Skip the Sip: Why you should keep the fruit but ditch the juice

Juice seems to be everywhere in the American diet, from apple juice at kids’ snack time to orange juice on every breakfast table.  While I love the taste of juice as much as the next guy, when it comes to health, I know that choosing an actual fruit is the way to go. (and yes, this includes 100% fruit juice).

Here’s the deal: nature packages fruit in the perfect way by combining sugar with tons of fiber.  Yes, you’re consuming some simple sugars, but by slowly consuming it along with slow-digesting fibers, you also slow down glucose absorption and minimize blood sugar spikes. When we instead take a fruit, squeeze out the sweet juice, and discard all of that wonderful fiber, we wind up absorbing way more sugar in a fraction of the time.  This leads to blood sugars that climb too quickly and go far above the desired limit. If you have pre-diabetes, diabetes, or insulin resistance, this is exactly the type of sugar overload you want to avoid.

A large orange, for example, has ~15 grams of sugar mixed in with 4.5 grams of fiber, and it will probably take a while to eat. Your standard 12 ounce single-serving bottle of orange juice, on the other hand, has about 35 grams of sugar and no fiber– and most of us could drink that in a few minutes!  Think about what a difference that makes for your blood sugar spikes.

Here are my tips for avoiding the fruit juice sugar spike:

  • If you just can’t kick the craving for juice, try diluting it to cut the sugar. Mix with water for a milder flavor, or try mixing with seltzer for a bubbly alternative.
  • Don’t be fooled by the healthy sound of “100% fruit juice”– although they may be pure natural juice, they are still incredibly high in sugar.
  • There are lower-sugar juice available on the market if you’re comfortable consuming non-nutrative sweeteners (aka artificial sweeteners without calories). Always check the label, though, to see just how much lower the total carbohydrates (which includes sugar) will be.
  • If you’re used to drinking juice with certain meals/snacks, try substituting it with fruit if cutting it out cold turkey sounds too ambitious.  If you like juice with breakfast, swap it for a small fruit cup, add berries to your pancakes or cereal, or slice up an orange for that same OJ flavor. If you usually choose juice for something sweet on the go, try a more portable fruit like grapes, clementines, or apples.
  • Juice can actually be a better alternative than other sweeteners if you’re using it as an ingredient in place of table sugar or corn syrup, as you will still get some vitamins and minerals from juice but not from straight sugar. Try substituting a 100% fruit juice concentrate like apple or grape for granulated sugar in your baked goods, keeping in mind that the sugar content may be similar but the nutritive value is a bit better.  You’ll likely need ~6oz juice for every 1 cup of sugar, and a bit less liquid as even juice concentrate contributes liquid.

Happy New Year: Crafting a Realistic Resolution

“New Year, New You!”
“This year, I’m going to be healthy!”
“My New Year’s diet starts today!”

New Year’s is the perfect time to hit the reset button — a fresh year represents a new start where you can commit to self improvement.  I love the idea of establishing a New Year’s resolution to help kick start your healthy changes, but it’s hard to overlook the tendency of resolutions to fizzle out by the end of February.

To stretch the lifespan of your resolution and create a long-lasting behavior, try making it a very specific goal.   The solution lies in a classic goal-setting acronym S.M.A.R.T. Specific, Measurable, Attainable, Relevant, Time-Bound.  By tailoring your resolution

  • Specific: Define what actions you need to do to achieve your goal
    • If your overall goal is to be healthier, ask yourself HOW you will do that. Perhaps you want to eat more vegetables, less fast-food, or fewer refined sugars.
  • Measurable: How will you measure your success?
    • Avoid just stating you’ll do something “more” or “less” (work out more, eat more fruit, drink less coffee) and instead add a defined target goal, like eating at least 1 serving of fruit a day or going to the gym 3 times a week.
    • These concrete numbers will help you keep better track of your progress by giving you a reference point.
  • Attainable: Set goals you can realistically achieve
    • This is a huge part of setting successful goals- choose something that is challenging but doable, to make sure you can see it through.
    • If you haven’t touched a vegetable in years, it would be ambitious to say you’ll eat 3 servings of veggies every day. If you try to add one serving per day, though, you may stick with it much longer.
    • Similarly, you’re more likely to stick to “cutting back” than you are to “cutting out” foods or behaviors that aren’t particularly healthful. This will lead to sustainable behavior change so you can turn your resolution into your new norm.
  • Relevant: Is this goal going to help you achieve your big picture goal?
    • Here’s the key question: Will the specific goal you’re setting help you achieve the overall desired outcome?
    • If the answer is yes, then you’ve set a goal that aligns with your overall vision of health (relevant!).
    • If the answer is no, then your focus may have shifted throughout the process, so center your attention back on what it is you really hope to achieve.
  • Time-Bound: Factor in frequency or deadlines for your goals
    • There is no right or wrong timeline for a goal– it is entirely up to your current habits and your desired outcomes.
    • You might resolve to start eating at least one vegetable per day, one vegetable serving per meal, one new vegetable each week… They’re all worthwhile goals with a timing-specific limit (per day, per meal, each week).
    • Defining this aspect of frequency will help you be consistent, keep track of your actions, and know whether or not you’re hitting your target.

