Micros and Macros

In this post, I thought I would take it back to some basics: micronutrients (the little guys) and macronutrients (the big guys).

Micronutrients

Micronutrients are all your vitamins and minerals, like iron, zinc, vitamin D, and vitamin E – just to name a few. They are called micronutrients because you only need a little bit of them each day. Your fruits and vegetables are packed with tons of these, but they are also in lots of other foods.

Micronutrients are responsible for things like eye sight, bone health, thyroid function, blood pressure, and many, many more.

Right now, on the nutrition fact labels you will always see vitamin A, vitamin C, calcium, and iron. That is because back in 1990’s when the label was designed, those were the nutrients that people often did not get enough of. Now, you may know that there is a new nutrition fact panel coming out, which will be mandatory for manufacturers to use by 2021. On this label you will see vitamin D, calcium, iron, and potassium since these are the micronutrients that most people are low on now.

Macronutrients

Macronutrients are your carbs (including sugar and fiber), proteins, and fats. They are called macronutrients because – you guessed it – you need large amounts of them each day. Protein rich foods include fish, animal meats, and soy products (like tofu and tempeh). Fats come from foods like avocados, nuts, seeds, oils, and butter. Carbs come from grains (quinoa, bulgur, rye, rice, wheat) and foods made from grains like bread and pasta, corn, peas, and fruits. There are also lots of “combination foods” like beans, eggs, and cheese that provide a good mix of 2 or 3 of these macronutrients.

Macronutrients are our main sources of energy, growth, and building blocks for muscles.

Why does this matter?

Micro and macronutrients are both crucial for survival. We can’t live healthfully if any single one within these two groups is missing. I wanted to talk about this because many food products market themselves as “healthy” because they have extra whole grain or protein. For example, I love Kodiak Cake pancakes, which are “protein packed” and made with 100% whole grains. While it is great to have a little extra protein and whole grains these pancakes don’t have many micronutrients. Now think about broccoli and carrots – super healthy right? Yes, they may be packed full of micronutrients but they have very few macronutrients.

See – that’s why variety is important and eating only vegetables all day isn’t really a good thing. There is no single food that can provide all the nutrients we need. Mix things up, try new foods, and maximize your nutrient intake!

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SMART Goals

My adult outpatient rotation is officially complete and I loved this second week just as much as I did the first! As promised in my last post, I am going to share a little more about making changes. I think we can all agree that making change is hard, and I was reminded of this patient after patient last week. So many of them came in saying they knew exactly what is healthy and what they had to do but they just couldn’t do it.

That is where setting goals comes into play. I’m not talking about a goal of losing 30 pounds, normalizing blood pressure, or managing kidney disease – those are vague and don’t really motivate us to make change. Instead, I encourage patients to set SMART goals. SMART stands for Specific, Measurable, Attainable, Relevant, and Timely.

SMART

Let me give you an example. Say you do want to lose those 30 pounds. What are some ways you will do that? Reduce the number of sugary drinks you have? Start walking more? Eat more vegetables? Those take care of the “Specific” part of your goals but now you have to fill in the M, A, R, and T.

Pretend our patient typically has 2 small Coke’s from McDonald’s every day (one before work and one after work). Here’s the patient’s goal:
S- Have less sugary drinks
M- When the patient only has 1 small Coke each day (until his next appointment with the Dietitian)
A- It is attainable because he will only stop at McDonald’s drive through after work
R- It is realistic for this patient because he is ready and motivated to make that change.
T- Every day

So this person goal is: Limit sugary drink intake to one small coke every day (an improvement from two he is having now). Doesn’t that seem more realistic than losing 30 pounds? – I sure do!

You can do the exact same thing with exercise and eating more veggies. I typically recommend patients have 2-3 goals they will work on each time they make an appointment. Once the goal is consistently achieved they can set new goals. For example, our patient here could set his next goal to be one small Coke every other day, etc. until he is no longer drinking Coke.

Setting these smaller goals that seem achievable makes patients a lot more motivated to actually try to achieve them. They know exactly what they have to do, how to do it, and how long to do it for. Remember, all the little things add up so even small change like this can make a big difference.

What are your health goals and how can you turn them into SMART goals?

Med-Surg, Outpatient, and Change, Oh My!

