Category Archives: supplements

Indian Summer lunch

It was absolutely STUNNING out yesterday, and I was stuck running errands, cleaning, and perfecting the ultimate protein waffle that is in compliance with renal restrictions. I decided to do a protein waffle taste test for my patients next week and figured I would just sub applesauce for the banana (too high in potassium) and all-purpose flour for the whole wheat (too high in phosphorus) in this Perfect Protein Pancake/Waffle recipe that I know and love. However, that didn’t go over so well…the batter stuck to one of either side of my waffle iron and just kinda crumbled apart. I tried another recipe that contained 3 eggs and just 1/4 cup flour — it ended up like a waffle-scramble. Ew. I’ll share what I came up with soon…I still may make a few tweaks. As tedious as this recipe adaptation has been I’m glad I decided to do it. Not only can I more closely relate to the frustrations of my patient’s diet restrictions, but they desperately need help finding creative ways to get in 80-100+ grams of protein a day. My little old ladies can only eat so much meat!!

Despite my waffle making, I was craving something leafy and green and full of flavor.

Done and done. I have been saving this recipe for the perfect occasion, and an Indian Summer day was it!

Lightened Up Caesar Salad with Zesty Croutons from Cara’s Creature Comforts

Salad dressing:
1/2 cup light mayonnaise
2 Tbsp red wine vinegar
2 tsp dijon mustard
2 tsp white wine
1 tsp Worcestershire sauce
1 tsp anchovy paste
1 clove garlic, minced
1/8 tsp ground red pepper

Croutons:
2 c sourdough bread 8 ounce mini multi-grain or whole grain loaf, cubed
1/2 tsp Creole seasoning garlic powder
1 clove garlic, minced
1 Tbsp olive oil

Salad:
3 large heads Romaine, cut into bite sized pieces
1/3 cup Parmesan cheese, grated

Directions:

Whisk together mayonnaise, vinegar, mustard, wine, Worcestershire sauce, anchovy paste, garlic, and pepper in a bowl. If time permits, cover and chill for at least one hour for flavors to blend.

Preheat oven to 350° F. Cube bread and place into a large Zip-lock bag. Drizzle the olive oil over the bread cubes, close the bag, and shake to coat. Spread cubes in a single layer on a baking sheet lined with tin foil and sprinkle with garlic salt. Bake for 20-25 minutes, or until bread cubes are golden.

Place lettuce and croutons in a large bowl. Add dressing and toss to coat thoroughly. Sprinkle with cheese and serve. Serves 5 salad entree portions.

Nutrition Information (per serving): 259 calories; 13.6 g. fat; 7.6 g. cholesterol; 547 mg. sodium; 28.4 g. carbohydrate; 8.8 g. fiber; 9.6 g. protein

Result: I am on a Caesar salad kick lately and this was delicious! I was kinda scratching my head at the ingredient list, but it works and it tastes just like it should! I’ve never used anchovy paste before, and I was definitely squeamish about doing so, but I think it does add a lot of punch to the dressing that you can’t get from another ingredient. Another bonus is no raw eggs. While never always eat raw cookie dough, it’s never really “safe” to consume raw eggs, which this Caesar dressing does not contain. I love the nutrition stats on this version especially if you compare to say, Panera Bread, whose entree Caesar salad clocks in at 390 calories and 27 grams of fat. The portion size is PLENTIFUL and the dressing is more than enough to go around! Enjoy!

Mr. Prevention and I won’t be behaving THAT well today, however. Just as I had my eye on that gorgeous salad recipe, I’ve also had my eye on a crab queso dip! Guys, I’m BURNING out on Buffalo Chicken Dip. Making it has become monotonous and old. Mr. Prevention, however, continues to eat it like it is his job. I hope the crab queso goes over well, because I’m on strike against Buffalo Chicken Dip this week, as good as it is! And if the crab dip is a bust, I’ll have a whiny husband until football next weekend. C’mon, crab queso dip…be good! 😀 We are I am also making another chili recipe…entry #9!

Minnesota at home…we got this. I-L-L…I-N-I!!