If you make your goals S.M.A.R.T, you will be able to gauge your success, stay dedicated, and hopefully see your resolution through for the year to come!

Wishing you a very happy, healthy 2019!

Frozen Foods: Off Limits or Fantastic Time-savers?

When we’re in a pinch for time, frozen foods seem to be the perfect answer: a full meal in a matter of minutes! But what do those time saving meals mean for your health?

I find that the freezer aisle is a very love-it-or-hate it area of the supermarket; either you can’t shake the image of a 1950’s family eating mushy TV dinners straight from the microwave and therefore won’t touch the stuff, or you adore the convenience of a pre-made, high-flavor complete meal that requires no prep (though you’ve probably never checked the label).

I fall somewhere in the middle. The health-food wave is slowly spreading throughout most supermarkets, and the freezer aisle is no exception! The trick to shopping here is to know what you’re looking for and how to compare products.

Here’s my Top 5 Freezer-Friendly Shopping Tips:

  1. Sodium Alert
    Salt has been used as a natural preservative since ancient times, which is why so many frozen (and canned) foods are packed with sodium! The American Heart Association recommends most people consume no more than 2000 mg sodium daily (the same as 1 level teaspoon), while those with a history of heart disease should aim for 1500 mg sodium.  For any large meal like a frozen dinner, choose meals with 600 mg of salt or less. Many popular brands have over 1500 mg in one serving, so definitely start eying the sodium before picking a meal!
  2. Well-Balanced Meals
    As tempting as it may be to purchase just frozen truffle macaroni and cheese, try to choose well balanced meals that have some fresh vegetables and whole grains. Many companies are creating more well-balanced meals using organic produce, ancient grains, and lean protein to help your meal be nutritious as well as delicious.
  3. Look Beyond the Label
    Perhaps more than any other aisle, the freezer is full of items marketed towards dieters. Just take a look at how many have words like ‘lean,’ ‘light,’ and ‘healthy’ in the brand name! While those foods very well might be great choices, a title alone doesn’t guarantee that. Always look at the nutrition facts before trusting the marketing, examining the calorie content (I’ve seen meals range from 200 to over 800 calories in a serving), saturated fat content (the goal is as low as possible here), and sodium amount to make sure your meal is actually a healthy choice.
  4. Bulk Up With Veggies
    Some meals look delicious on the cover but are far too small when you actually pop them out of the box (if you ever see a meal for under 300 calories, that’s a red flag that the portion will be petite). Instead of doubling up, bulk up your meal with frozen fresh vegetables! Frozen produce is often flash frozen right after harvest so the nutrients are preserved, and any vegetable on its own (without any sauce or butter added) is still very low calorie, high in fiber, low in sodium, and high in nutrients. You can add a lot of bulk to tiny but delicious meals this way.
  5. Be Adventurous!
    Take advantage of the wild array of recipes available at your fingertips! Food companies have recognized that consumers like to try foreign cuisines and complex meals that we wouldn’t cook for ourselves, so take a walk on the wild side and try some new flavors. I’ve seen Indian, Japanese, Chinese, and Mexican dishes as well as meals featuring ancient grains, unique herbs and seasonings like lemongrass, and flavorful curries.

 

Next time you think about ordering take out or driving through the fast food window, consider the freezer aisle for some potentially healthier alternatives. Do you have any brands or lines that are your go-to or that you’re looking forward to trying? Comment below!

 

Bonus: for some insight into frozen breakfasts, take a look at my Low-carb Breakfast post featuring a breakdown of some popular items!

Why Your Diet Doesn’t Work: The Imprecise Science of Caloric Balance

“Want to lose one pound of fat? Just cut 500 calories from your diet each day and you’ll shed one pound per week!” We’ve all heard that sensationalized claim before, and if it sounds a bit too good to be true, that’s because it is. This math is based on the premise that it takes exactly 3500 calories to burn one pound of fact, but that information itself is inherently flawed.

Weight maintenance is essentially a function of our basal metabolic rate, or BMR: the amount of calories your body burns daily just to survive. Just like it takes more energy to power larger machinery, it takes more calories to feed all of the cells in larger or heavier people– so they naturally have higher BMRs. If you were to lie in bed for 24 hours without any activity or intake, after fasting for at least 10 hours, your BMR is the number of calories your body would burn.

We can estimate our BMR with equations like the Harris-Benedict and Mifflin St Jeor equations, which take your height, weight, age, and gender into account. If you’ve ever tried to calculate your calorie needs online or via app, they probably use these equations.

