Make no bones about it: Importance of nutrition and skeletal health

It is easy to understand how bones can be overlooked. They are masked by multiple layers of skin, muscle, and fat tissue that captivate our culture’s attention. Social media is speckled with pictures of fit individuals putting their muscles on display, but not often, if ever, does a photo surface of their bone density scans.

However, without bones we would all be a little less stable and a little wobblier. Bones accomplish the obvious by giving a body structure, but they also protect organs, support the muscles we work so hard to tone, and store important vitamins and minerals.

The human body is made of more than 200 bones in various shapes and sizes. Their makeup includes a combination of collagen and minerals, such as phosphate and calcium. The elastic quality of the collagen paired with the toughness from the minerals creates a strong yet flexible framework.  As firm as bones are, that little bit of elastic-give is appreciated when a body takes a spill.

The medical diagnosis for dangerously weakened bones is known as osteoporosis, and the risk for developing the condition is derived from factors both in and out of one’s control. Unchangeable factors include the gender, age, race, family history, and body frame size of an individual. Being female, elderly, of primarily Caucasian or Asian decent, having a parent or sibling with the condition, and/or having a small body frame increases a person’s risk. Additionally, hormone imbalances can be of concern, particularly when involving sex and thyroid hormones, as well as parathyroid and adrenal glands.

A serious consequence of osteoporosis, especially among the elderly, is a hip fracture. A report by the Center for Disease Control updated in 2015 states that annually there are 258,000 hospital admissions for hip fractures among people aged 65 and older. For further information, Physical Therapist, AJ Grzesiak, provided an article found under the Blog section of the website (Treating Pelvic Dysfunction in a Functional Way) where he goes into detail about the importance of pelvic bone and muscle strength for improved quality of life with longevity. 

Thankfully, there are preventative measures that can be taken. When it comes to developing and maintaining healthy bones every stage of life is significant, but emphasis is placed on adolescent growth periods. Parents around the world urge their children to eat right so they can grow up strong. The mineral calcium is especially encouraged, with daily recommendations being up to 1300 milligrams during adolescence, the high end throughout one’s lifetime. Calcium’s prominence in this area became its claim to fame, and turned low fat dairy products and leafy green vegetables into nutrition superstars. However, it does not act alone.

If calcium is the superhero of protecting bone health, Vitamin D is surely the sidekick. This vital vitamin shines like the sun that generates it, working to help the calcium be absorbed from the food eaten, therefore assisting in the renewal and mineralization of bone tissue. Its importance should not be downplayed. Individuals living higher than the latitude of 37 degrees are at greater risk of deficiency, since it is difficult to receive enough sun exposure during the dreary winter months. To put that into perspective, this would include Americans living above an imaginary line drawn from Richmond, Virginia to San Francisco, California.

Adding to this issue, food sources naturally high in vitamin D are limited, with the most common being oily fish, like salmon, tuna or mackerel, as well as eggs and liver. However, for those allergic to these items or those avoiding meat, this poses a problem.  Thankfully, many foods are now being fortified and the general public can get more of this nutrient by consuming dairy products, breakfast cereals, or supplements.

In 2010, the nutrition scene was rocked when enough evidence was provided to increase the daily recommendation for vitamin D.  Individuals between the ages of one to seventy now require 600 international units daily, and those older than seventy require 800. To put this into perspective, 4 ounces canned tuna will provide 350 international units, whereas one hen egg will have approximate 35.

Although calcium and vitamin D reign supreme, there are supporting players equally imperative to creating and maintaining bone integrity.  Notable nutrients include:

-       Vitamin K: Required for the correct mineralization of bone, actually working harmoniously with vitamin D to improve bone density and reduce risk of fracture. You will find it in abundance in dark leafy green vegetables, like spinach, cabbage, and kale, as well as in liver and some fermented cheeses and soybean products.

-       Zinc: Important for the “bone remodeling cycle,” meaning bone tissue renewal. Zinc helps reduce the risk of osteoporosis by assisting cells that build bones up, and slowing down how much bone is inappropriately broken down. Foods known for having zinc include lean red meats, poultry, whole grains and legumes.

-       Magnesium: Although deficiency is rare in well-nourished people, magnesium plays an important role in the formation of bone and should not be neglected.  Since we now know minerals are responsible for bones’ strength, considering 50-60% of the body’s magnesium supply is stored in bones is proof of their merit. Green leafy vegetables, legumes, nuts, unrefined grains, and fish are all good sources.

 It can be observed that various foods are mentioned in this article. A well-rounded diet is crucial for maintaining good health, no matter what the focus. Highlighting the importance of these nutrients does not infer that one should overload, but merely aim for the recommended daily amount. However, if your bones are at risk of being brittle, ensuring that you are receiving enough of these nutrients in particular is advised. In severe cases, laboratory values may need to be taken to see if a vitamin or mineral supplement is necessary.

Adding your favorite greens to a dish brings texture, color, and nutrition.

Adding your favorite greens to a dish brings texture, color, and nutrition.

To do this through nutrition, prepare your meals and snacks to contain maximum bone-enhancing nutrition.  For example, at breakfast have sautéed spinach with your eggs, or choose whole grain cereals with milk if on-the-go. You don't have to plan a meal with every food included. Simply add one or two of the items into your already established favorites. 

The human body is a powerful vessel, and thanks to its bones, can stand a little taller. The United States Department of agriculture provides information about how much of the aforementioned nutrients to consume each day to keep these bones in tip top condition. Follow the link below and select the vitamin or mineral of your choice:

http://fnic.nal.usda.gov/food-composition/vitamins-and-minerals

Since various medical conditions and circumstances can influence bone health, if you have concerns I recommend seeking personalized information from your physician and/or Registered Dietitian.

 

 

 

 

 

 

 

 

 

Information Sources ~ for more specifics on where I found what, just ask :-)
http://ajcn.nutrition.org/content/85/1/300S.full
http://www.ncbi.nlm.nih.gov/pubmed/11684396
http://www.osteoporosistreatment.co.uk/Zinc
https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/risk-factors/con-20019924
http://www.niams.nih.gov/health_info/bone/Bone_Health/Exercise/default.asp
http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html

Sleep and Eating: A relationship worth nurturing

In the media, few topics occupy more screen time and print space than body weight and sleep. Newly released statistics showing growing obesity rates and zombie-like images of sleep-deprived citizens routinely make headlines, each time with a different identified cause. Whether it be work stress, family responsibilities, or a favorite primetime reality show, it is not hard to find a reason to put off sleep or reach for a snack.

The viewer interest stems from the fact that we are all affected. At one point this week, odds are we hit snooze, suffered through a 2:00pm lag, or gripped over an extra pound or two gained.

Among the working class, a sense of comradery is felt between two caffeine dependent employees waiting in line for a coveted pre-work java in the wee hours of the morning. An empathetic glance from slumberous eyes shared, both knowing they are starting another day after burning the midnight oil the evening before.

The inverse relationship between the two is acknowledged – we eat too much and sleep too little. Research is now rolling out the “why” behind this vicious cycle, bringing light to a worrisome trend in a fast paced society. Here is what we know…

In a nutshell, what and how much we eat is driven by emotional, cognitive, biological, and environmental factors.  Researchers Alyssa Lundahl and Timothy Nelson from the University of Nebreska-Lincoln sum it up by saying, “after a bad night's sleep, the hormone controlling appetite is affected, emotional stress is greater, more food is desired to compensate for lack of energy and impulsivity is increased, all of which affect the amount of food that you would consume in a day.”

The main hormones referred to are known as leptin and ghrelin.  

