Grocery Store Tours for “Eating Healthy with Diabetes™”

Registered Dietitian Nutritionist
Registered Dietitian Nutritionist
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.
Balance Your Food Choices
Balance Your Food 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 or call 1-877-728-6655.

(Sponsored Post)

New Year, New Dietary Guidelines: Eat Less Junk, Eat More Plants, Eat Real Food

This holiday season I was able to spend time with my parents who are now 70’ish. Did we sit and read or watch TV? No, I went to Tai Chi with mom and motorcycle riding with dad.

Motorcycling with Dad!
Motorcycling with Dad!

My mom was the reason I became a dietitian. She emphasized nutrition my entire childhood. She cooks from scratch using real food and incorporating plenty of vegetables, fruits and nuts. She even has her own blog, The Gluten Free Edge. My dad is not much of a plant food eater but she finds creative ways to prepare the ones he does like or encourage him to like others. Despite their age, they are living life healthy and well.

The recently released 2015-2020 Dietary Guidelines provide healthy eating patterns like my mom uses to help prevent chronic diseases like obesity, heart disease and Type 2 diabetes. The Department of Health and Human Services and the United States Department of Agriculture undergo a lengthy process every five years to ensure that the Dietary Guidelines reflect the most recent science. Obesity and other chronic diseases come with increased health risks and costs. Healthy eating helps you take control of your health and enables you to live a healthy, high quality of life.

The key is choosing a healthy eating pattern 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 choose a healthy eating pattern or you can use the many tools available to incorporate the new Dietary Guidelines using many of the foods that you enjoy.

The areas to consider include:

Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level and accounts for your taste preferences, culture, traditions, and budget.

A healthy eating pattern includes real food and more plants:

  • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
  • 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

A healthy eating pattern limits processed foods and junk:

  • Saturated fats; Saturated – less than 10% of total calories per day.
  • Trans fats; Generally, found in processed foods.
  • 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 in moderation.

There is a healthy eating pattern for every one and everyone’s lifestyle. Registered Dietitians 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

Does an Apple a Day Keep the Doctor Away?

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!

Optimize Your Health!
Optimize Your Health!

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.

Pair Protein and Carbohydrate
Protein and Carbohydrate

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.

2015: To Infinity and Beyond

To Infinity and Beyond
To Infinity and Beyond

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:

Blue Zones Power 9
Blue Zones Power 9
  • 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

FD-2014-FB-LogoFood 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 24th, 2014, Food Day.

Medical Nutrition Therapy and Medical Food Policy

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.

Diet Restrictions for PKU
Diet Restrictions for PKU

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?

Be a Food Safety “Top Gun”

As we head into the summer months, food safety becomes even more important. This short video:

Be a Food Safety "Top Gun"
Be a Food Safety “Top Gun”

provides tips and tools for preparing safe food for your friends and family.

Key points in your “Top Gun” flight plan include:

Avoid the Danger Zone – Keep food out of the range (either above or below) between 40 degrees and 140 degrees Farenheit.

Feel the Need for Speed – Store food  within 1-2 hours in shallow dishes for rapid cooling to below 40 degrees.

Turn and Burn – Roast meats to above 325 degrees;  Rotate and reheat to above 165 degrees; Hold at or above 140 degrees.

Knowing you have completed these tasks, you can relax and enjoy a delicious, safe meal with your family!


United States Department of Agriculture. Food Safety and Inspection Service. Food Safety Education.

Photo from Google Search:
Top Gun Photos

Music from iTunes: Kenny Loggins

To find a Registered Dietitian: Texas Academy of Nutrition and Dietetics

Natural, Local, Fresh

Homestead Farms
Homestead Farms

This summer semester one of my school assignments was to visit a local farm. Homestead Farms is a quaint farm located in Keller, TX at 4160 Keller-Hicks Road. If you blink, you will miss the driveway tucked in the middle of the urban development of Keller. The website indicates they sell fresh produce and raw goat’s milk. However, I soon learned that they additionally sell fresh meats, eggs and fresh cow’s milk products. When I pulled up, I was surprised at the number of patrons in the store.