The only way to actually measure your BMR, though, is through ‘calorimetry‘ (which literally means ‘calorie measurement’); direct calorimetry requires you to stand in a specialized chamber that measures how much heat your body is producing (impractical for most people), and indirect calorimetry can use respiratory tests to measure how much oxygen you inhale and carbon dioxide you exhale over a set period of time (somewhat more practical and actually available at some fitness and medical centers).

Of course we don’t just lie in bed all day. When we factor in our daily activities, we can find our Total Energy Expenditure (TEE), which means how many calories you burn on a typical day doing your usual activities. This is about 20% higher than your BMR if you are mostly sedentary to up to 90% higher if you are a professional athlete. Most people who are moderately active (1-3 days of intentional physical activity or exercise) burn about 38% more calories than their BMR.

This is where the error happens: It is very difficult to know how many calories you truly burn in a day. According to predictive equations, as a 5’4″, 27-year-old, mildly active, average weight female, my estimated BMR ranges from 1360 calories (Mifflin Jeor) to 1430 calories (Harris-Benedict), and my TEE should be about 1630 – 1720 calories daily.   I actually had indirect calorimetry done at a local gym last year, however, and my results showed that a better estimate for my BMR is 1123 calories and my TEE is close to 1350 calories.

That’s about 20% fewer calories fewer than traditional estimates- meaning that my body needs way fewer calories than the textbooks tell me.

Moving onto the second major issue: the 3500-calorie rule just doesn’t seem to be true.

This number came from a 1950s study by Max Wishnofky called “Calorie Equivalents of Gained or Lost Weight,” which posits that one pound of fat would require about 3500  calories to burn based on the scientific principles of fat. (If you’re interested in the gritty details: 1 pound (454 grams) of fat cells contains about 87% actual fat, and since it takes about 9 calories to burn one gram of fat, than a whole whole pound (454 grams) should burn up using about 3700 calories).  If you took a literal pound of fat and threw it into an incinerator to measure how much energy was required to literally burn it, that might be accurate. However, it doesn’t take our physiology into effect, and for better or for worse, our bodies are extremely adaptive at trying to preserve our energy stores.

Wishnofsky also examined a 1930s study by Strange, McCluggage, and Evans (“Further studies in the dietary correction of obesity”) which essentially starved for weight loss and found that they lost 0.6 pounds per day with a 2100 calorie deficit. How would one have such a severe deficit, you ask? They were put on a 360 calorie diet.

  • The diet: 360 calories made up of lean steak, fish, egg whites, whole milk, orange juice, yeast, minimal vegetables, and salt contributing ~58 grams of protein, 14 grams of carbohydrates, and 8 grams of fat each day. By today’s medical standards this would be a study of intentionally invoking severe malnutrition.
  • The participants: only 13 patients participated, and they were all in a hospital setting. Their weight ranged from 180 pounds to 427 pounds at the start of the study.
  • The outcomes: everyone obviously lost weight – the average was 35 pounds over 59 days. This was VERY inconsistent, though: actual weight loss ranged from 5 pounds over 8 days to 104 pounds over 176 days. 

This very small data pool based on a severe starvation diet showed that people lost about 0.6 pounds with a 2100 calorie deficit each day – making the weight loss ratio 1 pound to every 3500 calories. The 3500 calorie rule is based on these 13 people, severe starved for anywhere from a week to 25 weeks. 

I think this just exposes a truth we all know deep down inside: it’s just not that simple. Reviews of studies indicate that we lose weight more slowly than the rule would predict because our body burns fewer and fewer calories as we lose pounds. If you’ve ever watched a season of The Biggest Loser, you’ve seen this reality in action. Contestants used to lose over 20 pounds per week in the beginning when they were larger and had more excess weight to lose, but by the final weeks, they were following severe diets and working out 10 hours per day only to lose 2 – 3 pounds per week. Over time, their bodies required fewer calorie per day to run, so that calorie deficit rule shifted for them.

The good news is that researchers are now starting to battle this well-known rule to promote more realistic weight loss attempts. Dr. Diana Thomas and colleagues are leading this crusade with a math-driven approach, modeling actual weight loss journeys to create calorie / weight loss curves showing significantly less weight loss than the 3500 calorie rule predicts. Though many weight loss apps still use standard formulas to calculate how many calories you need per day for weight loss, a much more sustainable method would be to try to improve the overall quality of your diet, monitor what you currently eat and try to implement a slight deficit, increase your physical activity, and adjust things your plan as you go.

There is one slight upside to the 3500 rule, which is that it is memorable enough to communicate that caloric deficit is needed to burns weight. The downside is that it dramatically overestimates the rate of weight loss and can inspire dangerous levels of calorie cutting. I would never recommend eating less than 1200 calories; crash diets slow down your metabolism as your body adapts quickly to its new low-energy state, and nearly everyone rebounds back to a poor higher-calorie diet later on. Emphasizing overall nutrition quality, seeking a registered dietitian for ongoing nutrition counseling and support, and focusing on nutrition as a health goal rather than a means to an end can help you actually achieve your goals and maintain them long-term.

