Susan Weiner Nutrition

By Guest Blogger

Amy Santo

Master’s Candidate in Clinical Nutrition, New York University

Have you ever wondered where your nutrition and dietary advice comes from? Since 1980 “The Dietary Guidelines for Americans” have been published by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). These guidelines are published about every 5 years and provide nutritional recommendations for Americans over the age of 2.

The 2010 Dietary Guidelines are encouraging a switch to a more portion-controlled, plant-based diet emphasizing beans, legumes, peas, nuts, seeds, fruits, vegetables, and whole grains. Fat-free and low-fat dairy products, as well as low mercury seafood and fatty fish are also recommended as part of a healthy diet. The guidelines also advise eating a moderate amount of lean meat, poultry, and eggs.

Many Americans have difficulty with the concept of moderation. We often think “if some is good, more must be better”. Or we tend to eliminate certain foods completely from our diets rather than eat them in “moderate” amounts.  The government is now recommending a “flexitarian” lifestyle in order to encourage a more plant based diet for those Americans who previously ate too much meat and who didn’t include plant based choices in their meal plans. A flexitarian is described as a semi-vegetarian who does not practice an exclusively vegetarian diet but chooses to eat meat infrequently or less often than in a traditional Western diet.

A practicing vegan or vegetarian does not eat meat. Although I am not a strict vegetarian, I have decided to follow the flexitarian lifestyle. Flexitarian diets are rich in fiber, vitamins and minerals. In addition, people who follow a flexitarian diet generally eat fewer calories and less fat, weigh less and have lower cholesterol levels than do non-vegetarians according to the Mayo Clinic. Flexitarinism is linked prevention of chronic diseases, such as cardiovascular disease, obesity, diabetes, and hypertension. It’s cost effective and delicious too!

As a flexitarian, I truly appreciate an occasional succulent steak… along side my quinoa, bean salads and lentil soups. I’m exploring more tofu salads and looking forward to trying innovative plant inspired recipes. 

The new dietary guidelines are scheduled to come out in November 2010. Stay tuned for more blog entries regarding the new Dietary Guidelines!

The full Dietary Guidelines Advisory Report is available to read (as well as more information and public comments about the Dietary Guidelines 2010): http://www.cnpp.usda.gov/dietaryguidelines.htm. Are you interested in following a flexitarian or vegetarian lifestyle? I’m enjoying the health benefits of being a practicing flexitarian.

Long gone are the days that we feared the taste of high fiber foods! Foods rich in fiber are delicious and provide important health benefits.  Fiber can help us feel fuller longer and therefore help us with weight control! Fiber can reduce the risk of developing type 2 diabetes and heart disease. Since fiber can increase the size of your stool  (fiber helps produce a bulkier stool) it can also prevent or relieve constipation. Fiber is also linked to colon and breast cancer prevention.

We do not have the ability to completely digest fiber. Simply put, our bodies don’t produce the digestive enzymes that break down fiber. Insoluble fiber  is the type that can help ward off constipation by increasing the bulk of stool. It may also help control blood sugar.  This type of fiber is found in wheat, corn, nuts, green beans and dark green leafy vegetables.

Soluble Fiber  can help lower blood cholesterol and blood sugar. It regulates blood sugar by signaling the liver to stop making  glucose. Additionally, soluble fiber can improve insulin sensitivity. Soluble fiber lowers “bad cholesterol” or LDL (low density lipoprotein) levels which is great news for heart health.  Soluble fiber is found in barley, oats, psyllium, beans, apples, citrus fruits, carrots, flaxseed and oat bran.

Trying to lose weight? A high fiber diet makes you feel fuler longer so you tend to eat less. Also many high fiber foods take a long time to chew, which will help with portion control.

According to the American Dietetic Association, the average American eats about 14-15 grams of fiber per day, while the American Heart Association recommends we eat 25-30 grams per day! It’s important to increase your fiber consumption slowly to help prevent excessive gas build up and stomach upset. Without water, fiber will cause severe stomach discomfort. So as you increase your fiber intake, make sure you drink an adequate amount of water (at least 6- 8 glasses per day).

