Nutrition | Bonnie Modugno, MS, RD

IS WORK-LIFE BALANCE AN OXYMORON?

March 20, 2013 by Bonnie

Years ago I learned of a company CEO who stopped all overtime except if it was approved by his office. Within in three months absenteeism, sick leave and tardiness declined by 30% across the board. Just this last year I was asked to speak about nutrition and health to employees of a media company, but advised that I shouldn’t address the 14-16 hours days they usually worked. Most employees know when they are being toyed with, and I declined the invitation. Today stress and the cost to business is getting prime time exposure.

Ariana Huffington reports that corporate CEO’s are finally connecting the dots between stress and the bottom line. I found myself both cheering and jeering at the same time. It seems that mindfulness and yoga are the hot buzz words in corporate culture with studies showing reduced absenteeism, sick leave and other indirect costs, costs that are 200-300% higher than actual health care bills. It’s time the business minds paid attention–but I don’t trust that their attention is what it needs to be.

It is too easy to encourage workers to take a few yoga classes or meditate for a few minutes on company time–and then have them return to unreasonable work loads and a corporate culture that encourages excessively long work days, working after hours and plugging in on vacation. Where is the time for preparing healthful meals, engaging in regular physical exercise and other core ingredients of good health when everyone is working 10-12 hours days on top of a 1-2 hour commute?

And then there is that issue with outsourcing and job insecurity all the while corporate practices hold cash in foreign subsidiaries to avoid paying taxes for the very services their communities need. Most Americans experience considerable stress as their quality of life continues to deteriorate–just as the executive office continues to reap the rewards of reigning in costs and driving profits. The disconnect is obscene and more so all the time. Yoga and mindfulness can’t fix that. So, if corporations are serious about reducing both the direct and indirect costs of health care, I have a few questions to ask each CEO, their board of advisers, and anyone looking for greater and greater returns on their investments:

1. Are efforts to address stress in the workplace serious or just paying lip service?

2. Can yoga and mindfulness really trump low wages, obscene workloads, job insecurity, and the incessant drive for profits over people ?

3. When will CEO’s and their boards stop sucking more and more of the profits into their own pockets and support their workers in materially meaningful ways?

4. Is “Work/life balance” a misnomer?

While you ponder these questions, you may want to read this article and watch this video and consider what it means for every one of your employees, everyone who lives in your community, and the overall health of this nation when corporate policies continue to drive inequality. We have only one life. It doesn’t matter how much CEO’s talk about mindfulness or a work/life balance. Employees won’t have a balanced life when work–and the effort to hang on to one’s standard of living–saps most of their space, time and energy.

Filed Under: Blog Tagged With: absenteeism, corporate policies, cost of healthcare, energy, exercise, fitness, health, inequality, mindfulness, nutrition, overtime, stress, tardiness, time, work life balance, yoga

Health Counseling: Who thinks the same message works for everyone?

April 11, 2012 by Bonnie

Blood tests–specifically serum cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides–remain the backbone of screening for cardiovascular disease. My father died at 44 from congestive heart failure. I have my levels tested regularly. I finally cleared time to get a fasting blood test.

BLOOD TEST RESULTS

Fasting tests are the biggest challenge. Mornings are a rush, getting my son off to school and both my husband and I off to work. I don’t want to fast until mid morning by the time I could get to the lab. I don’t feel good and am not nice when I get over hungry. I waited until my son’s spring break last week.

The results look better. Total cholesterol, LDL cholesterol and triglycerides dropped. HDL cholesterol stayed steady. But obviously not good enough for Kaiser. I received my annual counseling letter in the mail yesterday. They want me to sign up for a cholesterol class and I may need medication.

I already argued this issue with my physician last year. There is no good data suggesting medication for women without previous evidence of disease (not just a risk factor) is beneficial.

Out of curiosity my husband attended the cholesterol class last year. It was taught by a nurse who couldn’t answer his food questions. (Where are the dietitians?) He came back with a 113 page manual that was published in 2003. I reviewed the material and found it dated and inaccurate.

FOLLOW THE ENCLOSED DIET

I focus on the rest of the letter. The next line reads, “Please follow the enclosed cholesterol diet.” (I repeat, where are the dietitians?)

I almost choke on the words. I am admonished to eat more fruits and vegetables. Eat less red meat. Replace butter and margarine with oils. Limit foods high in cholesterol. Be physically active and lose weight.

