The Various Roles of an RD: Clincial Dietitian

As many of you know, I am currently in the middle of my Dietetic Internship (DI) which is the last step before I'll be certified to take the exam to become a Registered Dietitian (RD). Every DI across the country, whether based out of a college like the one that I got matched to or based out of hospital, has three elements to the rotations: clinical, community, and food service. Some DIs focus more on one particular element, but each program must incorporate each of those elements at some point. It's a great way not only to learn from many different preceptors and prepare us for the big exam that comes at the end, but also to see the varied roles that are out there for an RD once we pass the big exam! So I've decided that as I go through my internship and work with RDs in different settings I'll highlight that career path here. Hopefully this will give you a better picture of what an RD does and the various options available to someone in this field. Keep in mind that these descriptions are based on my experiences with people in these roles but the responsibilities are certainly different in different places.

Clinical Dietitian
A Clinical Dietitian works in a hospital with patients who are admitted as "in-patient" - this is different from someone who might work in a hospital with patients who schedule appointments to see him or her (that would be "out-patient").

At my clinical rotation a typical day for a clinical dietitian would look something like this:

First thing in the morning, print the sheets that tell us everyone who is currently admitted to the hospital including what date they were admitted and what their admitting diagnosis is. Based on their diagnosis, we then figure out when we need to see them. Basically if they are admitted for something nutrition related, we see them sooner. This prioritization is necessary because there isn't enough time to see everyone while they're in the hospital and it would not make sense for us to go see someone who has had hip surgery but has a normal appetite when someone who has stopped eating gets discharged before we have a chance to see them!

Based on their diagnosis, or if a nurse or doctor has requested that we see a patient, we now know who we need to see that day (each day's notes get carried over to the next day so that we can keep track of how many days a person has been here and when we need to see them based on the prioritization). Once you know who you'll be seeing that day you can start to do some research into their past: what is their medical history, have they had weight change recently, have the nurses been recording their appetite, etc. After the background has been researched we head to the floors where the patients' rooms are. We hope that the ones that we need to see are in their rooms and available though often they're off the floor for a test or busy with another medical professional. Once we do get in to see the patient we do our interview to gather information from the patient. Depending on their admitting diagnosis we ask questions such as: What is your normal weight? How is your appetite currently? Have you noticed your pants are feeling looser? Do you typically follow a diabetic/low salt/fat free diet at home? Would you be open to trying a supplement such as Ensure?

Once the interview is over we go off to type our note into their medical file. The note includes information from the interview as well as our nutrition diagnosis. The nutrition diagnosis is written as a PES statement: Problem, Etiology, Signs and Symptoms. Here is an example of a PES statement: Inadequate oral intake related to nausea and vomiting as evidenced by patient report of not eating for 5 days prior to admission. We then address what we're going to do about the nutrition diagnosis such as suggest supplements, educate them on the diabetic diet, etc and how we will monitor their progress (track lab values, weights, how much they're eating).

In addition to repeating that process for all of the patients on the list for that day there are also meetings such as interdisciplinary rounds to attend and patients on nutrition support to follow-up with (tube feeds or total parenteral nutrition).

There is even more that a clinical dietitian does in their day-to-day role in a hospital but hopefully this sheds some light on one very important role that an RD can play!

The Campaign Against Sugar Sweetened Beverages

When you're studying to become a dietitian, you end up talking a fair amount about sugar sweetened beverages. That's the official name for soda, juice, sweet tea - pretty much any drink that's full of calories but doesn't fill you up. SSBs, as we refer to them, creep their way into many different conversations. Should kids in schools have access to them? Should people be able to use food stamps to buy them? Is giving your kid a soda every day akin to child abuse? And now the conversation has entered the public arena with the recent ban on certain sizes of soda in New York City. Whether or not that law will go into effect remains to be seen, especially since the beverage industry has begun to fight back. But regardless, it's gotten the general public, and not just people in the nutrition industry, to talk about SSBs.

My internship director recently passed along this video about The Real Bears put out by the Center for Science in the Public Interest. I debated whether or not to share it here; while I agree with the message that soda consumption needs to be greatly reduced in many people's diets, I'm not sure if this video is an effective way of getting that message across. Take a look and then let me know your thoughts!

Get Active! Get Dirty...

So you've been a runner, you've tried the whole cycling thing, maybe even started swimming so that you could do all three and call yourself a triathlete. But where's the fun in pounding clean pavement, coasting down pristine roads, swimming in (hopefully) crystal clear waters? If you're ready to take your workouts to the next level and get good and dirty, then it might be time to try something new.

Soiled Runners

Tough Mudder Vermont 2012

When you're ready to combine running with getting good and dirty, plenty of options await you. Perhaps you want to get dirty but not covered in dirt - then you could find a local Color Run where you where white and get pelted with colored corn starch during the race so that you end up looking like a rainbow. Or if you need obstacles mixed with dirt, try a Warrior Dash, a 5K that has boot-camp style elements. Want to mix in some blood with that dirt? Take it one step further and do Tough Mudder race, where not only do you have obstacles which will likely involve you falling into cold water, running through fire, and on your hands and knees in the mud, but you get shocked by electrical wires at the very end, after jumping (and smacking yourself up against) a half pipe which is, of course, covered in water and mud.