 

The overall takeaway:

  1. It is difficult to calculate your accurate BMR.
  2. It is even harder to then calculate your TEE
  3. Even if you can figure out how many calories you need daily, it is difficult to know how steep of a calorie deficit you would need to burn 1 pound of fat as the 3500 calorie rule is unreliable and based on absolutely extremist, insufficient research.
  4. Focus on improving diet quality, achieving a mild but sustainable caloric deficit, and seek assistance from a nutrition professional if you feel lost!

 

 

Resources:

Wishnofsky M.  Caloric equivalents of gained or lost weight. American Journal of Clinical Nutrition. 1958 Sep-Oct; 6(5):542-6.

Strang JM, McCluggage HB, Evans FA. Further studies in the dietary correction of obesity. American Journal of the Medical Sciences. 1930;179(5):687–693.

Thomas DM, Gonzalez MC, Pereira AZ, Redman LM, Heymsfield SB. Time to Correctly Predict the Amount of Weight Loss with Dieting.  Journal of the Academy of Nutrition and Dietetics. 2014;114(6):857-861.

Top 5 Ways to Get Back on Track after Thanksgiving

We’ve officially kicked off the holiday season with Thanksgiving – and if you’re like most Americans, you ate several times the calories you normally would!  I’m a big believer in enjoying celebrations and eating guilt-free on those days, though even those who are normally mindful of what they eat can easily eat seconds and thirds of their favorite family recipes (followed by tiny portions of about 6 different desserts).

The key to surviving the holiday season from this point on while still adhering to your health goals is to take each day at a time- follow these tips to make it to New Year’s without backsliding into old habits.

  1. Leave the holiday splurges for the holidays.
    If you follow one tip all season, make it this one! Food traditions are at the heart of many holiday celebrations, so enjoy them on the actual day-of, but don’t carry those bad eating habits with you for the rest of the season!
    Whatever your major holidays are — Christmas Eve, Christmas day, Hanukkah, New Year’s Eve, a certain holiday party you’ve been waiting for — enjoy the food and drink on that day but go back to your normal eating routine once the event is over. If you carry out that celebration mentality every day until New Year’s and eat twice the calories you normally do, you can easily pack on the pounds or wind up with out of control blood sugars. This goes for leftovers as well; definitely enjoy those Thanksgiving leftovers, but serve yourself smaller portions so you don’t overeat like you may have while feasting with family.
  2. Listen to your Hunger Cues.
    If you’ve ever eaten to the point of becoming uncomfohunger scalertably full (a feeling very well associated with holidays), you probably ignored your hunger cues. Our bodies are great at telling us when we need to eat and when we can stop, but our love of flavor usually leads us to keep eating far beyond that point. Using a mental Hunger Scale can help you identify when you need to eat or wait so you can eat more intuitively. Throughout the season, ask yourself if you are eating because you are hungry (scale points 3 & 4) to the point of satiety (points 5 & 6) or beyond that (points 7 & above) so that you can enjoy your holiday treats without feeling stuffed.
  3. Don’t drink your calories.
        Alcohol is a major part of many holiday festivities, but it’s a two-fold trap when you are watching your health! First, alcohol is packed with calories – and the heavier the drink, the more calories it packs.  While a light beer or a 4 ounce glass of champagne has around 100 calories, a heavy winter lager or a martini can easily have over 200. Add creamy drinks like eggnog or dessert martinis and those drinks pack more than 300 calories each. The second trap here is that alcohol dulls your inhibitions and often leads to eating far more than you ever would while sober! This is especially true for anyone who restricts their eating on a daily basis, so if you tend to be a crash-dieter, you may find yourself eating twice what you normally would once alcohol silences that voice in your head. My tip is to cap yourself at once drink so you can enjoy yourself while still being able to hear your hunger cues rather than overindulging unintentionally.
  4. Plan ahead.
         This may be the least fun tip, but it’s the most practical. If you are going to a holiday party where you know your friend’s famous seven-layer dip or decadent dessert will be served, make a mental plan of how you will be allotting your calories. This can help you enjoy your favorite items without feeling guilt that you splurged all night long. A good rule of thumb is to try to divide your dinner into courses like you would at a restaurant: an appetizer, dinner, and dessert. Choose your favorite small app, a main course with protein and some vegetables if available, and one sweet plate (or drink) for dessert rather than grazing mindlessly all night.
  5. Stay mindful between meals.
    There are only a few actual holidays this season but many normal days with special treats lying around. If you love to buy seasonal snacks or work in an office with a constant supply of desserts, make a mental note of how often you are eating otherwise celebratory foods throughout the day. If you are having multiple sweets throughout the morning and afternoon, you are likely having way more calories and carbohydrates than you would eat any other time of year, and this can do a number on your blood sugars and waist line. Find a happy medium that works for you, like only eating workplace treats two times a week instead of every day or saving your treats at home for weekends.

