Hydration, Hydration, Hydration!

May 26, 2015 at 11:15 am | Posted in Health | Leave a comment
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By Marjorie Clapp, MGH Dietetic Intern

The human body is comprised of roughly 60-70% water. For this reason, maintaining proper fluid balance can dramatically influence how well our bodily systems work, including nerves and muscles, cognition, and immune function. Unfortunately, staying hydrated isn’t always easy. In fact, about 70% of Americans are chronically dehydrated. Here are some tips and tricks to help keep you hydrated this summer.

How do I know if I’m dehydrated? Feeling thirsty is the most obvious indicator that you need to drink more. The color of your urine can also help determine your hydration status. Your urine should be pale yellow or clear. If it’s darker than that, it’s time to drink! Other common signs of dehydration include headache, dizziness, fatigue, confusion, and irritability.

Hydration Tip: Keep a tall glass of water on your bedside table and drink before getting ready for your day.

How much fluid do I need? Although fluid needs depend on many factors, including size, activity level, and climate, a good goal is to consume no less than 64oz each day, although some research estimates needs to be much higher (~90oz/day for women, ~125oz/day for men).

Hydration Tip: Exercisers require additional fluids to replenish water lost through sweat and respiration. Weigh yourself before and after working out and aim to consume 3 cups of water for every pound lost during exercise.

When is the best time to hydrate? Anytime! Aim to sip fluids throughout the day to prevent dehydration. Although it’s recommended to consume the majority of your fluid from water; milk, juice, soda, and caffeinated beverages count towards your fluid goal. Just remember to read labels. Calories from sweetened beverages can add up quickly! Food can also help you reach your fluid goals. Water-rich foods include lettuce (96% water), watermelon (92% water), grapefruit (91% water), broccoli (91% water) and yogurt (89% water).

Hydration Tip: Keep a water bottle on hand in your bag or purse to encourage hydration throughout the day.

What about sports drinks? Most sports drinks contain electrolytes (sodium, potassium, chloride, phosphorus) and added sugars to help your body refuel after strenuous exercise. If you’re sweating heavily or exercising for more than 60 minutes, a sports drink may be appropriate. However, most people can rehydrate appropriately with water and a balanced post-workout snack such as an apple with string cheese, hummus and whole grain crackers, or a banana with 1-2 Tablespoons of nut butter.

Hydration Tip: Try diluting/cutting your sports drink with water to provide some electrolytes but reducing the sugar and calories.

(Post content reviewed by MGH Department of Nutrition and Food Services)

My Story: Overcoming Fears of Starting Insulin

May 15, 2015 at 2:18 pm | Posted in Guest Post, My Story | Leave a comment
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By Kevin

Rock climbing. Photo Credit: Bryan Wintersteen

Writing a blog post on “Overcoming Fears of Starting Insulin” turned out to be harder than I thought. I mean, who knew writing something like this would be that much more difficult than composing an e-mail at work or posting a snarky comment on Facebook? And to be completely honest, after extending (read: missing) my deadline a few times I was starting to feel a bit hopeless that I could actually pull it off.

But then I saw Steve Martin, the actor, comedian, author, and banjo virtuoso (don’t believe me? Check this out, I think you’ll like it) on Late Show with David Letterman and inspiration struck. Martin’s appearance on Letterman reminded me of one of my favorite scenes from his 1986 comedy ¡Three Amigos!

To set the scene, at this point in the film The Amigos (played by Martin, Chevy Chase, and Martin Short) have decided that although they are merely Hollywood actors who play hero gunfighters in the movies, they will help the inhabitants of a small Mexican village confront and defeat the very real bandits and their ruthless leader, El Guapo (played by Alfonso Alau), who have terrorized the town for years. Lucky Day (Martin’s character) attempts to inspire the villagers with this speech.

What on Earth does this have anything to do with “Overcoming Fears of Starting Insulin”? Well, I think for most people with Type 2 diabetes, like yours truly, our “El Guapo” is starting insulin. It’s something we will have to face eventually and something that once we do, we will be better and healthier for it. For me, when my endocrinologist suggested insulin five years ago, there were two very different fears I had to overcome.

The first was the fear of admitting failure. The suggestion that it was time to start insulin was, for me, like admitting that I had failed myself, my wife, my family – everyone who cared about me.  If I had eaten better, I wouldn’t need insulin. If I had exercised more, I wouldn’t need insulin. And now if I needed insulin, then clearly I failed at managing my diabetes.

