Those of you who know me, know I have a passion for helping people navigate healthcare. This passion was born watching my two young adult daughters and my brother, who recently passed away, trying to deal with medical issues in the current healthcare environment.
As a result, I chose to do my Public Health Doctoral Residency focusing on Health Literacy at the University of Texas Center for Health Communication and Literacy Coalition of Central Texas (LCCT) with Dr. Mike Mackert. While in my residency, I was hired by the LCCT as Director of Health Literacy. There I worked making recommendations focused on injury, illness and readmission prevention through improved health communication. April 2016, I received the Distinguished Scientist award from the Texas Academy of Nutrition and Dietetics for my research and work in modifying the healthcare environment in Texas regarding health literacy. This fall, I will join the UNTHSC Institute for Patient Safety (IPS) as an Senior Fellow to lead the program in health literacy.
Not everyone responds to stress in the same way. However, stress can impact your personal and professional life as well as your health. So, the best defense is a good offense when it comes to stress. Some proactive ways to abate stress include:
• Diaphragmatic Breathing – slow controlled breathing from belly not chest
• Mental Imagery – imagine yourself in a peaceful, restful place
• Creativity – expressing yourself through writing, art or making music
• Active Skills – dance, yoga, tai chi, quigong or desk exercises
• Social Skills – reaching out or spending time with others
• Healthy Living Skills – eating right, regular exercise and adequate sleep
All of these skills can help give your mind and body a much-needed break. As a Registered Dietitian, I know that what you eat may actually help relieve your tension. Some foods may help stabilize blood sugar or, better yet, your emotional response.
10 foods and nutrients to reach for when you’ve just about had enough:
Green Leafy Vegetables – The University of Otago in 2013 found that college students tended to feel calmer, happier, and more energetic on days they ate more fruits and veggies. It can be hard to tell which came first—upbeat thoughts or healthy eating—but the researchers found that healthy eating seemed to predict a positive mood the next day.
Turkey Breast, Nuts, Seeds, Tofu, Fish, Lentils, Oats, Beans and Eggs – You’ve probably heard that the tryptophan in turkey is to blame for that food coma on Thanksgiving. The amino acid, found in protein-containing foods, helps produce serotonin a chemical that helps regulate hunger and feelings of happiness and well-being. On its own, tryptophan may have a calming effect.
Whole Grain Breads, Cereals and Grains – Stress can cause your blood sugar to rise but instead of reaching for that candy bar or soda, go for complex carbs found in whole grains like oatmeal or whole wheat bread. Complex carbs won’t contribute to your already potential spike in blood glucose. But provide a brain calming chemical called Serotonin.
Yogurt – With all the buzz about the microbiome, new research indicates the bacteria in your gut might be contributing to stress. Research has shown that the brain signals to the gut, which is why stress can inflame gastrointestinal symptoms; communication may flow the other way too, from gut to brain. A 2013 UCLA study among 36 healthy women revealed that consuming probiotics found in cultured dairy products (yogurt in the study) reduced brain activity in areas that handle emotion, including stress.
Salmon, Nuts and Seeds – Research has shown that cultures that eat foods with high levels of omega-3s have lower levels of depression. Omega-3 fatty acids in salmon also have anti-inflammatory properties that may help counteract the negative effects of stress hormones.
Blueberries, Strawberries, Raspberries and Cranberries – The antioxidants and phytonutrients found in berries fight in your defense, helping improve your body’s response to stress and fight stress-related free radicals that can cause damage to your cells ultimately impacting your health.
Chocolate – Antioxidants in cocoa used to make chocolate (and higher in dark chocolate) trigger the walls of your blood vessels to relax, lowering blood pressure and improving circulation. In fact, dark chocolate contains unique natural substances that create a sense of euphoria.
Fortified Milk – Milk fortified with vitamin D provides a good source of this nutrient. People who had sufficient vitamin D levels had a reduced risk of panic disorders compared to subjects with the lowest levels of vitamin D. Other foods high in vitamin D include salmon, egg yolks, and fortified cereal.