Riding Rugged
I always assumed that if you were a cyclist and you wanted to get dirty, you picked up mountain biking. Mountain bikers, in my experience, enjoyed the dirt, liked the fly recklessly down bumpy mountainsides with their fat knobby tires, and did very little uphill riding. Well, turns out that if you want to get your skinny tires dirty, there is a sport for you too! I recently attended the Gran Prix of Gloucester, a championship cyclocross race. In cyclocross, participants ride several laps of a course featuring any number of obstacles such as sand, stairs, wooden risers, hairpin turns, muddy pits, etc - all on a road bike (or a special cyclocross bike which looks a whole lot like a road bike). Sometimes they have to dismount and un-clip their pedals, or if they're really skilled they can bunny hop up and over (jumping while still on your bike). The riding goes on for approximately 45 minutes and whoever finishes the course first wins! For local races in your area, check out the race calendar.

Gran Prix of Gloucester 2012

Gran Prix of Gloucester 2012

Love that Dirty Water
I like to at least pretend that all of the water that I swim in is clean - or at least a very safe level of unclean - so I won't focus on races you can do if you're a swimmer who wants to get dirty. However, because of the nickname, here is information on the Charles River Swim, a 1-mile race that takes place each June, assuming that the water has been deemed safe and free of toxic algae by the government...

Good, Nutritious, and Cheap: Can it Be Done?

Before starting my dietetic internship in a couple of weeks, I have to complete an assignment where I eat for three days with the budget suggested by the USDA Thrifty Meal Plan. Based on my age and the fact that I only cook for myself, that will give me about $19 to stretch for three days. Oh, and I have to attempt to get in all of the suggested amounts of macro and micro nutrients with that money. I'm actually really looking forward to the challenge and have been contemplating various meal combinations over the past few days.

Today I ran across a link to this site, the Environmental Working Group's Good Food on a Tight Budget. While eating for cheap and still getting nutritious food is going to be hard enough on its own, it's interesting to think of the added challenge of also picking foods that have the fewest pesticides or the least amount of added chemicals. Take a look at their lists of good food on a tight budget and see if it inspires you to make a change in the way that you grocery shop. And if you have any suggestions for my three days of eating with a budget, let me know!

Eggs Still Excellent

www.freedigitalphotos.net

Perhaps you've seen the recent headline about how eating eggs is just as "dangerous" as smoking cigarettes. I know it caught my eye on more than one occasion, especially as multiple news outlets picked it up and ran with it. The gist of the recent study is that egg yolks can clog your arteries just as much as smoking tobacco can clog your arteries. If I had more time on my hands I'd read the study to figure out just what kind of correlation they were basing this headline on. Luckily, the editor over at Livestrong did that already, so here's the link to his article: Do Eggs Cause Heart Disease?

What it (hard) boils down to is that eggs are a great source of protein and the yolks are full of important vitamins and minerals. Yes, they also contain cholesterol, so as you would with any food that has some good parts and some less-amazing aspects, enjoy in moderation!

Talking Nutrition with Triathletes

Healthy food for hungry triathletes!

Last night I gave my first of (hopefully) many talks about nutrition to athletes. It helped that the athletes in question were members of my triathlon team and helped even more that I had the support of Nicole Cormier, RD of Delicious Living Nutrition in case there were any questions that I couldn't answer! Back in my former life as an editor, I hired Nicole to work on several nutrition books, which she's still doing. It's great to be working with her in a different capacity now.

The talk was at the bike shop that sponsors my team, Wheelworks in Belmont and about 17 teammates came out for the "Everyday Nutrition for Triathletes" talk. I brought lots of fresh fruit and veggies along with hummus, greek yogurt mixed with dill, and two healthy dishes, recipes below. We talked through daily calorie needs based on the Harris Benedict Equation, daily protein and carbohydrate needs, and talked a bit about pre- and post-race nutrition and hydration. I think it went really well and people were really receptive. It's always great to get little reminders of why you've made life changes like this - I love talking to people (especially athletes) about healthy eating, and look forward to continuing to do it for a long time!

Southwestern Protein Fiesta

1 bag Trader Joe’s frozen Fire-Roasted Corn, defrosted

1 bag frozen edamame, defrosted

1 can black beans (no-salt added), rinsed

1 bunch cilantro, rinsed and chopped

1 container fresh salsa

 

Mix all ingredients together and bring cold to a potluck or BBQ, serve warm over rice or quinoa for dinner, roll it in a whole-wheat tortilla for lunch, throw it over salad, or put in your morning eggs!

Whole-Grain Mediterranean Toss

½ cucumber, diced

½ container cherry tomatoes, halved

1 can garbanzo beans (no-salt added), rinsed

1 package low-fat feta cheese

3-4 cups cooked whole grain (quinoa, brown rice, whole-wheat orzo, or barley)

¼ cup fresh basil, chopped

Balsamic vinegar, pepper to taste

Mix all ingredients together and serve hot inside steamed halved peppers, cold at a picnic, or as a side with grilled chicken!