The farm started about 6 years ago but the land has been in the Farris family since 1889. It is a true family farm. There are three families living on the farm who keep an eye on everything. Sarah runs the retail store and Michael runs the dairy and farm. The location is great for drop-in customers and invites Agro-tourism to teach people about agriculture. Many people today have lost touch with how real food is grown.

Homestead Farms caters to people changing their diet to more natural or locally grown, health food enthusiasts, moms and people who want fresh, wholesome foods for better health. Parents buy for children and infants. Since goat’s milk (or cow’s milk) alone cannot meet an infant’s nutritional needs, you have to both dilute and supplement goat’s milk with the missing nutrients. For parents interested in using goat’s milk, a registered dietitian can help ensure that nutrient needs are met. Additionally, it is important to remember that the Centers for Disease Control does not recommend consumption of unpasteurized milk of any kind especially by vulnerable populations such as infants, children, elderly or immuno-compromised individuals.

Sarah informs me they have never had an illness result from their milk. They milk about 40 goats twice each day taking about 3 hours each time they’re milked. Good sanitation practices keep the milk clean as it is taken directly from the goats without ever touching human hands. Then, the milk is instantly cooled and stored in milk tank for aseptic bottling. They sell out of fresh milk every day. They have a raw to retail permit but customers must purchase their milk at Homestead Farms per Texas State laws. Additionally, the farm undergoes inspection monthly by the Texas Department of State Health Services.

Sarah states that goat’s milk is very mild flavored. 80% of their diet is grass and some grain with added vitamins and minerals. She goes on to say that the lactose in raw goat’s milk is better tolerated and natural enzymes assist with digestion. Having heard Sarah’s declarations regarding all of the benefits of drinking goat’s milk, a quick review of the literature yielded little unbiased medical research to provide evidence to support these claims. Research should be pursued to substantiate the many anecdotal experiences about the medical benefits from goat milk consumption, which abound in trade publications and the popular press. This could be a good topic for future research!

Nubian Goats
Nubian Goats

The goats are Nubian goats from Africa…they make higher fat and protein milk like Jersey Cows. They also have beef cattle that are grass fed up in Montague County. The farm strives very hard to feed the animals what is naturally eaten. The pigs are raised on premise, purchased at a few hundred pounds and slaughtered at around 1,000 pounds.

In their produce, no pesticides are used…they are not certified organic but grow to organic standards. They embrace the “circle of life” concept to keep a sustainable farm by reusing and repurposing between plants and animals. Goats, pigs and chickens eat garden waste and animal waste can be used to fertilize crops.

While I was there, I did taste the raw goat’s milk. It was really light and fresh with a small goat cheese flavored aftertaste and was fantastic! The farm makes a great field trip for schools, a unique venue for birthday parties and an ideal way to reconnect people with how food is produced.


What about Water?

From a small age, I have always loved being around water. I learned to swim by literally jumping in the pool at age 5 or 6 and just taking off much to my mom’s dismay. Water has such a calming effect on me that I recently moved to be able to access the Trinity River Trails at a moments notice. Now, there is research being done regarding the therapeutic value of “blue space”.

Trinity River
Trinity River

In looking at the health benefits of water, scientists have been able to combine the calming effect of the green-scape which shows stress levels are lowered according to how much greenery present with the calming effect of water. Using images combining the two, starting with a pond progressing in size to a coastline increasing amounts of water in each image, people showed a strong preference for more and more water in the images in self-reported feelings of calm. So, research is indicating that being around “blue space” has emotional and mental benefits but at the same time dietitians know that water offers physical health benefits as well.