Seeds – Flaxseed, pumpkin seeds, and sunflower seeds are all great sources of magnesium (as are leafy greens, yogurt, nuts, and fish). Loading up on the mineral may help regulate emotions. Magnesium can help alleviate depression, fatigue, and irritability especially for women feeling irritable during that time of the month. The mineral also helps to fight PMS symptoms, including cramps and water retention.
Nuts – As well as good fats, cashews are an especially good source of zinc. Low levels of zinc have been linked to both anxiety and depression. Walnuts contain alpha-linolenic acid, an essential omega-3 fatty acid, and other polyphenols that have been shown to help prevent memory loss. Pistachios have been shown to lower vascular constriction during stress, which means your blood pressure may not get as high and the load on your heart is reduced.
Choosing healthy foods from the list above can impact your mood on a positive note, helping to relieve tension, stabilize blood sugar, and send your stress packing. If you look at the list, it basically reflects a well-balanced diet such as recommended by MyPlate. So, manage your food and manage your mood to have a less stressful 2017.
March is National Nutrition Month that means it’s time to clean up your eating act and “Put Your Best Fork Forward” because when it comes to your body, every bite counts!
In today’s ridiculously connected world, it’s not just about how much you weigh—it’s about getting the nutrients you need to feel good and be healthy all the time. Because you never know who’s checking you out online, at the gym or in the office. Who will you inspire next?
Sounds scary, right? Being true to yourself or serving as a role model and mentor doesn’t have to be…when it comes to your health. Incorporate the tips and tools below, and you’ll be able to be your best self all the time (without having to put forth a Herculean effort daily).
1. Respond promptly. Eat when you are hungry, don’t wait all day to eat because you’ll end up using your fork foolishly and eating too many calories at one time. How much we eat is just as important as what we eat. Eat and drink the right amount for you, as MyPlate encourages us to do.
2. Listen carefully…to your body. Be sure to balance rest, good nutrition and physical activity to maximize your health and wellness. Find activities that you enjoy and be physically active most days of the week. Whether running, walking, biking or skating enjoying your activity will help you put your best foot forward when it comes to your health.
3. Be positive. Think of your fork as a tool to deliver an eating style that includes a variety of your favorite, healthful foods. Then, slowly cut back or limit food choices that are not as healthy such as fried food, processed foods and sugary beverages.
4. Research beforehand. Anytime you start a new lifestyle regimen, you should check with your primary provider. Manage your weight or lower your health risks by consulting a registered dietitian nutritionist. RDNs can help put your best fork forward with easy-to-follow personalized nutrition advice to meet your lifestyle, preferences and health-related needs.
5. Be adventurous. Fearlessly strut your new fork attitude and practice cooking more at home while experimenting with healthier ingredients. Research shows that regularly eating home-cooked meals as a family is linked to healthier and happier kids, and teens who are less likely to use alcohol, drugs, or cigarettes. Adults also reap considerable benefits from eating home-cooked meals as they tend to be happier and healthier while consuming less sugar and processed foods. This can result in higher energy levels and better mental health.
Join us in celebrating National Nutrition Month when you “Put Your Best Fork Forward” Choosing well when choosing when and where you put your fork can reap many benefits in your health and life.
February is American Heart Month. Show your heart a little love by taking care of yourself and getting screenings that can help assess your risk for heart disease. Heart disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke. In fact, heart disease kills more women than all types of cancer combined. Show yourself and your family love this month and throughout the year by leading an active lifestyle and providing a heart-healthy diet.
The first way to reduce your risk of heart disease is to be active. Regular, moderate activity lowers blood pressure and helps your body control stress and weight. Find activities that you enjoy alone or as a family and be physically active most days of the week. Whether running, walking, biking or skating enjoying your activity will help you make it part of your routine. Children and teens should get 60 or more minutes of physical activity per day, and adults should get at least two hours and 30 minutes per week even if you build in just 10 minutes at a time. Encourage your family to take a walk after dinner or play a game of catch or basketball.
Choose a healthy eating plan that is right for you. That means an eating pattern that can be maintained for your lifetime and, at appropriate calorie levels to promote health and support a healthy body weight. A Registered Dietitian can help you or you can use the many tools (some below) available to help you make a healthy eating plan using many of the foods that you enjoy.
