Fast food & obesity

I received this from a Lakota East student:

Ms. Andrews,

 

I'm Abbie VanFossen with the Lakota East Spark, and I would like to get your thoughts on the topic of a story that I am writing. The story focuses on Americans and their addiction to fast food, and how it has contributed to the obesity crisis. Any help you can give me would be greatly appreciated! I'll just include a few questions in this email to sve you as much time as possible.

 

Do you see the growing popularity of fast food in America?

Yes- it has become a staple in many homes.  Most families eat out at least 3 or more times/week, and some professions (such as truck drivers) eat fast food several times per day.

 

Why do you think Americans have come to rely on fast food?

Fast food is cheap, tasty (not to me, but to some) and convenient.  Also, many families believe their kids won't eat healthier options, so picking up fast food avoids hassles at the dinner table.

 

What aspect of American food culture do you think most contributes to to the obesity crisis the United States is experiencing?

This is multi-factorial.  Part of the obesity crisis is related to excess calorie consumption- from soda and other sweetened beverages, large portion sizes and high fat foods.   We're also a 'push button' nation.  We have remotes for everything, so our activity levels have seriously declined. Finally, many people don't think regular exercise as necessary.  People can't seem to commit time to exercise, but they have no problem watching 2 hours of TV per night or playing with electronic games and devices.

 

How much does portion size contribute to the high obesity rate in the United States, in your opinion?

Portion size of food obviously contributes to the high rate of obesity in the US.  In other countries, portion sizes are more reasonable and cultures to 'use' food to reduce anger, depression and other psychological conditions.  When people eat out, portion sizes are quite large, and they get used to that.  If they knew what a true serving size was, they'd be amazed at how much less they really should be eating.

 

Thank you so much for your time, I greatly appreciate it!

Carbs and blood sugar

Hi Lisa…hope all is well!  Ok…this is my question:  since I have 45 carbs for my meals and 30 for snacks…let’s just say I was still hungry after my 45 carbs…how long should I wait to eat something else?  I am hoping to get my glucose and fasting insulin test done in January with my physical…so I hope I have made some improvements!  This whole carb thing freaks me out!

Always happy to help.  As for the snacks/meals and timing, I'd say try to wait at least 3 hrs before eating something else.  You don't want to get into the habit of eating every 2 hours if possible.  Make sure you're including protein w/your meals and snacks.  It will help manage your blood sugar better and keep you feeling fuller longer.  Eggs, string cheese, nuts/seeds, natural peanut butter, etc are all great.  Edamame is another good high protein snack that's vegetarian.

Good luck w/your test!

Peanuts & Peanut Butter- yay or nay?

Lisa,

Is there such as thing as too much peanut butter/peanuts?  It is high in fat - but it is healthy fat, correct?  Should one still limit the amount that they eat?

Well, of course you can eat too much of anything!  But, in general, nuts are very healthy, although high in fat, calories and sodium (unless they are lightly salted or unsalted).  They contain mostly mono-unsaturated fat, which is heart healthy.  If you're watching calories, nuts and peanut butter are calorie dense, but also filling due to the protein & fat content.

With peanut butter- it is really best to get natural peanut butter (the type where the oil is on the top and you have to mix it in).  This type is typically made with nuts and/or salt ONLY and doesn't have any other added ingredients like palm oil, molasses, sugar, etc.

Palm oil, which is saturated, replaced trans fat in most peanut butters.  So, even if the label says "natural", it may have palm oil, which you don't want.  Saturated fat increases blood cholesterol, and a new study actually suggests it may affect fertility in men.  Drop the butter, too!

I would not pour the oil off on natural peanut butter, because then you're left with a clump of nuts that won't spread on a sandwich.  Instead, store the peanut butter upside down in your pantry before and after mixing it. Gravity will make the oil go to the bottom and make it easier to mix up each time.

Most natural butters will say "refrigerate after opening", which will make it more solid when you want to use it.  You can put it in the microwave for ~30 seconds to warm it up.  Honestly though, I don't put it in the frig. We go through PB so fast in my house that I'm not worried about contamination.

Hope that helps!