-       Leptin is a protein produced by the fat cells within the body. Once made, your fat cells get used to holding a certain amount. Like a gregarious host welcoming guests, a cell feels satisfied when enough leptin is present. If that cell starts having lower than normal levels (like when a person starts reducing how much they eat to lose weight) it begins to feel deprived. Desperate, a series of signals are sent to try and retrieve what it feels it needs. Despite our best efforts, that nagging hungry voice is heard, telling you to reach for a snack to calm the persistent hunger. Leptin can be a bossy hormone, and doesn’t like when the party isn’t packed.

-       Ghrelin, essentially, is that nagging voice. Leptin ignites the reaction, and ghrelin is called to duty. Produced by stomach acid, this hormone is an appetite stimulant. Meaning, it tells a body it needs to eat, and won’t stop until it gets enough.

In a perfect world, these hormones would work together like a well-oiled machine. When hungry, we would eat the obligatory amount to satisfy our cells and give our bodies just enough energy. After we burn the energy off through exercise and daily living, we would in turn crave the right portion of food to refuel, creating a precise equilibrium and a healthy body weight. Unfortunately, signals can get crossed or misconstrued, and we all know the world, as beautiful as it is, is not perfect.

Human bodies are complicated organisms. Research is discovering that a person who is overweight or obese for their body frame likely has high levels of leptin, meaning they should feel satisfied and not crave more food. The problem is the brain ignores the plea to stop eating. This phenomenon is known as “leptin resistance.”

Little Averie, my niece and sleeping beauty

Little Averie, my niece and sleeping beauty

Of course, how one becomes overweight or obese in the first place may be due to multiple reasons. We can’t forget the other factors that influence our body weight, those being environmental, emotional and cognitive in nature. We tend to develop habits that cause us to reach for food as well. Stressed? Grab a snack. Smell the fresh baked bread? Try a piece. When consistently giving in to these temptations, combine this with a lifestyle that is not conducive to exercise (desk work, anyone?), and the energy conserved starts to outweigh what is being burned. Even if we were getting enough sleep, if we are not controlling these other factors, we still could be above our healthy body weight.

However, we can’t discount the considerable influence sleep has. Now the question is, how much is enough?

In 2004, Dr. Eve Van Cauter and colleagues from the University of Chicago set out to see how a body reacts when sleep deprived for two consecutive nights. They took a group of 12 healthy young men and only allowed four hours sleep each night. When they measured their hormone levels, compared to their pre-study levels, an 18% decrease in leptin and 28% increase in ghrelin was found.

Van Cauter and crew were also interested in looking at the ratio of ghrelin to leptin (meaning how much “hunger” hormone was circulating compared to how much “fullness” hormone). First they study the men’s levels again, but this time after they were allowed 10 hours of sleep per night, for two nights in a row.

What they found was that after a night with four hours of sleep, the ration of ghrelin to leptin increased by 71 percent compared to a night with ten hours in bed. Bluntly put, with less sleep the men were more likely to feel hunger pains.

Additionally, a questionnaire was given to the men, asking them about their hunger levels. Overall, they reported a 24% increase in appetite, with a “surge in desire for sweets, such as candy and cookies, salty foods such as chips and nuts, and starchy foods such as bread and pasta.” We know these as being energy packed. It is difficult to determine exactly why there was an affinity to this type of food, but it could be related to Lundahl and Nelson’s hypothesis that a double whammy is going on: weakened inhibitions on top of a body craving quick energy to make up for its languor.

The National Sleep Foundation (yes, it exists) also has looked into how much sleep is needed to properly function. It varies with age, but the average adult should slumber for 7 to 9 hours per night. In general, the younger you are the more sleep you need. A growing infant requires an astonishing 14 to 17 hours of snooze time.

When we take this information, and apply it to real life scenarios it can feel like we hit a dead end. The problem of carving the time and “turning off our brains” in order to get enough sleep for some people is insurmountable. Plus, if already overweight, falling to sleep and then staying asleep can be arduous. Health complications like sleep apnea (when a person will momentarily stop breathing during the night) is worse when a person carries excess weight about their trunk and neck area. 

So what’s a person to do….are we screwed?  I don’t have the answer for you, but I highly suggest starting small. Clinicians recommend turning off artificial lights, removing all distractions from the bedroom, and being under the covers ready to rest by a certain time…no matter what. CNN recommends 6 minutes of bedtime yoga to calm you down and improve your sleep habits (link to full article found below). Everyone’s lifestyle is unique, so a solution will be individualized.

Sleep and a healthy weight are two peas in a pod. They work together to improve your overall health. Set yourself up for success and make sleep a priority, and like well-placed dominos, your health goals will consequently fall into place. 

 

CNN Article: http://www.cnn.com/2015/03/26/health/sleep-better-yoga/index.html).

National Sleep Foundation: http://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

  

Additional Works Cited:

http://www.sciencedaily.com/releases/2015/06/150601104537.htm

http://www.sciencedaily.com/releases/2004/12/041206210355.htm

http://www.sciencedaily.com/releases/2009/03/090325132151.htm

Sometimes eating healthy stinks....literally: Garlic, onions and prostate health

Does your man have bad breath after a zesty dinner with garlic and onion? If you love him, get over it.

Despite their arguably unpleasant aroma, these allium vegetables’ nutritional benefits and unique taste compensate for their adverse side effect.

Acting as staple ingredients in various cultural cuisines, these vegetables tend to dominate the flavor profile of the dish they integrate. The number of vegetable species belonging to the allium group is vast, with their most notable members being leeks, scallions, onion and garlic.

Their use for medicinal purposes premiered in ancient Chinese, Indian, and Egyptian cultures. While not all nutritional claims have stood the test of time, many have been proven effective through research and have prompted further investigation. Their alimentative qualities in regard to improving cardiovascular health and reducing one’s risk of all-site cancers are well documented, especially among cancers effecting reproductive and digestive organs.

Recently, researchers have taken an interest in allium vegetables’ role in boosting the health of a male’s prostate, therefore reducing his risk of inflammation, benign prostatic hyperplasia (enlarged prostate), and cancer. Complications of these conditions range from mild yet annoying, such as difficulty with urination, all the way to deadly. According to the American Cancer Society, in 2015 it is estimated that 1 in 7 men will be diagnosed with prostate cancer during their lifetime. This alarming statistic has caught the attention of medical professionals, bringing dietary habits into the limelight in hopes of identifying methods of prevention.

Garlic and onion have extensively been studied, and have shown promising results. A 2013 meta-analysis published in the Asian Pacific Journal of Cancer Prevention assessed the relationship between allium vegetable intake and risk of developing prostate cancer among men. In total, 9 research articles were reviewed, and the paper concluded that allium vegetable intake, specifically garlic, was indeed related to a decreased risk for prostate cancer (1). Although weaknesses within the meta-analysis are cited, such as the accuracy of dietary recalls and the small number of studies reviewed, it still gives justification for ongoing research.

Interestingly enough, the science behind garlic and onion’s offensive stench is also thought to be a secret weapon for protecting prostate health. These vegetables contain organic compounds with sulfur attached. Yes, sulfur, the same thing that causes eggs to smell rotten. When garlic or onion is chopped, the compounds are activated and a smell is produced. Currently, researchers are looking into how these compounds may help kill off prostate cancer cells that are trying to reproduce at a rapid pace. At this time, positive results have been seen in rats, but more research is needed to identify how much of these compounds are needed to have an effect on humans.

What is widely accepted is these stinky offenders ability to help reduce platelet aggregation in the body, and therefore reduce the risk of blood clotting and heart disease. As of 2009, heart disease was noted as being responsible for 1 in every 4 male deaths in the United States (2). Reason enough to include garlic and onions in your favorite recipes. As for how to do this, the most beneficial way is to crush or slice the vegetables first, then wait 10 to 15 minutes prior to cooking. This allows time for the powerful, new compounds to form, and not be killed off right away in the heat of the cooking process.

