3/19/11

Crepes with fresh fruit

I promise...there are lots of Marni-creations being made in the Sumbal-household. Unfortunately, my camera has not witnessed a lot of them :(

With only 1 week left before Staff Relief, I am amazed at how much I have learned in the last 13 weeks of clinical nutrition (Long Term Care 5 weeks and Acute Care for the past 8 weeks). I spent my last 2 interning days in the ICU, CCU and rehab and I have 6 more days to overload my brain with tube feeding calculations. I don't think I have ever used my calculator so much in my life!

(for any future RD's/Students, this website is really helpful: http://www.csun.edu/~cjh78264/tubefeeding/introduction.html)

Never have I realized the importance of knowing my medications until I was placed into the ICU and told to put a pt on nutrition support/tube feeding and to figure out the rate and formula. I still have a little trouble finding the best formula because you have to take so many things into consideration such as labs, wt and meds.

Most of the patients in the ICU are on Propofol (anesthetic) and many are ventilated. Many pt's are also intubated. The propofol rate given to the pt for sedation really throws things off because propofol is a fat-based medication and can bring a lot of calories to a person. So when figuring out the correct rate for TPN feedings, it is important to take this medication into consideration so that you don't provide more than 60% fat.

Many of the patients in the ICU aren't eating, can't eat or have something wrong with the GI system, so needless to say, there are a lot of recs being made for tube feedings/nutrition support and my brain is filed with numbers by the end of the day.

Once again, 3 years ago I never realized what I was getting myself into when wanting to get the "RD" behind my name. I'm amazed at the knowledge of clinical dietitians and what they are responsible for in an acute care setting.

The other day Karel was craving fruit so I decided to have a fruit-filled dinner. I made yummy crepes with a Quaker Oatmeal Pancake batter. Super simple.

1 egg white
Splash of milk
About 1/4 cup - 1/3 cup batter
Enough water to make the batter soupy (dripping off the fork when you mix it)

Yogurt
Fruit
Wheat Germ (honey)
Walnutes

1. On a non-stick pan, on low heat, with a little non stick spray, pour a laddle full of batter, just enough to cover the pan (the batter should be thin, like a thin pancake).
2. Flip after a minute or two, when the edges start to curl up.
3. Spread a little yogurt on the crepe and sprinkle with honey wheat germ and chopped walnuts.
4. Add fruit and fold
(Fruit: oranges, pineapple, nectarine, strawberries, blueberries, kiwi, peach)





3/17/11

Multivitamins

I am a supporter of MVI's. I don't feel that they are needed to boost the immune system or enhance health because that's what fruits and veggies are for...if you eat them. I also don't believe that a MVI needs to cost $50+ a month. However, as much as I LOVE my heart-healthy diet, my diet changes on a day-to-day basis. For example, on the weekends I eat far less veggies than I do during the week and I'm ok with that. I eat a lot more fruit and a lot more starchy carbs such as bread and grains. Why? Because my workouts are longer on the weekends, I expend more energy and due to the length of my workouts, I miss several meals. Also, my cravings for veggies are less on the weekends compared to the week. But having said that, I have no problem eating copious amounts of veggies during the week and I still eat veggies on the weekends, just not as much as during the week.

I think it's perfectly fine to have a diet that varies on a day to do basis so long as you cover your basis either through supplements or through different foods. I don't believe that supplements replace food in the diet but that is what supplements are for...to supplement the diet. Supplements may improve health if you are deficient in vitamins/minerals but food is the best source of fuel for both your health and your active lifestyle. Even for me, I take Calcium + vit D, a MVI, tissue rejuvinator (from Hammer) and B Complex on a daily basis. I think I have no trouble getting in my calcium but sometimes even with yogurt or milk post-workout in the early am, sometimes I don't have a substantial amount of calcium until the evening or until the next day. Therefore, taking 1 Calcium + vit D/d is simply nutritional insurance in the case that my body doesn't meet the recommended amount of Calcium for the day.

In my latest issue of Consume Reports on Health (April 2011) there was an article on MVI's: Skip the wild add-ons. I thought I'd share it with you because there was some interesting info that I thought you would enjoy reading....enjoy!

