Thursday, August 29, 2013

Food Records!

Ah the food journal. Not that I've done any amount of formal research on the subject, but I would hazard a guess that it's far and away the most irritating part of a Dietitian appointment. Most sessions start out something like this:

Quick check in, how was your week? Step up on the scale for me... any challenges this week? Okay, let's get out that food journal. Cue cold sweats. You know, I had it, but I must've left it in my car (this may or may not be accompanied by some light rummaging if there's a bag present)... or on the counter... Maybe the journal is there, but oops, it's not complete. Missing a meal or two here, or perhaps entire days, maybe just yesterday was filled out haphazardly in the waiting room.

That's not to say that no one does it. Plenty of our clients here at NG fill it out. Some without complaint, others ask within seconds -- again? Can I stop this yet? So where does this resistance come from? Maybe it's annoying, having a little book to carry around. Maybe you just forget, after all, Morgan Spurlock taught us all about the 28-days-to-change-a-habit-rule (recent research out of the UK suggests as little as 12 days with high motivation, though the anecdotal evidence says much longer). So, in my own non-scientific way, I've compiled a list of barriers to filling out the food journal, and hopefully, a few ideas on how to overcome them:

Reason 1: I don't have time - I've done a food journal in the past, it's usually a pretty standard part of the education experience to become a dietitian. Some of us do it in a counseling class, or even in nutrition education, but human nutrition 101 will usually involve keeping a journal for anywhere from 3 to 7 days, followed by use of a nutrient analysis software to help us analyze the data. I gotta say, I wasn't the best about it the first time around (neither were my subjects, usually a friend or family member that's willing), but once you get past the initial resistance, I don't think I've ever spent more than about 5 minutes (total) on a food journal during the day. Maybe 2 minutes per meal just to get it all down, if I'm being particularly verbose about what was going on that day. So while it may feel like a lot of time and energy, it really doesn't take too long.
Solution:Get it done when you finish your meal. It doesn't take as long to do, especially since you aren't racking your brain -- was that 1/2c broccoli or more like 3/4? Did I butter my toast this morning? And 30 seconds later you'll be out the door and on your way!
Bonus: It'll be more accurate too, all the better for you to turn in to your dietitian.

Reason 2: I forgot I'd say for most people, especially in the beginning stages, this is probably true. I've been eating meals for well over 20 years now. And I have a particular formula. Decide what to eat, grab a plate, prepare the food, put it on the plate, grab some silverware, eat it, put away dishes, move on with my day. That's a long time to make a routine, and suddenly start changing the steps. So what do you do? How can you possibly remember that there's this new step in your meals?
Solution: Put your food journal somewhere memorable.On the kitchen counter, where you'll see it. Integrate it into your routine. Do you cook and follow a recipe? Great! What better time to jot it down. As you line up the ingredients, make a few quick notes about what's going to be on your plate. Go out to eat a lot? You can keep a small journal in your pocket to take quick notes on, and if needed, transfer the information to your regular journal. Pack a lunch? You can slip the journal in with your lunch, or even fill it out as you prepare your food. Eat at the same time every day? Set an alarm on your phone, it will ping to remind you -- time to journal!
Bonus: Making this habit early in the process gets you moving along with your dietitian, and that means you can move on with your nutrition that much quicker!

Reason 3: I left my journal at home. I go-go-go-go!! If the tiny pocket journal from #2 isn't something that appeals to you, there's another option. As a dietitian, I prefer for my clients to have a separate food journal. I like it because it physically separates it from everything else going on, but again, any food records is better than no food records.
Solution: Some clients really click with using their phone. It's a pretty genius idea, it's always with you, and using a note-taking app affords you all the advantages of writing time, type, quantity, preparation method and even feelings (hungry, full, tired, etc) that were going on at the meal.
A word of caution: I love the note-taking apps. There are dozens out there, free, paid, and they can do all kinds of fancy things. Most phones even come with one built in. Seriously, go for it. But many apps specifically made to be a food journal can be overwhelming. They allow you to log all kinds of things, which may or may not be relevant to your course of treatment with your dietitian. There is such a thing as too much information, so if you choose to use one of these apps, discuss it with your dietitian and see what's a best fit for you.
Bonus: Some apps, such as Rise Up or Recovery Record give you the option to connect with your dietitian on a digital level. You may even find that the phone helps develop the habit, and then you can move to a written journal for a bit more freedom in the way you log your meals and interact with your dietitian.

What's your biggest barrier? Anything in particular that makes this an annoying daily task to complete? Let us know, and we'll crowd source solutions in the NG office!

- Les, MS RD LD

Thursday, August 15, 2013

Dietitian's Lunchbox

Here at Nutritional Guidance, we work hard for our clients. Helping each and every person that walks through our door meet their nutrition needs, answering questions, and providing education and information. We don't simply provide a meal plan, or an "eat this" guide, but rather we work together, with both individuals and families, to make sure that they are able to meet their goals and be successful.

As the school year kicks into full gear, we are here to answer your questions about how to provide a diet that meets our four main criteria: balance, adequacy, variety and moderation. Believe it or not, there are ways to get each of these things into the lunchbox and out the door every morning before the bus arrives.

In the coming weeks, we'll be sneaking a peek into the lunch boxes here at Nutritional Guidance, and sharing what we find.