The organic sulfur compounds do not stand alone when working to keep a body in tip-top shape. The exact mechanism that makes allium vegetables so powerful is likely multifactorial, and their high flavonoid and antioxidant content is surely a principle contributor (3).  These compounds are dynamic cell preservers. In combination with a diet including a wide variety of colorful fresh fruits and vegetables, these vegetables work to promote optimal health.

How much garlic and onion one needs to consume in order to reap the benefits is still being studied, but a degree of insight has been provided. A study conducted at the Fred Hutchinson Cancer Research Center in Seattle found that eating a teaspoon of fresh garlic and a half cup of onions each day raised levels of key enzymes used for removing toxins in the blood cells of healthy women. Although the amount needed for men has not yet been directly studied, the authors believe there would also be benefit, but a higher daily dose is likely needed (4).

Next time you devour an allium vegetable-filled dish, don’t be agitated by the unpleasant aroma that lingers, but rather embrace it. It is a reminder that the vegetable are doing its job to enhance your health.

 

 

 

 

 

 

 

1)     Allium vegetables and risk of prostate cancer: Evidence from 132,192 subjects. Xiao-Feng Zhou, Zhen-Shan Ding, Nai-Bo Lui. Asian Pacific Journal of Cancer Prevention. 2013

2) Center for Disease Control. Division for Heart Disease and Stroke Prevention. Found at: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm

3) Hedges, L.J., Lister, C.E. The Nutrition Attributes of Allium Species. Crop and Food Research Confidential Report No. 1814. Found at: http://www.vegetables.co.nz/resources/1files/pdf/booklet_onion_leek_garlic_foodreport.pdf

4) Galland, Leo. "Surprising Health Benefits of Garlic and Onions." Huffington Post: Healthy Living. Found at: http://www.huffingtonpost.com/leo-galland-md/health-benefits-garlic_b_900784.html

Spotlight on Eggs

With spring upon us, the opportunity presents itself to examine a food that has been under scrutiny over the last four decades. Spotlight is on - the egg.

The nutritional benefit versus bodily detriment of the esoteric egg is even disputed among professionals. Eggs have been said to increase one’s risk for a heart attack and stroke, yet in the same breath potentially lower their risk for type 2 diabetes, help increase muscle building after a work out, and are a good source of 11 essential nutrients. So, what is it? Do we welcome them on our plates or toss them aside. Let’s get crackin’.

Few foods are versatile enough to make their way into any dish of the day. Whether as the focal point of a meal or the gel that holds it together, the adaptable egg always gets an invite. To other foods, the egg is that friend who is down for anything.

For breakfast it shines- scrambled, poached, fried, etc. Eggs hit a high note before most of the population jumps out of bed. They bake and sizzle their way onto our plates, holding the weighty role of being the first food your body may greet as it prepares to start the day. For lunch and dinner they are surreptitious, often making their way into cream sauces, pastas and baked goods. They can do double duty, plopping themselves on top of a burger, then deftly blending into the mayonnaise that covers the bun.

Today, consumers are fortunate to have eggs available year round. However, throughout antiquity chickens began to produce eggs come springtime. Conditions were fitting this time of year, when there was plenty of daylight and the temperature was moderate. It is not coincidental that eggs make their way into Seder and Easter plates, since these celebrations take place during a time when eggs are abundant.

Technically, eggs can be laid by numerous female species, including birds, reptiles, amphibians, and fish. For the sake of simplicity, I’m focusing on the prevalent chicken egg. Considering the chicken was one of the first domesticated animals, estimated to go back as far as 5400 BC in China and India, eggs have been incorporated into the human diet for literally thousands of years. Once domesticated, chickens would make the trek across the globe, thus, eggs for everyone!

For most, the savory flavor of an egg has never been questioned. However, the same cannot be said for its impact on human health.  First, the nutritional breakdown: per one large chicken egg, you will find 80 calories, 5 grams fat (1.6 saturated, 0.7 polyunsaturated, 2.0 monounsaturated), between 180 to 200 milligrams cholesterol, less than 1 gram carbohydrate, and 6 grams protein.

The amount of cholesterol found in eggs has been of concern due to the prior thought that excessive consumption from it in food would result in an increase of our very own serum cholesterol levels. However, in 2015, the Dietary Guidelines Advisory Committee (DGAC) released a statement that rocked the nutrition world to its core (or in this case, its yolk?). Since the 1970’s, the medical field advised the public to eat less than 300 mg of cholesterol a day. Considering the average large egg at the time was thought to contain around 270 mg, a person could surpass their daily allotment with a morning Western Omelet. This year, the tables have turned, and the shadow that hovered over the humble egg has lightened. When referring to the 300 mg per day recommendation, they wrote, “The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association/American College of Cardiology) report. Cholesterol is not a nutrient of concern for overconsumption.” 

Bold statement, especially given that the previous recommendation was to limit egg-yolk intake to 3-4 per week. How is the panel of 14 experts in the fields of nutrition, public health, and medicine coming to this conclusion?

A meta-analysis published in 2013, reviewed research studies looking at the connection between egg consumption with coronary heart disease and stroke. After identifying 17 studies that fit their criteria, their work suggests that higher egg consumption (defined as eating up to one egg per day) is not associated with increased risk of coronary heart disease or stroke. However, when taking a closer at just diabetic patients (who are at higher risk for heart disease) the results were not as clear-cut. Oddly enough, they found an increased risk of coronary heart disease among diabetic patients who had high egg consumption, yet a reduced risk of hemorrhagic stroke. Ultimately, they concluded further studies are needed on the diabetic subgroup. 

When I read this, I was left perplexed. On the side of caution, I would assume one would still want to be weary of egg consumption, especially since diabetes can go undetected for years. But wait. Just this week the University of Eastern Finland submitted research to the American Journal of Clinical Nutrition that found egg consumption may actually benefit someone at risk for developing type 2 diabetes.  Researchers followed 2,332 men (ages 42-60) for 19.3 years, and during that time recorded that 432 of those men developed type 2 diabetes. The kicker? They concluded that egg consumption was associated with a reduced risk of type 2 diabetes. In fact, men who ate on average four eggs per week had a 37% decreased chance of developing the disease as opposed to the men who only ate one egg per week. However, eating more than four eggs per week showed no additional benefit.

The mixed messages can be mind boggling, and to be honest we are still getting more research to review. However, some undeniable facts have emerged. According to Dr. Steven Nissen, the Cardiovascular Medicine chairman at the Cleveland Clinic, only 15% of your very own circulating serum cholesterol comes from your diet, and the remaining 85% comes from what your liver makes and sends out. Therefore, keeping your liver healthy is priority number one.

As a whole, there is lack of evidence to support that eggs alone should be limited for improved health. Of course we have to be realistic. Now that I have officially scrambled both yours and my own brain, it is time to assess the big picture.     

      

Don’t judge a food by a single nutrient

      Regardless of the controversy surrounding dietary cholesterol, eggs are still loaded with beneficial nutrients known to support and improve health. They contain high quality protein, caretonoids like lutein and zeaxanthin, choline, B vitamins, and oh so much more. Arguably one of the most important attributes is its Vitamin D content. With 40 international units per large egg, it is one of the few dietary sources where Vitamin D can be found. Given the high prevalence of Vitamin D deficiency among those living in northern climates with little sunlight, this is a crucial fact to make known.

Shift your focus: what else are you eating with your eggs?

