughter Consulting and a member of the elite food organization Les Dames d’Escoffier, has mixed feelings about the survey’s results.  “I love seeing fermented foods at the top of the list. Fermentation creates so many powerful flavor molecules, which can lead to greater enjoyment of foods. But I hate seeing non-dairy milks. Cow’s milk provides so many essential nutrients in a natural, delicious form.”    

Keep in mind, this survey is what RDNs see as the top trends for 2019. Trends aren’t always positive! Facts aren’t always driving consumers’ decisions. Perceived truths are often the drivers, and there is no shortage of myths and misinformation about food and nutrition in the popular media.  

As for that other trendy diet consumers liked, intermittent fasting, isn’t that just a formal way of what we used to call, skipping a meal?

To sum up, here’s the complete list of

  1. Fermented foods, like yogurt
  2. Avocado
  3. Seeds
  4. Ancient Grains
  5. Exotic fruit, like acai, golden berries
  6. Blueberries
  7. Beets
  8. Nuts
  9. Coconut products

Now, make your 2019 about #factsnotfears!