2/5/11

2 weeks down!

I can't believe I am already entering week 3 of my acute care rotation. Technically, after this week I will only have 6 more weeks of "interning". This kinda scares me because I still have so much to learn. After my 9 weeks of acute care interning (which followed 5 weeks of long term care), I will have 4-weeks of staff relief to finish up my internship. I have plenty to keep me busy between now and the end of April and I find myself wondering if I can squeeze any more minutes into my long and busy days.

This week I was amazed by what I saw in the hospital. The week started with a Code Blue around 4pm on Monday. All of a sudden I notice around 20+ people, including physicians, family practice, MD's, surgeons, nurses, pharmacists, nurses, etc, rushing to a patients room. I asked the RD what was going on and she told me that a patient was in cardiac arrest. I wasn't able to multitask and work on my case because I was watching the excitement down the hall. I am not sure how the patient is doing but they took him to the ER after they used the defibrillator on him. Talk about an exciting end to my day.

I did my first electronic charting this week and managed to do 3 nutrition assessments during my first real week of clinical interning. I've been spending much of my time on the infectious disease, Cancer and heart/open heart floors but every case is new and I am still getting familiar with reading physician notes, understanding labs and getting the right lingo for my nutrition note. I feel good about my nutrition calculations and finding a good intervention and I just love talking with the patients (that's my favorite part).

So far this week I have seen the following conditions (not limited to):
-kidney stones
-MRSA, Ecoli and UTI
-C-diff
-Cerebral Palsy w/ schizophrenia
-Septic joint
-Left total knee replacement
-Chron's disease (2 cases) with one of the pt's having 80% pancreas, no spleen, no gallbladder and 12 inches of intestine left and the other case in a young patient with abdominal pain. Both pt's were on PPN feedings for nutrition support.
-Open heart surgery pt
-Pancreatic cancer pt
-Renal failure with excessive alcohol abuse (pt was recently discharged with home hospice)

I am amazed by the human body and now, more than ever, I don't take for granted what my body allows me to do on a day-to-day basis. My heart, brain, lungs, kidney's and liver are healthy and my muscles are strong. I am independent, I can move as I please and I'm able to make my own choices when it comes to my diet.

Have you thanked your body today? It's never too late to give a little thanks to the one and only body that allows you to swim-bike-run, sleep, love, cuddle with your furry little one(s), eat and live a quality-filled life.

And, after you thank your body, take a little time to assess whether or not you are making the best choices for your individual needs and lifestyle, when it comes to fueling your body and reducing your risk for disease. I certainly don't want to see any of my blog readers in the hospital for a high risk nutrition assessment!

2/4/11

USDA Dietary guidelines - latest edition, key points

If you are a regular reader of my blog and try to apply some of my suggestions to your every-day life, I think you'd agree that we are doing well in terms of meeting the new USDA dietary guidelines! Not to mention, meeting the guidelines while pursuing an active, multi-sport lifestyle...and balancing the rest of life! YAY for eating more plant-based meals! Keep up the great work!

Key points from the new USDA dietary guidelines:
-WHAT you eat and HOW you eat, both matter in overall diet and health.
-Have a snack before you head out to a party
-Enjoy your food, but eat less
-Avoid oversized portions
-Make half your plate fruits and vegetables
-Switch to fat-free or low-fat milk (1%)
-Compare sodium in foods like soup, bread and frozen meals - and choose the foods with lower numbers (the average intake of salt from Americans is 3,400 mg/d. Recommendations are 1,500 mg/d for high risk groups and 2,300 mg/d for all others).
-Drink water instead of sugary drinks
-Eat more fruits and vegetables and consume at least half of all grains as whole grains.
-Choose a variety of proteins, including beans, peas and soy products.