      Although dietary cholesterol may be out of the limelight, there is still concern regarding saturated and trans fat’s potential to increase risk of heart disease. It is important to keep in mind what typically is served with your eggs in the morning. If you are choosing bacon and cheese then placing it over a croissant, I hate to burst your bubble but the egg is not the concern in this meal. However, if you added sautéed vegetables to your egg scramble, well you just used it as an avenue to load even more nutrients into your body. Also, think of what else you choose throughout the entire day, not just in combination with the egg. Unless you are deathly allergic to a specific ingredient, the odds of a single food being the cause of your health’s demise are very slim. Reassess all of your choices. It should be noted that when research only collects food recalls, this is a difficult factor to adjust for, and should be kept in mind when reviewing results.

What are you eating in place of your eggs?

      This final point is coming from personal experience. In clinic, I may hear a patient proudly report that they have renounced eggs in their diet, yet as a substitute are now eating cinnamon sugar bagels with light cream cheese. Now, I’m not saying this delicious breakfast isn’t okay occasionally. However, the shift to a food with a high sugar content makes this concerning if consumed on a daily basis.


Rather than fat-shaming eggs, let's learn to embrace them as a convenient, inexpensive way to boost our nutrition intake. No need to go to the "eggs-treme." While more research continues to roll out, I advise keeping moderation in mind. When considering the information available at this time, I personally recommend staying between 4 to 7 per week (which could equate to one egg per day) to get the benefits without over doing it. Enjoy, and toss the guilt aside.





Works Cited:

1) Tinker, Ben. "Cholesterol in food not a concer, new report says." CNN online. http://www.cnn.com/2015/02/19/health/dietary-guidelines/index.ht

2) Ying Rong, Li Chen, Tingting Zhu, et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 2013; 346:e8539. doi: http://dx.doi.org/10.1136/bmj.e8539 (Published 07 January 2013)

3) Jryki K Virtanen, Jaakko Mursu, Tomi-Pekka Tuomainen. Egg consumption and risk of incident type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. The Am J Clin Nutr April 2015. doi: 10.3945/ajcn.114.104109  

4) Herron, Kristin L; Fernandez, Maria Luz. Are the current dietary guidelines regarding egg consumption appropriate? J Nutr. Jan 1, 2004 vol 134 no. 1 187-190. http://www.jn.nutrition.org/content/134/1/187.short

5) Welland, Diane. "Sunny Side Up - Eggs can be part of a healthy diet." Today'sDietitian. Vol. 12 No. 7 P. 22


Carbohydrate: Friend or Foe?

Every decade or so there emerges a new villain in the nutrition world, and I would give this era’s title to carbohydrate. In the 1990’s, fat was shamed, but with the popularity of the Atkin’s diet, fat graciously handed the reigns to its macronutrient reciprocal, carb. However, has carbohydrate truly earned this reputation, or has it been misunderstood?

The thing is, carbohydrate is in the majority of food you eat – and it is there for a reason. Talking chemistry, a carbohydrate is technically the combination of oxygen, carbon, and hydrogen. The same elements that are found in the air you breath, the diamonds you wear, and the nightly stars you admire. I will admit things can get complicated, because carbohydrate can then be broken down into smaller categories, such as starches, fibers, and simple sugars. For now, I’m just going to introduce the infamous component of fruit, pasta, and baked goods (just to name a few).

If you take away the glamour and emotion tied to food, and instead look at it from a primal perspective, food is needed for energy. Without energy, you would not exist. It fuels your body’s movements as well as your mind’s thoughts. Luckily, because it breaks down into glucose, carbohydrate is one nutrient that has the raw materials needed to keep us ticking.

I like to think of carbohydrate as your mother’s favorite child – when it is around, it tends to get all the attention. After devouring a hardy breakfast of buttermilk waffles with syrup, you are now in a “fed” state. Both of these foods are weakly configured and loaded with carb, therefore minimal effort and time is needed to get the glucose to your blood stream.  From here, a cascade of events happen, including the release of insulin to make sure the glucose is used or finds a home. A human body strives for homeostasis, especially when talking about serum glucose (aka blood sugar) levels, and takes this job very seriously. Your blood likes some glucose to keep it company, but gets aggravated when too much of it loiters around. 

As Einstein said, “Energy cannot be created or destroyed, it can only be changed from one form to another.” For me, this quote says it all. If you eat a meal that has a lot of carbohydrate, your body is going to be bombarded with energy that wants to be used quickly. If you don’t use it up, your body is now left with the responsibility of taking care of it. It can’t just “destroy” the available glucose, but instead will store it for another day. Glucose stockpiles are created and saved in your muscles and liver, and after these organs become saturated goes on to build fatty acids. These embody the new “home” I was speaking of, and it is not exactly what anyone trying to rid of already existing fat wants to hear. So, like any jealous sibling will tell you, having too much of the favored child around can cause annoying problems.

Depending on your motive, you may want LOTS of fuel, or you may want to keep it to a minimum (are you getting ready to run a marathon, or about to finish your work day from the comfort of your computer chair?). If you are fairly sedentary after your morning waffles, to anyone striving for weight loss, that rush of glucose is more of a menace.

So what’s the answer to carbohydrate? Moderation!

Your personal definition of moderation depends on the lifestyle you live. Are you extremely active? If so, you can benefit from a greater portion of your calories coming from carbohydrate. However, if you are trying to lose weight, keep your portions smaller. Don’t neglect starchy foods, just don’t hog out, and choose them wisely. The rule of thumb for an individual is limiting a starchy food to ¼ of your plate. The other portions should be ¼ of a lean-protein dense food, and the remaining ½ should consist of a light, non-starchy vegetable. For example, if you prepared grilled chicken, sweet potato and steamed broccoli - the chicken is your protein, the sweet potato is your carbohydrate, and the broccoli is your non-starchy vegetable. Now portion them appropriately (the broccoli should be the bulk).

This article could really go on and on. Entire books have been written about carbohydrate. I will pick up with more information in future articles, but the first step is understanding the basics. I wish to leave you with these take away points:

- Some sources of carbohydrates are better than others when it comes to your health. Like people, carbohydrate is only as good as the company it keeps. When fiber hangs around, carbohydrate’s likeability factor gets a boost. Processed baked goods are low in fiber, whereas fresh fruit is packed with it.

- Sugar is a simple form of carbohydrate, and food manufacturers love to add it to their products (Why? Because it tastes fantastic). If your snack came to you in a box, read the label. Odds are you are eating more carbohydrate than you think. Quite honestly, this is the biggest issue I encounter when working with individuals that wish to lose weight. We tend to be oblivious to what was added to our food.

- You always want to get more bang for your buck. Since you are limiting carb-dense foods to 1/4 your plate, make sure they come with copious amounts of vitamins and minerals. Brown rice is more nutritionally dense than white, and whole grains more beneficial than refined. Use carb to your benefit, it's not all that bad once you get to know it. 

Fiber & Why it is Marvelous: Part Three (Insoluble)

It takes two to tango, and soluble’s dance partner is the rugged insoluble fiber. With words like roughage, tough, and coarse used to describe it, I like to think of insoluble fiber as the dark-side yang to soluble’s yin. Together, they are a powerful force for good health.

If you’ve been feeling a little clogged up lately, insoluble fiber will be your new best friend. Its specialty is promoting movement of materials through your gastrointestinal tract. Granted, everyone’s degree of bowel regularity differs, as genetics and other lifestyle factors also influence this. However, if you get the recommended daily amount of insoluble fiber, along with regular exercise and lots of water, your new nickname may just be Old Faithful.

Insoluble fiber’s most recent claim to fame is its potential to help combat health issues that are becoming worrisome in the United States: obesity and type 2 diabetes. This tough stuff that gives food its shape may be life saving, in many ways. Let’s dig into this further…

Insoluble fiber can make up the protective casing of food. The perfect example is a kernel (or the seed) of grain. Looking at the kernel is reminiscent of a Russian Matryoshka doll. You know the ones, the colorfully painted wooden figurines that when cracked open contain a smaller version of the lady inside. Crack that one open and you’ll find another, then another, and another. The outer casing of a kernel is called the bran, followed by the endosperm, and then the germ.