If you find yourself struggling and need extra guidance on how to prioritize your health goals while still enjoying the holidays, nutrition counseling with a registered dietitian nutritionist can make a huge difference. I have a great holiday deal through the end of the year and an even better Black Friday deal through 11/26, so this is the time to book a session!

What exactly is an RDN, and why should I trust one?

Everybody eats. All day long, no matter what you do from sun up to sun down, at some point your body needs food and you will eat. You’ll repeat that every day for the rest of your life, and so you will naturally form opinions about your food and perhaps which ones are ‘good’ or ‘bad.’ Your mother and your grandmother will tell you what to do to stay healthy; the fittest guy at the gym will swear he knows how to shred fat; catchy headlines and Google searches and talk show hosts will all offer ‘the key to weight loss!’ The enemy is fat! No, gluten! No, sugar!

I’ll give you a hint: if there was one key to overall health or weight loss, one simple meal plan to solve it all, whomever discovered it would be a trillionaire and you wouldn’t be reading this article. However, nutrition is much more complex than that. 

If you feel like there is an overwhelming amount of conflicting information out there, you’re right! That’s because there isn’t really one clearcut ‘healthy diet’ for everyone. Certain people DO need to cut out gluten, or watch how much potassium they eat, or strictly cut their sodium, or follow a medically-prescribed ketogenic diet to prevent seizures. However, deep Google dives will yield a lot of discordant information if you don’t know exactly what kind of nutrition information is a) pertinent to you, b) scientifically sound, and c) safe.

That’s why we need Registered Dietitian Nutritionists (RDN). Most people don’t know that an RDN is different than a ‘nutritionist’ or a ‘health coach.’ I myself didn’t know the difference until I pursued this path professionally, but those three little letters — RDN — hold a lot of meaning about the quality of nutrition education and counseling my colleagues and I provide. To become an RDN, you must:

  1. Complete an undergraduate degree including about 90 semester hours (more than a standard major) of in-depth science and nutrition-focused curriculum
  2. Complete over 1200 hours of supervised professional practice internship working under dietitians in clinical settings (hospitals, nursing homes, rehabilitation centers, dialysis centers), community locations (like WIC, Head Start, or Meals and Wheels programming for food security), and food service roles (implementing food safety standards and learning the managerial functions of food service directors)
  3. Pass a credentialing exam that covers principles of nutrition and food science, human anatomy and physiology, educational theory and application, counseling techniques, research techniques and interpretation, medical nutrition therapy for individuals in all stages of life and with varying diseases, employee and financial management skills, and menu creation and implementation just to name a few topics.
  4. Soon all RDNs will be required to hold Master’s degrees, though many dietitians (including myself) already hold a Master’s in areas like clinical nutrition, nutrition and food science, business, health care administration, or public health.

Other nutrition professions like ‘health coach’ or ‘nutritionist’ do not require the same degree of formal training (some have quick online courses that cover overall healthy eating without any explanation as to the scientific foundation of these principles or the medical implications). You may find some non-dietitian individuals who do have formal health education and experience, but you can’t be certain of the wealth of training your practitioner has completed unless he or she is a dietitian.

The New Jersey Academy of Nutrition and Dietetics has launched a campaign to support Registered Dietitian Nutritionists as the nutrition expert– and I highly suggest you check out the launch video here!

The Numbers Game: Understanding Your Blood Sugar Levels

So your blood sugar runs high- but what is considered ‘high’? Are they slightly elevated, or are they far above your target range? Are they improving with time or do they keep climbing? The first step to blood sugar control for people with diabetes is understanding your numbers, which can help you identify personal patterns and track your progress over time. There are three main blood sugar measures to take into account: Fasting blood sugar, Post-prandial blood sugar, and Hemoglobin A1c.

Fasting blood sugar refers to the glucose level measured after several hours without food, like when you test first thing in the morning.

At this point, your body has already utilized whatever carbohydrates you consumed the night before and is now running off of stored carbohydrates which means it is trying to be very efficient; you should have enough glucose in your blood to help your cells run but not much more than that. Any elevated levels are a sign that something is off and your body is not able to move glucose into your cells optimally. Whether this is due to a lack of insulin (generally type I diabetes or progressed type II) or because your cells are not as sensitive to the insulin as they should be (generally type II), a high fasting glucose at a physical exam is often a first warning sign of diabetes for patients. A normal range is 70-100 mg/dL, with levels under 70 considered abnormally low and requiring intervention to bring them back up. Levels between 100 and 125 mg/dL fall within the prediabetic range, meaning you are at risk for diabetes and have some impairment of your glucose utilization, and levels over 125 mg/dL qualify as one sign of possible diabetes.