QUICK SUMMARY:
*Eat more whole grains, vegetables, fruits, low-fat or fat-free milk, yogurt and cheese or fortified soy beverages, vegetables oils such as canola, corn, olive, peanut and soybean and seafood. Eat less added sugars, solid fats (including trans fats), refined grains and sodium.
*Reduce sodium consumption to 1,500 mg/d (about 2/3 tsp of salt) and no more than 2,300 mg/d. High risk individuals (51 yrs or older, African Americans and individuals with a history of high blood pressure, kidney problems or diabetes).
-Consume less than 10% of calories from saturated fatty acids and replace with monunsaturated and polyunsaturated fatty acids. Focus on the type of fat, not the overall amount. Reduce consumption of solid fats and increase liquid fats such as oils as well as plant-based foods, like nuts, seeds, olives and avocados. Also, consume omega-3 polyunsaturated fatty acids like cold-water fish (aim for at least 8 ounces of seafood each week).
*A healthy eating pattern limits intake of sodium, solid fats, added sugars, and refined grains and emphasizes nutrient-dense foods and beverages—vegetables, fruits, whole grains, fat-free or low-fat milk and milk products,3 seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds.
*To curb the obesity epidemic and improve their health, many Americans must decrease the calories they consume and increase the calories they expend through physical activity.


Here is the link to the 2010 Dietary Guidelines.

2010 Dietary Guidelines

I don't think it is necessary to read the entire 112 pg document. However, in order to stay up-to-date with scientific and practical guidelines/information, I recommend reading a few of the chapters so that you have a little educational background when it comes to hearing "myths" or ads/commercials for "quick fixes" when it comes to your health and/or weight loss. For my blog readers, who like to live a healthy and active lifestyle, I think you will find some of the pages very helpful and informative. Take a little time to read the following pages so that you can start finding what may work best for you and your lifestyle and athletic needs/goals.

Chapter 1, pg 5 - Importance of the Dietary Guidelines for Health Promotion and Disease Prevention
Chapter 2, pg 13-17 - Calorie Balance: Food and beverage intake and Physical Activity
Chapter 3, pg 32 - Chapter summary of foods and food components to reduce
Chapter 4, pg 33-40 - Foods and Nutrients to increase
Chapter 5, pg 46-53 - Building healthy eating patterns. Principles for achieving a healthy eating pattern and putting the principles for a health eating pattern into action (pg 52 has a section on vegetarian adaptations of the USDA food patterns)
Chapter 6, pg 59 - Resource list for helping Americans make healthy choices


The appendix list is on pg 8 of the guide. There are several great resources located on this page, such as food safety principles (p 62), using the food label (p. 73) and lacto-ovo vegetarian adaptations of the USDA food patterns (p. 81). You can also find selected food sources of potassium, fiber, calcium and vitamin D.

2/3/11

New Dietary Guidelines

Breaking news (albeit, a few days late).
I hope you can find a little time in your day today to read the new 2010 dietary guidelines.
Here is the email I received from the American Dietetic Association early this week:

Today is a significant day for our Association and profession as the 2010 Dietary Guidelines for Americans were released. You can download the Guidelines and supporting materials at USDA Center for Nutrition Policy and Promotion website. They represent the government’s cornerstone for nutrition policy and education for the next five years and affect the work of every registered dietitian and dietetic technician, registered.
ADA has issued two press releases on the new Dietary Guidelines – one that gives our overall reaction to the new DGAs and another that focuses on how consumers can apply the Dietary Guidelines to their own individual eating plans. In addition, media coverage of the release of the Dietary Guidelines includes a substantial number of interviews with ADA members, including our Spokespeople. Links to some of this media coverage will be included in this week’s issue of Eat Right Weekly.


Enjoy!
helping consumers

urgent prescriptions

less sodium and sugar, more exercise

More exercise, less food

2/1/11

Training for Weight Loss

Did you hear that Iron Girl has a new main sponsor!!!
Athleta, the Sonoma County based women's sports and active apparel brand, has signed on as the new title sponsor for Iron Girl. With 13 events nationwide, ranging from 10K/5K to half-marathon, duathlon and triathlon, the Athleta Iron Girl Event Series empowers females of all ages to lead a healthy and active lifestyle.

Also-Trek is the official bike sponsor of the Iron Girl Series.
http://www.trekbikes.com/women/

HOW EXCITING!!

I hope you enjoy my latest article in the Free Iron Girl Newsletter.

Training for Weight Loss
Marni Sumbal, M.S.

The 2011 Athleta Iron Girl Event Series is rapidly approaching; do you have your mind set on a race? Participating in an athletic event can be an excellent way to increase fitness, overcome physical and mental obstacles, reduce risk for illness and improve cardio-respiratory endurance. Training with a set goal in mind, rather than resorting to compulsive exercise or extreme calorie restriction, can also be a great way to lose or maintain weight.