The areas to consider include:
Consume healthy meals and snacks that account for all foods and beverages within an appropriate calorie level and fits your taste preferences, culture, traditions, and budget.
A healthy eating pattern includes fresh food and more plants and fiber:
♣ A variety of vegetables – dark green, red and orange, legumes (beans and peas), starchy,
and all vegetable plants
♣ Fruits, especially whole fruits
♣ Grains, at least half of which are whole grains
♣ Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
♣ A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes
(beans and peas), and nuts, seeds, and soy products
♣ Oils from plants – high in monounsaturated and polyunsaturated (good) fats
A healthy eating pattern limits processed foods, high fat foods and junk:
♣ Saturated fats found in fatty meats – less than 10% of total calories per day
♣ Trans fats; Generally, found in processed foods – raise your LDL (bad) cholesterol,
which increases heart disease risk
♣ Added sugars; Less than 10% of total calories per day
♣ Sodium; Less than 2300 mg per day
♣ Alcohol; If you drink alcohol, it should be only in moderation
There is a healthy eating pattern for everyone and everyone’s lifestyle. Registered Dietitian Nutritionists are the experts in food and nutrition that can help you plan an eating pattern that is right for you. Additionally, you can find various examples of healthy eating patterns and the Top 10 Things You Need to Know on the 2015-2020 Dietary Guidelines webpage or ChooseMyPlate.gov.
When it comes to keeping children healthy and well during the holidays as a Registered/Licensed Dietitian, I know the best defense is a good offense. In a recent interview, I discussed how the holidays typically bring chaos to our everyday schedule. We can proactively promote children’s health during the holiday season through several courses of action to keep things sane:
Maintain a regular schedule and serve nutritious foods
Pediatric researchers’ findings discussed in the October 2014 issue of Parents magazine, suggest that sleep is also essential to good health. When kids get the sleep they need, they may have a lower risk of becoming overweight and developing diabetes as well as experience fewer learning problems and attention issues. They also stated that sleep is as important as nutrition and exercise. It’s when the body reboots and rebuilds allowing brain cells to “take out the trash” each night, flushing out disease-causing toxins.
Staying on track with nutrition is easy with MyPlate Kids’ Place. The site provides online resources and tools for children to help them make wise choices in a fun and appealing way. The MyPlate graphic guides them to include all food groups in their meals and snacks. At the same time, the MyPlate Website offers science-based advice to help kids and their parents build healthy meals and maintain or achieve a healthy weight. Following the MyPlate guidelines encourages more fruit and vegetable intake – often “the forgotten” food groups. Fruits and vegetables contain important phytonutrients that can boost immunity and help optimize health.
Watch holiday party foods and beverages that could be hazardous to children
During holiday gatherings, we might be distracted or in atypical situations. It only takes a second for a tiny hand to grab a nut, a shrimp or a glass. The next thing you know a child is choking, having an allergic reaction or experiences alcohol poisoning.
Common holiday foods and food preparation such as nuts, olives, shrimp, cheese chunks and other “bite size” food portions are potential choking hazards and should not be given to children under age 4. Keep serving trays on high counters and separate from “child friendly” food service.
Every 3 minutes, a food allergy reaction sends someone to the emergency department. The incidence of those involving children has increased 50% over the past 15 years. If you host at home, inform your guests bringing dishes of your child’s food allergies. If you are attending a party, help plan the menu or inquire about the menu in advance then, bring snacks and desserts that your child can safely eat. However, in any situation Communication is Key. Making sure everyone involved knows about your child’s food allergy is the safest route.
Alcohol poisoning is a common risk for children during the holiday season. Many parents host holiday parties where alcohol is served. Take care to remove all empty and partially empty cups as soon as possible. Keep alcohol containers in elevated locations during the event and put them away immediately after the event. Because kids imitate adults, many may drink the beverages they see adults drinking. Children become “drunk” much more quickly than adults, so even small amounts of alcohol can be dangerous.