When a grain is refined, they crush and shift away the bran and germ, leaving only the starchy endosperm. You guessed it, removing the best source of fiber (gasp!). Rather, let’s say we kept that kernel whole, bran and all. If you were to eat it, your digestive juices would have to mangle the casing in order to get to the goods that can be used as energy (we know them as calories). This takes time, and really puts your body to work.

The benefit is, if the energy found inside the kernel is coming from carbohydrate, instead of having a rush of broken down carbohydrate to your system (known as serum glucose), it is going to be delivered more slowly, bit by bit. Unless you plan on using this energy to sprint laps what’s the rush? Tell the carbohydrate it needs to relax. One thing I want to point out is that we often hear the word sugar in place of glucose, but really, they are referring to the same thing. I am going to say glucose because I want you to be familiar with the terminology.

Imagine you are working the front desk at a business. What would you prefer, customers to come in steadily throughout the day, or for the business to be completely idle until there is a mad rush an hour before you are scheduled to leave. The decision is easy, and your body thinks so too.

I could really go off at this point about how continually sending rushes of glucose to the blood stream can wreak havoc on your health, but I’m going to have to stay the course. Essentially, in type 2 diabetes the body is not able to take care of the glucose that comes in like it used to. I am not going to simplify the disease, there are various complex reasons why serum glucose levels can spike, but what you eat definitely plays a role.

In a fully functioning body, after food with carbohydrate is eaten the body would see the resulting glucose, think “hey, new energy!” and send workers to transfer it to the cell to be used. With type 2 diabetes, the body looks at the glucose, realizes that some of the workers are running late or quit, and thinks “eh, I don’t feel like dealing with you right now.” The sticky glucose stays in the blood stream, effects blood flow, scratches up artery walls, and is an utter nuisance. I don’t want you to have the wrong idea. You need some serum glucose; it’s very important for your body to operate. You just want it in a controlled fashion.

Next, on to the topic that at one point or another seems to come into everybody’s mind: weight. First, insoluble fiber helps a person maintain a healthy weight in the obvious way. Since it takes longer to break down a food with fiber, the body will have a feeling of fullness for an extended period of time. Therefore, causing the person to want to eat less.

The American Nutrition and Dietetic Association (known as AND) released a position paper heralding the benefits of fiber. It was published in 2008, with the latest version up for revision as we speak (still waiting on that, but given that I just praised fiber for slowing things down, perhaps I should be patient too). However, the information is still relevant. Regarding weight management, they reported that research reveals:

-       Eating insoluble fiber takes longer to chew causing you to slow down. While you chomp away, your saliva and digestive juices build up to take on the incoming food. Your stomach gets the memo and begins to expand, resulting in a feeling of fullness.

-       Fiber doesn’t completely go alone. It takes nutrients hostage as it travels through the small intestine. This means a few of the calories you ate will opt to go along for the ride instead of being absorbed.

The proof is in the pudding. This same position paper cites numerous studies that show a person who consumed more fiber each day generally had a lower body weight. The average effect of increasing dietary fiber across all the studies reviewed showed that when a person ate 14 extra grams of fiber per day over the period of about 3.8 months, they on average ate 10% less calories, and therefore lost 4.2 pounds. Pretty nice considering you are adding something to your diet and not taking it away.

As I begin to wrap this article up, I am going to conclude with something no one wants: hemorrhoids. To take preventative steps, increase your insoluble fiber now. Without enough bulk in the stool more strain is needed to pass a bowel movement. Visualize this, when a body builder lifts heavy weight it looks like the blood vessels in their forehead could explode. Well, your poor rectum and anus feel like this when enough fiber isn’t around to make its job easier.

Finally, tips for the wise: increase your daily intake gradually. Count how much fiber you are eating right now, and then add 2 or 3 grams the next day. Increasing your intake too fast can cause bloating, stomach discomfort and urgency to go the bathroom. Repeat this practice at a comfortable pace until you are getting the recommended daily amount of 25 to 38 grams each day.


Start today by adding some of these foods to your meals and snacks:


Food:                                      Total Fiber:                Of that, grams that are Insoluble:

½ cup cooked Barley               4 grams                      3 grams

½ cup Garbanzo Beans            4 grams                      3 grams

½ cup Lentils                          5 grams                      4 grams

½ cup cooked Corn                 2 grams                      2 grams

½ cup Spinach                        2 grams                      1 gram

½ cup Broccoli                        3 grams                      2 grams

1 medium Pear w/ skin            4 grams                      2 grams

1 medium Apple w/ skin          3 grams                      2 grams

1 cup Blueberries                    2 grams                      2 grams

¼ cup raw Almonds                3 grams                      2 grams

½ cup Sunflower Seeds          3 grams                      2 grams


Not only are these foods beneficial, but they taste great too. Enjoy your daily fiber endeavors!

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*All dietary fiber facts taken from the Cleveland Clinic Foundation online website. Copyright 1995-2010.

Fiber & Why it is Marvelous: Part Two (Soluble)

What can be described as gooey and causes fermentation? That would be soluble fiber. It may not sound appealing, but to our bodies soluble fiber is a true terrestrial gift. Like the saying goes, don’t judge a book by its cover (or in this case, its sludginess).

When comparing the two types, what differentiates soluble from non-soluble, is that soluble fiber turns into a gel when added to water, whereas non-soluble will not. Oatmeal is a prime example. When you place the oats into boiling water, within seconds you’ll have a paste. The longer you cook it, the thicker it becomes.  

If you did this with a bell pepper, you’ll have a soggy pepper, but it won’t be a gel.

Take a bite of that oatmeal and the viscous, glutinous fiber oozes through your digestive track. A similar action happens with the soft insides of apples. Part of what gives the meat of the apple its shape is a substance called pectin. Pectin is actually a type of soluble fiber. After you bite into the apple, chew it up, and send it down the hatch, your body will then take the nutrients it needs and discard the pectin (but not before the pectin works some magic…we’ll get to that…)

Of course pectin isn’t alone. It belongs to a family of soluble fibers that like to hang out in our food, such as inulin oligofructose, mucilage, beat-glucans, psyllium, polydextrose pylols, resistance startch, and wheat dextrin.

Fiber Smart Powder Supplement, made from soluble corn fiber (3g per 1 tsp)

Fiber Smart Powder Supplement, made from soluble corn fiber (3g per 1 tsp)

Don’t get caught up on the names. They are long tongue twisters, but being familiar with them will help you know if the food you purchase has functional fiber added to it. Look at your “high fiber” bread. Odds are inulin or wheat dextrin is a guest star.

Going back to how soluble fiber acts in your gut -- I want you to think of silly putty rolling over a floor covered in dirt. As you roll the putty with the palm of your hand, the gummy putty will start to pick up the little speckles of dirt. When you look back at the floor where the putty passed, it will be a little cleaner. Less dirt!

Why am I drilling this point home? Because it gives insight into why soluble fiber is heart healthy. After you eat, one of the digestive fluids that is called to duty (meaning, to break that burger down) is bile acid. The bile acid will do its job then want to get out of there. If you have sticky soluble fiber in that meal, the broken down bits of bile acid will hitch a ride and go out the shoot at your next bowel movement.

If you do not get enough soluble fiber, the dilapidated bile acid turns into the houseguest that stayed too long. It will set up camp in your intestines or want to be reabsorbed. Here is why this is a problem:

-       Bile acid is high in bad cholesterol, so we don’t want it reabsorbed. Instead, we want “out with the old and in with the new.”