In the meantime, here are a few tips about putting that lunch together -- not only for kids going back to school, but for those long days at the office where you'll be bringing lunch in with you, or just for packing a picnic for a day at the beach.

- Where are you going? Is there a refrigerator where you can keep you lunch chilled? Are you going to have access to a microwave? Remember, not having a fridge doesn't mean you can't bring chilled foods! Freezer packs can be picked up at the grocery store -- many for less than a dollar. An insulated lunch box will go a long way in helping keep your food chilled -- and safe -- until lunchtime. We'll be checking with both hot and cold meal options to help you and your loved ones meet your needs at the office and at the school cafeteria.

- What do you like? Especially for younger children, lunch may not be the time to introduce a new food or to attempt one of the 35 trials it takes for acceptance of a new (or oft-rejected) food. Instead, pick from foods that you know will go over well in the lunch box. Carrot sticks, fruit and other finger foods can be a great way to pack in fiber, vitamins and minerals at lunchtime. Get creative!

- Pack it together! Having your child help pick out foods for the lunch is a great way to get them involved. Sit together and make a grocery list -- providing options such as banana, apple or berries, can help your child take a bit of responsibility for the contents of the lunchbox, as well as help them learn what makes up a great meal. Children are also more likely to eat and enjoy foods that they helped prepare!

- No cleanup required! Remember, even with a 30 minute lunch break, often times on 15-20 minutes of that can really be used for the meal. Keep it simple and neat! Spaghetti and meatballs can be a part of a great meal, but it can be hard to eat (and keep clean!) at the lunch table, especially if this is a meal for a younger child. Complicated wrappers are to be avoided, and cutting up fruit or veggies in advance can help maximize the time that can be spent eating and enjoying the meal.

What challenges do you face packing meals each night?

We'll be checking in with our dietitians in the coming weeks to get some great ideas for planning, prepping and packing those lunches, so stay tuned!

- Les, MS RD LD

Wednesday, August 14, 2013

What does it all mean?, Taste, pt 7

Together, we’ve been (more or less) reviewing the tastes, where they come from, what they mean to the body, and what the body might be telling you when you crave a certain food. Sometimes you may not recognize the craving, but you may just feel hungry, sometimes even after having eaten. Your brain might be saying, “Hey! You just ate, you really shouldn’t be hungry.” But at the same time, you just feel like eating, or maybe you’re getting hungry but can’t really tell why. If your meal (or your diet) isn’t in the right balance, your body may be trying to signal that it is missing something. This could be energy, vitamins, minerals or protein. Sometimes you can tell which – let’s review:

Sweet – energy
Bitter – danger, or perhaps nutrient rich
Sour – pH balance
Salty – electrolyte balance
Savory – protein

Sometimes you can’t, it may just be a general hungry feeling. But no fear, there’s a simple way to make sure you’re getting everything you need, and I’ll tell you my secret because I’m feeling particularly generous today – keep a balanced diet. Get plenty of grains, fruits, veggies and protein. This will help ensure that your body is getting everything it needs – energy, vitamins, minerals and nitrogen (protein) to keep the body running smoothly and efficiently. In turn, this will help you stay healthy so you can keep up your busy active life.

Monday, August 5, 2013

Prescribing Weight Loss

Recently, we wrote about the AMAs decision to label Obesity as a disease, and some of the benefits that this may have for patients; namely, that this decision could potentially lead to insurance reimbursement for programs and medications promoting healthy weight. With insurance reimbursement comes incentive for research and ultimately, pharmaceutical development. In fact, within the last year, two medications have been released on the market specifically for this purpose – Qysmia and Belviq.
Belviq has shown some promise – trials have shown only slight (and not statistically significant) increased risk for issues with heart valves over placebo (not even .5%). While it does hold some potential for recreational use, that is minimal as well, as those side effects only occur at high-doses and seem to be minimal (1).
Qysmia, which is actually a combination of phentramine and topiramate, was released earlier in the year, is the first diet-pill approved by the FDA in over a decade. Sales have thus far not been promising, and the drug has not passed muster world-wide – the EU did not approve its sale or use. As for the drug itself, both components have known issues, particularly for women of child-bearing age, but the FDA did approve it, and it could be a valuable tool in promoting weight loss.
These medications must be prescribed by a physician, and they work in combination with a balanced diet and exercise plan. They are not intended to be used for a pesky pound or two at beach season, but only for patients with a significant amount of weight to lose. Typically, significant means BMI >35, or BMI >30 with related medical issues, such as type 2 diabetes, or high blood pressure.
There are plenty of other weight loss drugs, supplements, pills and herbs available on the market. Many lack any real research to back up the claims. Others may be more sinister in nature – marketed as an all-natural product or herbal supplement, all the while containing less friendly ingredients. Sibutramine and Phenolphthalein are common offenders (2).
Sibutramine has been shown to suppress appetite – hence its diet-pill marketing. However, it can also cause damage to the heart and undesirable alterations in blood pressure. This is of particular concern for individuals who already have an existing heart condition, or who are at risk, such as those who are overweight or struggling to control blood pressure. Phenolphtalein is a laxative, and there are concerns about its safety, particularly as related to its potential carcinogenicity.
There’s a lesson here: Be a critical consumer, do your homework to determine potential risks. Consult with your physician before taking any medications or supplements. And remember, even FDA approved medications are intended for use with a balanced diet and exercise.
- Les, MS RD LD
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