However, with time, the dramatic weight loss you saw when you started training will reach a plateau. As you get deeper into a training plan, your lactate threshold, strength, speed and endurance capacity will increase as your body becomes a well-fueled, efficient machine. Overall, this will be beneficial to your fitness, but your body will not respond to the physiological demands of training like it did in the past.



To avoid this dreaded "weight plateau," change your current routine (both cardio and strength training) to include more short, high-intensity intervals or workouts. Additionally, be sure to give your body adequate rest, not only during workouts, but during the week. A well-rested body will be able to respond more favorably when it comes to adapting to the physiological demands of training.



When it comes to your daily diet, take time to prioritize your individual pre-, during (if needed) and post-training nutrition to help prevent fatigue and assist in both performance and strength gains. Keep in mind that as your training changes, so must your daily diet. Pay attention to the intensity and duration of each training session, which will help in planning your sports-nutrition strategy and meeting your individual weight (and training) goals in line.



Marni holds a Master of Science in Exercise Physiology, is a Certified Sports Nutritionist (CISSN) and holds a certification by the American Dietetic Association in Adult Weight Management. Marni is a Level-1 USAT Coach and is currently pursuing a registered dietitian degree. She is a 4x Ironman finisher and has qualified for the 2011 Ironman World Championship. Marni enjoys public speaking and writing, and she has several published articles in Lava Magazine, Hammer Endurance News, CosmoGirl magazine and Triathlete Magazine, and contributes monthly to IronGirl.com and Beginnertriathlete.com.
Any questions, Email trimarnicoaching@gmail.com

Oprah staff goes vegan

Just about to get on my trainer to start an early bike+run interval workout.
Saw this on TV and quickly set my DVR. Thought you all might be interested.


Vegan one week challenge

I am always interested in how others are portraying different diets, so this should be interesting.

1/31/11

Unexpected findings

Does coffee cause pancreatic cancer? Do B vitamins lower the risk of stroke? Do fruits and veggies prevent colon cancer? These are a few of the hunches about diet and disease from the last 40 years that haven't stood the test of time.

In my latest issue of Nutrition Action, there was a great article on Unexpected surprising findings from the last 40 years. I found all 9 findings incredibly exciting to read and I thought I'd share a few of them with you.

I'll start with one of my favorite topics: SLEEP!!!

Too little sleep can lead to too much fat

Thirty or 40 years ago, who would have suspected that too little sleep could show up on your bathroom scale? Today, we sleep less and weigh more..and the two may be related.
The average American now sleeps one or tow hours less per night than he or she did 40 or 50 years ago. In 1960, an estimated 16% of young adults slept fewer than seven hours a night. Today it's 37%.
"We now have lots of studies on sleep and obesity," explains Kristen Knutson, assistant professor of medicine at the University of Chicago.
"And most find that short sleepers are more likely to be obese than longer sleepers."

A "short sleeper," she notes, is "someone who typically sleeps fewer than six hours a night." But the link is stronger if you look at just five-hour-a-nighters.
For example, in a study that tracked more than 68,000 women, those who slept fewer than five hours a night were 32% more likely to gain roughly 30 pounds over the next 16 years than those who slept for at least seven hours a night.
To find out how sleep deprivation might alter fat deposits, Knutson and her colleagues enrolled volunteers who slept overnight in a laboratory. When they were allowed to sleep for just four hours a night for one or two nights, the researchers saw more ghrelin (A hormone that increases appetite) and less leptin (a hormone that tamps down appetite). than when the volunteers were allowed to sleep for nine hours.

"We also asked each person, 'Are you hungry"' during the day," notes Knutson.
"after two days of shorts sleep, people were hungrier than after the long sleep."
And the more ghrelin and leptin changed, the more hunger changed. "That confirmed our suspicions that these hormones are having a strong effect on appetite," she adds.

IN a month long study, volunteers averaged 1,090 calories a day from snacks when they were allowed to sleep for 5 1/2 hours a night, but only 870 calories a day from snacks when they could sleep for 8 1/2 hours (The participants, who couldn't leave the lab during the study, were allowed to eat as much as they wanted).
They got their extra calories mostly from high-carb snacks like pretzels, chips, crackers, popcorn, snack bars, muffins, cookies, pudding, ic crea and candy.
And they snacked more after 7 pm.
"The less people are allowed to sleep, the more they snack, and it's not just because they're awake fro more hours," says Knutson.
Why would lack of sleep lead to less leptin and more ghrelin?
"Sleep restriction is associated with increased sympathetic nerve activity-the flight-or-fight response," explains Knutson. That stress response "could explain why sleep affects not just leptin secrition but glucose metabolism and insulin resistance."

