Our Perspectives on GLP-1 Agonist Medications

CW: discussion of weight, weight loss, weight loss drugs, BMI, and eating disorders. 

As dietitians working with eating disorders (ED), we are no strangers to how fad diets and weight loss drugs negatively impact our clients and our society at large. We may spend many sessions reviewing the science, unpacking the harmful discourse, and helping our clients define and seek the best choices for their health and wellbeing. For some clients, this includes ED recovery, body acceptance, and eventually Intuitive Eating. For other clients, the desire for a smaller body is overwhelming, and they may not be ready or interested in a more weight-inclusive approach to nutrition and movement. 

As everyone is in a different stage of change, and may have varying health beliefs and goals, we consider our role as one which includes unconditional acceptance of where our clients are in their wellness journey. With our understanding of the nuances and factors that impact our clients’ eating behaviors, we aim to reduce harm and fight weight stigma by providing a more compassionate and inclusive approach. For this reason, we work with clients who may be taking or are considering a GLP-1 agonist (such as Ozempic, Wegovy, and Mounjaro), even if our dietary counseling does not expressly advise on intentional weight loss. 

GLP-1 agonists have been gaining attention from the public in recent years. Originally developed for managing type 2 diabetes, GLP-1’s are now increasingly recommended by physicians for weight loss. The reasons for any person making the choice to use a GLP-1 are complex and nuanced, and we support our clients and their autonomy as they make their own informed health choices. At Nourish for Life, we are interested in understanding the “why” our clients make their decisions, helping them navigate “if” a GLP-1 could be a safe decision, and supporting their physical and mental health throughout the process. Further stigmatizing the desire for weight loss by making a client feel uncomfortable approaching these conversations with their dietitian is not helpful and may cause increased harm and break trust. 

In this article, we want to share more about these drugs and how we work with our clients to support them - whether they choose to use them, or not. 

How Do These Drugs Work?

GLP-1 agonists work by mimicking a hormone called glucagon-like peptide-1, which is naturally produced by our bodies to promote blood sugar regulation, the sensation of fullness, and increase metabolism. They have been approved by the FDA and have been available for use by patients with type 2 diabetes for nearly a decade. Brand names for GLP-1 medications are Ozempic/Wegovy, Saxenda, Mounjaro, and Zepbound (among others). Typically the doses for weight loss are greater than the doses used for managing diabetes. 

GLP-1 agonists activate GLP-1 receptors in the body, leading to several effects. They increase insulin secretion (which draws glucose from the blood to our cells) and decrease glucagon release (inhibiting the conversion of liver glycogen to glucose, which is then released in the bloodstream), helping to lower blood sugar levels. They also slow down gastric emptying, meaning food stays in the stomach longer, causing fullness for more extended periods. Additionally, GLP-1 medications affect the brain's appetite centers, reducing appetite and increasing feelings of fullness(1). Herein lies the drug effects that promote weight loss in individuals who take these medications.

GLP-1 Agonist Considerations

Those who are contemplating taking a GLP-1 each have their own individual and personal reasons, and we urge everyone to talk with their care team about these reasons and any potential risks. There is so much chatter and misinformation on the internet, discussing their concerns with a trained professional may help people become more informed. Even though some people may (inaccurately) believe these drugs offer a kind of “easy” path to weight loss, taking these medications can be a challenge physically and mentally. Before starting a GLP-1, here are just a few important factors to consider:

• Health ≠ Weight: Weight loss or a smaller body size does not equate to improved physical and mental health(2). We strongly recommend our clients have a therapist to help unpack and process concerns they have about their health and wellbeing. Conversations with one of our dietitians can help clients better understand their health beliefs and ideals, identify gaps in their knowledge about nutrition, physiology, and medicine, and provide emotional support regardless of what they choose to do.