Here’s a look at some high fiber foods. As you can see, fiber is only found in plant based foods.  (The data below is from the USDA National Nutrient Database):

Apple, with skin                              1 medium                                     3.3 grams fiber

Asian pear                                          1/2 medium                               5.0 grams fiber

Raspberries                                        1 cup                                             8.0 grams fiber

Dates                                                     1/2 cup                                        7.1 grams fiber

Cooked whole wheat spaghetti   1/2 cup                                        3.4 grams fiber

Air popped popcorn                        3 cups                                          3.5 grams fiber

Cooked lentils                                     1/2 cup                                       7.8  grams fiber

Cooked black beans                          1/2  cup                                       7.5 grams fiber

Almonds                                               24 nuts                                          3.3 grams fiber

Peanuts                                                  28 nuts                                         2.3 grams fiber

Cooked mixed vegetables              1/2 cup                                        4.0 gram fiber

Sweet red pepper                               1 medium                                   2.4 grams fiber

If you are suffering from inflammatory bowel disease or another digestive disorder which might limit your ability to eat high fiber foods, please consult your doctor before altering your nutritional care plan. I usually recommend getting most of your fiber through food sources. Foods rich in fiber are generally high in vitamins as well (and fairly low in calories). Consult your physician if you feel you  might benefit from a fiber supplement. Learn to read food labels to make sure you are working towards your fiber goals.  Make fiber part of your healthy diet today!

If you suffer from Crohn’s Disease or Ulcerative Colitis, you’ve undoubtedly tried a number of remedies to help alleviate the symptoms. My clients often share their frustration about having to limit their daily schedules because of the severe consequences associated with IBD. Inflammatory Bowel Disease (or IBD) is literally an inflammation of the intestines, accompanied by bouts of diarrhea, stomach cramping and occasionally extreme weight loss.

Let’s consider some useful nutritional suggestions to help manage IBD. Although it can feel as if everyday is a challenge, I’d like to help you improve your overall nutritional health. Some of my suggestions vary based on your current state of IBD control! For instance, if you are in the midst of an IBD flare up (or crisis), it’s important to follow a “low residue” diet (also limited in fiber). Low residue and low fiber are not exactly the same thing. However, during an acute bout of pain and inflammation, we don’t want to do anything that would further irritate or inflame the intestines. That means eating softer and easily tolerated foods.

If your physician recommends following a low residue/low fiber diet during periods of extreme discomfort, try to avoid high fiber foods (no more than 10 grams of fiber per day). Avoid foods such as  whole grains and fresh fruits and vegetables as well as nuts and seeds.I  know, it sounds like the opposite of what we usually preach for good health! I also recommend cutting back on dairy products and caffeine, as those foods can stimulate bowel movements.  But remember, this is a temporary diet that should be followed during a  painful flare-up.  Cook high protein foods such as fish, poultry and eggs well (so that they are soft), puree most vegetables (avoiding broccoli, cauliflower and cabbage). Try applesauce and unsweetened canned fruits. Soft pasta might also be well tolerated. Sometimes nutritional supplement drinks (in a very elemental form) can be suggested by your physician (if you feel you can’t tolerate whole foods).  Sugar free foods that contain sugar alcohols (such as sorbitol) can be very hard to digest and should be avoided (as they can cause diarrhea). It is also important to limit large amounts of foods such as fat which could make your symptoms more severe. It’s also important to limit alcohol.

Even during those times when you are experiencing a flare-up, you must try to stay well hydrated and well nourished. I recommend eating 5-6 small meals per day, at all times with IBD. Eating smaller meals (higher in lean well cooked protein) can help you recover faster and feel stronger. Drink lots of water. This will also help prevent severe constipation. When you have IBD, bowel habits can range from diarrhea to constipation (over a short period of time). Water should be an important part of your daily regime.

When your IBD is under control, ask your physician and registered dietitian about increasing the fiber content of your diet. Many studies have proven that higher fiber diets can help reduce the risk of digestive and bowel diseases. The American Dietetic Association recommends a daily fiber intake of 25-30 grams per day for the average adult. However if you have IBD and have been following a lower fiber diet, you must increase your fiber intake very slowly (and only with the permission of your doctor)! Foods which contain high amounts of fiber include: whole grains, fresh fruits and vegetables, nuts and beans.

Treating and managing IBD requires individual assessment and treatment.  In addition to nutritional management and medications, exercise and stress management can be very helpful.  Please check out my previous post “Inflammatory Bowel Disease: More Than Just An Upset Stomach” for more information on IBD. Also check out CROHN’S & COLITIS FOUNDATION OF AMERICA for more support and information. Stay tuned for more information about eating well with IBD!