What to do if your child gets sick
According to the Institute for Healthcare Advancement, 88% of adults are not health literate. This means they do not have the skills to understand basic health information available in healthcare facilities, retail and media or to read medicine bottles. If you end up at the doctor’s office, be sure to ask questions and plan for follow-up on your child’s illness. According to the National Patient Safety Foundation, three most important questions for all of us to know before we leave the doctor’s office:
What is the main problem?
What should I do about the problem?
Why is the course of action needed?
Following all of these proactive steps can be your best defense, when it comes to keeping children healthy and well during the holidays. This will not only protect your child from harm, it will keep you out of the emergency department and ensure that you can ring in the new year in peace.
Do you know which foods go in what food groups? Did you know there are food groups? Do you know how to read food labels? The last time you went to the doctor did they tell you to eat healthy and exercise? What does that mean? And hardest, how do you make healthy eating happen in your busy life? The ability to do so depends on your nutrition literacy or ability to understand food and nutrition. Nutrition literacy is closely tied to health literacy. Health literacy is the ability to find, understand, and use health advice to stay healthy. Are you health literate and food literate?
Learning how to stay healthy is now a worldwide public health goal. Healthy People 2020 lays out many goals that include eating healthy and moving more to live a healthy life. Learning how to eat right is part of health. But do we really understand how?
A registered dietitian nutritionist can help you learn about and prepare healthy food. There are also many tips, tools and resources prepared by registered dietitian nutritionists or places that employ them to help make nutrition easier.
The Dietary Guidelines for Americans say we should eat food from all of the food groups to meet our nutrition needs. We should also stay at a good calorie level to maintain a healthy weight. A great resource for doing these is MyPlate. On the MyPlate.gov website you can:
•Test your food group IQ and use a variety of tips, tools, quizzes and resources to help you meet your nutrition goals. Such as:
o Tracking your child’s growth.
o Gaining the right amount of pregnancy weight.
o Learning the right portions for the food you eat.
•Find out your Body Mass Index (BMI) or height and weight measure and how that relates to your health.
•Get recipes, cookbooks and menus that can help you prepare healthy food.
•Use daily checklists and trackers can help you keep up with the calories and nutrients you are eating.
However, there are many more topics sure to answer your nutrition question. Meeting with a registered dietitian nutritionist might be the best way to find the nutrition plan to meet your goals. You can find a registered dietitian nutritionist in your area through your local hospital, clinic, healthcare provider, local dietetic association or the EatRight.org tool.
This November, I am speaking at the Alzheimer’s Association North Central Texas Chapter’s Symposium on the relationship between health literacy and cognitive loss prevention. Since September 21st is World Alzheimer’s Day, I thought I would go ahead and share some of the research that will be the basis for my talk, “Healthy Body, Healthy Brain” because the time to start preventing cognitive decline is NOW.
o Disseminate the latest science to increase public understanding of cognitive health and to dispel common misconceptions.
o Help people understand the connection between risk and protective factors and cognitive health.
Both of these priorities require that the information be communicated in plain language and ways that are usable to the average American. Under the current health care plans, preventive (or protective) services such as yearly physicals and health screenings are provided for free. These preventive visits can help provide people with knowledge, tips and tools needed to maintain a healthy body that in turn, can help maintain a healthy brain.
Given the rapid aging of the U.S. population, increasing the use of preventive services by adults aged 50 or older is a key public health strategy. Despite the effectiveness of these potentially life-saving preventive services:
o Only 25% of adults aged 50 to 64 years are up to date on preventive services.
o Less than 50% of adults aged 65 years or older are up to date on these services.
The problem is limited health literacy.
o Many people do not understand preventive services and/or their insurance benefits and how to use the preventive care benefits.
o Many people do not have adequate nutrition literacy and health literacy skills to incorporate recommendations if they do seek preventive services.
o Additionally, prevention should start early in life. We should incorporate health literacy, health and wellness principles in K-12.
o Lastly, policy recommendations are lacking to ensure people receive health information they can understand and adhere to the recommendations.