Go Nuts!

I'm a huge fan on snacking on raw almonds. They've got protein, calcium, monounsaturated fat (the good kind), potassium, vitamin E... the list goes on. So this morning I was excited to read in the Tufts Health Letter that new research by the USDA Agricultural Research Service shows that almonds actually have 24% fewer calories than originally thought! The American Journal of Clinical Nutrition published the article, which shows that for some foods like nuts, the original way of figuring out how many calories a food contains could be inaccurate. They got real nitty gritty to measure this, by analyzing "output" shall we say, from people participating in the study. Here's an article that summarizes the study. Keep in mind that this new information only applies to whole, raw almonds, not chopped or roasted or those covered in wasabi, honey, or chocolate!

Fantastic Farmer's Market Finds

It drives me crazy that my local farmer's market doesn't open until mid-June. But then when it does open, I walk through turning up my nose at things labeled "green-house grown." I want fresh and local, and I want it now! Which means I have to be patient. Luckily I was able to bring home some pretty good finds yesterday and while I've been considering what to do with them, I thought of some handy tips for shopping at a farmer's market.

• Try new things. If you aren't sure what something is, it's OK to ask the purveyor how it is generally used or what dishes it might complement. My best suggestion for trying a new vegetable is to first saute in olive oil with a little bit of salt and pepper; that way you'll get a sense of the true flavor before tossing it in with other veggies and seasonings. You'll be able to figure out yourself what it would pair well with!
• Bring cash and ask for weights. I'm not great at eyeballing what a pound of squash might look like, so it can be tricky to know how much to ask for when items are sold by weight. Yesterday I only had $3 left by the time I reached the final booth and the pattypan squash were $2/lb so I asked the woman for $3 worth. I ended up with a whole lot more squash than I actually wanted! But that's OK because it's delicious and I can share with friends. But I probably would've been better off asking how much a couple of small squash would cost to begin with.
• It's in season if there is a lot of it. A few years ago I was so excited that a stand had eggplant for just $1 each. Then the next summer I had a recipe in mind and went to the farmer's market all ready to purchase them only to find that I was several months too early for eggplant at such a cheap price. In the beginning of the season you're likely to find lots of lettuce and other leafy greens; tomatoes and other more colorful vegetables come a bit later.

Pattypan squash from the farmer's market

If you're looking for motivation to try a new fruit or vegetable, try doing an internet search for the health benefits. For example, I just got the newsletter from SCAN, the Sports, Cardiovascular, and Wellness Nutrition subgroup of the Academy of Nutrition and Dietetics. In it, I learned about the aerobic exercise performance enhancing qualities of beets, rhubarb, and arugula. One study showed that eating 7-8 beets 3 hours prior to performance can improve performance in addition to improving circulation! Another study showed that consuming tart cherries made for faster muscle recovery. So if you're looking for performance benefits or just looking for something delicious, head to your local farmer's market and get cooking.

So You Think You Eat Healthy?

It's something that even my soon-to-be dietician friends and I say to each other: "I'm eating healthy, but I'm not losing weight!" We have studied very meticulously the specific reasons for this, but complaining about it always makes you feel a little bit better. For those times when it seems like there's just nothing you can do, no way to possibly eat healthier, here are some reminders...

Just because it's "healthy" or "better" doesn't mean you can throw portion control out the window. With the exception of some raw or steamed vegetables, even healthy food in large portions will give you a lot of calories. I know I personally give myself a bit of a pass to eat a little bit too much if I'm having whole grains with vegetables and a lean protein. But especially with foods like rice or pasta, whole grain or not, you should still only be having about a 1/3 cup size portion.


Eating healthy without exercising isn't enough. If you are a person who normally exercises and then stops, just eating healthy will not make your body feel the same. Also make sure that you're not overcompensating for hard workouts when you eat afterward; calculate calories burned and consume equal or less, but not more.


Your body has a "set point" where it likes to be. This can be the hardest point of all to remember. If you're trying to lose weight and are doing it in a safe, healthy way but nothing seems to work, remember that your body is very happy right where it is and might be fighting your efforts. Remind yourself that you're doing the best that you possibly can for your body and that while you might not be losing weight, you're likely preventing a host of diseases both short term and long term by eating clean, unprocessed foods, whole grains, and super nutritious veggies.

A Sneak Peek at the Copenhagen Marathon Expo

Today I had the opportunity to explore the Copenhagen Marathon Expo! The race is tomorrow and while I won't be here to watch the 12,000 or so runners, I didn't want to miss my chance to see the expo since I've spent quite a bit of time at marathon expos in the states. I was mostly curious about the sports nutrition products that are being marketed in Europe and got some great photos and information from vendors, as well as several samples to bring back home to try. However, that information requires some additional research. Time (as well as internet access) is precious at the moment so I'll just post one photo and the promise of a post regarding European sports nutrition, to come. If you're curious about my trip to Denmark, with most of my time spent eating and drinking rather than being active, check out Mother and Daughter Spiser.