Post-prandial blood sugar simply translates to levels ‘after eating.’ This test is usually taken two hours after your last meal, and the numbers will generally be higher because you have just introduced a large volume of glucose into your system. Some degree of a blood sugar spike is normal after eating; your body digests whatever carbohydrate you consumed, breaks it down into small glucose molecules that enter your bloodstream, and insulin helps to move that glucose into the cells where it’s needed. Two hours after eating, a normal blood sugar level would return to under 140 mg/dL. For people with diabetes, that number is often over 180 mg/dL, which shows that your body is having a difficult time transporting the glucose from your blood stream into your cells. Your doctor may formally test this with an Oral Glucose Tolerance Test where you consume a controlled amount of glucose followed by blood testing two hours later, and levels over 200 mg/dL are considered within the diabetic range.

Hemoglobin A1c (often shortened to ‘A1c’) is a bit different than the other two tests because it reflects your average blood sugar over the last 90 days rather than at a set period of time. Your result is given as a percentage that shows how much residual glucose is stuck to your red blood cells, and a higher percentage means higher overall circulating levels of glucose. A normal A1c is under 5.7%, with the prediabetes range falling from 5.7% to 6.4%. An A1c of 6.5% or higher is a major sign of possible diabetes as it shows that your blood sugar tends to run much higher than the desired range.

Once a person is diagnosed with diabetes, there are similar goals that indicate good control: Fasting blood glucose should be under 130 mg/dL; 2-hour postprandial levels should be under 180 mg/dL, and Hemoglobin A1c should be under 7%.

For your reference, here’s how all of these numbers compare to each other:

Fasting Glucose (mg/dL)

Postprandial Glucose (mg/dL)

Hemoglobin A1c

Normal levels

70 to under 100

Under 140

Under 5.7%

Prediabetes

100 to 125

140 to under 180

5.8% to 6.4%

Diabetes

126 or higher

180 or higher

6.5% or higher

Goal for people
with diabetes
(after diagnosis)

70-130*

Under 180

Under 7%

*Some doctors may prefer fasting blood sugars of 80 or over to minimize risk of hypoglycemia, which is often the case for elderly patients. All of these numbers can also be impacted by other medical factors including medications, chronic diseases, and inflammation, so the results alone may not constitute a diagnosis – always speak with your physician if you are concerned.

These ranges are also slightly different for pregnant women as they have a larger volume of blood and therefore will have automatically lower concentrations of glucose. Imagine diluting 4 ounces of iced tea with 4 ounces of water – it may taste be less sweet as it is less concentrated, but the entire glass will still have the same amount of sugar as the 4 ounces of iced tea alone, so the low concentration is somewhat deceitful. Instead, physicians generally test for gestational diabetes (the onset of new diabetes symptoms during pregnancy) with an Oral Glucose Tolerance Test where they test their blood sugar response to a concentrated high-glucose drink.

Nutrition is a major influencer of blood sugar control. The carbohydrates you consume correlate directly to your increase in blood sugar, though the magnitude of change is different for each individual. I’m familiar with the tendency of many patients to start medication and believe it negates any need for dietary intervention, but combining a carbohydrate-consistent diet with medications will optimize your results. There is solid research that diet modification can help to decrease your A1c while also helping you better understand how your food choices impact your blood sugars, and many endocrinologists routinely refer patients to dietitians for medical nutrition therapy.

For more information on understanding your numbers, check out these trustworthy websites:

Top 5 Food Blogs to Follow

If you eat like an RD, think like an RD, or just love food like an RD, then you need to be following these five foodie sites. There are thousands (if not more) incredible nutrition bloggers, food photographers, and media dietitians out there, but these are a few stand out options to get your nutrition fix.  Prepare yourself for some powerhouse dietitians, career inspiration for food-lovers, and a whole lot of entertainment.

Steph Langdon, WhatRDsDo.com:  This website is a platform to highlight the incredible careers of dietitians, as curated by Canadian dietitian Steph Langdon. Her mission is “to inspire people to become dietitians and inspire dietitians to aspire to achieve great things” — and she does just that with each detailed interview profiling standout RDs.

The Good Food Jobs blog, GoodFoodJobs.com/blogWhether looking for a food-first career on a rural farm or in a bustling city, GoodFoodJobs.com is the website for you, and their Gastrognomes blog component is a real hidden gem. Gastrognome, their combination of gastronomy + gnome, is defined as “a jovial individual whose main purpose on earth is to connect people who derive pleasure from good food,” and I’ve never heard a word that captures the soul of a foodie quite as well! The goal of this site is to highlight individuals who found their dream jobs through the website’s services, whether they work in agriculture, business, culinary arts, the media, nonprofits, or food production, and the profiles of these gastrognome provide fascinating inspiration.