-       If the bile acid is removed, your body will need to make more. Your liver gets the cue to create some, and uses bad cholesterol to do so. Ultimately this lowers the amount of bad cholesterol swimming around your body.

-    The metabolized bits of bile acid can actually damage the walls of your colon, which puts you at greater risk of colon cancer ('nuff said).

 Another benefit of eating the recommended about of soluble fiber is its ability to cause fermentation in your colon. Yes, fermentation, the same process that creates refreshments like beer and wine. This was the magic I was referring to with pectin. Although it may seem odd that this process is beneficial, there is no doubt that fermentation improves the health of your gut, and therefore your overall well being.

 By keeping the good vs. bad bacteria in balance, fermentation allows your colon to better absorb the vitamins and minerals you are eating from food. Basically, it preps the colon for digestion.

Fermentation also helps produce little guys called short-chain fatty acids, which are the main fuel source for your colonic cells (think of it this way, cells have to eat too). Don’t let their pint-sized name fool you, these short-chain fatty acids are powerful protectants of the gut, and some research shows they help reduce the risk of colon cancer as well as boost immunity.

 If you thought fiber was only good for laxation (aka, regular bowel movements), then you were sorely mistaken. Considering your gut health is strongly tied to your immune system, the next time an illness strikes perhaps you should ask yourself, “Have I eaten enough soluble fiber lately?”

 This far into the article, you have a good understanding of why soluble fiber is beneficial, so now let’s go into where we can find it. Listed are 10 foods that contain a substantial about of soluble fiber.

  • 1 ¼ cup fresh Strawberries = 1.1 grams
  • ½ cup cooked Broccoli = 1.2 grams
  • ½ cup cooked peas = 1.3 grams
  • ½ cooked Asparagus = 1.7 grams
  • 1 small fresh Orange = 1.8 grams
  • ½ cup cooked sweet potato flesh = 1.8 grams
  • ½ cup cooked Kidney Beans = 2.0 grams
  • ½ cup cooked Brussels sprouts = 2.0 grams
  • ¾ cup cooked Oat Bran = 2.2 grams
  • ½ cup cooked Black Beans = 2.4 grams

 In Part One of this fiber saga, I stated that our bodies would benefit from 25-38 grams of total fiber each day. How much of that should come from soluble fiber exactly? Well, the Institute of Medicine did not specify this for us, but there is a diet called the Therapeutic Lifestyle Changes diet (TLC for short), that suggests at least 5 to 10 grams of soluble fiber per day, but really pushes for closer to 10 to 25 grams daily.

The TLC is not a fad diet, but rather a style of nutritious eating endorsed by the government to help reduce a human body’s serum LDL cholesterol level (the bad kind of cholesterol that can cause major health problems when it gets too high). When the creators of this diet were studying how much soluble fiber to recommend, they found that if you consistently ate 5-10 grams soluble fiber for 6 weeks, you’ll drop your LDL cholesterol by 3 to 5%. Not too shabby.

 Moral of the soluble fiber story: beans, beans they’re good for your heart! The more you eat, the more….prepared your body will be to fight off illness and keep running smoothly! 

 

3/4 cup cooked oatmeal with heart healthy walnuts

3/4 cup cooked oatmeal with heart healthy walnuts

*All soluble fiber in food values taken from the Harvard University Health Services May 2004, “Fiber Content of Foods in Common Portions” list.

Fiber & Why it is Marvelous: Part One

Fiber has emerged as a nutrition superstar in recent years. Food companies have discovered its importance and touted its benefits on every whole grain product occupying our shelves. From crackers to brownies, it appears our starchy favorites have suddenly gained more grams of dietary fiber per serving.

As a dietitian, I think this is a step in the right direction. However, I do get a little discouraged, because fiber is naturally found in so many foods, and these foods have an arsenal of other health benefits to go along with them. Although it is nice, the public didn’t need Kellogg to add fiber to their granola bar to get the daily-recommended amount. Turns out a lot of people are confused (health professionals included), as I often get asked, “What exactly is fiber?”

For a dietitian, this question can result in a fervid reaction. Fiber makes us excited (really), because it is so beneficial (and under consumed). The average American eats about 15 grams each day, when they really should be getting anywhere from 25 to 38 grams (women and men, respectively). However, the answer to this seemingly simple question can be far more complex than anticipated. I am going to keep it as simple as possible, because for your heart, colon, and overall well-being’s sake, I want you to embrace fiber.

In short, fiber is the tough, cell walls of plant-based food that goes undigested. Essentially, our digestive juices don’t know what to do with it, but rather have to mangle it up in order to get to the nutrients our bodies can absorb and use.  The fiber material is then discarded through a bowel movement. If you have ever eaten corn, you may know what I am speaking of. I actually get a little sad for fiber, because it does the tough job of holding our food together – food that goes on to nourish our bodies. Albeit, like a tale of unrequited love, the body takes what it needs and tosses the maimed fiber out. Oh well…

Currently, there is debate over the different types of fiber and what we should call it. As someone who is responsible for teaching others what to eat, I wanted to pull my hair out many times while searching for the correct terminology. Many a Saturday mornings have been spent researching this (wish I was joking).

So, after reading the definitions formulated from the Institute of Medicine, American Association of Cereal Chemists, Health Canada, and more, I have respectfully taken their words into account and decided on this:

-       First, we are breaking down this indigestible matter into two categories: dietary fiber and functional fiber.

o   Dietary Fiber: naturally found in food. The skin of fruits, insides of beans, stringy-things on celery, etc.

o   Functional Fiber: isolated fiber bits taken from naturally grown food that is then consumed or added to recipes. Think Metamucil or the inulin put in our granola bars.

-       Next, Dietary Fiber can be broken down into two categories of its own.

o   Soluble Fiber

o   Insoluble Fiber

Two bullet points is a mediocre way to fully explain soluble and insoluble fibers. Tackling both types in one article would do fiber an injustice. Instead I’m going to break it up and give it the love it deserves. To learn more about how absolutely marvelous dietary fiber can be, sit tight for parts two and three of my fiber saga.

Nonetheless, I won’t let you go without a teaser. One thing EVERYONE agrees on is how wonderful fiber is for your health. Here are just four of its potential benefits:

1.     Reduces the risk of cardiovascular disease

2.     Improves bowel health by reducing the risk of colon cancer and keeping bowel movements regular

3.     Helps maintain a healthy weight

4.     Helps control the body’s blood sugar (known as serum glucose) levels

To get your brain salivating for more knowledge, here is a slide show glorifying foods loaded with fiber:

 

To be continued...

 

Nutrition-Focused Physical Exams: The Past & Future and Dietetic Practice

In cold winter months, red sores that won't heal and appear on the corners of a patient’s mouth might be dismissed as dry skin. A physician would likely prescribe a skin ointment. This may treat the problem on a superficial level, but the actual issue could lie much deeper, and it's in these moments that a dietitian can bring an essential perspective.

Where a physician may see an underlying disease as the cause, the dietitian will hypothesize that these sores could be related to a nutritional deficiency or excess. In this particular scenario, the dietitian sees evidence of a riboflavin deficiency.

Among dietitians, the old saying, “You are what you eat,” is taken to heart. As knowledgeable professionals, dietitians understand that the quantity, quality and type of nutrient taken into the body will impact a person’s physical health in a positive or negative way.

Being a relatively young science, the field of dietetics continues to develop and grow. Along with this growth, the dietitian’s role within the medical team is expanding. A recent example of this is the standardization of the assessment process used to establish a nutrition diagnosis. These guidelines were created so that dietitians can uncover all the evidence needed to pinpoint specific problems that can be resolved with nutritional intervention.