3D model of the Isotretinoin structure

Do you suffer from frequent bouts of nausea, heartburn, indigestion, stomach bloating, or diarrhea? How often do you change your schedule due to an upset stomach? Do you find yourself planning your daily itinerary around the availability of restrooms?  Many people believe that rather than addressing a nutritional issue, temporary relief is available in the form of an anti-acid. Pop, pop, fizz fizz oh what a relief it is (catchy tune but really not addressing the issue)!  Stomach discomfort and diarrhea can be a sign of a more serious problem called Inflammatory Bowel Disease. Inflammatory Bowel Disease (IBD) refers to two chronic diseases: Ulcerative Colitis and Crohn’s Disease. According to the Centers for Disease Control, these diseases may affect as many as 1.4 million people in the United States. Symptoms include  diarrhea,  abdominal pain, fever, rectal bleeding, loss of appetite, weight loss, chronic fatigue, and inflammation of the skin, eyes, and joints. Serious complications can also occur, including intestinal blockage and ulcers, malnutrition from poor intestinal absorption of nutrients, and increased risk for colon cancer.

The exact cause of Inflammatory Bowel Disease remains unknown. According to the Mayo Clinic, there are a number of possible contributing factors in the development of IBD. Genetic predisposition, a compromised immune system from a virus or bacterial infection, cigarette smoking, being of Caucasian and particularly Ashkenazi Jewish descent, and eating a very high fat and low fiber diet can all lead to IBD. The Mayo Clinic also highlights a correlation between Isotretinoin (or Accutane), a powerful medication used to treat severe acne, and Inflammatory Bowel Disease. Isotretinoin  has a chemical structure and function which is similar to vitamin A.  The drug  was approved by the Food and Drug Administration in 1982. It  has been widely prescribed despite its well-known links with birth defects and it might also impair the immune system’s response to intestinal bacteria. Hypothetically, this can result in inflammation and the development of IBD.

Research studies indicate a strong association between Isotretinoin  and Inflammatory Bowel Disease. A study published  in the American Journal of Gastroenterology by Crockett et. al (March 2010),  reviewed a number of  cases of IBD which were linked with Isotretinoin exposure. Ulcerative colitis was strongly associated with Isotretinoin use, causing a 50% increased risk of developing Ulcerative Colitis in those who have used Isotretinoin previously compared to those who have not. The higher the dosage of Isotretinoin , the greater the likelihood of developing Ulcerative Colitis.

Due to strong scientifically backed evidence indicating a connection between Isotretinoin and IBD,  thousands of  lawsuits have been filed against Roche Pharmaceuticals, the maker of Accutane. Many plaintiffs state they developed severe gastrointestinal disorders after taking the medication and criticize Roche for not issuing sterner warnings about the dangers of the drug. The latest development in the series of Accutane lawsuits occurred on February 16, 2010, when a New Jersey court ruled that Roche Pharmaceuticals must pay $25.16 million in damages to a man who claimed he developed debilitating IBD after taking the medication. Roche Pharmaceuticals maintains they will appeal the latest results.

The bottom line is that if you have a family history of Inflammatory Bowel Disease, or have experienced stomach issues while on  Accutane , please discuss proper treatment options  with your doctor.  IBD management is possible through both medication management and nutrition counseling from a registered dietitian. Don’t wait! Talk to your doctor today if you are experiencing ongoing stomach discomfort. Remember you are your own best advocate!

Amy Santo
Dietetic Intern, New York Presbyterian Hospital
Master’s Candidate in Clinical Nutrition, New York University
amyjsanto@gmail.com

3D molecule custocy of Karl Harrison and 3dchem.com.

Everyone needs a good laugh.  Whether you are giggling or laughing out loud, laughter is terrific mood booster which can help set the tone for the day ahead. Now there is research available showing that laugher can promote appetite! Imagine having a compromised appetite because you’re sick or depressed, and being able to improve your food intake with a hardy laugh. What a fabulous concept!

We already know that exercise can improve appetite in people who are ill or suffering from depression. Over the years I’ve worked with many chronically ill people who are also experiencing depression, and simply can’t eat an adequate amount of food. Several of my elderly clients have many health ailments that limit their activity level and therefore don’t enjoy the benefits of improved appetite as a result of increased movement. So this new research is a very welcome adjunct therapy to good nutrition, increased exercise (as medically appropriate) and medications (such as anti-depression medication or appetite stimulants).