And insulin resistance-which means that the body's insulin does a lousy job of lowering blood sugar levels-raises the risk of heart disease and diabetes.
Sure enough, "In a recent meta-analysis, short sleepers were more likely to develop diabetes than normal sleepers," says Knutson. Short sleepers are also more likely to end up with high blood pressure.
What's the next step? "To see if extending sleep will make good things happen," she says. "Does it benefit insulin resistance, blood pressure, inflammatory markers, and appetite hormones?"
Time will tell.

1/30/11

Pizza bread and the Right Stuff

Pizza sits really well in my tummy. I just love pizza!!! It's not the triangle shape that I enjoy but rather the combination of flavors from the sauce, cheese, veggies and bread.
I have made so many different types of "pizza" from pizza french bread and dressed-up frozen pizza's to pita pizza's and flat-bread pizza's. Aside from ordering pizza from a local restaurant while traveling, I haven't ordered-out for a pizza in over 2 years. I'm not against ordering out but I'd rather prepare my pizza the way I like it and not have to wait for it to be delivered.
Here's my latest pizza creation. I didn't feel like adding toppings to the pizza so instead I made a little "hot" salad.

Pizza bread
French bread
Tomatoes
Garlic
Mushrooms
Red onion
Spinach
Chives
Cheese
Spices: pepper, chili flakes
Marinara Sauce
0% plain Greek yogurt
Olive oil

1. In a non stick pan, on medium heat, cook mushrooms, garlic and onions in a little olive oil. Cook until golden brown.
2. While veggies are cooking, toast bread and chop spinach, chives and tomatoes.
3. When bread is toasted, spread with a little greek yogurt and marinara and top with a few slices of fresh brick cheese (I used Swiss).
4. Top with tomatoes and chives and sprinkle with spices.
5. Top spinach with veggies. Enjoy!




The Jan/Feb 2011 issue of Nutrition Action is PACKED with AWESOME material. I wish I could type out the entire magazine for my blog readers but I will do my best to provide some great articles for your viewing.

I quickly flipped to the back page so I could read my favorite section of the magazine.
RIGHT STUFF and FOOD PORN

The food porn article was on Pepperidge Farm Petite Cakes (which I will feature in a separate blog) but what caught my eye was the Right Stuff article featuring Finn Crisp Thin Crispbread.

I am sure that my Trimarni athletes know how much I adore WASA crackers as the best pre-training snack (w/ PB) but in the case that we haven't worked together on coaching or sports nutrition, I LOVE WASA crackers. They are a staple in the Sumbal house and go great with cheese, on salads or crumbled on yogurt. I buy mine at Big Lots where they are half the price of Wal-mart.
Hope you enjoy the article.

Finntastic
"Packing so much goodness into something so slim and delicious takes real dedication" says the box of Finn Crisp Plus 5 Wholegrains Thin Crispbread.
Who knew? If you're a fan of Finn Crisp's Traditional Rye Crispbreads, you may have wondered how the company manages to squeeze so much flavor into one remarkably slender wafer (apparently, it's not that easy). Thank goodness Finn Crisp went to all that trouble.
The new 5 wholegrains crispbread adds, well, four other whole grains, "for an even tastier and healthier crunch." And, since the crisps are imported from Finland, the label reveals how much of each major ingredient you're getting. (Wouldn't that be handy to have on U.S. labels?)
The crackers are still mostly rye flour (65%) plus oat flour and oat flakes (8%), barley flour and wheat flour (4% each), and millet (1.7%).
Together, they deliver three grams of fiber for the tow-slice (1/2oz) serving that's listed in the Nutrition Facts, or six grams for the 1 oz. serving that most cracker labels show. And those grams are intact fiber, not the isolated kind (like inulin, oat fiber, wheat fiber, or polydextrose) that bakers use to make impressive (though misleading) fiber claims. It's the real deal.
Bonus: a 1 oz. serving has just 120 calories and 140 milligrams of sodium, so it won't stick to your rib padding...or pressure your arteries.
Spread on a dollop of hummus or a thin slice of Brie, or enjoy them sans topping. Finn is in.