The same message is sent out every year. Are the administrators and health professionals at Kaiser merely happy to check off the box or do they truly believe this is the path towards behavior change?

ONE SIZE DOES NOT FIT ALL

David Katz, MD is the founding director of Yale University’s Prevention Research Center. His 2011 Lenna Frances Cooper Memorial Lecture was published in the February, 2012 edition of the Journal of the Academy of Nutrition and Dietetics. He makes many valuable points, but this one sticks. “Messages that most effectively motivate behavior change are tailored messages; customized messages; individualized messages.” Five references follow this statement.

I already know what I am doing and why I am doing it. I don’t plan to change. But I cringe for other Kaiser members who would benefit from attentive and individualized nutrition consultation. Why do Kaiser patients get an anonymous and formulaic counseling letter from Kaiser each year?

Filed Under: Blog Tagged With: Academy of Nutrition and Dietetics, behavior, cholesterol, counseling, David Katz, health, heart dieseae, Kaiser Permanente, medication, nutrition, triglyceride, Yale

Questioning 5 Nutrition Myths on Huffington Post

October 18, 2011 by

Nutrition misinformation is ubiquitous. Sometimes the misinformation is lack of deeper thinking. A recent Huffington Post entry by Kristin Kirkpatrick, MS, RD, LD, caught my eye for just that reason.

Ms. Kirkpatrick addresses 5 dissonant myths probably tied together since it’s Thanksgiving week. She addresses myths about carbohydrates, eating late at night, weight gain during the holidays, the nutrient value of fresh vs. frozen food and the five second rule about eating food after it has been dropped on the floor. Each of the discussions left me wanting. Here’s my take on each of them.

1. THE CARBOHYDRATE MYTH

In 2002, researchers analyzed the diets of over 10,000 Americans by categorizing them by their carbohydrate intake. They found that those who had the highest intake of carbohydrates had the lowest overall intake of calories and were more likely to be at a normal weight.

My first thought is, “How nice it is to be insulin sensitive.” People who enjoy insulin sensitivity can eat a higher carbohydrate diet, they don’t get sugar and carbohydrate cravings, and they don’t gain water or fat weight readily. Of course they are leaner and eat less.

One third of Americans are born relatively insulin resistant. Lifestyle factors can make this worse. There are many studies that show many people thrive on a lower carbohydrate intake, some showing remarkable differences in weight management depending on genetic predisposition. (See work by Chris Gardner)

Continuing to insist that carbohydrates aren’t bad is missing the point. The question for each of us is how much and what kind of carbohydrates work best to give us the energy and sense of well being we seek.

2. THE MYTH ABOUT EATING LATE AT NIGHT

A calorie is still a calorie whether it is 6:00 p.m. or 10:00 p.m. The main importance is how many calories you consume throughout the day.

A calorie is a calorie. But not all calories are treated the same in our body. Nutrient partitioning is a phenomena that determines if your food will be used for energy or stored as fat. People who are insulin resistant secrete more insulin in response to their food intake. Excessive insulin drives energy into fat stores. This often causes a rebound hypoglycemia, increasing hunger and cravings for carbohydrate.

In addition, sleep and food intake influence hormonal responses that impact your appetite. As explained by Susan Dopart, MS, RD, a higher carbohydrate diet without adequate protein tends to increase ghrelin levels and “grows the appetite.”

Calories count, but hormones are potent factors determining what happens after you eat those calories. Weight management is not merely a math problem. If it was, we would have solved it by now.

3. THE WEIGHT GAIN DURING THE HOLIDAYS MYTH

They found that the average weight gain from Thanksgiving to New Year’s was less than 1 pound (0.8lb)

One of the biggest mistakes science makes is reporting findings that lead people to believe that the average experience is everyone’s experience. This data would be much more useful if the researchers or the author discussed the range of weight gain.

On the same diet people have very different experiences. Dr. Gardner’s research shows just that. My guess is that the insulin sensitive people experience far less weight gain, if any, as they enjoy the treats of the season.

Insulin resistant folks enjoy a few sweets, start to gain, experience even more carbohydrate cravings, and are soon slipping and sliding through the rest of the holidays. These are the folks who bring up the average. They can readily gain 5, 10 pounds and more between Halloween and the New Year.

It works in reverse as well. Weight loss is almost always easier for insulin sensitive folks.