What needs a MVI?
Some people might not be able to meet their nutritional needs through diet alone. Those include women who are pregnant, breast-feeding or trying to conceive; those consuming fewer than 1200 calories a day or who are cutting out an entire food group (insert my thoughts....this shouldn't be anyone reading this blog!!) and those who have a condition that depletes nutrients such as cancer or diabetes.
(insert my thoughts...I think athletes should be listed here because we expend more energy and certainly, even athletes don't consume "perfect" diets and require more nutrients than the average sedentary individual).

How to choose
Formulas that contain iron can be a good choice for premenopausal women, who might need to compensate for iron loss from menstruation. Men and older people typically don'tn eed more iron and should look for a formulation without it. Botanical ingredients and food extracts found in some specialty formulas are often present in such small amounts that they're essentially useless - and that's if they even had a proven benefit to begin with. And look out for unexpected additions: One A Day Women's Active Metabolism contains 120 mg of caffeine per pill = more than the amount in a can of Red Bull - plus guarana seed, a natural stimulant. In addition these tips can help you wade through the claims:

Think outside the gender box:
An older man who doesn't eat dairy might be better off with the higher dose of calcium in his wife's vitamins. And a vitamin for men might be a better choice for an older woman who eats lots of calcium-rich foods or already takes calcium pills (But be sure to check the other ingredients to make sure they're safe for you).

Don't swallow all the claims:
Extra B vitamins won't necessarily boost energy; ginkgo hasn't conclusively been found to charpen the mind; and supplemental vitamin E won't help your heart. If you look closely, you'll usually find a disclaimer stating that the claims haven't been evaluated by the FDA.

Talk with your doc if you have a medical condition:
In particular, if you take MVI that has an active ingredient with a known biological effect - such as the plant sterols in Centrum's Cardio formula, which can help lower cholesterol - it should be evaluated and monitored along with other treatments that you are using.

Avoid Megadoses:
Unless your doctor tells you that you need more than 100% of the recommended daily intake of a particular nutrient, you don't.


*There has been a lot of talk in the triathlon world with Iron Supplements and I am not a fan. With the article written by non-RD's and "health experts" I'm surprised that there is talk about iron supplementation without any talk about discussing this mineral with your primary care doctor before using. Here are two articles I found discussing Iron and the Endurance Athlete and Iron Overdose.

http://home.trainingpeaks.com/articles/nutrition/iron-and-the-endurance-athlete.aspx

http://www.vitamins-nutrition.org/vitamins/iron-overdose.html

3/15/11

Have you ever tried soy milk or greek yogurt?

It wasn't too long ago that I had my first taste of greek yogurt. I have always enjoyed the taste of soy milk but I rarely buy it for Karel and myself. I enjoy skim milk (as does Karel) and we drink a lot of it.
Many people are hesitant about drinking cow's milk because of the stories that "cow's milk is poisonous" or that it contains cancer-causing hormones. While research may support side effects of drinking milk from hormone-injected cow's, there is a lot of research on the many benefits of drinking milk. But what about meat consumption? We have read research on meat increasing the risk of inflammation and lowering meat consumption to decrease dietary fat as well as vegetarians living longer and more quality-filled lives than meat-eaters (although there are certainly many meat-eaters who live long lives and vegetarians who die from cancer). It would be interesting to see if there is a relation of cancer and people who drink cow's milk and then comparing how much meat is in the diet. Perhaps the people more likely to increase risk of cancer from drinking milk are also those who consume a high quantity of meat and not just from drinking milk. It would be neat to see the risk of disease/cancer in lacto-ovo vegetarians who drink cow's milk.
Greek yogurt is tasty, but it is a bit costly depending on the brand and where you buy it. I think it is great that soy milk is an option for those who don't like the taste of skim milk and want the calcium and a sweeter taste or for those who can not tolerate skim milk.
Soy milk is both a lactose- and casein-free choise for those with dairy allergies. The milk is made from the soybean plant and is a wonderful source of protein.
FYI:
If you are lactose intolerant you are allergic to the lactose in milk. Soy milk or lactose free milk would be a great option. If you are casein intolerant, you are allergic to the main protein found in milk and lactose-free milk is not an option. Lactose-free milk contains the same proteins as milk so if you are allergic to milk proteins you are also allergic to lactose-free milk.

