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.

The CDC and Alzheimer’s Association through a partnership called the Healthy Brain Initiative worked closely with the National Institute on Aging and the Administration on Aging to formulate the National Road Map to Maintaining Cognitive Health. Along with the need for further research and other initiatives, two of the 10 priority areas include health literacy:

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.

Every five years, a new set of Dietary Guidelines for Americans (DGAs) sheds more light on nutrition science details and updates what we know about eating right. In reflection of the new DGAs, the 2016 Academy of Nutrition and Dietetics’ National Nutrition Month® theme is “Savor the Flavor of Eating Right.” Basically, that means – eat more fruits and vegetables, keep your splurges sensible, and embrace balance, variety, and moderation. This being said, no food should be vilified.

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?

As a registered dietitian, I am often asked about the best diet to follow for diabetes. As a health literacy expert, I know that socioeconomic factors, reduced access to healthcare, language, cultural factors and lack of cultural competence by healthcare providers can impede people actually following through with recommendations. When you have diabetes, keeping your blood glucose (blood sugar) in a healthy range can help you feel your best each day. Learning to consider your carbohydrate intake to manage your blood sugar depends on your ability to meal plan using food labels and a flexible meal plan of carbohydrate choices while including protein and fat for good nutritional balance. The American Diabetes Association Create Your Plate meal planner for diabetes can be a great tool for managing your carbohydrate choices.

In a study done in 2012, Delahanty et al. compared the estimated intake of nutrients and foods in The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial to assess dietary intake among a large, ethnically and regionally diverse group of young people with recently diagnosed type 2 diabetes after participation in a standard diabetes education program. Overall, the study showed that young people with Type 2 diabetes are not meeting the recommended food and nutrient intake guidelines placing them at risk for degenerative diseases such as obesity and Type 2 diabetes. The study additionally concluded that changing these nutrition and lifestyle habits might be impeded by physiological, cultural and social factors that families may need assistance to overcome. Staying healthy sometimes means digging deeper into the barriers preventing people from exercising and eating healthy. In my experience, the assistance families and individuals need may be as simple as learning what to purchase at the grocery store with an explanation of why and how food selections make a difference.

However, we as providers may be too busy working with individual clients and depending on our workplace setting may not be able to take people to the grocery store to help them learn. Luckily, starting in March pharmacists have teamed up with a local registered dietitian nutritionists to enhance your diabetes care plan with education and tools about the foods you eat every day including reading food labels. This comes in the form of Eating Healthy with Diabetes™ grocery store tours offered at a variety of local grocery stores including: Acme, Albertsons, Carrs, Pavilions, Randalls, Safeway, Shaws, Star Market, Tom Thumb and Vons. For a list of available tours in your area, and to register, go to diabetesdigest.com/EHWD or call 1-877-728-6655.

(Sponsored Post)

This past weekend, I spoke at the Texas Osteopathic Medical Association conference. As I prepared my speech, I suddenly realized that what we had been telling people for years about the apple was entirely rotten! These days, I recommend that my clients and patients eat not only carbohydrate (the apple) but also fat and protein (think pairing the apple with peanut butter) with every meal or snack. The reason: Blood Sugar Control!

The 2010 Dietary Guidelines recommendations (new ones arrive in 2015) focused on foods that Americans need to increase and decrease. The foods to increase include fruits, vegetables, whole grains (complex carbohydrates) and low-fat and non-fat dairy foods. The foods to decrease include both refined grains and added sugars (simple carbohydrates). The primary function of carbohydrate is to provide glucose particularly important for the brain and central nervous system. Glucose is the main fuel for these systems. After a meal, glucose is stored in the muscles and liver as glycogen for the body to utilize for energy between meals by breaking glycogen back down into the glucose components.

As people become overweight, glucose homeostasis can become disrupted and insulin resistance may develop. When a meal is consumed, the pancreas secretes insulin to facilitate transport of glucose into the cells. How high insulin levels surge determines whether the body stores glucose as fat or uses glucose immediately. In insulin resistant individuals, the body cells do not respond to insulin. The pancreas continues to secrete more insulin in an effort to achieve a response. Insulin resistance can exacerbate a tendency towards Type 2 diabetes and perpetuate overconsumption in response to surging insulin levels and a lack of transport of glucose into the cells. However, insulin resistance is not caused by carbohydrate consumption rather overweight and genetics. When a person loses weight, insulin resistance may resolve.