In Danish, "Pace Setter" translates to "Fart Holder"

Metabolic Armband Post #2!

Last time I promised to post the results of wearing a metabolic armband while handing out bars to runners at the expo, handing out numbers to runners at the expo, and watching runners run the marathon! And here it is. [Good news: I am now the proud owner of a fancy pants metabolic armband so expect more posts like this to come!]

Day of working at the marathon expo (7am-7:30pm): 2830 calories burned (3733 calories for the entire day). Clocked in almost 10 hours of “moderate” physical activity which is much higher than a normal day (see image).

The amounts of moderate physical activity (brown) and vigorous physical activity (yellow) I had from working at the expo

Handing out race numbers (12:30-6): 700 calories

Biking 15 miles of the marathon course: 363 calories

Watching people run 26.2 miles: 750 calories (and cheering, of course!)

Thursday, running for 30 min: 296 calories

Afterburn 60 minutes: 139 calories

Saturday, biking 15 miles: 255

Running a 5K (26 min): 242

Afterburn 30 minutes: 90 calories

The graph of calories per minute when biking (8:00am-9:15am) and running a 5K (10:00am-10:26am)

Unfortunately the afterburn results were not very scientifically accurate so I'll be trying out more of those types of tests soon. For now though, I'm off to Denmark... I'll be doing research for a book about eating, so I've got my running shoes and metabolic armband packed and will be reporting to you from there!

"Wear as few clothes as decently possible..."

Marathon runners coming through!

So said an e-mail sent to runners who qualified for the Boston Marathon this year. The weather in Boston has been fairly cool recently. However, today on Patriot's Day (aka BOSTON MARATHON DAY), it reached almost 90 degrees. I've spectated at races that have been unexpectedly extremely hot  and it's been a mess: officials telling runners part way through that the race was shutting down and they should stop running, runners not listening to them and continuing to run despite the removal of services like water and medical support. Not a good idea. I was impressed by the way that the Boston Athletic Association handled this year's heat wave. A few days before the race they decided to give runners the option to defer until next year if they didn't feel safe running in the heat. They advised people who had never run a marathon before not to run (aka the charity runners because all other runners had run at least one marathon before to qualify for Boston). If you did decide to run, they advised that you wear as little clothing as possible. They added mist tents, more water, and cooling stations inside buildings like churches and schools.

My favorite long-run fuel; strawberry Clif Shot Bloks

The Boston Marathon weekend is always a fun one for me and this year was no different. I spent Friday and Saturday working in the Clif Bar booth at the marathon expo. I love chatting with runners about how to incorporate Clif products into their training and racing plans and hearing people's stories about their favorite flavors or when a Clif Bar saved their life (you'd be surprised how many people have a story like this, often about a hiking trip). Then on Sunday I volunteer at the expo for registration and get to give runners their number and answer any questions they might have about the course, the buses in the morning, etc.

Then comes the day itself... Marathon Monday. There are always masses of bikers that wake up early and cycle the 26.2 miles to Hopkinton and back. I've never felt quite ready enough to do that in mid-April but I did bike 7.5 miles of the course out and back this morning, covering Heartbreak Hill and getting to Wellesley and back. It was fun seeing all of the spectators getting their chairs set up, seeing the volunteers prepping the water station, the kids writing on the streets with sidewalk chalk. After the bike ride I got to relax and cheer on the 27,000 runners from mile 23. I gave out sunscreen, my friends gave away free popsicles, and we helped a runner or two who needed some extra support.

Always trust a pale girl to bring the SPF 70 to the party

All-in-all it was an exhausting weekend - and I didn't even run the marathon! But it was well worth it. If you're curious about how many calories working at an expo, biking part of the marathon course, or cheering for hours can burn, stay tuned for an upcoming post because I had my metabolic armband on through it all... And if you're interested in trying to qualify for Boston, the guy behind No Meat Athlete has a new business called Run Your BQ (Boston Qualifier). Good luck!

What's In What You Eat?

Confession: I'm stealing this post idea from Hungry For Change, or Take Part Food as they're calling themselves these days. They posted this clip from SNL about "Almost Pizza" and I thought it was worth passing along:



Have you thought recently about what exactly goes into the food that you buy prepackaged? Something like pizza, you'd assume would have the typical crust ingredients like flour, toppings like cheese, veggies, etc. While it might not be able to walk under the fridge like the one in the clip, take a look next time you're in the freezer section; you'll find ingredient lists that read like a novel.

And while we're on the subject of frozen pizza... there are redeeming qualities to some frozen pizzas such as the calcium from the cheese, the vegetables (if there are vegetables), the iron from the meat. But pizza should only be a "sometimes food" (as Elmo would say), not an "anytime food" because in addition to those redeeming qualities you'd be hard pressed to find a frozen pizza that is not loaded with saturated fat and sodium; and that's if you only eat what they deem is one serving. For example, the Freschetta Three Meat Medley Pizza considers 1/5 of the pizza a serving and in that one serving you'll get 930mg of sodium (~39% of your daily allowance) and 7g of saturated fat (~35% of your daily allowance). So if you eat two or three pieces... you can see where I'm going with this. But if you want to eat frozen pizza once in awhile, go for it - just try to get the thin crust style with veggies. And in case you're wondering, there's plenty of white flour and calories in the pizza, so you can bypass those that come with bread sticks, wings, or cookies in addition to the pizza (YIKES!).