Sally Kuzemchak, RealMomNutrition.com: This RD is one mother of a dietitian – and she has made her website a “judgment free zone” focused on nutrition in the home with an honest and realistic spin. From inspiring ‘snacktivism’ (upgrading our current junk food options) to providing the ultimate lunchbox guides, this is a great spot for parents that need support when feeding their family.

Alissa Rumsey, Alissarumsey.com:  Most of Alissa’s blog posts are dedicated to a very important facet of nutrition that stands in stark contrast to fad diet culture: her ‘ditch the diet’ mentality, which promotes intuitive eating by focusing on your own body cues. She has mastered nutrition media as a former Academy media spokesperson and frequent nutrition freelancer, so don’t be surprised if you recognize her already. Bonus: If you’re an aspiring nutrition entrepreneur, Alissa’s website is the place to go for tips on everything from social media strategy to freelancing resources.

The Sarcastic Nutritionist, Thesarcasticnutritionist.comThis one is a bit more irreverent, so get ready for sassy humor from this dietitian duo. Their line of merchandise features quips like “putting the RD in neRD” and “Calories don’t count when you drink with a dietitian.” There’s a bit of profanity to bring some punchlines home so be forewarned, but if you have an affinity for the edgy, you’ll enjoy every last item.

Bonus foodie site – Food Bites, @FoodBites on instagram: If you haven’t seen the food art on @FoodBites instagram yet, be ready to smile. Their food art takes creativity in the kitchen to the extreme!

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Just Keep Going: How Nutrition Really Works

I want to share my thoughts about one of the major misconceptions I hear about nutrition and health that I think it’s time we debunk: Health is not a linear path. The mental blueprint we develop of a cookie-cutter approach to health (diagnosis, treatment, cure) is not realistic. Ongoing wellness is a continually evolving experience which is often frustrating when we are looking for a specific positive outcome. In Western culture, our first approach is usually medical. We seek a physician’s advice; perhaps we incorporate alternative medicines; often we look to our friends and family for recommendations on which practitioners to trust. Each person’s goal will be slightly different, ranging from symptom management to total ‘cure’ to slowing the progression of something. Inevitably most people will experience a lot of trial-and-error with medication changes, second opinions, symptom management that improves or declines at different periods… and that is all part of the journey for overall health management.

Nutrition works the same way.  The path from goal to outcome is very rarely straight. Maybe you want to lose weight; maybe you want to gain weight; maybe your blood sugar is difficult to control or you have a family history of heart disease that you are trying to stave off. Our inclination is to seek the most direct path from point A to point B, so we often turn to whatever diet seems the most promising.  Sometimes the severe diets seem too overwhelming and we never make a change. Sometimes we decide we’re willing to count macros, eliminate entire food groups, drink ‘detox’ beverages, and google meal plans if we think it might get us the outcomes we are hoping for. The problem is that, inevitably, you’ll have days when those strict plans are not possible. You’ll get sick of drinking a shake for breakfast or avoiding your grandmother’s pasta or eating the same lunch five days a week. Maybe your triggers will be a bit stronger than usual — you’ll have an extra-stressful week at work or a sick child to take care of or a budget cut that will eliminate your gym membership. Whatever the cause, life will get messy and our food choices will become more complicated once again.

Our reaction at that moment is the deciding factor in our long term success.

I’ll say that again because it is the foundation of my entire practice: our reaction when life gets in the way (despite our best intentions) is the deciding factor in our long term success.

We can choose to give up. We can beat ourselves up over our decision to order take out instead of cook, skip yoga and binge a new show all weekend, stop carb counting during vacation, enjoy a late night bag of chips just because we want them. OR we can cut ourselves some slack and make a plan to move forward.

To focus on long-term quality nutrition, you have to make peace with your humanity. Eating is a social and emotional experience just as much as it is a necessity. Choose to improve your overall diet so that you can live an overall healthier life, whether that means weight changes or following a medically recommended diet. Aim to do that as much as possible, but recognize that you will not do it 100% of the time. Instead, find a personal degree of balance that will allow you to sustain your new healthy outlook for the long haul. Have the cake at a birthday party – but maybe skip the wine. Let Friday night be pizza night – but order a side salad for the table and eat one piece instead of two or three. Enjoy your late night chips after a particularly rough week, but don’t finish the bag. Or hey, maybe you DID have the wine and cake, three slices of pizza, and a bag of chips. These instances don’t derail your nutrition. They don’t stop you in your tracks. Just keep going. If you have a whole week or month or year where you stop caring about your nutrition at all, that’s okay. It’s life. Decide to keep going.

Maybe this sounds odd coming from a dietitian, but I’ve been down these same roads myself. It took a long time for me to realize that I would not always be able to ‘follow the rules’ so to speak despite my best intentions (I love to eat, and eating makes me feel good when life doesn’t, and that inherent emotional connection is not something you choose to just forget- it’s there and it’s very real). When I learned to shake off that feeling of defeat and approach each food choice as a blank slate, I found that I was able to sustain my healthy habits far longer.  I would rather make 75% of the best choices I can for the rest of my life than 100% for a month or two and then give up. 