Enjoy some "Blue Space"
Enjoy some “Blue Space”

As we head into the summer months, paying attention to water can play an important role in balancing health as per the World Health Organization (WHO) definition. The WHO defines health as the complete state of mental, physical and social wellbeing. In the summer, we tend to socialize more outdoors and around water. These provide great outlets for our mental and social needs. However, many of us forget that as the temperature rises and we perspire more especially with exercise, we need to mind our water intake.

Water is often the forgotten nutrient. The human body consists of approximately 50-75% water and since we cannot store water, we need adequate amounts daily. Water is needed for many basic body functions as well as being a part of lean muscle mass, bones and fat stores. Each person will require different amounts of water based on body size, climate, weather, physical activity, foods eaten and individual metabolism.

Children require anywhere from 4-5 cups per day and adults 6-10 cups based on age and gender. Like all other nutrient needs, a Registered Dietitian can help determine the amount of water optimal for individual needs and lifestyles. Consuming too much or too little water can both have adverse effects especially for active people and athletes of any age. Research shows just a 1-2% level of dehydration can impact athletic performance and overall wellness.

Water is a Nutrient
Water is a Nutrient

Sources of water can include milk, plain water, coffee, tea, soup, juice and other beverages even soft drinks. However, sugar sweetened beverages should be limited due to the additional calories with generally limited nutrient content they provide. Foods with high water content can also contribute to total fluid intake such as watermelon, pineapple, celery and other fruits and vegetables. Alcohol as a beverage should be limited to recommended levels. Since alcohol can have a diuretic (dehydrating) effect, a good habit is to drink a glass of water for every serving of alcohol consumed when consuming alcohol. This helps to abate not only dehydration but also adverse effects of alcohol or hangovers, the next day.

As I write this post, the day outside is beautiful. Having survived another stressful semester of my doctoral program, I covet every moment of “blue space” to rejuvenate my spirit and refresh my mind before we start back to studies. So, I will end now and head out for a walk on the river…with a bottle of water in hand!

Are You Health Literate?

Teresa 2013
Do you “Talk the Talk”?

This Friday, I will have the privilege of speaking at the North Texas Dietitian Spring Seminar on Health Literacy. Additionally, I am coordinating the Health Literacy Conference sponsored by the United Way of Tarrant County, UNT Health Science Center and Texas Health Resources to be held in April for health professionals. This emerging topic impacting health outcomes is of utmost importance to all health professionals. For registered dietitians, translating our language into understandable, actionable terms not only from the medical but also the culinary world can mean help our clients and patients succeed when it comes to optimizing their health and wellness.

Quality health care depends on effective patient communication. The effectiveness of health care communication has received increased focus with the advent of the Affordable Care Act (ACA) requiring that consumers receive clear, consistent and comparable health information from health plans and insurers. At the same time, the ACA emphasizes patient-centered care using methods to improve patient understanding of complex medical issues.

Do you hear what I hear?
Do you hear what I hear?

Health literacy is the ability of the public to obtain, process and act on health information to optimize and maintain their health. A growing body of research indicates that limited health literacy can lead to adverse health outcomes due to patients’ inability to follow instructions on medications, labels and health messages. This is especially important in preventative care such as nutrition and physical activity.

Research estimates indicate that between one-third and one-half of all adults struggle with health literacy. This may lead to limited overall health and wellness, increased and longer hospitalizations, trouble managing chronic conditions, increased use of emergency care and higher mortality rates especially among the elderly, ethnic minorities and people of lower socioeconomic status. Limited health literacy costs the U.S. between $106 and $236 billion annually.

Health literacy issues have been traditionally viewed as individual patient deficits in knowledge and skills affecting their ability to manage health issues. Recently, adverse outcomes have been recognized as a health care system issue involving the complexity of navigating technical health information and exceedingly complicated health care systems. In this emerging view, much more of the responsibility for patient knowledge is borne by the health care system rather than by the patient. For many people, food procurement, preparation and nutrition are a foreign country with their own language, customs and mores. Registered dietitian’s translate for our patients to help them navigate food and nutrition and become successful in protecting their health.