Boy has this semester flown by! I am officially 1/3 of the way done with my Dietetic Internship and Monday is my last day of class for the semester. Last week marked the end of my general medical-surgical (med-surg) rotations in the hospital, which were a total of eight weeks: two weeks in cystic fibrosis and telemetry, two weeks in geriatrics and trauma step-down, two weeks in cardiac, and two weeks in bone marrow transplant. While I liked some rotations better than others, I honestly didn’t love any of them. Most of the time I was seeing patients due to unintentional weight loss and decreased appetite (both of which are major issues in the hospital). Unfortunately, the standard of practice for these patients is to recommend using high calorie/high protein supplements (which are filled with sugar) and encourage high calorie foods. I also didn’t feel like seeing a patient for 10 minutes, one or two times during their hospital stay really made an impact on their health. I wasn’t encouraging them to eat healthier or make better food choices in their daily life, I was just trying to manage symptoms and ensure they could be discharged as soon as possible. Besides all these dislikes, I did learn that I loved doing calculations for enteral and parenteral nutrition (feeding via a tube or IV) in patients that couldn’t eat food orally.

The past week I have been in my adult outpatient rotation, and I have absolutely loved it so far (which is very reassuring after not loving my previous eight weeks). My preceptors are amazing and I definitely see it as an area I am interested in working in in the future. You get to spend so much more time with the patients and it is exciting to see them learn and make progress with improving their diet. I have also learned a little bit about integrative and functional medicine, which also sparked my interest. It is a growing field and focuses on a mix of different eastern and western medicine techniques, plus uses food as a method of healing different types of diseases.

With all of my experiences this past week in outpatient, I thought I would share a few words of wisdom (per usual). It has been exciting to see all of these patients be so eager and motivated to make change (which is definitely different from the patients in the hospital). But, at the same time, change is difficult and it requires work. You can’t expect to just show up and meet with a dietitian and, poof, you start losing weight or controlling your diabetes. The same thing goes for reading my blog. While I love that people are reading my posts and I am able to share information, reading doesn’t translate to results. In fact, we only remember about 10% of the things we read. In order to make positive changes, you have to take the information you read and hear, and put it into action.

Since this post is getting a little lengthy, I’ll leave it at that for now, but I’ll share more about making changes in my next post!

Chocolate Covered Banana Pops

I feel like I have posted a lot of nutrition tips recently, so I thought I would switch it up and talk about one of my new favorite healthier treats.

My idea of fun last Saturday night was spending my sweet old time walking up and down the aisles of the grocery store. It is amazing what you can find when you aren’t in a hurry to grab all your usual items! My exciting find this week was Diana’s Banana Dark Chocolate Banana Babies.

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These delicious treats are simply a frozen half of a banana covered in dark chocolate on a stick. Even better…each one is only 130 calories and they only have three ingredients: banana, chocolate, and peanut oil (no crazy chemicals or preservatives)!

They also make little banana slices covered in chocolate, but I like the ones on the stick because you don’t really have to worry about the chocolate melting on your fingers. I have also seen tons of recipes on Pinterest to make your own chocolate covered banana treats. I have tried to make the slices before and it was a bit of a mess, but the pops would be a fun, healthier treat to make with kids. They can even decorate them with toppings like nuts and sprinkles!

Enjoy!

P.S. Remember, even though they are healthier and one of my new favorites doesn’t mean they should become your new breakfast or entitle you to the whole box. They still have a saturated fat and sugar, just a lot less than some of your traditional desserts.

Breakfast Cereal

Cereal: It is the “go-to” breakfast. Whether you pour a bowl at the table in the morning or dump some in a bag as you are running out the door, it is a pretty classic breakfast. In fact, grain-based breakfasts have been found to help people lose weight better than those who eat a traditional eggs, sausage, and toast breakfast.

Unfortunately, those grain-based cereals can be more like sugar-based cereal. Froot Loops, Frosted Flakes, Coco Puffs, and Lucky Charms and even cereals like Kellogg’s Smart Start, Kashi, and Raisin Bran that are all marketed as “healthy” have heaps of sugar in them… sometimes more than a chocolate chip cookie!

I know that makes finding a healthy cereal very confusing, so here are my top 4 tips for choosing a healthy cereal to start your day with.

  1. It should have less than 10g of sugar per serving
  2. At least 3g of fiber per serving
  3. At least 5g of protein per serving
  4. The first ingredient should start with the word whole (ie. Whole wheat, whole grain, etc.)

If your cereal box doesn’t meet all 4 of these, put it back on the shelf and try another one of the other 500 cereals in the aisle. The one exception is protein. If your cereals falls a little short on protein, that is fine, but I would recommend having a side of eggs or low sugar Greek yogurt on the side.