This approach might look differently when you apply it. Maybe you are looking to make 90% ‘ideal’ choices and that’s a sustainable balance for you. Maybe choosing the healthier foods 50% of the time would be a huge change for you. Both are great goals if you’re making positive changes that you will be able to maintain. Whether you are looking to start with strict parameters and a drastic overhaul to break some bad habits or would prefer to gradually ease into healthier choices so that they become your new norm, you can do so while being mindful of what’s best for your body. In the long-run balance tends to be the best kept secret to sustainability. You will likely find that you can keep your new choices going much longer when you take that approach.

If you leave this website or my practice with one message and one message only, I hope it’s this: do the best you can as much as you possibly can, and when you hit a road bump, just keep going. 

 

If this sounds like a philosophy that might work for you as well, contact me about nutrition counseling.

Vita-Myth Busters

It’s time to address the realities behind Vita-Myths– those legends and lore surrounding *magic* vitamin supplements with tall claims, as well as misconceptions about the vitamins and minerals in our food. There’s a new trend of hyper-focused micronutrients blends capitalizing on our health goals. Some of them are chewy. Some of them are sugar-coated. Most of them are being touted by celebrities as the reason their hair is so darn shiny. Do we need vitamins and minerals? Absolutely. Are some of our beliefs about these vitamins and minerals missing the target? Probably.

 

Vita-Myth #1: There’s no such thing as too many vitamins!

The answer here is a resounding FALSE. Vitamins can either be water or fat soluble, which determined how your body stores them. While you can eliminate excess water soluble vitamins from your body easily (use your imagination), fat soluble ones get stored for the long haul and can actually be toxic in mega-doses. The ones to watch are vitamins A, D, E, and K. If you’re taking one or more supplements that contain these, make sure you’re not accidentally doubling up on doses or you risk storing far more than you need.

Vita-Myth #2: You don’t get any vitamins or minerals from meat.

Again- this one is false! Meat has such a mixed reputation in the nutrition medica world; people praise it as the ultimate protein source but also shun it due to the fat content of some cuts. Meat is actually one of the best sources of B vitamins as well as minerals like zinc and iron; our bodies actually absorb the iron from meat much more efficiently than iron from plants. It is also the only major source of vitamin B12 in the diet, so it is generally recommended that vegetarians and vegans take a supplement to avoid deficiency (Lack of B12 can cause nerve tingling, numbness, weakness, and fatigue). Overall, meat really is a nutritional powerhouse – so enjoy it! (In reasonable moderation, of course).

Vita-Myth #3: Vitamin-rich foods may decrease your chance of getting cancer.

This one has some truth behind it, and it all comes down to the science of free radicals and oxidation. ‘Free radicals’ was the hot buzz term a few years ago, and though we still know that it has a negative implication, most people don’t quite know the science supporting that.  The world around us is made of molecules or groups of atoms (as are we!), and unfortunately, certain molecules can damage others through their interactions. When an atom steals a little piece (an electron) from another molecules, it creates a ‘free radical.’ These are basically rogue atoms that will do whatever it takes to get a new replacement electron. In our bodies, free radicals go around aggressively stealing electrons from our cells, doing damage along the way and putting your cells at risk of abnormalities like cancer. Antioxidants, however, have the ability to stop these free radicals in their tracks so they can do no further damage. Vitamin C, vitamin E, and beta-carotene (a precursor of vitamin A) are the three most potent antioxidants, and they’re found very high concentrations in (you guessed it!) fruits and vegetables. It’s true what they say, kids – eat your fruits and veggies!

Vita-Myth #4: Only dairy has calcium.

My apologizes, cow friends… your milk is not the only place we can get our highly important calcium. The ‘Got Milk’ ads sure did their job, didn’t they? In reality, you can get calcium from a wide range of foods including leafy greens (kale, collard greens, bok choy, broccoli), boned fish like sardines, sesame seeds, almonds,  and a lot of fortified non-dairy alternatives like almond milk or even orange juice. Milk is one of the best sources, but eating a diet rich in these other foods can help you make up the difference if you aren’t a huge dairy-eater.

 

Now that we’ve cleared the air of some of the most common vitamin rumors, I’ll leave you with this: I do believe in vitamin supplements. If you eat a perfectly balanced diet, you may be eating the recommended amount of vitamins and minerals (aka the micronutrients), but unfortunately the standard American diet is not always rich in variety. There is not a large body of research supporting the benefits of supplementation (except for folic acid during pregnancy – that is directly correlated to lower rates of neural tube defects), but I do think that a general multivitamin is a good safety net for most people. Overall, the best way to get the bulk of your vitamins and minerals is through a well-rounded diet made up of foods from all food groups (surprise!)

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