Helping people access preventive care by using their health insurance should be the first step. The second step would include following current recommendations. Healthy People 2020 Guidelines on Preventive Services, Nutrition and Physical Activity and Healthy People 2020 Guidelines on Health Literacy provide the framework to facilitate optimal cognitive development and preservation through health literate practices.
In an article this past May, the Mayo Clinic discussed that overweight and Type II diabetes could exacerbate the tendency towards cognitive decline. They offered these recommendations that align with the Healthy People 2020 initiatives:
• Follow your health care team’s recommendations about the most appropriate plan for monitoring your blood glucose, cholesterol level and blood pressure.
• Eat healthy foods, including fruits, vegetables, whole grains, lean meats, and low-fat milk and cheese.
• If you’re overweight, eat a healthy diet and exercise to lose weight. Obesity can lead to diabetes and other health problems.
• Exercise at least 30 minutes most days of the week.
• Take any prescribed medications on schedule.
However, understanding how to practice these all together may need interpretation and facilitation through health literate care from providers such as registered dietitians, pharmacists, physical therapists, exercise specialists or community health workers. Helping people understand how to live a healthy lifestyle through small changes in their living circumstance will not only help prevent cognitive decline but also degenerative and chronic disease that exacerbates and contributes to this decline.
During the first full week of April each year, the American Public Health Association (APHA) brings together communities across the United States to observe National Public Health Week. This annual observance serves as a time to recognize the contributions of public health and highlight issues that are important to improving our nation. This year’s theme is Healthiest Nation 2030.
In order to meet that goal, the #1 issue that needs focus is Health Literacy. The American Medical Association maintains that poor health literacy is a “stronger predictor of a person’s health than age, income, employment status, education level and race.” At the same time, the Agency for Healthcare Research and Quality (AHRQ) states, “9 out of 10 Americans may lack the knowledge and skills needed to manage their health and prevent disease.”
In peer-reviewed research, low health literacy has been linked to poor health outcomes that end up costing people more not only monetarily but also in quality of life. These poor outcomes can include:
• Reduced ability to understand labels and health messages
• Limited ability to follow medication instructions
• Lower likelihood of accessing/receiving preventive care
• More hospitalizations
• Worse overall health status
• Higher mortality among the elderly
• Shorter life expectancy
• Worse physical and mental health
• Greater use of emergency departments
The Center for Medicare & Medicaid Services states 18.7% of patients are readmitted to the hospital with the same or similar condition within 30 days of discharge, 75% of those readmissions are preventable and Joint Commission says 75% of those preventable readmissions are a result of miscommunication. Thus, it stands to reason that improving communication could help to improve healthcare. In fact, Reducing Medicare and Uninsured patient readmissions by 1% in Texas would save nearly $440,000,000 annually while improving quality of life through better health and sustained wellness.
“Health Literacy” means the degree to which individuals have the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions in the treatment, payment, or coverage of care while successfully navigating complex health care systems. Last legislative session, HB 3105 in Texas sought to establish a broader definition of health literacy, to include a focus on the patient’s need for transparent information about health care cost, quality, and treatment options. In other words, improve the information the patient receives from providers and healthcare entities.
Several states have proposed or adopted health literacy legislation. Similarly to Louisiana, I would like to see all states adopt guidelines that make 5% to 10% of the total required continuing education credits of all providers be in the areas of health care disparities, cultural and linguistic competency, and health literacy. Also, all states could challenge university medical and health science centers, healthcare facilities, pharmacies and health centers to implement health literacy programs for both patients and providers to help meet these requirements while embedding health literacy concepts into medical education, workshops, community outreach and trainings regarding patient safety and patient communication.
Most importantly, in order to change the culture of health by 2030, our nation should integrate health literacy into K-12 Education. Bringing up a generation of health conscious and articulate consumers and workers is the only real way to reduce health disparities and improve access to high-quality health care, patient compliance and patient outcomes. Then, we can truly become the Healthiest Nation 2030.
At a recent health related meeting, someone was lecturing the audience of health professionals about the virtues of choosing fruit over brownies for dessert. Then, in order to shame those who might do so, the person asked for a show of hands on who would choose the brownie. I raised my hand (me, the dietitian)…I was the only one in the audience who raised my hand. The point to this story is that all foods can fit into a healthy lifestyle that includes a variety of nutritious foods and physical activity.