My husband and friend once rode over 500 miles in a fund raising bike ride. Both riders ate the same food for the entire week. Both ate mountains of pasta, bowls of rice and handfuls of cookies to fuel themselves over the miles. The insulin sensitive guy lost 2.5% body fat over the 7 days. My husband lost 0.5%.

In private practice for over 25 years, I continue to observe people with a ride range of metabolic responses to food. Each person is their own puzzle and deserves to develop an approach to food that works for them. The person who gains 5-10 pounds over the holidays needs different support and guidance than the person who gains little or nothing.

4. THE FRESH VS. FROZEN FOOD MYTH

In the winter, however, eating fresh means not only paying more, but perhaps getting fewer nutrients. That’s because during the winter months, many fresh produce options have to travel hundreds and sometimes even thousands of miles to reach the grocery store.

I mostly don’t have a problem with this content, except I live in Southern California and the Huffington Post is a national, if not global publication. It is curious to me that the writer would limit her comments to her experience in the Northeast.

I appreciate the challenge of fresh fruit and vegetables in the Northeast. I remember a favorite aunt who lived in the Hudson River Valley. She would often chatter excitedly about the opening of farmer’s markets in early June. It would give me pause. In Southern California, my farmer’s markets are open all year long.

The disconnect for me is the assumption that produce traveling thousands of miles has fewer nutrients. I don’t think the issues is miles as much as time since harvesting. I’ve spoken to supermarket produce workers in Los Angeles. Too many people don’t know that produce in supermarkets is often sold 7-10 days post harvest–even with the San Jouquin Valley just a few hundred miles away.

The nutrition issue is freshness, not distance. It is important to not confuse the issue of nutrients with other significant discussions like sustainability. In the end, I agree that frozen produce may be the best nutritional bet during winter months for many people.

5. THE MYTH OF THE FIVE SECOND RULE

They found that when a piece of bologna was picked up off the tile floor that over 99 percent of the bacterial cells from the floor were transferred to the bologna.

People hear the word bacteria and get scared. We are a bacteria phobic people. For decades science and medical thinking has hinged on the premise that bacteria is bad. I’m not so sure.

We need healthy bacteria to keep us protected from opportunistic pathological strains. There is much discussion in the health care community that what we are lacking is enough healthy bacteria in our soils, in our food, in our guts. Lack of healthy bacteria has been linked to increasing incidence of gastro-intestinal diseases, asthma and allergies, as well as poor immune systems.

Today pro-biotic and pre-biotic supplements are sold everywhere. We pay extra for these bacteria to be added to our food. Why not let ourselves eat food that is a little less sterile? The real issue isn’t whether there is or is not more bacteria on our food. We need to ask better questions. Is it harmful? Is it helpful?

We need to be honest about what bacteria to be concerned about. Most of the pathogenic bacteria linked to our food supply is associated with animal and human feces, open wounds, and spoiled food. I don’t know if the bacteria found on the floor matches this risk.

My guess is that the researches know and probably reported this data in their findings. I would find the discussion more significant if Ms. Kirkpatrick could have addressed what kind of bacteria they found and it’s relative risk profile.

Filed Under: Blog Tagged With: bacteria, calories, holiday eating, late night eating, myths, nutrients, nutrition, Susan Dopart, weight, weight gain

Who’s Nightmare? A Nutrition Counseling Parody on You Tube

October 18, 2011 by

Marion Nestle recently tweeted her followers, alerting us to a you tube video titled “So You Want To Lose Weight“, mocking a nutrition counseling session. Gable Kermit, the creator and a registered dietitian, claimed he was creating an amalgam of his patients. Did he realize he was also creating an amalgam of dietitians?

The patient depicted the most demanding, opinionated, resistant, clueless, and defended patient I can imagine. Every request was met with defiance, every suggestion was met with opposition. I hope this is a parody.

It was the comments that gave me pause. There are only a few, but many of the participants are registered dietitians. They see their patients and howl with the release of pent up frustration. I wonder if they realize that patients will view this and probably both laugh and cry. How many of them will relate to the behavior of the dietitian?

THE DIETITIAN ON A MISSION

The dietitian is focused and unwavering. His job is to help this woman lose weight. The robotic nature of the voices only serves to underscore the robotic nature of his mission. This dietitian has no clue.