Question: What’s your favorite salad dressing? And be honest, do you eat cookie dough batter, too? 😉

Go Illini,

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Filed under dialysis & kidney disease, fiber, fruits and vegetables, garlic, low-carb, protein, recipe, reduced-calorie, salad, supplements, vegetarian, work

motivated by money

I talked a little bit about what I’ll be doing as a renal dietitian, but I didn’t mention that I am responsible for improving very poor lab values in my patients. In dialysis, dietitians most closely monitor albumin, potassium, phosphorus, calcium, and parathyroid hormone (PTH). And most importantly, low albumin levels correlate with increased risk of mortality and morbidity. Not good. I walked into a rather bleak situation and it’s 100% on me to turn this around. Pressssure!!

Because everyone loves “free” money and winning, I created a little competition for our patients. Every month, after labs are drawn, patients can earn chances to win Kroger gift cards that they can use on medications, food, or gas. Patients get 1 entry for every criteria they meet: albumin within range, potassium within range, phosphorus within range, and NO missed treatments. If they are able to meet all 4 criteria, they get 2 extra entries.

And in order to increase long-term compliance with medications and diet, this competition will be on going each month, with 4 winners each month. I hope it works! Or at least helps 🙂

I’ve also requested the clinic to purchase protein supplements for our patients who need the added nutrition. Most of the malnourished patients find protein supplements to either be too expensive or not palatable. And because of strict potassium, phosphorus, and fluid restrictions, not just any protein supplement is appropriate. After doing some research and speaking with drug reps, I chose LiquaCel for my patients. This is a product previously unfamiliar to me, but it is gaining popularity quickly among the protein malnourished populations. After tasting samples I can confirm that this stuff is DELICIOUS! And just 1 ounce provides 16 grams of protein — perfect!

Quesiton: What’s the last challenging situation you were in at school, work, or otherwise? Do you like to be challenged or does it push you out of your comfort zone?

I have to admit, I’m a bit out of my comfort zone on this one. Especially since I have to stand before a committee next Wednesday and give evidence as to what steps I’m taking in order to remedy our patient’s poor nutrition statuses. 😦

Or on a lighter note…anything fun planned for the weekend?? 😀

I am meeting Gina tonight for dinner and drinks! We got together back in June, and I’ve been anxious to hangout again! And now that we’re in Columbus for good, that will be much more doable 😉 We both have new jobs and I’m sure we’ll gab on and on about dietetics…especially since we’re leaving the guys at home! 😉

TGIF,

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Filed under dialysis & kidney disease, dietitians, dining out, friends, protein, supplements, volumetrics, water, work

Q&A: ginseng, hidden sodium, and raw milk

Quick update: Home inspection did NOT go well…at all (you can’t judge a book…or a home…by its cover!). Back to square one. Oh the joys of buying a home…I’ll keep you guys posted. Thanks tons for all of your support and well wishes on our big move. Despite the hurdles and big changes, I need to stay positive while we’re in transition!!

As for the job-hunt, I am trying to keep an open mind but I want to still keep my paws in diabetes…some how…some way. I am nearly 50% complete with my 1,000 diabetic education hours needed to sit for the exam and I am not giving up that easily on pursuing my CDE. Diabetes is my passion!

And on to a most excellent line-up of Q&A!

Jodie of Jodie Pilates: I would like to know your opinion on ginseng, specifically for energy. Are there any other supplements you can suggest for energy?

Prevention RD: Caffeine and ginseng are the two most natural stimulants that come to mind. I recently started taking ginseng for my blood glucose and have noticed no increase in energy*. However, ginseng is most commonly found in large doses in energy drinks, such as Red Bull and Monster and is most “famous” for its stimulant-effects. I feel both caffeine and ginseng can be a part of a healthy diet, but I think a good night’s sleep is the best energy boost of all! 😉 Note: If you do utilize ginseng or caffeine, do so earlier in the day to help avoid sleep disturbances.

*Ginseng is working beautifully in lowering my fasting blood glucose, however! My fasting blood sugars have gone from 95-103 mg/dl into a much preferred 83-90 mg/dl range. In less than a week, I am SO pleased with the results!