• Eating Disorder Screening: Some eating disorders are associated with the desire for thinness. Thus, there is a probability that folks may have been inappropriately prescribed a GLP-1 without being screened for an ED, and people who have struggled with ED may be more interested in exploring these drugs(3). We do not recommend that folks with an active eating disorder begin a GLP-1 medication without communicating any eating or body image concerns they have with their physician and therapist. Intentional weight loss while in treatment for an ED is not appropriate. The potential side effects (discussed below) could complicate the process toward recovery. Also, weight loss does not address the underlying emotional/behavioral issues surrounding the ED and body image disturbances(4). There is also a risk that some folks with EDs may misuse a GLP-1 agonist for the purpose of weight loss(5), as we’ve seen happen in the past with other drugs and supplements, sometimes with severe consequences. 

• Side Effects: Common side effects we observe in our clients that take a GLP-1 include nausea, diarrhea, vomiting, and constipation. Add to this, that reduced appetite makes identifying sensations of hunger and fullness more difficult. Some people may experience more serious side effects such as hypoglycemia, pancreatitis, gallstones, bowel obstructions, or gastroparesis(6). With rapid weight loss comes the risk of sarcopenia(7) (loss of muscle mass) which can impact long-term health. Anecdotally, we have noticed increased risk of severe mental health side effects in some of our clients, such as depression and suicidal ideation. 

• Cost: These medications can be expensive, averaging around $1,000 per month(8), and insurance might not cover the costs, especially if the BMI is below 30. 

• Long-Term Commitment: Studies show that weight loss achieved with GLP-1 medications is generally only maintained while the medication is being taken(9). About two-thirds of the weight lost is typically regained within a year after stopping the medication.

• Weight Cycling: Since there is a likelihood of weight regain when stopping a GLP-1 agonist without long-term change in health behaviors, there is also a risk of weight cycling. Studies have looked at the health effects of losing and gaining weight repeatedly over time, and found adverse health outcomes, such as impaired metabolism, worsened cardiometabolic markers, insulin resistance, binge eating, depression, sarcopenia, and higher mortality due to these frequent shifts in body weight (10,11).

How We Approach GLP-1’s in Our Practice

As dietitians that practice from a HAES® lens, we support our clients’ health without weight change as a primary outcome. However, we understand that our society has promoted weight loss as a desirable goal, and sometimes even a moral obligation. So we completely understand why taking a weight loss drug can seem appealing. We also believe that medication stigma can cause harm to our clients. Everyone deserves autonomy without judgment when it comes to their health choices. 

If you were curious how we would support folks that are choosing, or maybe already have chosen, to use a GLP-1 agonist, here is a little sneak peek into how we work: 

• Ensuring proper and adequate nutrition:  These medications reduce appetite and increase feelings of fullness, which can further complicate our interoceptive awareness and can lead to inadequate nutrient intake. Our dietitians offer nutrition education and assistance creating an individualized meal plan to ensure clients get the nutrients their body needs without restriction.

• Maintaining muscle mass: Any amount of weight loss will lead to muscle mass loss(12). We guide folks on how to maintain muscle mass while taking these medications using nutrition and movement(13). 

• Managing side effects: Our dietitians are knowledgeable about the common side effects of GLP-1 medications and can provide strategies to manage symptoms like nausea, diarrhea, constipation, and hypoglycemia. 

• Developing sustainable changes: Beyond managing immediate concerns, we work together to find long-term dietary and lifestyle approaches that support physical and mental health. This can include learning how to understand and respond to hunger and fullness, creating routines around food and movement, processing body image distress, and encouraging self-care activities.

• Education: We will weed out the nonsense found on the internet and focus on evidence-based information from the most up-to-date science available on GLP-1 agonists. As trained Registered Dietitian Nutritionists, we take the research and our client experiences into account when making recommendations or suggestions. 

• Social Justice/Trauma Informed: Topics that are often left out of the doctors office while being asked to “step on the scale” and “do you want to try a GLP-1?” are broader, important issues that affect a person’s perception of their body size and their health outcomes. This includes our culture’s obsession with thinness, food industry, food access, healthcare inequities, “Big Pharma”, safety in our communities, financial stability, and racism (among others). We also understand that some individuals may not feel safe exploring their body in terms of hunger/satiety signaling as this type of connection may evoke feelings of fear and trauma often held in our bodies. 