When I met with my diabetes educator, however, she reminded me that Type 2 diabetes is a progressive disease, moving on to insulin was merely the next step in my treatment, and that it was my previous treatments that were failing to adequately treat the disease. In short, it wasn’t me it was my treatment that was failing. Once I heard this I was much more accepting of insulin as an option. I wanted to feel better than I was feeling at the time, and insulin was just the next phase of my diabetes management.

The second fear was about the administration of insulin. I had visions of not being able to do anything spontaneously with friends or family anymore (“Sorry I can’t make it, I forgot my insulin so I need to head home.”). I was pretty nervous (and admittedly still am) about hypoglycemia after a previous episode with another class of drug. And while not generally afraid of needles, I had never self-administered an injection. How long is the needle we’re talking about here? I thought it was going to be about six inches long. Would it hurt? I was sure it would be agonizing.

Again, a little education went a long way to allaying these fears. Injecting insulin turned out to be pretty anti-climactic, really. It’s had no negative impact on my life whatsoever. Being on insulin has not limited me socially. With help from my health care practitioners I have had no issues with hypoglycemia. The mini-pen needle is about as long as my pinky fingernail and causes no pain at all.

And most importantly, I’m healthier and happier ever since I faced the Type 2 diabetic’s “El Guapo” – and won.

Eating Healthy Away From Home

April 30, 2015 at 10:40 am | Posted in Nutrition | Leave a comment
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By Suzanne Russell-Curtis, RD, CDE
Bulfinch Medical Group

Dining out can be a fun time to relax with family and friends, however when trying to eat healthy the experience can become stressful. Restaurants are recognizing people are trying to eat healthier and will often indicate healthy options and accommodate special requests. However, learning how navigate a menu on your own can make the process a little easier. Here are some quick tips on making healthier choices at a restaurant.

Choose:

  1. Broiled, baked, grilled or sautéed
  2. Au jus (cooked in own juices)
  3. Fish, Poultry and Lean meats (Sirloin tips, eye of the round and Top round)
  4. Oil based salad dressing such as Oil and Vinegar
  5. Steamed vegetables
  6. Half or appetizer portions

Pass:

  1. Fried or crispy foods
  2. Cream or butter sauces
  3. Fatty cuts of Beef (New York strip, Porterhouse, Filet Mignon, T-bone and Prime rib)
  4. Creamy salad dressings and soups**
  5. Mashed potatoes or loaded baked potatoes
  6. High fat toppings (cheese, bacon, sour cream)
  7. Full portions

** Soups are often very high in sodium

Extra tips:

Popular restaurant chains now have web sites with nutrition information listed. Check it out and decide on your dish before you go to the restaurant. Once you get there be the first to order – you’ll be less tempted to change your mind.

If you’re headed to a restaurant that brings chips, bread or other goodies before the meal, tell your server you don’t want these tempting treats brought to the table.

Ask for a doggie bag to come at the same time as the meal. Place half of your meal in the box and close it up before you take your first bite. You’ll be less likely to open the box and put the food back on your dish (or eat it out of the box) then if you just cut the meal in half and leave it on your plate.

Have a healthy snack such as raw vegetables and hummus before you go to the restaurant. This will help you avoid over eating.

Umami

April 24, 2015 at 1:38 pm | Posted in Nutrition | Leave a comment
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By Madeline Quinn, Dietetic Intern

5 Basic TastesHave you ever heard of the buzzword, umami, but aren’t quite sure what it exactly means? Most people generally do not recognize the umami flavor while eating due to its subtle and mild taste. Umami, discover in 1908 by Japanese Dr. Kikuknea Ikeada, is a Japanese word meaning “pleasant savory taste.” Presently, it is the fifth taste among the original tastes of sweet, sour, bitter, and salty.

As a result of receptors for the amino acid called glutamate, we are able to taste umami. Glutamate occurs naturally in fish, meat, vegetables, and dairy products. It’s also available as its salt form in MSG. Cooking and fermentation helps release this amino acid to experience the umami flavor. Similar to glutamate, the umami flavor is conveyed by certain compounds found in meats and vegetables. When combined in a dish, such as a mouthwatering cheeseburger with ketchup, umami complexes heighten the flavor.

Umami has Umami Foodsdistinct taste receptors found all over the tongue – now that’s impressive! A remarkable amount of foods are rich in umami, including: tuna, cod, seaweed, shellfish, tomatoes, truffles, soybeans, carrots, shiitake mushrooms, green tea, soy sauce, parmesan cheese, meats, poultry and even breast milk. Thus, umami is an extraordinarily diverse taste category, and impacts a vast majority of one’s daily food intake. Next time you cook up some shiitake mushrooms or have the urge to lather your sushi with soy sauce, remember, your meal would not be the same without the savory umami flavor.

