Monday, February 15, 2010
He talks about reforming school lunches. Teaching kids about food. Real food, not just fast food. My thesis was about school food environment, so I hold this topic close to heart.
The part where he goes around asking kids what kind of vegetable he is holding up, and every kid answers wrong, it just breaks my heart and makes me want to cry. (around 12:00 min)
Keep watching, and the part where he makes a visual about how much sugar there is in (flavored) milk nowadays is just... astounding.
Monday, February 8, 2010
Friday, February 5, 2010
Everybody knows that we should eat healthily, stop smoking, and exercise regularly. But how much good can those habits really do? It turns out that the answer may lie in the theory of epigenetics.
Wikipedia defines epigenetics to be "the changes in phenotype (appearance) or gene expression caused by mechanisms caused by mechanisms other than changes in the underlying DNA." Simply put, it's the idea that external factors, other than your individual DNA, can cause changes to what genes get turned on and off. "Our genes, not the whole story" in US News & World Report (February, 2010) explores this new area of research.
The article mentions a pilot study led by Dean Ornish that found that 30 men with prostate cancer were able to change lower their prostate-specific antigen scores and the activity of their tumors with intensive lifestyle changes, such as exercising 30 minutes daily, doing yoga or meditating for an hour daily, boosting their social support networks, and eating a low-fat diet based primarily on fruits, vegetables, beans, and soy protein.
Furthermore, the article cites stress as one of the factors that can change gene expression, for the worse. According to Moshe Szyf, an epigenetics researcher and profession at McGill University in Montreal, stress hormones "are pervasive...traveling to every organ and tissue" which can ultimately change actual genes that help us deal with stress.
This article excites me. It validates my belief that we have more control over who we are than we think. As Ornish states, "our genes are a predisposition, but our genes are not our fate." Family history may be strong for cardiovascular disease, or diabetes, or Parkinson's, or disease XYZ, but we do have the power to change or at least postpone its onset by developing good living habits and learning how to deal with stress (short and long term ones). Eating adequate fruits and vegetables and skipping sodas does matter; not smoking does matter; exercising regularly does matter - all in ways we may not be able to see. But our bodies can most certainly feel it. And in the long run, that is what matters the most.
For some education videos on epigenetics, check out University of Utah's site.
Source: Baldauf, Sarah. "Our genes, not the whole story." US News & World Report Feb. 2010: 24-26.
Ornish D, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci USA. 2008;105:8369-74.
Thursday, February 4, 2010
That got me thinking. Many times in working with clients, we may naturally assume that we know what is best for them. For me, I get super excited, and I just want to unload ontol them my knowledge as well as what to eat and what not to eat. However, I often lose sight of what is important to them. Perhaps soda is one of those things that a particular client is unwilling to give up, but he/she is able to stop having desserts after each meal. Or perhaps having that one piece of dark chocolate at the end of the day is what motivates another client to get to the gym and work at that treadmill.
Whatever it is they need to keep working towards their goal, it is up to us dietitians to find out. They should not be feeling deprived. Instead, dieting, as well as many other facets of life, should be more of a compromise - having less of the things you don't care about as much so that you can have more of the things you love.
Wednesday, February 3, 2010
A little bit before the holidays, I ran across a social worker whom I had not seen in the hospital for a while. Nancy* and I started working at about the same time; we had sat next to each other at orientation, and we both started on the same floor. Even though she was many years older than me, we hit it off pretty well.
Anyways, there was something curious about Nancy that day. Her face looked blotchy as if she had been sitting in the sun for too long, and her fingers had cuts and band-aids all over. Yes, Southern California sun can be brutal even in November, but it just seemed too much! Little did I know, Nancy had more to share than just a story about being sunburnt.