In the first few sentences his patient tells him in her tone, words and behavior that she is ambivalent. She tells the dietitian she wants to lose weight, but then blocks him at every angle. He never relents. For 10 agonizing minutes the dietitian continues the good fight, trying to extract damning information from her, use that information to illustrate what she is doing wrong, and tell her what she could do differently. It’s old school nutrition counseling.

I know, this is how I was trained over 30 years ago. I mentor young dietetic interns, and I know that nutrition counseling is taught differently today. The sad reality is that these young and bright interns hit the hospital floor and soon find out that there is little application of more sophisticated skills in the real world. Too often practicing dietitians are using the old textbooks.

IS THE PATIENT HEARD?

To be fair, most dietitians working in hospitals and clinics don’t get an adequate opportunity to do their jobs well. At UCLA, the diabetic patients are routinely allowed four 15 minute visits with a dietitian a year. That is hardly enough time to establish rapport and find out what is happening with the patient much less provide them with information and guidance. It is even more impossible with a resistant, oppositional or ambivalent patient, even if you have the skills.

Too often nutrition counseling is all about the dietitian doing their job. The expectations come from administrators, insurance companies, physicians, and sometimes the patients themselves. Just tell me what to eat.

While the dietitian may listen, it is often to identify what needs to be done or what the patient can do differently. I wonder what we would find out if after every nutrition counseling session the patient was asked, “Did you feel heard?”

I squirmed watching So you want to lose weight? Xtranormal. I felt tense for the dietitian, I ached for the patient.

READINESS, WILLINGNESS, ABILITY TO CHANGE

Mostly I wanted to step in and say something. Maybe I would recap the exchange and ask, “I’m not sure what you are looking for. I hear that you want to lose weight, but I am also hearing that you don’t think you eat very much. What do you think is going on?” or maybe I would say, “It sounds like you feel you are doing everything you can. How can I help you?” Possibly I would venture, “I wonder why you are seeing me today. When I am working with a patient, I always listen for words that tell me you are ready or willing to do something different. I am not hearing those kinds of words.”

And then I would let the patient fill in the space.

DIFFERENT, MORE EFFECTIVE COUNSELING SKILLS

Overall, I am most disturbed by the dietitian’s inability to stop and reflect on the patient’s resistance. Some level of ambivalence, resistance or opposition can be expected . It comes with the territory, the business of change.

Not all patients are so intensely stuck (I really do want to believe this is a parody). But for the ones who are, dietitians need to be able to shift gears. Different counseling skills or training in motivational interviewing could go a long way.

Too many patients come because their doctor sent them, their spouse threatened them, their children begged them. Sometimes they feel desperate one moment and make a call, and by the time they step into the office, they are not in the same place.

WHO SHOWS UP?

I always wonder who is going to show up at an appointment. A willing, ready patient or the darker twin who is defended as they walk through the door. Not every patient is truly ready or willing to be told what to eat. Not every patient comes to the visit honestly looking to change right away. Sometimes they only wish they were.

The challenge of nutrition counseling is to support, guide and facilitate the patient’s journey to cultivate an approach to food that works. This takes more than nutrition science and biochemistry. This takes more than counting calories, grams of carbohydrate or fat. This takes more than 15 minutes four times a year.

There is an opportunity here to explore the nature of nutrition counseling today. What is your experience as a dietitian, as a nutrition consultant? as a patient or client?

Filed Under: Blog Tagged With: ambivalence, counseling, dietitian, motivational interviewing, nutrition, patient

MY PROFESSIONAL CONTINUING EDUCATION: A PEEK INSIDE

October 18, 2011 by

I typically offer insight and advice to situation that impacts the public at large. With this blog, I zoom the spotlight in to focus on the world of continuing education for health care professionals.

It is not easy to sit still in conferences from 8 AM until 5PM with two +/-10 minute breaks and less than an hour for lunch. Every 35 minutes another topic, a rash of power point slides, a few pressing questions and on to the next topic, the next speaker.

Thankfully the American Society of Nutrition planned the event over three days, with the first and last day a blessedly truncated four hour stint.

I only had to suffer through one full day of ridiculous scheduling. Still, last night I found myself sitting at the airport and barely able to focus. I felt brain dead. I am exhausted.

This morning I feel broken. Three days of sitting for too long in straight chairs with no room to move, no table to write on, and minimal breaks or time to allow my body its normal range of motion have taken its toll. My yoga class was both excruciating and a relief. I struggled with the effort of trying to release the tension, of trying to realign my aching, cramped and misaligned self.