The current American diet tends to provide an excess of simple sugars and starchy foods generally leading to poor nutrition and storage of excess calories as fat. In addition, low intake of fiber can lead to disorders of the gastrointestinal system. Added sugars or simple sugars are found in candy, sugar-sweetened beverages and desserts and generally provide calories with little vitamins or minerals. Complex carbohydrates or starches are found in potatoes, breads, cereals and starchy vegetables such as corn. These complex carbohydrates provide vitamins and minerals as well as fiber. Refined grains tend to provide less fiber and nutrients and have become increasingly prevalent in the American diet.

Eating complex carbohydrate sources such as fruits, vegetables and whole grains as suggested by the 2010 Dietary Guidelines for Americans, provides people with vitamins, minerals and fiber currently lacking in the American diet. These complex carbohydrates must be broken down to be absorbed and move more slowly through the digestive track helping people to feel fuller longer but also moderating blood glucose levels. However, eating complex carbohydrate alone can be problematic in rising of blood glucose when eaten without protein or fat. This may result in a rebound need for further eating or snacking. Overall, maintenance of blood glucose homeostasis and gastrointestinal integrity from eating complex carbohydrates such as the apple can promote optimal health and well-being just balance that carbohydrate by adding some protein and fat.

My daughters have done two bonding things heading into the New Year. First, they took beautiful pictures together that will always be cherished. The pictures exemplify the deep love of sisterhood despite the quarrels of everyday life. Second, they got “sister” tattoos. The interesting part is that they chose the infinity symbol as the tattoo to share that will bond them symbolically for the rest of their lives.

As I begun contemplating the symbol they chose, I decided to look up the definition. Wikipedia defines the infinity symbol as an abstract concept describing something without any limit and is relevant in a number of fields. An extension of that definition is that it symbolizes eternity, empowerment, and everlasting love. As a result, I decided this could be applied to the field of health and wellness.

A New Year always represents new beginnings. As a registered dietitian working in healthcare and obtaining my doctorate in public health, I often see people who are not healthy and well but have every possibility to be healthy and well. There is a fine line between poor health and good health that is defined by lifestyle. Why not choose an infinity of wellness? Empowering oneself to make simple choices everyday that can lead to an eternity of good health and a productive life filled with everlasting love for yourself then share that love through service to others.

Currently, I am lucky to be serving in Fort Worth on the Blue Zones activation committee. As a Blue Zone community, Fort Worth is choosing to create a place where people can live longer, healthier lives. The purpose of this initiative is to improve the well‐being of our community by optimizing physical surroundings, policy, and social connections. The goal is to bring real and tangible changes to people’s lives by making the healthy choice the easy choice. The hope is to engage Fort Worth in health and wellness on every level. The great news is this makes choosing an infinity of wellness as a New Year’s resolution a reachable goal for everyone! Adopt the Blue Zones initiative Power 9 Principles for a healthy lifestyle as your New Year’s resolution and reap the limitless benefits that a healthy mind and body can provide:

• Activity as a regular part of daily life
• Stop eating when one is 80% full
• More beans, whole grains, vegetables, nuts fruits; Limit meat and processed foods
• Drink red wine, in moderation
• Have a reason to get up in the morning
• Make time for stress relief
• Belong to and participate in a spiritual community
• Make family important; Family rituals and traditions
• Pick the “right tribe”; Surround yourself with people of like values

Food Day is not just a day it’s a movement. Engaging in local or national efforts to ensure healthy, local and sustainable food supplies, can not only support food production through reforming factory farms, supporting fair working conditions for food and farm workers, and supporting sustainable farms but also promote safer, healthier diets through food and nutrition education while ending hunger. Food Day brings attention to the issues of food systems in our country by providing a chance for everyone to rally around these shared goals.