Liz in Dallas: My grandmother and my dad have both recently been put on low-salt diets. It is easy for them to deal with at home, since my grandmother and my mom cook all their own food and very rarely eat anything processed. The problem seems to be out at restaurants. Both of them eat out for lunch pretty much every day, and my grandmother also goes out to eat for dinner quite frequently. What should they be ordering to avoid sodium overload? Are there dishes that they should always avoid? What do you think are the most sneaky sources of sodium?

Prevention RD: Low-sodium “diets” are tough…really, really tough. Restaurants are notorious for using exorbitant amounts of salt. If it’s possible, your grandmother and dad could decrease the frequency of meals out, or dine at restaurants with published nutrition information (e.g. Chili’s, Applebees, Subway, etc.) so they are sure to make a salt-friendly meal selection. If meals out are a must, there is plenty to know, however! Anything breaded or fried is going to have more salt, so looking for key words on menus such as baked, broiled, steamed, and grilled can be helpful in reducing salt. Chips, fries, and other side dishes such as potato salad are also high in sodium, as are sauces, dressings, and other condiments. Because sodium is hidden in just about everything, the best thing to do at restaurants is to exercise portion control, especially since the portion sizes are generally rather large. When ordering food at a restaurant, they can ask the server to put dressings and sauces on the side so they can control how much they consume. And it’s always an option to take home half their meal and have a small snack before and/or after dining out. Sharing meals is another great option. Best of luck to them! Great question 🙂

Lena of LMC in the World: I read an article in a recent Economist magazine about the trend of raw milk. It was saying there are some nutritional benefits which are eliminated in the pasteurization process and some people are selling/buying raw milk. Had you heard of this trend? It also said the FDA has not identified any nutritional benefits and there are still a number of laws to restrict the sale of raw milk because it can be dangerous. I would love to hear your thoughts.

Prevention RD: What a great question! This is a HOT trend right now, you betcha! Raw milk and dairy simply not been pasteurized, as you stated. Unpasteurized dairy can contain harmful and potentially fatal bacteria including E. coli, Listeria, and Salmonella. The National Dairy Council, Food and Drug Administration, Centers for Disease Control, American Medical Association, and the American Academy of Pediatrics, among others, endorse pasteurized milk and dairy. According to the National Dairy Council there is no scientific evidence to suggest that there is any nutritional benefit to raw milk and dairy of that which has been pasteurized. In fact, pasteurized milk is fortified with vitamin D, making is a more nutritionally desirable product over raw milk. And did you know that it is actually illegal to sell raw milk in some US states? Check out your local raw milk and dairy laws if you choose to consume raw dairy. While raw milk and dairy carries some risk of bacterial contamination, I think the larger issue is knowing where the products come from and the cleanliness of the site. I know there are many raw milk and dairy advocates out there, but I tend to side with the majority on this one. Would I try raw milk or dairy from a dairy I trusted? Probably. Is it recommended for the young, old, or uninsured? Probably not. 😉

I’ll leave you with a picture of my sleepy girl after her day at camp. She snored ALL night!

Question: What supplements do you take and why?

Happy half-way to Friday!

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Filed under blog topic request, blood glucose, coffee, complimentary and alternative nutrition, condiments, diabetes, dietitians, dining out, enriched/fortified, farming, fast food, food safety, hypertension, minerals, raw food/rawism, restaurant, sleep, sodium, supplements, vitamins

Giving ginseng a go!

Late post today…I was busy sleeping in 🙂 Glooorious!

Last night we went over to our friend’s, Tiffany and Matt, home for dinner. Tiffany is a wonderful cook and Matt is a grill MASTER! We had a wonderful Cedar-Smoked Maple-Glazed Salmon served with farro. YUM!

I contributed a fruit salad:

Thanks Tiffany and Matt! 😀

Adding ginseng to the mix…

The 2 grams of Metformin I am taking daily to help lower my blood glucose (thanks to PCOS) doesn’t seem to be cutting it. My fasting numbers are yet to get out of the mid-to-upper 90’s and I want them in the 80’s! After doing some research and supplement hunting, I have decided to try Asian Ginseng to help lower my blood glucose.