I have learned to live my life a different way. I am having a hard time getting my head around the fact that I am sacrificing my own health and well being attending a conference about nutrition and health.

WHY CONTINUING EDUCATION?

I am required to accumulate continuing education hours to support my registered dietitian status. I try to avoid the more conventional meetings. Now I remember why. These stoic sessions allow little time for discussion, minimal collaboration among the attendees and the information is definitely top down. This is old school.

This is also the norm for most continuing education models. It is the model for conventional education. It is not the model for effective education.

TOP DOWN INFORMATION

The researchers tell us clinicians what we should be doing based on their limited and often less than spectacular findings. Even modules that are described as workshops end up being an endless stream of verbal diarrhea. The last one I attended was a hyperactive press of everything the speaker could think of telling us as fast as possible with audience participation limited to truncated questions or quick yes and no responses. It was challenging to grasp at the pearls in the midst of all the noise.

I wonder why there hasn’t been more change. I have been attending continuing education conferences for over 30 years. This weekend I was flashing back to conferences I attended in my first years out of school. It felt the same.

HOW CAN CONTINUING EDUCATION BE MORE MEANINGFUL?

What is desperately missing is genuine and meaningful discussion amongst the researchers and clinicians. There are many times clinicians witness trends and make observations that would improve how a researcher designs a study, sets the hypothesis, and evaluates the data. This collaboration could make the research far more dynamic and far more useful. Who is going to be brave enough to challenge the status quo?

The current model of scientific continuing education is flawed as long as the attendees are not given an opportunity to more fully discuss the research findings with the investigators in a meaningful way and share their clinical observations. Ideally the conference would encourage meaningful exchange.

ADJUSTING THE CONTENT TO FACILITATE LEARNING
Here are a few suggestions from one of the legions of attendees who suffer from lack of more considerate program planning:
1. Slow it down. Give researchers a longer time 75-90 minutes, mostly to facilitate interaction with the participants.
2. Limit scope. This allows for a more focused and thorough address of issues. We all have to set priorities and most of us attend more than one conference a year.
3. Point, counterpoint presentation needs to be just that. This model is what drew me to this meeting. I enjoyed the platform and discussions re: sodium and the role of diet and aging. The discussions re: fat in the diet were less than vigorous. A primary author of one contested study was in the audience. Her research had been categorically skewered by both speakers. She was the true counterpoint. Her rightful position was at the dais, not just speaking as an attendee.
4. Workshops need to be workshops. Speakers need to calm down and allow for interaction, not just a nod or acknowledgment after a comment. They are not the only ones with information. We can learn from each other.

ADJUSTING THE PHYSICAL PLANT TO MAXIMIZE FOCUS

I have a few suggestions to share with program planners everywhere.

1. Plan no more than 1.5 hours of lecture between breaks.
2. Provide meaningful breaks—at least 30 minutes that allow participants to go to the bathroom, make phone calls and MOVE—sitting all day is not healthy for us, nor does it help us stay attentive and learn.
3. Schedule adequate lunch time—we are talking about the presentations. This is just as valid a way to learn as getting information funneled to us in a lecture, if not more.
4. Stay on time—the adjustments in the schedule will help everyone enjoy the presentations and calm down.
5. Provide the slides. How this happens and in what form to minimize waste is challenging. My guess is that it can be figured out.
6. Figure out what to serve. It is appalling to me that “breakfast “ is mostly starchy carbohydrate with fresh fruit and caffeine, and breaks are mostly sugar and caffeine.

WE NEED TO WALK THE WALK AND STOP MAKING EXCUSES

In the end it is important to ask ourselves, “Why are we imposing an impossibly unhealthy environment on the planners, the speakers and the attendees?”

I am kind of tired of bringing my own yogurt, cheese, peanut butter or hard boiled eggs just because the continental breakfast is cheaper. That is one of the same arguments our clients give us for not making better food choices. We expect them to change.

I don’t want to be scolded by program planners because we are not on time. I don’t want to be herded from one presentation to another like cattle. This does not bring about the best in anyone.

We learn about the role of stress in disease, and yet create it for ourselves by attending conferences that are absurd environments for learning. I know this can be done better. I have been to events that leave me feeling invigorated, not exhausted. Restored, not broken.