This new data on the connection between laughter and improved appetite in the elderly or chronically ill can be extremely helpful for care givers and family members. The study was conducted by Dr. Lee S. Berk,  a preventative care specialist and psycho-neuro-immunology researcher at Loma Linda University’s Schools of Allied Health and Medicine in California. Dr. Berk released the following statement:  “the value of the research is that it may provide those who are health-care providers with new insights and understandings and thus further potential options for patients who cannot use physical activity to normalize or enhance their appetite”. The news was directly released from the Federation of American Societies for Experimental Biology (April 26, 2010).

Although it was a small study (14 volunteers in total), I believe the findings are significant. The participants all watched different types of videos over a three week period of time. The hormone levels of those who watched the “funny”videos, mimicked positive changes similar to people who exercised moderately. These findings are particularly interesting to me, as I strongly believe in a “mind-body” connection. My clients and I always focus on the relationship between the mind and the body.  Your head is actually attached to your body. What you feel emotionally effects your physical being,  just as your body effects your thoughts. This research provides another possible way to stimulate appetite in those who are struggling to eat due to depression.

If you are a health care provider or caregiver to someone whose appetite has been negatively effected because they are ill or depressed, please continue to provide them with appetitzing food and encourage them to stay as physically active as possible. They must also remain complaint with their medical regime. But now think of ways to make them laugh! Pop in a funny movie, tell some silly jokes or share a hilarious story. You can also share  funny pictures (like the one I posted above of the dog playing the guitar)!  What makes you laugh? Everyone could use a little laughter. So laugh and eat together and enjoy the road to improved health!

Spring is a time of beauty and renewal. The sight of flowers blooming, the smell of grass growing  and the sound of birds chirping make us feel that anything is possible. Living in the Northeast, I’ve learned to appreciate and welcome the change of seasons. The arrival of Spring allows for endless possibilities.

March is not only the arrival of Spring, it is also National Nutrition Month! If you made nutrition related New Year’s resolutions which never materialized, think of March as your “spring- board” into good health! What can you do to improve your nutritional health?

Make National Nutrition Month work for YOU. Here are some suggestions to get you going:

-Maintain a daily food journal!

If you do one thing to improve your nutritional health this Spring, please keep a food journal. Very often we don’t realize all the little extras that we eat and drink. 100 calories here and 50 calories there can really add up.  Keep a record of everything you put into your mouth to figure out where all of those extra calories are coming from. Keeping a food record can also point out what you are missing (healthy unsalted nuts, fruits and vegetables).

- Eat 4-6 servings of vegetables a day

Veggies are very low in calories and very high in fiber! Fiber can help keep you fuller longer and stabilize your blood sugar levels. One serving of vegetables is about 1/2 cup. Try eating different color veggies (such as an orange pepper, green broccoli and red tomato).

- Go For The Omega 3′s

Include unsalted walnuts, ground flaxseed, salmon and albacore tuna into your menu. At least 3 servings of these foods each week will help protect against heart disease (and can even help with brain function).

-Go For The Winning Whole Grains

Throw out the white bread. Toss the white rice. Get rid of the white pasta. Instead try whole grains, brown rice, quinoa and cous cous. These are nutritionally dense choices which also pack a good fiber punch!

-Eat Breakfast

Get yourself started in the morning with some wholesome eggs with veggies, whole grain cereal with unsalted nuts and fat free milk or natural almond butter on whole wheat bread and blueberries. If you are not hungry in the morning, you probably ate too much the night before.

- Cut Back On your Salt

Reduce your sodium intake to less than 2,300 mg per day (that’s about 1 tsp of salt per day). Find out more about salt and your diet.

- Bring Your Lunch With You To Work Or School

Be prepared. It’s not only the boy scout’s creed, it’s the only way to assure that you have the right foods with you to get through the day. What a great way to save money! Bring your food and water with you, everyday.

I could go on and on with more tips and suggestions on how to make National Nutrition Month personal for you. Perhaps the best way to improve your well being is to help better the life of someone less fortunate. During March (and hopefully for months and years to come) please donate money or needed supplies to your local food pantry. Contact your local religious community leaders or town office to find a food pantry near your home. I guarantee that they will welcome donations of money, supplies (such as canned goods), and time (serving meals to the less fortunate). The best way to celebrate National Nutrition Month this March is to be achieve your personal best. Start by sharing the nutrition tips mentioned above and by helping those who perhaps don’t have the same resources available. Let’s make National Nutrition Month the beginning of a Spring to remember.

Walnuts: nutty goodness contained within.