There is a lot of research in support of ginseng use for glucose-lowering effects. And I’ve consulted text books from my undergraduate years, as well as a little gift from Celestial Seasonings

I almost wish I didn’t know as much as I do about blood glucose! When we got back from frozen custard last night, my blood glucose was 88. This morning fasting, it was 94. So frustrating! Meformin is designed to slow down hepatic glucose production meaning that it suppresses the amount of sugar the liver outputs, as well as make insulin in the body more sensitive to glucose. With my fasting glucose unchanged on a high dose of Metformin, I am utterly confused! I am very pleased with the way my body processes carbohydrates when I eat, however. A silver lining, if you will! My liver is just extra sweet, I guess! 😦

In order to help my fasting blood glucose, I’ve decided to give ginseng a try. I purchased these 2 supplements:

Note the GMP logo:

As well as ginseng drops:

There is a lot of varying opinion on ginseng dosing, so I am going to start with 1-2 grams a day. I plan to take the ginseng in the morning to help avoid any insomnia — a side effect of ginseng as it is known as an “energy” supplement. It’s also good for immunity!

Here goes nothing!

Lily wanted to say hi. I think the heat has increase her appetite…she layed like this all morning wanting more breakfast!

Question: What are you up to today? How’s the weather near you? 97º F and sunny in Tulsa! HOT HOT HOT!

Staying cool,

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Filed under blood glucose, carb-controlled, carbohydrates, complimentary and alternative nutrition, diabetes, diet, dinner, dog, entertaining, fish oil/omega-3's, food safety, friends, fruits and vegetables, grilling, herbs, low-carb, PCOS, pets, research study, supplements

The Gila Monster

As I’ve battled with insulin resistance and the side effects experienced while taking the diabetic drug, Metformin, I’ve become increasingly interested in the other glucose lowering agents on the market (outside the ones I’m most familiar with in my clinic — Metformin, glyburide, glipizide, Actos, novolog, and Levemir). One drug in particular, Byetta, has piqued my interest.

[source]

Byetta helps the pancreas produce insulin more efficiently in type 2 diabetics. Byetta’s major drawback for consumers is the fact that it is an injectable. Most interestingly, Byetta is derived from the saliva of the gila monster. This poisonous lizard is native to desert regions of Utah, Nevada, New Mexico, California, Arizona, and Mexico. Byetta is FDA-approved and becomingly an increasingly popular glucose control agent in diabetics, for those willing to go the injectable route.

I find this amazing…anyone else? If an endocrinologist recommended I go on Byetta, I would do so. I’ve over-come the fear of giving myself an injection, so why not?

Question: Do you know of any “alternative” medicine treatments, drugs, or cures (i.e. cinnamon for blood sugar control or ginger for nausea)??

Heading back to Tulsa tonight! Busy, busy, busy!!

Amazed by science,

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Filed under complimentary and alternative nutrition, diabetes, dietitians, prescription drug, supplements, travel, work

Coconut Water: Health Food or Health Fad?

[source]

Good news, coconut water lovers! Unlike the questionable coconut oil, I give coconut water 2 thumbs straight up!

As I was trying to stay awake on the red eye to Columbus last night, I found myself purusing the pages of my ADA Times. Highlighted as a consumer trend, coconut water was discussed. And appropriately so. I would go so far as to argue that coconut water is one of the biggest trends in nutrition today.

[source]

Coconut water, unlike coconut milk, is found inside young, green coconuts. The water is thin and filmy with a distinct flavor and mild sweetness. Comercially-sold coconut waters are pasteurized to prevent from food borne illness. However, DO NOT keep coconut water for more than a day in the refrigerator once opened.