Nancy said that she was declared vitamin D deficient by her internal medicine doctor and was prescribed 50,000 IU vitamin D once a week for 6 weeks. Two weeks into it, she started noticing that her skin was itchy. Thinking that it was her new laundry detergent, she re-washed all her clothes and bed linen with the old laundry detergent, but to no avail. By the time she went back to the doctor, she had already taken her third dose. The doctor had her electronic file and had asked her if she had taken any new medication, but both had neglected to consider vitamin supplements. By this time, her skin was itching so much that wearing clothes literally hurted her. Yet, she had to cover herself up to go outside because the sun rays hurt her skin. She was taking Benedryl around the clock and sleeping. "Life was miserable." By the time she took the fourth dose, Nancy's husband finally found online the side effects of vitamin D toxicity, all of which matched up to Nancy's. Astonished, Nancy called her doctor to inform him of this effect, to which he answered that he knew nothing about it and that he has been prescribing vitamin D to other patients with no complaints and reactions. Even more astonishing was when Nancy finally got a chance to look at her vitamin D lab report, her value was actually within the normal range, merely on the low side, meaning that she was not actually vitamin D deficient as the doctor claims!
To which I ask, then why the huge dose, doc?
It seemed scary that a doctor who has been presribing a vitamin supplement knows nothing of its potentially toxic effect. It also did not help that research about vitamin D toxicity is limited, such as the toxic dosage. Perhaps my friend Nancy was unlucky in that she had a sensitivity to the vitamin D, but perhaps other people also experience this without ever finding out the reason for their sickness. Symptoms of hypervitaminosis D include fatigue, nausea, vomiting, weakness, loss of appetite, and itchy skin. Vitamin D should also be avoided in those with kidney disease, hypercalcemia in the blood, atherosclerosis, and hyperparathyroidism. When taking a multivitamin, make sure the fat-souble vitamins A, D, E, and K are not meeting greater than 100% of the recommended needs. If taken in large amounts for an extended period of time, they can stay in your fat tissues and cause more damage than good.
Currently, the adequate intake recommendation for vitamin D is 200 IU (birth - 50 years of age), 400 IU (ages 51-70), and 600 IU (ages 70+), which can be met through an adequately balanced diet, 30 minutes in the sun daily, and an over-the-counter supplement as needed. Avoid long-term supplementation of more than 2,000 IU daily as that is the upper limit established by the Food and Nutrition Board (FNB). Prescription-strength supplementation include vitamin D2 (ergocalciferol), which provides 50,000 IU per capsule, and vitamin D2 liquid (drisdol) at 8,000 IU/ml, and should be reserved for those seriously deficient of vitamin D.
Lastly, don't forget: vitamins and mineral supplements are still considered medications. When taking a multivitamin, make sure the fat-souble vitamins A, D, E, and K are not meeting greater than 100% of the recommended needs. If taken in large amounts for an extended period of time, they can stay in your fat tissues and cause more damage than good.
1. Hancock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007;85:6-18.
2. Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: An Evidence-Based Review. JABFM. Nov 2009; 22: 698-706
* Name has been changed to remain anonymity.
Edit: There is a recent New York Times article on vitamin D.
Tuesday, February 2, 2010
Monday, February 1, 2010
I have been reading a lot motivational books and blogs and have been thinking about the common theme: Follow your dreams, follow your passions. It has led me to contemplate what my dreams and passions are.
I have (too) many.
Even though I thought I would never say this, but being a Clinical Dietitian has been one dream come true. It incorporates everything I love about being a dietitian - I get to help people, work with other medical professionals, and play around with numbers (especially now that I am in the ICU). While everyday is the same routine - you read charts all day trying to decipher doctors' handwriting then formulate your own notes in hopes that one, just one doctor, picks up on your recommendation(s) and writes the order, every patient is unique, and you never know what you are going to get when you get out of your car in the morning and walk into the hospital. It is so different from a regular 9-to-5 job that sometimes my family doesn't even understand what I do at work. *laugh*
But I want more.
I want to be able to write. To do creative work. To spread goodness, not only about nutrition and what you are supposed to eat (that was meant to be sarcastic) but about healthy living and everything beautiful in general. After I tried writing a simple article about vitamin D, and failed miserably trying to connect my coherent thoughts together to make one incoherent paragraph, I decided that I simply need more practice - practice observing, practice writing, and practice living out my dreams.
Thus, the birth of this blog.