UPDATE: Just saw on the news that in the UK Pizza Hut is unveiling pizza with a hot dog stuffed crust. Thoughts?

Finding the Right Fit

Does your bike fit you? Chances are if you can move the seat post up or down until your feet reach the pedals, your answer is yes. But have you ever actually gotten a bike fit to you? Bike fittings can be pricey, but they can save you a lot of pain throughout the season. A few telltale signs that you might need a bike fitting are: a sore lower back, tight shoulders, numbness in feet or hands while biking, and knee pain. Bike fittings range from the basic, where a trained professional will hold a string with a weight up to your hip in order to make sure that the positioning is correct, to the extremely advanced which utilize cameras and computers.

I was lucky enough to get a glimpse of this fancier type of fitting a few weeks ago at the Multisport Expo. Wheelworks, the bike shop that sponsors my triathon team, was demo-ing the Retul bike fitting. According to the website, "Retül technology is a cycling-specific motion-capture bike fitting system designed to provide qualified bike fitters highly accurate and comprehensive bike fit data. The system incorporates three-dimensional measurement, immediate report capability, and a millimeter-specific digitizing tool to provide the most accurate dynamic fitting solution in the industry."

My experience was fun; the trained Wheelworks employee first stuck little velcro dots on some specific points on my body (shoulder, elbow, wrist, hip, knee, ankle, etc), then velcroed the LED markers onto those dots (markers were connected to each other and attached to a battery pack). A few feet away was a sensor bar. The fitter could then look at his laptop and gather all sorts of data about my fit as I pedaled. I got to see an image of myself as a stick figure, with each LED marker showing up on the screen and little lines connecting those dots. I also saw an image of my knee strokes; the further apart the two lines, which represent your leg pushing down and pulling up, the worse your form. My lines were very close together which indicated that I don't change position much from the upstroke to the downstroke.

It turns out my fit is pretty good already (not a big surprise since I don't have much pain when I ride) so I didn't need too much tweaking. He did suggest a shorter handle bar in order to get a better angle when I'm riding with my hands near the brakes (as in the picture, above). He also suggested that I buy a foam roller since it hurt a lot when he pushed into my hip trying to find the specific area of my hip he needed to place the velcro.

Spring is a great time to get a tune up and fit before beginning to log serious miles on your bike. If you'd like a retul fit and you're in the Boston area I highly suggest Wheelworks. The retul website has a function where you can search for certified fitters in your area. Or, if you're thinking of something a little less fancy, call your local bike shop and ask if they have any fit specials going on. Your body will thank you!

Antioxidant Power House? Okie Dokie, Artichoke(e)!

My brother Erik and I recently decided to take a trip to California to visit our relatives. We wanted to add on a couple of days in a new locale and, based on tips from friends, settled on Big Sur, a region about 150 miles south of San Francisco and 300 miles north of Los Angeles. Not exactly big on planning ahead, we were chatting with family members the day before driving down about what our route should be. That's when I got some amazing news: directly on our way we would be passing through Castroville, the ARTICHOKE CENTER OF THE WORLD!!! I love artichokes. Growing up we would have them in the summer, steamed to perfection. We'd rip off the leaves, dip them in globs of mayonnaise, then carefully scrape off the weird hairy part to devour the heart. True, mayonnaise is not great for you. But cooked artichokes, according to a sign in Castroville, have more antioxidants than any other vegetable! Well worth eating, though you may want to find a healthier alternative to the mayonnaise like olive oil or lemon juice.

Some other fun facts about artichokes:

They are low in calories but high in fiber and many other nutrients like phosphorus, vitamin C, magnesium, folate, and potassium. Additionally, they are technically a thistle which, if you're like me, you never really stopped to think about.

If you've ever gone to buy artichokes and thought that they looked a little bit dirty or bruised, chances are that it was merely "frost kissed" which apparently "turns green like unkissed chokes when cooked" and is "preferred by artichoke lovers." I'd love to see their supporting data and would happily volunteer for a taste test.

Some other fun facts about Castroville, CA:

If you love artichokes as much as I do, you can go to the artichoke festival held there every year right around my birthday (this year it is the weekend of May 19-20). During this weekend you can make 3-D "agro art" out of fruits and veggies, eat artichokes in almost every form imaginable, go on a trip to an artichoke patch, etc.

There is a restaurant called the Giant Artichoke where they have an enormous artichoke perfect for photo ops and specialize in fried artichokes (they even sell them frozen so you can take them home). We got an artichoke sampler plate which featured a steamed artichoke, fried artichoke hearts, and artichoke bread which you'll notice came with an enormous scoop of butter (not pictured: mayo to dip the artichoke leaves in and ranch dressing to dip the fried artichokes in). Seems like maybe they could use an artichoke-loving RD on staff to help make the menu more healthy!