Coconut water contains plentiful amounts of electrolytes and minerals making it a most desirable form of all-natural hydration and nutrient replenishment for athletes and exercisers. One cup of coconut water contains 46 calories, less than 0.5 grams of fat, and is a good source of fiber (3 grams), magnesium (60 milligrams), potassium (600 milligrams), and vitamin C. A single cup also provides 252 milligrams of sodium and 9 grams of carbohydrate. A preferred list of stats compared to a cup of Gatorade offering 50 calories, 110 milligrams of sodium, a mere 30 milligrams of potassium, 14 grams of carbohydrate, and no fiber.

Added bonus: taste! Mmmm!

Off to have diner and drinks with fellow dietitian and blogger, GINA! I’m excited!

I hope to catch up with everyone soon, but we are busy busy busy while in Columbus! Lots going on, but more details on major life changes soon!

Question: Have you ever tried coconut water? Did you know its health benefits before now?

Nearly Friday,

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Filed under blog, carbohydrates, dietitians, dinner, exercise, fiber, food safety, friends, minerals, physical activity, sodium, supplements, vitamins

White Cheese Lasagna + Q&A

Interesting comments on yesterday’s “OIAJ: Safe or not?” post! Thanks for all the feedback!

White Cheese (Chicken) Lasagna adapted from All Recipes and recommended by Holly

9 whole wheat lasagna noodles
1/2 cup butter Smart Balance Light
1 onion, chopped
1 6 clove garlic, minced
1/2 cup all-purpose flour
1 teaspoon salt
2 cups low-sodium chicken broth
1 1/2 cups fat-free milk
4 cups shredded 2% mozzarella cheese, divided
1 cup grated Parmesan cheese, divided
1 teaspoon dried basil
1 teaspoon dried oregano
1/2 teaspoon ground black pepper
2 cups part-skim ricotta cheese
2 cups cubed, cooked chicken meat
2 (10 ounce) packages frozen chopped spinach, thawed and drained 6-8 cups loosely packed fresh spinach
1 tablespoon chopped fresh parsley
1/4 cup grated Parmesan cheese for topping

Directions:

Preheat oven to 350º F. Bring a large pot of lightly salted water to a boil. Cook lasagna noodles in boiling water for 8 to 10 minutes. Drain, and rinse with cold water.

Melt the butter in a large saucepan over medium heat. Cook the onion and garlic in the butter until tender, stirring frequently. Stir in the flour and salt, and simmer until bubbly. Mix in the broth and milk, and boil, stirring constantly, for 1 minute. Stir in 2 cups mozzarella cheese and 1/4 cup Parmesan cheese. Season with the basil, oregano, and ground black pepper. Remove from heat, and set aside.

Spread 1/3 of the sauce mixture in the bottom of a 9×13 inch baking dish. Layer with 1/3 of the noodles, the ricotta, and the chicken. Arrange 1/3 of the noodles over the chicken, and layer with 1/3 of the sauce mixture, spinach, and the remaining 2 cups mozzarella cheese and 1/2 cup Parmesan cheese. Arrange remaining noodles over cheese, and spread remaining sauce evenly over noodles. Sprinkle with parsley and 1/4 cup Parmesan cheese.

Bake 35 to 40 minutes in the preheated oven. Serves 12

Nutrition Information (per serving): 449 calories; 23.4 g. fat; 59.2 mg. cholesterol; 1117 mg. sodium; 20.5 g. carbohydrate; 2.3 g. fiber; 39.8 g. protein

Feedback: Yummm! Mr. Prevention gives a big thumbs up, too! He does, however, request chicken the next time I make this lasagna. I omitted chicken because it is 1) fairly high in calories as is, and 2) contains lots of protein even without the chicken! Great recommendation, thanks Holly!

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Q&A!!

It’s been awhile! Here we go! 😀

Molly: Do you know if there are any draw backs to cooking with instant (5-10 minute) brown rice versus regular brown rice?  I use the quick stuff cause after getting off of work, hittin the gym and then coming home, sitting around for 45 min waiting for rice isn’t all that appealing, hahaha.

Prevention RD: Um, totally agree! Unlike oats, for example, instant brown rice undergoes no additional processing to decrease its cook time. Instant rice is simply pre-cooked and dehydrated to shorten the cook time and the nutritional losses are insignificant. Really great question!