Post Content Reviewed by MGH Department of Nutrition and Food Services

Potato Basil Frittata

April 16, 2015 at 3:21 pm | Posted in Uncategorized | Leave a comment
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A frittata (similar to an omelet) can effortlessly transition from brunch to a quick weeknight dinner, being both elegant and easy.  Add a side salad to round out your meal.

Ingredients:
2 tbsp olive oil
4 red potatoes, peel left on, cubed
8 extra large eggs
¼ cup low fat milk or soymilk
½ cup basil, chopped
1/3 cup scallions, chopped
¼ cup grated pecorino romano or parmigiano reggiano cheese
3 ounces goat cheese, sliced into rounds
Pinch of salt and pepper

Instructions:
Heat a sauté pan on medium heat and then add olive oil. Add cubed potatoes and sauté, stirring occasionally, until potatoes are tender when pierced with a fork (about 15 minutes). Meanwhile in a separate bowl, whisk the eggs; then stir milk, basil, scallions, grated cheese, and salt and pepper into eggs. Turn on oven broiler.

Pour the egg mixture over the potatoes and cook on medium low heat for 3-5 minutes,
occasionally running a rubber spatula around the edges of the frittata to loosen. Frittata is ready for the broiler when eggs around the edge of the pan start to set, but the middle is still loose.

Top frittata with goat cheese rounds and place under the broiler for about 3 minutes or until eggs are set throughout. Run your spatula along the sides and bottom of the frittata to loosen from the pan and place on large plate or platter.

Yield: 8 servings

Nutrition Information per Serving:
Calories: 273 • Protein: 15g • Sodium: 327g • Carbohydrate: 18g • Fiber: 2g
Fat: 15.5g • Sat Fat: 6g

Standards of Medical Care in Diabetes 2015

April 2, 2015 at 11:14 am | Posted in Uncategorized | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people with diabetes. They were formally called Clinical Practice Recommendations but are now referred to as Standards of Medical Care in Diabetes. I would like to acknowledge that Dr. Deborah Wexler from the Diabetes Center at MGH is a member of the Professional Practice Group of the ADA, Glycemic Group Subchair. This group edits the Standards of Care and reviews ADA Position Statements.

These standards are meant to provide general treatment goals for patients with diabetes. They are not meant to replace clinical judgment. I am going to briefly review some of the changes this year; visit the American Diabetes Association website for a more detailed explanation of the standards. Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.

The ADA determined that the following themes were to be considered by clinicians, policymakers, and patient advocates at all times:

  1. Patient-Centeredness – These recommendations are a guide to care and must be adapted to each patient’s individual needs. There is no “one size fits all” in the care of diabetes.
  2. Diabetes Across the Life Span – People with Type 1 and Type 2 Diabetes are not only increasing in number, but are also living longer. There are few clinical trials that address the needs of this population, so it’s important that all health care team members communicate well to be sure the best care is provided.
  3. Advocacy for People with Diabetes – Living with diabetes is challenging. It’s important for all of us in this field to act as educators for our patients and the community. This is the best way to avoid issues of discrimination. The ADA has published position papers on diabetes and employment, diabetes and driving, and diabetes and correctional institutions, to name a few.

Standards Review of Changes

S2: Classification and Diagnosis of Diabetes – Screening of overweight Asian adults with another risk factor should be considered at a BMI of 23 or greater. All other overweight patients with another risk factor should be screened at a BMI of 25 or greater.

S4: Foundations of Care/Education – The ADA supports diabetes self-management education (DSME) for all patients with pre-diabetes and diabetes. This model has better health outcomes as well as possibly resulting in cost savings.

S4: Foundations of Care/Physical Activity – It’s important to be as active as possible. Sitting for more than 90 minutes at a time should be avoided.

S4: Foundations of Care/Smoking Cessation – E-cigarettes are not supported by evidence based research as a good alternative to tobacco products.

S4: Foundation of Care/Immunizations – All patients with diabetes need to be vaccinated annually for influenza. Hepatitis B immunizations should be provided for people ages 19-59 and there is consideration of this being done across the lifespan. Pneumococcal vaccination is also important. These recommendations are based upon the Centers of Disease Control (CDC) recommendations:

  • People over the age of 2 should receive the PPSV23 vaccine.
  • Adults who are 65 or older and HAVE NOT been vaccinated should receive the PCV13 vaccine and the PPSV23 vaccine 6-12 months after the initial vaccine.
  • Adults who are 65 or older and HAVE received PPSV23 should receive a follow up within 12 months of the PCV13 vaccine.