In fact, the current recommendation says limit added sugars to less than 10% of total calories – not to avoid added sugar all together. For a 2000 calorie typical American diet, that means 200 calories. This level of intake is thought to give people sufficient room in their diet to include key nutrients while keeping overall calorie intake at appropriate levels. All calories contribute to body weight, not just those from added sugars. When we restrict foods unnecessarily, we set ourselves up for bingeing on those foods later or sneaking them when no one is around…and possibly consuming them in excess. Consuming added sugars in excess can contribute to obesity and degenerative diseases. Embracing balance, variety and moderation allows us to eat our food and enjoy it too.
The Academy of Nutrition and Dietetics, reminds us that how, when, why and where we eat are just as important as what we eat. Making sure to enjoy the sights, sounds, memories and interactions associated with eating are essential to developing an overall healthy eating plan from the basic food groups (fruit, vegetables, whole grains, meat, fat and dairy) as well as a healthy relationship with food. A healthy eating plan emphasizes balancing a variety of food and beverage choices within an individual’s energy needs, rather than focusing on any one specific food or meal. In other words, a healthy lifestyle balances the foods and activities we enjoy with those we need. Improving overall health requires a lifelong commitment to healthful lifestyle behaviors, emphasizing maintainable and enjoyable eating practices and regular physical activity.
This February, I had the opportunity to rekindle my affection for America’s dairy farmers. I was invited to speak at the Great Lakes Regional Dairy conference on the health benefits of dairy foods such as milk, cheese and yogurt. Considering this invitation came on the heals of the 2015 Dietary Guidelines for Americans (DGAs) in which once again, Calcium, Vitamin D and Potassium are included in the list of nutrients of concern for the American public, I was more than happy to oblige.
It had been several years since I left my position as a spokesperson and registered dietitian for the dairy industry to pursue my doctoral degree. During this time, my love for dairy foods had not waned. However, I was happy to be reminded of my appreciation for the hard work that America’s dairy farm families do every single day to provide us with safe, wholesome and great tasting dairy foods. Dairy foods (milk, cheese and yogurt) contribute substantial amounts of many nutrients in the U.S. diet that are important for good health, making dairy foods a great nutrient bang for your calorie buck!
The 2015 DGAs confirmed the importance of milk and milk products in a healthy diet by maintaining the recommendation of 3 daily servings of low-fat or fat-free milk and milk products for those ages 9 and older. For children ages 4-8, the recommendation remained 2.5 servings, and for children ages 2-3, the recommendation remains 2 servings. Serving sizes are 8 ounces or 1 cup for both milk and yogurt and 1½ ounce for cheese. These recommendations can be easily met by using milk on your cereal at breakfast, sprinkling cheese on your baked potato or soup for lunch and enjoying a fruit and yogurt parfait for an afternoon snack and/or drinking milk for dinner.
Another topic I addressed was dairy intolerance. Whereas less than ½% of adults has a true milk protein allergy, adults with dairy intolerance most likely have lactose intolerance. The key to enjoying dairy if you have lactose intolerance is using simple tips to limit or manage the amount of lactose consumed at one time.
These simple tips include:
• Using smaller amounts of milk and include with a meal or snack. This helps to slow the digestion thus, give the body more time to digest lactose.
• Taking advantage of lactose-free or lactose-reduced milk products. New products are constantly being developed from real milk, just without the lactose, providing the same essential nutrients as regular products while tasting great.
• Enjoying yogurt. The live cultures in yogurt help to digest lactose.
• Choosing natural, aged cheeses which are lower in lactose such as Cheddar to top sandwiches, potatoes, soups or crackers.
Registered dietitians and other health professionals advise that people continue to enjoy dairy foods in recommended amounts to meet their nutrient needs from the nutrients dairy provides. It is difficult to get enough of these nutrients without dairy foods in the diet…and with all the great tasting options of milk, cheese and yogurt on the market today. Why miss out?