Lisa

Vegan nutrition for a toddler

Hello Lisa

 

I hope that this message finds you well!  Last time we talked, I had just started a vegetarian diet.  I'm now eating nearly completely vegan and my wife is does the same with the exception of some cheese of dinners a few nights per week.  We have not given our daughter (16 months) any meat.  We HAVE, however, been giving her organic milk, yogurt and cottage cheese.  Her pediatrician says that she is healthy as can be and is growing as she should be.  She does have eczema, however.  It is not severe but she does have flare ups from time to time that look as though it would make her very uncomfortable.  We've been doing a lot of reading and it seems as though many parents of children with eczema have great success with relieving the symptoms by eliminating dairy from the diet.  We are strongly considering this and wondering if you could provide some insight or provide a reliable resource that would help us better understand how we could raise her healthfully on a vegan diet during this extremely formative time in her development. 

 

I believe that we have her covered on protein with beans, soy, and nuts.  Where I am worried is her fat intake!  I know that she needs a lot fat and saturated fat and that DHA and EPA are REALLY important.  Do you have any recommendations on how to get her all the fat she needs and specifically the DHA and EPA?  I found this supplement and thought that maybe something like this could be the key:  http://www.vitacost.com/barleans-total-omega-3-6-9-vegan

 

If saturated fats are important then can we simply supplement with coconut oil which is loaded with saturated fat?

 

Again, Lisa, I appreciate and respect your opinion.

 

Thank you so much for your help! 

Dear Friend,

thanks for the note.  I'm glad you and your wife are doing well with the vegetarian/vegan diet.

I must confess- pediatrics is not my forte.  But- I do know a few things!

My fear with a vegan diet in toddlers is lack of iron, vitamin D, calcium, zinc and B12 for growth.  Protein needs can be met with beans, lentils, soy milk and other soy products, but kids definitely need fat for brain development and as a calorie source for growth/energy.  It's not just the omega 3, 6 and 9 she needs.  

There are many other nutrients lacking in vegan diets, especially in toddlers because they are growing so rapidly.  If she's not already on a decent supplement containing all of the above nutrients, that would be my first advice.  You can season food with olive oil, light margarine, etc to get some fat in her diet as well.  I don't know much about coconut oil in kids- that would be a good question for your pediatrician.  I don't think it could 'hurt', but I don't know how palatable it is either by itself.  I suppose you could put it in iron-fortified cereal, rice and other foods.

Rather than eliminating food (or beverages in the case of milk/dairy from her diet), I'd consider going to a pediatric allergist and having her tested to see WHAT is causing the eczema.  It could be dairy, but it could be another food as well (bananas, tomatoes, wheat, etc).  Peanut allergy could also be the culprit, but I think the recommendation for nut exposure is 3.  

That's my 2 cents!  Let me know how it all turns out.

Lisa

What's a typical day like for a dietitian?

Thank you for taking the time to talk on Tuesday.  I am a recent graduate from Indiana University and has recently joined the IT consulting profession in Cincinnati. Due to my current work experience and a strong interest in dietetics I am considering going back to school to become a dietitian. Therefore, I wanted to reach out to you to ask about your experience in this profession and would appreciate your advice on the following questions:

 

What is an average day for you like?

At the hospital, it is very busy.  The first thing I do is go through admissions, discharges and transfers then make a list of patients I need to see.  I cover the MICU (medical intensive care unit) and SICU (surgical intensive care unit).  I see patients that have had major surgery or are on life support due to respiratory infections or disease.   I may also see patients with acute renal failure, liver disease, gastrointestinal bleeding or acute heart attacks.

With consulting, I could be at the doctor's office I rent space from seeing individual patients or at a company working a health fair or doing a lecture.  Or, I may be at home making invoices, handouts or lectures.  My days vary quite a bit with consulting.  I could also be at Kroger doing a grocery store tour.

What is your interaction like with patients/clients on a day-to-day basis?

At the VA, I talk to patients about their diets and see how they are eating, order supplements and write progress notes.  If the patients cannot speak for themselves, I talk w/family members, nurses, MDs or other staff.  I spend a fair amount of time charting on the computer.

From your Linkedin profile, I understand you have experience in a hosptial setting, what was the drive for you to start your own practice?

I needed some variety in my career and was interested in wellness.  I like to teach and write, so the business is a good fit for me.