Filed Under: Blog Tagged With: communication, continuing education, education, ergonomics, health provider, learning, nutrition

The Limitations of the 2010 USDA Dietary Guidelines

October 18, 2011 by

Last week I heard Dr. Roger Clemens speak at the California Dietetic Association meeting in Pasadena. Dr. Clemens is a member of the 2010 Dietary Guidelines scientific advisory committee.

I am grateful for the candid discussion. I would never know the limitations of the 2010 USDA Dietary Guidelines if I only read materials printed by the USDA. Dr. Clemens spoke with honesty and humility. We really don’t know much about human nutrition. We only think we do.

NUTRITION IS A YOUNG SCIENCE

Nutrition is a young science, studied for a bit over 100 years as a specific scientific entity. Vitamins were discovered in the early 19th century. We didn’t appreciate the role of fiber until the 1970′s.

We are still debating how carbohydrate, protein and fat influence metabolism and energy utilization. We want to believe calories count, but maybe not as much as the hormones and other regulators that determine what we do with those calories.

During Dr. Clemens talk, five key messages resonated with me.

1. The 2010 Dietary Guidelines are not prescriptive. The guidelines are developed as a public health policy tool. It is a recommendation for the population, but not necessarily for individuals. This means there is plenty of range for people to figure out what balance of carbohydrate, protein and fat works for them. We do not all need to be on a lower fat diet.

2. Calories count, but no one is looking at hunger and satiety. There is not enough data to tell us which diet is better. Research shows that if you restrict calories, every diet works well to help people lose weight.

The problem is that no one is asking the dieters what they think and how they feel. We really don’t know more than calories count. Knowledge is not the same as behavior. It is time we look at what behavior science can tell us.

3. Too much refined sugar and starch is a problem, but the research that was considered didn’t find any distinctions between the impact of high fructose corn syrup, sucrose in white table sugar or any other sweetener. This is a situation where the time lag is glaring.

The dietary guidelines were drawn from research that is about 5-10 years old. The guidelines are always looking backwards at what we know, not what we are finding out. The onerous time lag makes it very difficult for me as a practicing dietitian to support the static position of the guidelines–especially since the current ones will be around for another five years.

4. The 2010 Guidelines continue to tell us to eat less fat, less saturated fat and cholesterol even as more current research tells us that fat is not the problem .

This is exactly the kind of rear view mirror thinking that is inherently a part of public policy that relies on research that takes decades and longer to plan, fund, conduct, and then publish results. It takes even longer to understand. No one study is significant by itself, so we need additional research for corroboration.

One saturated fat, stearic acid, is already vindicated. Stearic acid is naturally found in ruminant animals (cattle, goats, sheep, bison), along with milk and milk products from the same animals. It is also found in cocoa and chocolate. Stearic acid is not associated with increased risk of cardiovascular disease.

Milk, cheese, and red meat have been vilified for decades–and now we know better. In his talk, Dr. Clemens remarked that if you subtract the stearic acid component of saturated fat from beef and cows milk, there would no longer be enough saturated fat to be a problem, even by the old standards.

Interestingly, 8 of the top 16 sources of stearic acid in the American diet are high carbohydrate foods like grain desserts, mixed Mexican dishes, pizza, and candy. I’ve often wondered if it is the refined sugar and starch with added fats that are more of the problem, not the fat itself.

5. Sodium intake may be high, but it is not always a problem. It seems only people already predisposed to elevated blood pressure benefit from reduced sodium intake. In addition, whether someone actually develops hypertension due to the sodium in the diet depends on many other elements. Hypertension is not a single nutrient disease.

Total calorie intake, specifically overeating, is the biggest source of excessive sodium intake. If people started to eat just the energy they needed, sodium intake will drop right along with the excess poundage.

Highly processed and pre-prepared foods contribute 77% of all sodium in our diets. These foods are a major source of all sodium intake.

Just about 10% of our sodium comes from cooking and another 7-10% from the salt shaker. We don’t have to eat food that is less tasty or well prepared to reduce sodium content.

The best way to reduce sodium in the diet is to stop overeating. It is also helpful to purchase less highly processed and prepared foods. Lastly, we can learn how to season food for full flavor, not just to taste salty. By eating more fresh foods prepared at home, sodium intake will plummet even if we use the salt shaker.

GRATEFUL FOR A FLAWED BUT USEFUL TOOL

I am grateful for the impressive efforts of all the scientists, researchers, clinicians and academics who contribute to these Dietary Goals. They provide a framework for us to think about food, nutrition and health.