Full Up on Plant-Based Foods

None of us are sure exactly how it started - we were running stairs at Harvard stadium so I could track how many calories I was burning for my metabolic armband post. Someone mentioned that several people he knew were doing cleanses recently, I shared my opinion about the danger of cutting macronutrients out of your diet, and the next thing you know, the three of us were on a two-week long vegan cleanse*.

This was a lot easier for me than it was for either of them. I had already cut red meat and pork out of my diet and was a huge fan of tofu, legumes, and other vegan-friendly food products. Dan has a meat-share (like a CSA but with locally-raised meat) and Chris's breakfast routine every day includes two eggs. We sat at brunch that day after running the stairs eating eggs (me) and plenty of breakfast meat (them) going over what could and could not be eaten during these two weeks. Chris asked about bread (normally OK but check the package just in case) and we went over easy options for cooking at home (make sure to plan ahead) and eating out (Mexican and almost any type of Asian cuisine are the most likely to have options).

We all came out of it with mixed results, Dan making it the full two weeks despite his co-workers tempting him with copious amounts of Valentine's Day chocolate. Chris stopped early in order to get back to eating meat prior to joining Cross Fit (huge proponents of the Paleo Diet) and I did fine except for accidentally eating a handful of Cheetos halfway through the second week.

People often assume that you'll lose weight if you stop eating animal products, and I'm sure that a lot of people do (in fact, Dan did lose weight during the two weeks). For me though, I still ate just as many calories as I normally do, maybe even more because I constantly had a bag full of snacks with me in case I couldn't find any while out. It seems that many think of a vegan diet as being sparse, and in fact I've had people tell me that you "can't get full" on vegan food. True, there were times during the two weeks that I would've felt more full if I had been able to melt cheese on top of whatever I was eating, and I did get tired of the taste of soy milk, but besides that I ate some of the most delicious food I've had in a while. So for those who think of vegan food as nothing but bland tofu, mushy brown rice, and rubbery meat-replacement products, here were some of my favorite meals from the past two weeks....

Breakfast
Frozen hashbrowns sauteed in olive oil with wilted spinach, chipotle salsa, and lentils.
Whole-wheat tortilla with peanut butter and banana.
Steel-cut oats with maple syrup and walnuts.

Lunch
Whole-wheat tortilla filled with: brown rice, fire-roasted corn (comes frozen from Trader Joe's), avocado, cilantro, lentils, chipotle salsa.
Spinach salad with garbanzo beans, roasted red peppers, marinated artichokes, tomato, cucumber, and tabouli.
Whole-wheat tortilla filled with: white-bean hummus, chopped tomatoes, baby spinach, and falafel (frozen, again from Trader Joe's).

Snacks
I love Meatless Primal Strips and also ate plenty of my usual snacks (almonds, Luna bars, bananas, veggies and hummus).

Dinner
We had some great meals out including Grasshopper, an all-vegan Asian restaurant nearby, and True Bistro, an upscale vegan restaurant in Somerville.

As I mentioned earlier, Valentine's Day happened to fall during this two-week period and lucky for me I have a very understanding boyfriend who didn't mind helping me cook this delicious recipe for Polenta Lasagna with Portabellas and Kale that night. I was also helping out with data-collection in a school cafeteria on one of the days and after smelling lasagna all day had an intense craving. Fortunately, I was able to find this recipe which substitutes tofu for ricotta in a traditional lasagna and it really hit the spot!

Vegan lasagna: healthy, filling, and delicious!

All-in-all it was really interesting to go vegan for two weeks in order to see all of the challenges that people can face. It made me value clearly-stated food labels and I did end up planning ahead more often in order to cook at home. Dan has said that the two weeks made him appreciate vegetables in a way that he never has before and while he's not about to give up his meat share, he's going to make an effort to eat a more plant-based diet, perhaps going vegan every other day. The vegan diet made Chris appreciate what vegans go through, especially when eating out and he was excited to find some new recipes (like a vegan chili) to work into his normal routine. As for me, this morning I was back at my old habits eating cheese on my english muffin. What can I say, despite loving the concept of better health through a plant-based diet, I'm a Wisconsin girl through and through.

*I completely understand that people stop eating animal products for many different reasons and don't mean to imply that eating a vegan diet for two weeks is a trendy "cleanse" like an all-juice diet; we just called it a vegan cleanse because we were cutting out a normal part of our diet. I also don't mean to imply that animal products are toxins. This was just for fun.

The Truth is in the Metabolic Armband

If you're like me, you've probably done some sort of physical activity and thought to yourself afterward "gee, that must've burned a whole bunch of calories!" But how many? For a class last semester I got to wear a metabolic armband for 24 hours that tracked my calorie output (as well as my sleep quality, how many minutes of moderate and vigorous activity I did, and the number of steps I took). How does it do this? By strapping the band onto your upper arm, it measures "galvanic skin response" to see how much you sweat in addition to skin temperature, the rate at which heat is being dissipated, and, via the accelerometer, how much you're moving. I was so excited to get to use the armband but I had a hard time deciding which physical activity I wanted to do on my one day; it ended up raining so an hour and a half of hot yoga won out over other options. Still, I was itching to try out other activities.