I remember back to the 1990′s when snack foods were re-formulated to be fat free. Cookies and crackers, breakfast cereals and granola bars (although high in sugar and calories), became “fat free”.  As a result of eating these so called healthy low fat snacks, we all got a little fatter. Nuts got a bad rap because they were “high in fat”. Nutrition research has come a long way since the ’90′s. We now know that most nuts are heart healthy and rich in monounsaturated disease fighting healthy fat.

Snack foods don’t have to be limited to the standard cookie. Unsalted organic nuts are natures perfect snack food. Almonds, walnuts, pecans and  Brazil nuts are  top on my list of heart healthy snack choices! Almonds are rich in vitamin E, magnesium, calcium and selenium and provide dietary fiber. Walnuts (also known as king of the Omega 3′s)  can actually help improve brain function! Walnuts also contain a compound called ellagic acid, which is known to fight cancer and support the immune system. Pecans can help lower cholesterol and are a source of vitamins E and A as well as folic acid, calcium and potassium.  Brazil nuts have copper, niacin, vitamin E, fiber and selenium. So many fun, crunchy and tasty choices.

The trick with eating nuts (and any food for that matter) is to watch your calories and eat them in moderation. Portion control is the key…. as it is very easy to eat an entire bag of nutty goodness. Too many calories (even of healthy foods) will lead to weight gain. The protein, fiber and fat in nuts can help fill up your stomach, so you will be fuller longer! Nuts are very nutritious and nobody ever thinks of them as a “diet” food.

About 24 almonds (1 ounce) provides 160 calories and 6 grams of protein. 6-8 Brazil nuts (1 ounce) has about 190 calories and 4 grams of protein. 20 pecan halves have about 200 calories and 3 grams of protein. And 14 wonderful walnut halves have 190 calories and 4 grams of protein. All pack a powerful protein punch and a satisfying crunch!

Sprinkle a few nuts into your low fat yogurt or on your salad or whole grain cereal. Unsalted nuts are delicious in cooked veggies or steel cut oatmeal. Nuts are high in nutrients, but also in calories. So portion out your nuts and crunch away.

Thanksgiving is often stressful for many reasons. I’m sure we can all document many memorable Thanksgiving adventures. Who has traveled to grandmas in ghastly traffic or dealt with Aunt Edna’s comments about career choice? My favorite is the thought of  listening to  Uncle Stanley’s lecture on the state of economy. So this year, let’s vow not to make “eating” an additional stress. Eating on Thanksgiving can be a wonderful, non stressful and satisfying experience.

Let’s think about a few ways that we can avoid overeating on Thanksgiving. My first suggestion is to make sure you don’t leave the house if you are starving. If you are really hungry when you reach your destination, chances are you will be tempted to eat a lot of extra calories (especially if  Uncle Henry corners you about his multi level marketing idea). Eat an apple or another enjoyable fruit or cut up some celery and add a teaspoon of natural peanut butter before you venture out of your house. You’ll be in much better control when the appetizers arrive.

Try to limit your alcohol consumption (yes, I know this is difficult). Drink some water before you go for an alcoholic beverage. Alcohol has a lot of calories, and the more you drink, the more you might not care about what you eat.

Make sure you include veggies in your Thanksgiving feast.  If you don’t think your host will will have fresh vegetables available, offer to bring them! It will be a welcome addition to the meal. And it is unnecessary for 12 guests to bring dessert for 8 people. Someone should be assigned to bring some healthy, low calorie, fiber rich vegetables. If you are asked to bring dessert, offer to bring a fresh fruit platter. Everyone will appreciate the choice.

By all means have some of your favorite and traditional Thanksgiving dishes. Deprivation often leads to overeating so try to eat the more indulgent  foods in smaller portions. Put the turkey on your plate first, followed by vegetables and then add your favorite side dishes. Enjoy it all! Just try to limit the quantity.

Slow down and eat consciously. Believe me, you won’t run out of food. Decide what you would like to eat and portion it out! If you are used to eating lightly, don’t gorge yourself (you’ll feel sick). Remember that much of the traditional Thanksgiving fare is very high in fat (including cream sauces and butter) which could lead to stomach distress. Smaller portions and moderation is key!

Please don’t think of Thanksgiving as an eating orgy. Change your thoughts about the foods set in front of you. Consider the true meaning of the holiday. That’s right…. giving thanks. Go around the table and have everyone discuss what they are most thankful for. Perhaps the shared commentary by family and friends will be more satisfying then taking huge additional portions of candied yams and triple cream pie. Happy and healthy Thanksgiving to you and your family!