It is valuable to have the Dietary Goals as a reference, but it is equally important to remember the Dietary Guidelines are limited. We are still learning. The Guidelines can only tell us what was understood before 2010.

Filed Under: Blog Tagged With: calories, cholesterol, diet, dietary goals, fat, food, hunger, nutrition, public policy, Roger Clemens, satiety, saturated fat, sodium, stearic acid, sugar

THE FOOD CHAIN: Human Nutrition Gets It Backwards

October 18, 2011 by

My degree is in Food and Nutrition, Human nutrition that is. When I read research studies the emphasis is on what happens to humans. There is all kind of debate whether animal models are a good surrogate for the human experience. Mostly nutrition science agrees that studies with human subjects are best to determine what is important for humans. Maybe. But we need to look far beyond the human experience to address many of the nutrition and health concerns of our day.

Last Sunday I spoke at the Good Food Fest celebrating 30 years of the Santa Monica’s Farmer’s Market.

As I prepared my talk I looked for a picture of a food chain to insert into my Power point presentation. Many show humans, or at least a carnivore, at the top of the chain. I started to wonder how much these graphics reflect and influence our thinking.

BACTERIA FRONT, CENTER, EVERYWHERE

I chose one of the graphics, copied it and then adulterated the second picture with the missing component. Bacteria.

My graphic was more of a circle of life than a chain. I plopped a picture of bacteria in between “the degraders” (vultures, worms, insects) and soil. Then and cut and pasted a picture of the bacteria at every stage of the chain. I think bacteria is at the top of the food chain, at the beginning, and at every incremental stage in the circle of life.

WHAT ABOUT THE FOOD

On Sunday afternoon I spoke on a panel with Keith Eichenauer, the dairy/deli assistant manager at the Santa Monica Coop and Nate Pietso, owner of Maggie’s Farm. Keith defined organic, cage free, free range, grass fed and other notions of sustainably grown food. Nate discussed how this plays out on a farm and defined what it means to the farmer to grow food sustainably.

I followed. My first quip was something about humans not being the center of the universe. Bacteria probably is. It was the first time I had spoken these words and they resonated. I was struck by how this simple concept had eluded me until that very moment.

I spoke of the nutritional benefits of sustainably, organically grown food. More often than not organically grown food is more nutrient dense. More vitamins, more minerals and especially more antioxidants. In this day of inflammation involved with everything from diabetes to cancer and heart disease, more antioxidants in food is a good thing.

TROUBLING CONSEQUENCES OF CONVENTIONAL FARMING

I spoke of the very troubling consequences of conventional farming. I showed pictures depicting the extent of pesticide contamination and the impact of persistent organic pollutants. Many are known endocrine disruptors and are linked to major metabolic disease.

I discussed the impact of fertilizer run off and dead zones in the Gulf of Mexico come every spring. Excessive nitrogen in the run off drives algae overgrowth. The growth and death of algae sucks the oxygen from the waters. The entire ecosystem suffers, and a “dead zone” is created.

I spoke of antibiotic resistant bacteria from overuse and abuse of antibiotics in animal feed. Seventy percent of antibiotics used in this country are used in animals, mostly in feed to enhance their growth and minimize infection as they live in disease inducing conditions. I spoke of growth hormones used in animals being measured in ground water and the oceans.

REDEFINING THE STUDY OF HUMAN NUTRITION

I basically redefined human nutrition. My guess is that this awareness has been percolating for years. Now it feels obvious. Nutrition encompasses more than the study of nutrients in food. I can no longer be preoccupied by such a limited definition. Preparing for this presentation allowed me to formalize the notion that the entire food chain and all of the challenges of growing food are encompassed in the study of nutrition. They all influence the nutritional status and health of humans.

Today I am more curious than ever about the role of bacteria in nutrition and health. Research is poking at links with health and disease. All kinds of gastrointestinal (GI) tract and metabolic disorders are linked with bacteria. Our bodies host 10 times more bacteria cells than our own human cells. There are estimates of 500-1000 different types of bacteria in our guts and another 500-1000 species on our skin. We live symbiotically with these organisms, whether we pay attention to them or not.

BACTERIA AND RAW MILK

I showed a slide depicting a grass fed cow and the words “raw milk”. In the words of the moderator, the subject struck like a lightning bolt in the room.