S6: Glycemic Targets – Pre-meal targets have been changed from 70-130 mg/dL to 80-130 mg/dL to better avoid episodes of hypoglycemia.

S7: Approaches to Glycemic Treatment – The algorithm for medication management of diabetes has been updated to include the newest medications available for the treatment of diabetes. Lifestyle changes including healthy eating, weight control, activity, and education are still extremely important in all management strategies for diabetes.

S8: Cardiovascular Disease and Risk Management – The goal for patients with hypertension is now <140/<90. It is also perfectly acceptable for this goal to be changed to meet individual needs. The goals for lipid management have also been changed to focus more on each person’s individual risk and to keep the LDL <100. Again, this goal may be altered to meet the need of each individual.

S9: Microvascular Complications and Foot Care – Feet should be examined at each office visit if there is a history of deformity, ulcer, or decreased sensation.

S11: Children and Adolescents – An A1c level of 7.5% or lower are acceptable.

S12: Management of Diabetes in Pregnancy – This is a new chapter that provides guidance for the care during pregnancy from pre-conception across the lifespan.

It is important to remember that these standards are not the final say in how to care for people with diabetes. Always talk with your health care team about what is the best treatment for YOU.

.

Kale – A Powerhouse Vegetable

March 27, 2015 at 10:33 am | Posted in Nutrition, recipes | Leave a comment
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By Toni Ambrogio, Dietetic Intern

IMG_1782

While many leafy green vegetables are full of healthful nutrients, kale has recently taken the spotlight for its versatility in the kitchen. While kale may start as a crunchy, leafy vegetable enjoyed in salad, it can be easily softened into a soup or stew, or transformed into kale chips for a healthier snacking option.

What Makes Kale Healthy?

Kale contains beneficial nutrients like beta carotene, Vitamin K, and Vitamin C. Beta carotene plays a role in vision and immunity; Vitamin K aids in proper clotting and coagulation of our blood; and Vitamin C is an antioxidant. Antioxidants are molecules that attach to free radicals in our bodies. Free radicals can negatively impact our bodies by causing damage to cells. Kale is also known as a “diabetes super food” due to its low glycemic index.

Kale Chips

Preheat the oven to 225 degrees F.

Put the kale leaves in a bowl. Lightly pour the olive oil over the kale until the kale is glistening and coated (do not apply too much oil).

Transfer the kale to a baking sheet and spread it out for even cooking. Lightly season with salt. For a kick of citrus flavor, sprinkle with lemon pepper seasoning. Create a bold, new flavor by sprinkling the kale with chili powder and garlic powder. You can be very creative!

Bake until crispy, 45 minutes to 1 hour, depending on your oven. Cool and serve.

Ribollita – The Italian Minestrone

3 tablespoons extra-virgin olive oil (EVOO)

4 – 6 garlic cloves, chopped

1 medium to large onion, finely chopped

2 medium carrots, diced

1 medium zucchini, thinly sliced into rounds

Salt and freshly ground pepper

1/2 cup dry red wine

1 15 ounce can petite diced tomatoes, low sodium

6 cups water (or vegetable stock, low sodium)

2 15 ounce cans small white beans, low sodium

4 cups chopped kale

Directions:

  1. If vegetables are canned, rinse under water until water runs clear to rinse away some of the sodium.
  2. Heat a soup pot over medium-high heat. Add the EVOO. Add the garlic, three-quarters of the chopped onion, the carrots and zucchini and season with salt and pepper. Cook the veggies for 7 to 8 minutes, then add the wine to deglaze the pot. Stir in the tomatoes and stock and bring up the heat. When the soup boils, reduce it to a simmer and stir in the bread and beans. Pile the greens into the pot and wilt them into the soup.
  3. Simmer the ribollita for 5 to 10 minutes, stirring the soup as it simmers, until it thickens to a dense stew-like consistency. Turn off the heat, adjust the seasonings and ladle into shallow bowls.
  4. Additional – top each bowl with some of the grated Parmigiano-Reggiano cheese, an additional drizzle of EVOO, a spoonful of the reserved raw onion and some basil.

Nutrition 101: Carbohydrates

March 19, 2015 at 11:10 am | Posted in Nutrition | Leave a comment
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By Janelle Langlais
Dietetic Intern

Carbohydrates are the body’s instant source of fuel found in almost everything. Milk, cereal, bread, pasta, soda, juice, candy and sweets all contain carbohydrates, and even fruits, vegetables, nuts and seeds. During digestion, carbohydrates are broken down into sugar molecules used as the body’s main source of fuel. The body stores these sugars in your muscles to provide energy during exercise, and in your liver to provide energy while you are sleeping or fasting. Carbohydrates are essential for proper nutrition; in fact, the Dietary Guidelines for Americans recommends that 45-65% of your diet come from carbohydrates daily.