How do the two settings compare?

I have a set schedule with the hospital, I make my own hours (more or less) with consulting.

The hospital is hectic and I see sick people, the business is more laid back and I see healthy people.

I have more variety w/my business than the hospital, though the VA is a challenging and interesting place to work.

At the hospital, I have co-workers whereas my business, I am on my own.

What type of personality do you see in people who are successful in this field?

You need to be confident and like to work with people.  You have to enjoy reading and understand a lot of science and consumer interests.  In business, you need to network.  There is a lot of customer service in both positions.  Provide more than is expected of you!

And lastely, what do you most enjoy about your job, and what are some of the drawbacks of it?

I love teaching patients about healthy eating and seeing people get better, lose weight, etc.  The drawback of a hospital setting is that it never closes- so you have to work around holidays, etc.  I enjoy working with other medical personnel (speech therapists, RNs, doctors, etc).  I also get to teach interns at the VA.

Carbs on labels

I have a question…when I look at a label…it might say total carbs 5…then further down the label…it will say ….other carbs 1…what is that all about…?

Thanks for your question.  The nutrition facts section of the food label lists all carbohydrate sources including grains such as oats, wheat, bran, etc, fiber, sugar and any "fillers" that may contain carbohydrates.  These could be cellulose, methyl cellulose, corn or wheat starch, etc.  ALL carbohydrates can raise blood sugar and do contribute to the caloric value of a food.

I just found a great reference for food additives that may be helpful in understanding "what's in your food".
http://www.amazon.com/Consumers-Dictionary-Food-Additives-7th/dp/0307408922

ICU nutrition

Many of you may not know what a nutrition support dietitian does.  An RD in nutrition support works with patients that cannot eat on their own.  They may require feeding tubes and/or IVs to be fed.  Dietitians in nutrition support recommend and prescribe specialized nutrition for critically ill patients or patients that have undergone major surgery.   It takes knowledge in anatomy, physiology, digestion and confidence!  I refer to this type of work as my "meat and potatoes" because I work in a government hospital and am paid fairly well for my expertise.

This patient was a case study for UC College of Medicine students doing a rotation in surgery.  Below are my answers in italics.  While this work is stressful at times (who wants to see someone on a big blue breathing machine...?), I enjoy teaching doctors in training and taking care of patients in this high risk category:

75 year old patient s/p CABG day no 3, intubated, sedated in the CVIC. PMHx- DM, HTN, GERD. Labs today- alb 3.1, Glu-250-400 on insulin, Ca- 9.5, Na/K- 130/4.5. BUN/Cr- 35/1.5. The MD is unsure about extubating the patient. He is looking at your suggestions. Ht- 5’8”, wt- 220 lbs

1. Should the patient be considered for enteral  or parenteral nutrition?

Enteral nutrition.  If his gut works, use it unless contraindicated (patient is on pressors, suspected ileus or SBO post op, etc).  Feeding below his stomach (into small bowel) would be more appropriate given hx GERD, diabetes (risk for gastroparesis) and obesity.  This would reduce the patient's aspiration risk while intubated.

2. Determine energy and protein needs- show your calculations

Energy needs can be based on IBW of 154 lbs as pt is obese and on mechanical ventilation.   (22-25 kcal/kg and 1.2-1.5 gm pro/kg post op).  Calorie needs are lower to prevent overfeeding and increased CO2 production in the setting of mechanical ventilation.  Protein needs are higher to support wound healing and prevent muscle loss.

Estimated needs:  1550-1750 kcal, 84-105 gm pro

A high protein formula (such as Vital 1.2) could be used and run at a lower rate.  The patient's BUN/creat need to be monitored for changes as well as his hyponatremia  Too much protein and/or fluid could worsen renal fxn.

3. What do you know about current evidence that is accumulating in treating hyperglycemia in critically ill patients in the ICU with reference to nutrition support?

Hyperglycemia is controversial in the ICU.  You want "good control" but you need to prevent hypoglycemia.  An acceptable range of blood sugar in the ICU is ~150-180 mg/dL.  In this patient, scheduled insulin or an insulin drip would be appropriate once tube feeding is initiated.  Hyperglycemia in the ICU leads to increased infection risk and increased mortality.