Raw milk is a contentious topic, especially on the West side. Recent raids on Rawsome in Venice, CA, and confiscation of raw milk all over the country have raw milk afficcionados up in arms. Statements by the FDA claiming grave danger from raw milk seem out of proportion to documented risks.

My position is simple. We don’t live in the same world as Louis Pasteur. Science should be able to ensure adequate safety standards so that raw milk can be sold and consumed without undue risk to consumers who want their milk and milk products raw. After all, breast milk is “raw” and we don’t find too much trouble with collecting. storing and feeding that to our babies.

Maybe we need to rethink our position on food, period. Our food supply is safe, often too sanitary, and lack of adequate healthy bacteria is linked to many disease states. People now spend money for supplemental bacteria in the form of probiotics. They pay extra to feed bacteria in the form of prebiotics. Maybe we all could benefit from consuming healthy bacteria from carefully chosen raw, fermented and fresh-from-the-farm foods.

What is your take? Is there a need to get enough healthy bacteria from our food supply? Is raw milk the health risk that the FDA claims– or a vital living source of good bacteria?

Filed Under: Uncategorized Tagged With: animal feed, antibiotic resistant bacteria, antibiotics, bacteria, dairy, dead zone, ecosystem, farming, FBI, FDA, food chain, gastrointestinal disease, Good Food Fest, grass fed, growth hormones, Gulf of Mexico, human nutrition, Maggie's Farm, nitrogen, nutrition, organic, pasteurization, pesticides, prebiotics, probiotics, raw milk, rawsome, santa monica farmer's market, Santa Monica Food Coop, smfms, sustainability

Food Matters: Why Health Care Needs to Focus on Lifestyle First

October 18, 2011 by

A survey of the news over the past few weeks tells me the incidence of diabetes increased to 366 million people world wide. Stents continue to be performed after studies show they do not improve patient outcome. One third of Medicare and Medicaid dollars are wasted with mistakes and errors. A gross percentage of health care dollars are swallowed up by the insurance industry.

In our current “treat after the fact” medical system, prevention gets little attention or monetary support. When lifestyle intervention is warranted, nutrition services are routinely denied by third party payers or the coverage is intensely limited.

HOW DOES THE PUBLIC ACCESS A DIETITIAN?

Medicare pays for nutrition support of diabetics and people with renal disease. No nutrition support for cardiovascular or gastrointestinal diseases. No support for medical nutrition therapy for cancer and other diseases impacted by nutritional status.

Private insurers are even more difficult to deal with. Some insurance companies accept dietitians as providers. They are paid a fraction of their usual fee.

Mostly insurers deny payment because few have formal underwriting to cover nutrition services. Patients are forced to appeal a denial and ask for medical review. Reviewers are paid based on the number of claims they deny. Very few clients tell me their visits are covered.

As a registered dietitian I observe the conundrum with dismay. People are overwhelmed with our current food supply. It is abundant, adulterated, and often the cause of disease. We are wired for surviving scarcity. We do not yet know how to survive abundance.

PEOPLE NEED MORE HELP WITH DIET, NOT LESS

Avoiding a poor diet takes great skill and discipline, in addition to a healthy wallet. In a quick survey at a local market, it is possible to purchase 100 calories of foods mostly made with sugar, refined starch and added fats for pennies per 100 calories. Fruits and vegetables cost multiple times more.

Cost of 100 Calories Pavillions Market

ACCESS TO NUTRITION SUPPORT IS ONLY THE FIRST HURDLE

Dietitians are not given the opportunity to do their best work.Too many dietitians see clients for 15-20 minute visits. Many dietitians tell me that follow up visits are not routine. At one large health care organization most nutrition related classes are not even taught by a dietitian. A nurse teaches the diabetes and cholesterol classes and can’t answer the food questions.

No wonder many people complain that they find nutrition services inadequate. Knowledge is not behavior. Education is a first step, but is not necessarily enough to change behavior. Health care dollars are not available to address the life style issues that can make the most difference.

Our food supply is adulterated and abundant. The government continues to subsidize crops that make highly refined starches, sugar and added fats very cheap. There is no one right way to eat. How are people supposed to figure out an approach to food that works?

Filed Under: Uncategorized Tagged With: calories, cardiovascular disease, coliitis, crohn's, diabetes, diet, dietitian, fat, food cost, gastrointestinal disease, health insurance, IBS, medical nutrition therapy, nutrition, sugar by bonnie2000

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Food Matters: Why Health Care Needs to Focus on Lifestyle First

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