It’s a common misconception that people with diabetes can’t eat carbohydrates. Everyone can and should eat carbohydrates for proper nutrition, as many options like whole grains, vegetables, fruits, and nuts are nutrient dense (meaning they have a lot of nutrients but few calories). Pairing carbohydrates with foods rich in protein and/or fiber helps the body maintain blood sugar. As protein is the body’s long-lasting fuel, it slows down the digestion process which helps to minimize the effects of carbohydrates on blood sugar. Protein helps make you feel fuller longer, leaving you more satisfied than if you just ate a carbohydrate alone. Fiber also has a similar effects on digestion and “fullness” as it slows down digestion and adds bulk, aiding in maintaining a more stable blood sugar. An apple with peanut butter is a great example of a balanced snack: the apple contains carbohydrates and fiber, and the peanut butter contains lots of protein and a small amount of carbohydrate and heart healthy fat.

Overall, the key is moderation and balance.  Focus on incorporating whole grains, fresh fruits and vegetables into your diet. Opt for whole grain or whole wheat bread or pasta instead of white to increase your protein and fiber intake, creating more of a balanced plate. These foods also contain lots of vitamins and minerals which are essential to a healthy diet. Another thing to remember is to limit sugar-sweetened beverages such as soda and juice, and avoid refined sugars. These sugary drinks and processed foods contain large amounts of sugar and have little nutritional value. Opt for fruit-infused water or diet beverages to decrease your sugar and caloric intake for better health. Lastly, always remember is to be mindful of portion sizes! It is possible to have too much of a good thing, so always read your food labels and follow the serving size.

(Post content reviewed by the MGH Department of Nutrition and Food Services)

Lemon Fish with Carrots and Celery

March 5, 2015 at 11:30 am | Posted in Uncategorized | Leave a comment

The recipe is adapted from Polish cuisine and features fish flavored with lemon and black pepper, served over sautéed carrots and celery. Offer this nutrient-packed recipe hot, as a dinner entrée,or try it cold on a bed of greens.

Ingredients:
4 5 oz portions of scrod or cod (1.25 pounds in total)
3½ cups carrots, shredded (about 5-6 carrots)
1 1/3 cups celery, diced
3½ tbsp canola oil, divided
1¼ tsp lemon juice
¼ tsp kosher salt
black pepper (to taste)
1 lemon, cut into wedges (optional, as garnish)
1 tbsp parsley, chopped (optional, as garnish)

Instructions:
1. Preheat oven to 350º.
2. Cover a baking pan with aluminum foil (allow for foil to hang over the edges of the sheet pan).
3. Place fish on foil and coat fish with 1 tbsp canola oil and lemon juice; season with pepper.
4. Cover fish tightly with aluminum foil (make a few holes in the foil with a fork so that steam can escape).
5. Bake fish for about 15 minutes or until the fish is opaque and flakes easily with a fork. (The internal temperature should be 145°F.)
6. While the fish is baking, sauté celery with 1½ tbsp oil until tender, about 5-10
minutes. Add carrots, 3 tbsp of water and the remaining oil (1 tbsp). Season with ¼ tsp
salt and sauté vegetables for about 20 minutes, or until carrots are tender.
7. Serve fish over vegetables and garnish with lemon wedge and parsley, if desired

Yield: 4 servings (about 4 ounces cooked fish and ½ cup vegetables)

Nutrition Information per Serving:
Calories: 240 • Protein: 27g • Sodium: 375mg • Carbohydrate: 9g • Fiber: 3g • Fat: 11g •
Sat Fat: 1g

Recipe adapted by Agnieszka Szewc, Dietetic Intern

MGH Resources for Quitting Smoking

February 19, 2015 at 1:18 pm | Posted in Uncategorized | Leave a comment

Quitting smoking is one of the best things you can do for your health. If you’re ready to quit, there are a number of resources available that can help you be successful. Members of the Mass General community have access to in-person support and coaching through the MGH Community Health Associates Living TOBACCO-FREE Program. The Program’s multi-lingual coach speaks 5 languages: English, Spanish, Czech, Slovak and Russian. Call 781-485-6210 for more information.

Massachusetts residents can also work with a coach by telephone. Call the free Smokers Helpline: 1-800-QUIT-NOW (1-800-8-Dejalo para Español). The Smokers Helpline also offers interpretation in over 100 languages. Visit makesmokinghistory.org for more information and support resources.

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