I have slowly weaned myself away from "flavored" non-fat yogurts and I buy Dannon fat-free plain yogurt. Although Greek yogurt and soy milk are both super tasty and have wonderful benefits related to health, I find it much more satisfying for my personal diet to enjoy foods with little to no ingredients. To flavor up my yogurt, I like to mix in a little cinnamon, honey or fresh fruit for a sweet taste. It took a while to learn to appreciate the taste of plain yogurt but now I find myself enjoying it all the time. We replaced our ice cream habit with yogurt about 2 years ago and still today, Karel and I only enjoy ice cream on occasion and when we do...it's the real-stuff :)

Today I handed out samples of greek yogurt and soy milk at Dillon Cafe @ St. Vincent's Hospital. I had so many people tell me that they have never tasted greek yogurt or soy milk so this was a great opportunity for me to introduce people to something new. I just love it when people are open to new things and thinking/eating outside the box.

I am a firm believer in milk and yogurt in the diet, especially if you are an active individual. For both the protein and the calcium, I think yogurt and milk (whichever low-sugar option you choose) are great ways to keep your muscles, tissues and bones happy and strong.

This is a great guide to understanding Milk and Dairy food labels. I find that even if people tell me that they understand food labels, there is always something new to learn.

http://teamnutrition.usda.gov/Resources/mpk3_lesson3.pdf

Take a look at the different food labels and check out the vitamins and minerals on the bottom of each label, as well as the sugar and protein for various products. I always recommend to replace, not eliminate. So when you are searching for new products to add in your diet, first check out the ingredients and then based on the fewest ingredients, make your choice by choosing a product that makes you feel good about the sugar, protein, sodium, calcium (or fiber in your fav starchy/grain foods) and then calories.


3/14/11

Veggie burger day

As part of my contribution to National Nutrition Month (and a check mark on my objectives for my internship) I will/have been dedicating a few hours every week in order to get people inspired to try new foods.

The first day of my National Nutrition Month project was last Tues, where I handed out samples of veggie burgers (Morningstar) in Dillon Cafe (@ St. Vincent's Hospital).

This is not the first time I have asked people to try "New" foods so I know what to expect and to not to be overly sensitive when it comes to people not wanting to try something so delicious (or in my eyes, supper yummy!).

Food can be a sensitive topic and certainly an uncomfortable topic for many. I believe that you have to be very careful with how you approach food. No one wants to be educated and told what to do, especially when changes are necessary but difficult to make. Also, no one wants to be forced to do anything, especially when they struggle with making changes that others make so easy. While you need thick skin when asking people to try something new (especially when they didn't ask you to help them), you also can't be defensive. What works for you may not work for others and it's important that we all realize that we are all different and we all have different choices when it comes to food and how we fuel our lifestyle.

There are a lot of people out there (in both the nutrition and sports nutrition world) that claim food as "good or bad" or "healthy or unhealthy" or "don't eat or eat". I don't like those words. My favorite words are "emphasize and de-emphasize" as well as "performance enhancer and performance limiter". I find those words can be much more realistic when making changes and not so intimidating.

As I was handing out samples (which were enjoyed by many...the last picture is proof that I didn't eat all the samples, I promise) I wrote down comments by the testers. Here are some of the comments I heard when I asked people "Do you want to try a free sample of a veggie burger? If you like it you can order the veggie burger today for a discounted price!":

"I'm not a vegetarian"
I'm a beef person
I don't think so
Scared of it, it's not beef
Nobody wants that stuff. It's fake meat.
That's really good! You turned me.
Ok, I'll try it.
Is that fruit cake?
That's not that bad.
Are you a vegetarian? Do you eat that?
Love it...you sold me!
Don't like vegetables.
Always wanted to try one of those.
Love veggie burgers!
Is this that veggie burger thing?
Not that bad.
Probably need one, but don't want to taste one.
It's all right. I was a vegetarian for 2 years so I've had them before.
How many fat grams?
How many carbs?
I already know I don't like it.
It would be awesome if I liked it.