Subjective information — including diet recalls, food frequency questionnaires and patient statements — is some of the first evidence gathered during a nutritional assessment. Although useful, this information should be taken with a grain of salt since it runs the risk of containing inaccuracies and it must be tempered with objective data such as the patient’s diet specifics and history, weight and anthropometrics, clinical data such as medical history and a nutrition-focused physical exam (NFPE), biochemical data and nutrient/drug interactions and depletions. 

A dietitian working in the hospital or clinical setting will have access to laboratory values such as serum albumin (plasma protein) to establish nutritional status. But in recent years, research has found that this lab value has more to do with a patient’s state of inflammation than it does nutritional status. Knowing the limitations of laboratory values, more dietitians are now actively practicing physical examination abilities to determine signs and symptoms of nutrient depletions and excesses. This advance in practice is opening new assessment avenues and creating new knowledge within the profession and essentially better nutritional care for patients. 

NFPE is not a new concept. Since the 1400s, sailors who were out to sea for long periods of time feared scurvy when they noticed their sunken eyes, tender gums and swollen limbs. Many physicians at the time linked scurvy to poor hygiene on the boat, even declaring it to be contagious. It was not until the 1700s that James Lind revealed that lack of vitamin C was the actual cause, and he began treating the men with citrus fruit.

Some nutrient deficiencies or excesses are more obvious. For example, consider a patient with a cirrhotic liver. He may appear to have a normal body mass index due to ascites — an abnormal accumulation of fluid in the abdominal cavity. But a dietitian who takes a closer look at his arms could see that he also has tricep and bicep muscle wasting, which is a clear sign that he is not getting enough nutrients.

Dietitians provide a unique and useful health focus that other professions do not possess. Conducting a nutrition-focused physical examination is an undeniable way to show this to the medical community and, at the same time, better help those they care for. The more dietitians put its usefulness into practice, the more impact this type of advanced nutrition assessment is sure to have.

Recognizing Signs of Iron Deficiency

If you have felt increasingly tired and are having trouble concentrating, perhaps a good nap is in order. However, if over time you also feel it is impossible to keep warm, your tongue is becoming bright red, and your nails are turning pale, it's time to get your iron checked.

The mineral iron is essential for a properly functioning body. It can be found in every human cell, and holds the responsibility of carrying oxygen throughout our blood supply. Further proving its worth, iron aids in DNA synthesis and is a key element in energy production.2Since iron has a large presence in our system, when we are lacking sufficient amounts, symptoms of deficiency can manifest in many ways and affect multiple organs.

Despite the importance of this mineral, iron continues to remain the most prevalent nutrient deficiency in the U.S., and the leading cause of anemia — a condition when an individual has a depleted number of red blood cells or hemoglobin.1 This is of particular concern in women and young children who are experiencing growth spurts.

For medical professionals, this means becoming more attuned to the signs and symptoms that iron deficiency can cause:

Pallor of the mucous membranes: This is most evident in the face and palms of the hands. Assess for pale (less vibrant) colored tongue, lips, palms or skin under the eyelids.

Glossitis: Inflammation of the tongue, causing it to become bright red and swollen. The finger-like projections on the tongue’s surface may disappear, instead leaving the tongue smooth.

Koilonychias or brittle nails: Without sufficient amount of iron, the body has difficulty getting the nutrients to the farthest points on our limbs, including the fingernails and toenails, making them pale, weak and easy to break. Koilonychias is an extreme case when the nail begins to spoon, or become concave in shape.

A Nutrition-Focused Physical Examination should be performed on all individuals meeting with a dietitian — however, circumstance and heredity may put some people more at risk then others. The following individuals should be carefully examined for signs and symptoms of iron deficiency:3

  • Women who menstruate, particularly if menstrual periods are heavy
  • Women who are pregnant, breastfeeding or have recently given birth
  • Any individual who underwent surgery where blood was lost
  • Anyone who has experienced physical trauma
  • Persons with a gastrointestinal disease, such as Crohn’s, Celiac, Irritable Bowel or Ulcerative Colitis
  • Persons with Peptic Ulcer disease
  • Persons who underwent gastric bypass
  • Vegetarians or vegans who do not include iron-rich dietary choices

If one or all of these physical signs of iron deficiency are present, the medical team should be informed and laboratory tests ordered to confirm these findings. If an underlying medical condition is the cause, the team should be made aware to address the issue. Adding iron-rich and fortified foods to the diet is a safe initial form of treatment. Depending on the extremity of the deficiency, iron supplementation may also be required for repletion.

Having keen knowledge of the human body’s utilization of vitamins and minerals, and the potential consequences when deficiency is present, confirms the importance of the registered dietitian’s role in the medical team.

3 Ways to Grow Your Own Ingredients

In practice, whether advising on ways to combat heart disease, manage weight or reduce your risk for cancer, a dietitian will prescribe leafy greens and a ripe fruit like a pharmacist prescribes medication. The known health benefits of vegetation are numerous with more information being revealed daily. Grocery stores are the No. 1 spot Americans purchase their food — perhaps because lack of time, knowledge of materials needed and limited space serve as barriers to planting a garden at home. Yet with a little research and willingness to get his or her hands dirty, even novice gardeners can sprout their very own produce.

A lush piece of land with the green thumb to cultivate it is a reality for some, but for city-dwellers more accustomed to a metropolitan lifestyle this is simply unattainable. But fresh produce can grow in even the bleakest urban area. Provided are ideas for whatever the yard-size (or lack thereof) may be.

“Postage-Stamp” Backyard

If the greenery surrounding your house can be trimmed with hedge clippers just as easily as a lawn mower, you fall into this category. Space may be limited, but it's perfect for a raised-bed garden. The size of the bed can vary — if you are new to gardening, starting small works in your favor. By focusing on a select few vegetables, the task will seem less overwhelming.

With this garden type, you also have control over the dirt quality. You can create a soil-and-compost blend that will act as a nourishing environment for your seedlings. Soil erosion is kept in check with built-in drainage, and plants can be spaced closely together, so yields go up and water-use efficiency is maximized.

Container Gardening

To achieve the perfect mix of beauty and practicality, consider this option. Flower pots are excellent homes for your annuals, but vegetation can also thrive in them. But vegetables do require space, especially vining crops like tomatoes and cucumbers. A container with a 10-inch wide diameter and 12-inch depth is acceptable for most vegetation, but a 16- to 20-inch diameter pot is preferable. An added benefit of this method is that containing the soil gives you more control over the temperature. If a winter-freeze moves in, the pot can easily be covered or placed indoors temporarily.

Kitchen Sink Window

If four walls enclose the only property you inhabit, then a sunlit kitchen sink window is likely your best option. Interestingly enough, elementary school teachers have had this problem solved for decades with the foam egg carton! Just as they were in the science classes of your youth, these accessible containers continue to be a lovely home for a fresh herb garden. And multiple herbs can grow in a single carton, providing the opportunity to try out your horticulture skills, as well as your culinary skills when the herbs are ready for use.

Providing nutritious food on the table is reason enough to try your hand at planting a garden, but it is certainly not the only one. Other benefits voiced by gardeners include a reduction in the amount of money spent on groceries, as well as the actual activity being a way to alleviate stress. Regardless of your experience level or environment, give it a try! Your taste buds, pocket book and overall well-being will thank you.

Community Supported Fisheries: A Growing Movement

The phrase “Farm to Fork” has become a familiar concept among the dietetic community. The saying refers to knowledge of the origin of the food in our kitchens, along with ensuring that it took the shortest travel route to arrive there. The popularity of this practice has contributed to its ability to financially assist local farmers, sustain a community’s ecosystem, and improve the health of patrons by reducing dependency on mass-manufactured foods.