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Carissa of Fit to Indulge: I know you work with diabetics, and as an RD I need your backup. My grandpa’s physician wants him on this Atkins style diet and it ticks me off that his MD isn’t referring him to a dietitian instead. He wants my opinion, but I know as a student, it sounds better coming from a Registered Dietitian. What would you tell a patient?

Prevention RD: RED FLAGS!!! To be honest, I think his MD might be getting a kick back for referring patients to this program based on what the diet consists of in terms of low-carb/low-fat and the product information you attached. If you cut out carbs and fat, there’s nothing left but protein! I’d get an MD to refer him to an RD, or he could attend Weight Watchers meetings if he’s looking for the group support. Not ideal, but he won’t get to see an RD but maybe 1-2 sessions that would be paid for by private insurance or Medicare, unless he was willing to pay out of pocket. As a general rule of thumb, physicians should (and do!) give scientifically sound, broad nutrition and exercise advice: “Exercise more”…”Increase your fruits and vegetables.”…”Cut out the soda and candies”…“You need to lose 20 pounds,” etc. Excellent question, and I do hope he finds (safe) success!

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Lena of LMC in the World: I have found here in Asia that I don’t eat much meat, besides my random deliveries of KFC.  But, I find I am eating a lot more eggs.  I’ve never gone through a carton of eggs so fast and there’s almost always an egg involved if I get a local dish.  How does it compare if I’m swapping out eggs for meat (albeit unintentional)? Any words of caution or other thoughts?

Prevention RD: Eggs have moved up in the rankings – they are incredible and edible, after all! I would be sure to get adequate iron, especially as a woman. Fortified cereals, leafy greens (consumed with a Vitamin C-rich source), and beans are good sources of iron. A daily multi-vitamin doesn’t hurt, either! As for the cholesterol content of eggs, unless someone has high cholesterol, I don’t limit eggs if they are consumed as a part of a healthy diet. If someone has elevated cholesterol, limiting eggs may be necessary (~3 a week). Most cholesterol is synthesized in the body and does not elevate due to high cholesterol intake (found in liver and egg yolks). Good question! Jealous of all that yummy cuisine in Singapore! 😉

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Molly: I have a family friend who has type 1 diabetes.  She’s had it if not since she was born, definitely since she was a very young girl.  I’m friends with her on Facebook and many of her statuses are diabetes related.  I copied and pasted one of them cause I was curious what you would have to say. It reads: “15 carbs of juice officially does absolutely nothing to her sugar. And yet, AND FREAKIN YET, 10 carbs of kettle chips will kick her right over the edge. Why bother assigning numbers to carbs when they are So Clearly interpretative?”

Prevention RD: Yep, this is common among diabetics, particularly type 1’s. This concept is highly dependent on when blood glucose is measured, how quickly the food/beverage is absorbed (liquids are absorbed much more quickly than solids), the glycemic index of the food, the fiber content of the food, what the food was or was not consumed with, what exercise or lack thereof has been performed, and plenty more that even science cannot explain. There’s just no possible way to isolate each variable and determine concrete cause and effect data. For example, I have SEVERAL patients who record unfavorable rises in blood glucose after eating certain foods. For some, it’s potatoes, for some it’s milk. It’s a matter or trial and error to find what works for each individual and while trends in blood sugar can vary despite carb-counting, a pattern is still apparent in most. Unfortunately, there’s no EXACT science to insulin dosing, carb-counting, and diabetes, but it is still the best (and only!) system for determining insulin titration. AWESOME question – love the diabetes Q’s 🙂

Question: What’s your favorite Italian dish? Lasagna? Ravioli? Manicotti? Spaghetti?

P.S. Thank you for all the Lily love! I wish she knew how many caring bloggie mamas and papas are out there!! 🙂

Happy Hump Day,

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Filed under blog topic request, blood glucose, carb-controlled, carbohydrates, cholesterol, diabetes, diet, dinner, fiber, glycemic index, healthy cooking, microwave, protein, recipe, supplements, Uncategorized