Last week I was able to borrow the armband for a whole week for just this purpose. I had a couple of activities I knew I wanted to try and then I talked with friends and followers to see what activities they've been wondering about. When I could, I compared my armband results from those that either the machine indicated, a website calculated, or the instructor of the class estimated to see how accurate these tools are compared with the armband (which claims to be the most accurate armband on the market).

Here's what the Body Media website that the armband syncs to knew about me going into it: my gender (female), my hand (right), my height (5'3"), my weight (~130), and whether or not I am a smoker (no). Here are my calculations, I hope you find them helpful!

Monday

• 3 mile walk to school (50 min): 228 cal  

Comparison: Shapefit.com estimates that a 130 lb person walking 4.0 miles per hour, which is a little faster than I was walking, can expect to burn 236 calories per hour.

• 1 hour basic yoga class at South Boston Yoga which focused that day on hip opening: 141 cal

Tuesday

• 3 mile walk to school: 223 cal

Comparison: Monday the same walk burned 5 more calories - maybe my backpack was heavier that day?

• Sitting in an hour and a half long lecture having walked to school: 92 cal

• 30 minutes on the treadmill, totaling 2.5 miles: 271 cal 

Comparison: The treadmill, knowing only my weight and age, told me I burned 294.4 cal.

Tuesday was the day I burned the most calories - by walking to school, running on the treadmill for 30 minutes during lunch, and walking to dinner and then the train later that night, I burned 2828 calories, took 22,513 steps, and had a total activity time of 276 minutes. Could it be because I had slept for 8 hours and 4 minutes the night before, with 94% sleep efficiency (time laying down versus time actually asleep) making it the best night of sleep I got all week? Perhaps!

Wednesday 

Day off! After awhile you don't really notice the armband during your daily routine and sleeping, but Wednesday I had ghost armband syndrome and kept thinking I was still wearing it.

Thursday

• Sitting in an hour and a half long lecture having driven to school: 85 cal

Comparison: Sitting in the same lecture on Tuesday burned 7 more calories having arrived from walking rather than arrived from driving.

• 1.5 hour boxing class at Boston Boxing and Fitness (mix of jumping rope, weights, sparing, step-ups, push-ups, lunges, etc): 434 cal

Comparison: Shapefit.com estimates 354 cal/hr of "boxing, punching bag" but that jumps to 531 if you're "boxing, sparring" and 708 cal/hr if you're "boxing, in ring, general." 

Friday

• Spin class at Sweat and Soul, 45 minutes long on Real Ryder bikes: 226 cal

Comparison: The instructor estimated 800 when I asked him how many calories one could expect to burn; a Body Media rep says via e-mail "When using certain gym equipment you may notice that your overall armband information may be lower than it should be. This is due to the fact that the abnormal and usually smooth motions throw off the accelerometers in the armband. Different equipment can affect the overall accuracy of the armband in many different ways." I think that the number is on the low side, but it was also only a 45 minute class and I wasn't panting, though I did sweat completely through all of my clothes so maybe a more accurate estimation would be around 300 calories.
 

Note: These Real Ryder spin bikes are pretty cool. They're supposed to mimic real riding on the road so they move to the left and right - and you really have to engage your core in order to turn them. See the above video for an example. 

Saturday

• Stair running at Harvard stadium (the little stairs that you use to enter the stadium, up one set and down the next around the entire stadium and back which took approx 25 minutes): 187 cal

Sunday

• Hour long Zumba class at ZYP Fitness Plus: 391 cal

Comparison: The ZYP website says participants can "dance away their worries & 500-700 calories." Before I went to the class I never would've guessed that I would get such a good workout but you literally move (or shake) your whole body the entire time - so don't underestimate this as a really good full body workout.

Special thanks to Rachel, Lea, Barrett, Dan, Chris, and Meredith who suggested workouts and then kept me company (or brought me along)!

I'm planning on borrowing the armband again in the spring so that I can track calories burned for fun outdoorsy activities like cycling, hiking, and running. Is there an activity that you've always wondered about? (Besides swimming since you cannot submerge the armband.) Let me know in the comments section and I'll write about it next time! Interested in learning more about Body Media, how it measures calories burned, or how it compares with other armbands out there? Check out their comprehensive website.

It's February! Hearts Abound!

What a coincidence that on the first day of February, which is American Heart Month, I had my first day of rotations for my Clinical Nutrition class where we are counseling patients on the cardiac floor of a local hospital about the heart healthy diet. In honor of that, here are the five things that you (especially if you're at risk of heart disease) need to keep in mind in order to keep your heart healthy:

• Keep total fats low. You can do this by eating lean protein and watching your consumption of fats like cooking oil and whole milk (for example).
• Keep saturated fats low. You can do this by decreasing the amount of animal products you consume, especially things like red meat, pork, and cheese.
• Keep cholesterol low. You can do this by limiting the amounts of animal products you consume such as egg yolks and certain types of meat and fish.
• Keep sodium levels low. You can do this by eating less processed and prepared foods, cooking at home more, and being aware of sodium content and serving size.
• Keep fiber levels high. You can do this by eating high-fiber cereal, beans, whole grains, and fruits and vegetables.