However, as seafood gains notoriety for its nutritional benefits, could the phrase “Boat to Fork” be the next craze? Community supported fisheries (CSFs) around the nation are providing strong evidence that this will be the case. The basic premise behind a CSF is the same as it is for community supported agriculture, or CSA: Fishermen offer a certain number of "shares" to the public, and those buying the shares in return receive a portion of the yield each week throughout the fishing season.

Developed in desperation, Maine-based Port Clyde Fresh Catch Company became the first official CSF in 2007 when there was concern that the money was not there for a fourth generation to carry on the business. By involving the community and sticking by the “boat to table” concept, the business was able to stay afloat. Even more significant, they developed a new approach to the seafood business in America.

After observing the success of Port Clyde, other CSFs began sprouting up on the east and west coasts. Together, these fisheries have agreed to operate on a triple bottom line, which places emphasis on the responsibility to support the economy, society and environment. 

Regarding the latter responsibility — the environment — the fishermen are encouraged to be stewards of the marine ecosystem’s health. Rather than focusing on catching high-demand fish, they capture and promote species that are locally abundant. This is a win-win for all involved, as it allows fishermen to reduce costs and provide diverse products, and reduces the pressure to catch commercially popularized fish, which time and again has shown to lead to environmentally destructive methods of fishing.

CSFs also bring a unique opportunity to the culinary world by providing lesser-known species of marine life. Rather than the typical salmon or tilapia, chefs are now given hake or monkfish to work into a menu. Species that were once considered by-products of a catch are now the main dish on a dinner plate. This practice fosters creativity in the kitchen and subsequently provides the community with new flavor profiles to enjoy.

The majority of the CSFs have emerged near Pacific and Atlantic coastal cities and towns. However, with landlocked states such as Michigan and Minnesota home to literally thousands of fish-containing lakes within their borders, the odds of this practice growing throughout the rest of the country are very good. Time will tell if this concept continues to be embraced, but it appears community supported fisheries are an efficient way to support the fishermen and those they serve with fresh, affordable seafood straight from boat to fork.

Liver: It's What's for Dinner

In American culture, the mention of organ meat does not typically evoke a mouth-watering response. Yet internationally, carnivores across the globe don't hesitate to devour this edible animal tissue, often considering it to be a delicacy. Internal animal organs, known as offal, can be found in many dishes closely identified with a worldly region.

When in Scotland, for example, you can fuel up on haggis, a savory pudding made from, among other ingredients, sheep’s heart, liver and lungs. In France, a small snack could include foie gras, or fatty duck liver. Rather than wasting sources of calories and nutrients, chefs throughout history became creative and learned to prepare every ounce of the hunted animal.

However, recent controversy over the safety of offal consumption has become a hot topic.

On one side, many medical experts (and grandmother’s alike) tout the benefits of consuming offal. Take one of the more well-known edible organ meats: liver. One 4-oz. serving of beef liver contains 155 calories, 4g total fat, and a whopping 23g protein. It's also a good source of copper, folic acid, iron and B vitamins, as well as one of the most concentrated sources of vitamin A. The National Institute of Health even lists liver as a meat option that, when eaten moderately, may be beneficial to treat anemia.

Comparatively, a 4-oz. ground beef patty (80% lean/20% fat) provides 280 kcal, 22g fat and 19g protein. The ground beef contains many of the same micronutrients but, when placed side by side, the liver appears to be the more nutritious choice.

The other side of the debate brings other facts to light. Most notably, the seemingly healthful high concentration of vitamin A found in animal liver can be a fatal side effect if over-consumed. The active form of vitamin A, known as retinol, can build up to a toxic level within the body. To put it in perspective, one ounce of beef liver contains 8,881 IU vitamin A. The recommended upper limit for males and females older than 19 years is 3,000 IU. Other side effects of vitamin A toxicity (Hypervitaminosis A) include nausea, skin and hair changes, bone pain or swelling and birth defects.

Current cattle-raising methods offer a new source of controversy. Two main functions of an animal liver include detoxifying chemicals and metabolizing drugs. There is building concern over the method of injecting American cattle with growth hormone to produce a larger product yield. Since the liver acts as a filter, the concern is that consuming this organ will expose our bodies to larger quantities of hormone than we would get by only eating animal muscle.

All in all, the debate over the safety and health benefits of liver seems to lead to the same conclusion as many other of our decadent favorites: eat in moderation. The nutritional value of your total diet will determine if eating liver is actually beneficial, so be mindful of all the foods you choose to eat. If the flavor is one you enjoy, be careful not to go overboard, since there are known, and deadly, side effects. Young children and pregnant women should take extra caution, since they are at higher risk of vitamin A toxicity.

If you are feeling adventurous, give it a try at your next meal!

Honey: History, Harvest & Health Benefits

When tea and biscuits taste decidedly bland, there is one ingredient diners love to reach for: honey. A combination of the monosaccharides fructose, glucose, maltose and sucrose give this ancient food an irresistible sweetness that many prefer over other simple sugars. Recently, honey has gained popularity as concern heightens around the amount of sugar derivatives added to packaged foods. The search for a less processed sweet flavor alternative has led food purists to the delicious nectar. The art of beekeeping continues to evolve, and as a result honey harvesters are learning more about its potential complexity.

Although beekeepers, known as apiarists, skillfully avert painful stings to collect honey, the majority of the credit rightfully belongs to the insect for its work in producing the sweet substance. Honeybees, bumbles, stingless bees and even honey wasps all take on this task. The true origin of honey is the flower, therefore it is the largest determinant of the final product’s aroma and flavor. Enthusiasts categorize the honey into two floral groups; mono-floral and poly-floral. Mono-floral refers to a honey that comes from a single variety of flower, whereas in poly-florals numerous flower types come together to create a distinctive flavor. However, the term mono-floral should be given loosely since restricting thousands of bees to only one flower is near to impossible. To produce one pound of edible honey, bees can gather the nectar from more than two million flowers.

Like a fine wine, the location, season and surrounding vegetation of an area all influence the blossoms and, therefore, honey's flavor profile. Apiarists take great pride in their region's harvested product. Honey can be found all over the world, resulting in a cornucopia of nectars to savor.

In France, vibrant purple lavender flower adorn the fields of Provence, therefore lavender honey is a favorite among the locals. Known for its light lavender fragrance and medium amber color, it can be used to glaze chicken, flavor macaroons or enliven ice cream. In Greece, the herb thyme defines the distinct flavor of Hymettus honey. Named for the country’s Mount Hymettus, where thyme is plentiful, this variety is the signature ingredient of the region’s famous baklava dessert. It's a golden color, speckled with dark flecks, and its runny consistency makes it desirable for drizzling over bread or yogurt.

The United States alone is home to more than 300 varieties of honey. Fireweed honey is found in the Pacific Northwest, whereas the popular orange blossom honey is collected in Southern California, Florida and some areas of Texas. The list goes on, including avocado, blueberry, pine, pumpkin, tupelo and wildflower honey.

Nutritionally, honey's calories are derived from the monosaccharides. Per tablespoon, honey contains 65 kcals, 17g carbohydrate, 0g fat and trace protein amounts. However, honey's power lies in its cell-rejuvenating antioxidant value. Just as fruits, vegetables and flowers contain antioxidants, these compounds are in turn transferred with the nectar gathered by bees. Each honey variety will contain its own blend, giving it the potential to help prevent cancer, improve immunity and reduce inflammation when eaten moderately with a balanced diet.

Rarely will you find a food with stronger historical, nutritional and regional roots than honey. Although admired for its sweet simplicity, honey has shown it has far greater depth. Exploring the varieties of your local honey supplier can be a fascinating experience.