I’ll also mention that portions are a big deal with cereal. The serving size is usually ¾ to 1 cup but we often dump 2-3x that in the bowl. Try measuring out your cereal for a few days. You might be shocked by how much you are actually eating.

Here is a list of some good cereal options:

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Meatless Monday

If you thought hospital cafeterias were full of healthy food options, you thought wrong. Unfortunately, even in the building where heart disease is being treated, it is also being served on a plate in the form of fried chicken, onion rings, French fries, pizza, and deli sandwiches. Since those are the main options, I resort to the salad bar daily for my lunch, filling my bowl with romaine, kale, tomatoes, peas, mushrooms, and chicken. But it is only now, after almost 12 weeks, that I realized the cafeteria does “Meatless Monday’s”. I just thought every now and then the salad bar was out of chicken, but I have now realized it happens to be every Monday…the same day they don’t serve chicken fingers or BBQ chicken pizza.

With research linking meat consumption to cancer, cardiovascular disease, diabetes, and obesity, at least the hospital is on the right track one day a week. Meatless Monday’s is a concept used to both reduce health risks, but also reduce our carbon footprint since there is so much water and fuel used in meat production.

After the Meatless Monday realization I had, I decided I would try something other than a salad this past Monday. In a cafeteria where most of the food looks slightly suspicious, my meatless lunch was actually delicious – stuffed sweet potato with a kale, quinoa, and cranberry salad and a quarter of a roasted acorn squash. It was also nice to switch things up and have something other than a salad.

I have never participated in Meatless Monday’s before, but I think I might try to continue Meatless Monday’s through dinner at home. It is great motivation to get creative in the kitchen, try something new, and get some health benefits.

Worried you won’t get enough protein by going meatless? No need to worry! 85% lean ground beef has 10.4 grams of protein per 100 calories and broccoli has 8.5g per 100 calories… Pretty close, huh? Plus broccoli is full of fiber, vitamins, and minerals that meat doesn’t really have. And of course, there’s always quinoa, tofu, lentils, yogurt, beans, and nuts which are all good sources of protein.

Sure, meats have lean protein, vitamin B12, and iron, but you don’t need to have it everyday to reap the benefits. Give Meatless Monday’s a try! If anything, it is a good excuse to fill your plate with extra veggies, which never hurts.

Up for a challenge? In doing some google-ing about Meatless Monday. I also found there is a campaign called #NoRedOctober encouraging people to cut meat for the entire month of October. I know October is almost over but you can try it any month. Think you could do it? It would be tough, but even a meatless day or week is better than nothing.

Internship Update: Finally Time for Clinical

Last Friday marked a very exciting day…the last day of my food service rotations in my Internship. After 2 long weeks in the kitchen cutting fruit and making sandwiches, 1 week in the storeroom and purchasing, and 3 weeks working with a patient meal service manager, I am finally on to my clinical rotations!

As much as I don’t enjoy food service and could never see myself working in the field, I did have some valuable experiences. I learned just about everything there is to know about what patients can order, how patients order, where their food comes from, how it gets to them, and everything in between. As a dietitian, I can definitely see why it might be important to know what options the patients have while they are in the hospital.

Having my food service rotations first gives me good background knowledge on how the nutrition and dietary departments run, and I think I am well equipped to give patients meal recommendations based on their individual diet needs. I guess that I one perk of getting food service out of the way at the beginning (and I am glad I never have to put on another hair net again!).

Now, I have just finished day 2 of my clinical orientation. Day 1 was learning a lot about the electronic medical record and how the healthcare system works, but I am quickly getting the hang of it. My preceptor covers telemetry, general medicine, and adult cystic fibrosis floors so I have seen quite the variety of patients so far. I got to do my first note on my own today, and diagnosed a patient with moderate malnutrition. The patient’s doctor agreed with my diagnosis, which means the hospital gets reimbursed for my patient visit. I also feel very official (and old/not smart enough) wearing my white lab coat around 😉

That is pretty much all that is going on in the hospital. October is my busiest month with class work so I have been a busy beaver working on all my assignments every day after work. That unfortunately leaves me little time for any new recipes, but I have been enjoying a super simple (and of course, healthy) spaghetti squash bowl for dinner. I just mix spaghetti squash, steamed broccoli, peas, and chicken or ground turkey with some pasta sauce and wah lah… dinner is served.

Internship Status: Week 9/49