Want to get involved in heart healthy events? This Friday, February 3rd, is national wear red day put on by the American Heart Association. So put on your red dress, make heart-healthy choices in your meals and snacks, and celebrate the love.

How healthy is your heart?

(photo credit: http://www.freedigitalphotos.net/images/view_photog.php?photogid=1998)

"I Just Started This New Diet..."

These are words that anyone in the nutrition field is going to hear a lot throughout the years. Since I'm new to the profession it's still a somewhat novel experience for me. I'm also not well versed in the pros and cons of every new diet trend on the market (though I'm familiar with ones that were popular in book form during my years in the book industry). So this weekend when a family friend mentioned a new diet so was undertaking, I listened carefully as she explained the premise. It sounded similar to Atkins so I told her that cutting out carbs was not healthy and that if she was looking to reduce the amount of white flour in her diet she should try challenging herself to only whole grains and to pile on the veggies.

Then, I got a chance to look at the book that describes the diet, The Belly Fat Cure by Jorge Cruise. There were the standard high-protein, no flour, no sugar recipes. But in the back there was a list of acceptable and unacceptable ingredients to use and there, under the column GOOD FAT was (drum roll please): butter. I cringed. Don't get me wrong - I'll have butter on occasion, but if someone was skimming this book, as I was, they might have seen that and thought to themselves "Oh good! Butter is a good fat! I'll use it all the time now - and lose weight!" It seems likely that this type of misinformation is part of what's leading to so many people gaining weight and getting frustrated when they follow a "diet" or "cure" and don't see any improvement.

Luckily, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) has a link on their website with reviews of popular diet books to help consumers sift through the good, the bad, and the just plain wacky. The reviews are written by Registered Dieticians and tell readers what's good about certain diets and what to be wary of in others. Click here to find the reviews, listed alphabetically by book title.

To Go Vegan or Not to Go Vegan

Someone recently mentioned that they are thinking of going vegan and asked for my thoughts. As I came up with some questions to ask her to help consider the decision from a dietary prospective, I thought I'd post them here in case others are also thinking of going vegan in the new year, or just curious what changes they might need to make to their diet if they ever make the switch to a plant-based diet.

• Are you considering becoming vegan for purely ethical reasons, purely health reasons, or a combination of the two? 

This is important for several reasons; it tells me whether or not you'll be willing to make exceptions if need be. For example, if I'm doing a diet analysis with someone who has recently gone vegan purely for health reasons and realize that they have a soy allergy and hate all beans, I might see if they'd be willing to consider some alternative lean protein sources like yogurt or fish. It can also be more challenging to eat at restaurants or go to family or work functions if you're not willing to be flexible on occasion.

• What are the current sources of calcium, protein, and iron in your diet? Calcium sources include dairy products, fortified juices and soy milk, green leafy vegetables, and some nuts and beans. Protein sources include meat, poultry, fish, dairy, beans, nuts, soy, and tofu. Iron sources include beans, fortified cereals, whole grains, fish, meat, eggs, some nuts, and some green vegetables.

If a person currently gets the majority of their calcium, protein, and iron from animal-based sources I would suggest that they make a slower transition to veganism in order to make sure that they are willing to eat the right types of foods to get all of these important nutrients. For someone who already eats a lot of nuts, legumes, and veggies, it might not be as hard to make the full transition. Most people think that protein is the hardest nutrient to get enough of when becoming vegan, but as I mentioned last year in this post about vegetarian protein, there is protein in a lot of places that you might not expect it (like grains and vegetables). While protein is certainly a concern, I'd say it's probably more important to pay attention to calcium and iron since these can be easier to forget about.

• Are you willing to take supplements if your diet doesn't provide the necessary vitamins and minerals?

There is no arguing that when going vegan, at least at first, it can be a challenge to get the necessary vitamins and minerals. Technically B12 is the only nutrient that is not naturally available in non-animal foods. In order to get the recommended 2.4 mcg/day of B12, a vegan needs to either eat fortified foods or take a supplement (don't worry, the B12 found in these forms is not taken from animals, it is derived from bacteria). Foods fortified with B12 include soy milk and various cereals. It is important to check in either with a Registered Dietician or by doing an online food analysis to make sure that you're getting enough nutrients in your diet.

A vegan diet can be healthy and can prevent a host of diseases and health problems, but remember, there are plenty of the bad guys like sodium and fat in vegan foods as well. Just because that cupcake is vegan doesn't make it healthy! In fact, vegan products that are attempting to imitate meat have a lot of sodium in them in order to mimic the flavor. Some vegan baked goods make use of cashew butter and coconut oil - both things that are ok to consume in moderation, but aren't exactly what you'd call healthy either. As long as you learn to make smart choices and check often to make sure that you're getting all of the nutrients you need, going vegan can be fun - not to mention delicious!

If you have more questions about going vegan or advice (and recipes) for those looking to make the leap leave it in the comments section...