Everywhere you look these days, community gardens seem to be the trend in cities and towns throughout our country. This is great news considering less than 1 in 10 Americans over age 12 consume the recommended levels of total fruits and vegetables each day. At the same time, added sugars provide about 14% of total calories for the average American, and 21% for teenagers. We are basically eating a lot of processed low fiber foods that provide calories without many nutrients that our bodies need to be healthy and well. We are overweight and undernourished.

In fact, two out of three adults and one out of three children and adolescents in the U.S. are either overweight or obese. At a time when we are trying to reduce medical costs in our country, the annual medical cost for obesity is more than $150 billion, plus another $73 billion in reduced productivity. These costs are controllable through actions. Each community faces its own challenges. However, solutions should be based on local culture, history and resources. A good place to start is with kids in schools. Cooking with kids at home teaches them skills but many families are not cooking at home these days. Children who know where food comes from and how to cook meals will have a big advantage when it comes to being healthy.  On average, kids in the U.S. receive only 3.4 hours of food and nutrition education per year at school. The time to act is now.

Community and home gardens are a good way to teach children about food and give them a sense of purpose in tending to the garden while watching the foods grow. Getting food education into schools provides a chance for every child to learn hands-on cooking and essential food skills. If every child has the opportunity to learn about, grow and cook food, they’d have the knowledge and tools to lead healthier and more fulfilling lives. If you teach a child to cook, a lot of other things fall into place. Even if children learn how to make better choices in public venues, they are provided with food skills to advocate for their own better health. My recent quote in Women’s Health Magazine gives moms tips for choosing healthier foods when choosing fast food options. Parents should serve as role models.

Food matters to everyone. Together, we can tackle important challenges and improve access and availability of healthy foods throughout our communities, schools, restaurants, colleges and families. It just takes one day to get started in the right direction. Let that day be October 24^th, 2014, Food Day.

As a Registered Dietitian, some years ago I worked in the pediatric metabolic clinic at a major university medical center. Many of my patients were treated not just by medication but also through special diets that helped to bypass specific defects in metabolic or genetic pathways crucial to keep them alive. Now as a public health student and soon to be practitioner, I am concerned by the fact that our nation’s uninsured population includes 3.8 million children with special needs. In general, approximately 10.2 million children in the U.S. have special health care needs. Of these 60% of Americans have previously been covered under employer-sponsored plans exempt from state laws requiring coverage for specific testing and therapies necessary to particular genetic diseases.

One of these therapies is medical food, an important therapy in diseases such as phenylketonuria (PKU) and epilepsy as well as many more rare diseases such as fructose intolerance. The problem lies in the fact that few insurance companies understand these inborn errors of metabolism and few health plans are likely to cover these treatments unless states mandate coverage. According to the Health and Human Services Advisory Committee on Heritable Disorders in Newborns and Children, although 38 states now require medical food coverage, they establish varying caps, limit the coverage to certain disorders, set age limits or have narrow definitions as to what qualifies as medical food.

This leaves young families without access to a Registered Dietitian to assist them in navigating medical nutrition therapy for their child. One mother’s story told by the Family Voices division of the Genetic Alliance, spoke of the struggle to not only diagnose her daughter with fructose intolerance but then, her struggle to manage her medical food needs. The first time she went grocery shopping after the diagnosis, she spent three hours in the grocery store and went home with only six items her daughter could eat. This does not even address whether these items could meet her daughter’s full nutritional needs for growth and general health. She wanted desperately to seek the help of a Registered Dietitian, however, the family’s insurance did not provide coverage.

The ironic part to this story is that medical nutrition therapy is actually generally much cheaper than medication or complications that could occur by not following a diet conducive to the child’s health and wellness. These children have to eat to live so diverting normal food costs to appropriate foods to meet their specific needs can be a very cost effective treatment while minimizing complications and therefore, emergency department visits and hospitalizations not to mention possibly reducing day-to-day medications needed.

Medical food and medical nutrition therapy can play a role in a variety of disease states or just generally keeping people healthy and well. With the push of the Affordable Care Act encouraging people to take responsibility for their own health, my hope is that states and providers will understand the importance of medical nutrition therapy or nutrition coaching by a Registered Dietitian in helping people choose foods and lifestyles that will promote wellness. This will in turn, decrease overall health care expenditures in our country. And after all, isn’t that the goal?