• Supporting your emotional wellbeing: As mentioned previously throughout this article, there are so many things that can complicate a person’s healthcare decisions. Arriving at the point of considering a weight loss drug (or being recommended one) means that a person has likely been the target of fatphobic medical care, weight stigma, and body size discrimination. We aim to provide compassionate and supportive space to explore these concepts and the feelings they bring up, and work with you to identify perspectives and standpoints that might help you develop greater resilience.

• Eating disorder prevention: To date, there are no solid research studies looking at the effect of GLP-1s on the development of a new eating disorder or relapse of a pre-existing ED. However, we are trained to screen and treat EDs, and consider EDs a potential risk for any of our clients. Everything we do is done with the lens of ED prevention or recovery. We monitor our clients for signs of EDs and collaborate regularly with their care providers to ensure safety and improve health outcomes. 

Lastly, we have to acknowledge our own standpoints, positionalities, privileges, and biases to understand how fatphobia affects our clients. Some of us benefit from the social advantages of living in a thin body, being a certain gender, and our race. These privileges are unearned, systemic issues, and are embedded into our society and institutions. We continually engage in self-reflection regarding our privileges by asking questions, challenging our biases, and educating ourselves. 

We hope that this article helps you understand GLP-1 agonists, and our nuanced approach to working with clients who are taking or considering taking these drugs. If you have specific questions/comments, or are interested in starting nutrition counseling with us, we look forward to hearing from you!

Works Cited:

1. Smith NK, Hackett TA, Galli A, Flynn CR. GLP-1: Molecular mechanisms and outcomes of a complex signaling system. Neurochem Int. 2019;128:94. doi:10.1016/J.NEUINT.2019.04.010

2. Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105(6):929-936. doi:10.1016/j.jada.2005.03.011

3. Bartel S, McElroy SL, Levangie D, Keshen A. Use of glucagon-like peptide-1 receptor agonists in eating disorder populations. International Journal of Eating Disorders. 2024;57(2):286-293. doi:10.1002/EAT.24109

4. GLP-1 Medications and Eating Disorders - National Eating Disorders Association. Accessed October 16, 2024. https://www.nationaleatingdisorders.org/glp-and-eating-disorders/

5. Chiappini S, Vickers-Smith R, Harris D, et al. Is There a Risk for Semaglutide Misuse? Focus on the Food and Drug Administration’s FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset. Pharmaceuticals (Basel). 2023;16(7). doi:10.3390/PH16070994

6. GLP-1 Agonists: What They Are, How They Work & Side Effects. Accessed October 16, 2024. https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists

7. IKEJIMA S, KONDO S, SAKAI T, et al. Novel Approach to Sarcopenia in Diabetic Patients Treated with GLP-1 Receptor Agonists (GLP-1RA). Diabetes. 2018;67(Supplement_1). doi:10.2337/DB18-673-P

8. Popular GLP-1 Agonists List, Drug Prices and Medication Information - GoodRx. Accessed October 16, 2024. https://www.goodrx.com/classes/glp-1-agonists

9. H Wilding DM JP, Batterham MBBS RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Published online 2021. doi:10.1111/dom.14725

10. Rhee EJ. Weight Cycling and Its Cardiometabolic Impact. J Obes Metab Syndr. 2017;26(4):237. doi:10.7570/JOMES.2017.26.4.237

11. Kakinami L, Knaüper B, Brunet J. Weight cycling is associated with adverse cardiometabolic markers in a cross-sectional representative US sample. J Epidemiol Community Health. 2020;74(8):662-667. doi:10.1136/JECH-2019-213419

12. Cava E, Yeat NC, Mittendorfer B. Preserving Healthy Muscle during Weight Loss. Advances in Nutrition. 2017;8(3):511. doi:10.3945/AN.116.014506

13.Ozempic May Make Your Muscles and Bones Weaker. Accessed October 16, 2024. https://www.healthline.com/health-news/ozempic-muscle-mass-loss

Widening your window of tolerance

Why does it seem that at times we can regulate our emotions, and other times it feels like our body and mind take over and we just can’t “snap out of it”? Maybe you feel triggered and all of a sudden you feel shut down, numb, and want to hide or go to sleep. Or it could be that you feel worried and anxious and you can’t slow your thoughts or heart rate enough to return to a state of calm. Sometimes these feelings pass easily, and other times they disrupt our ability to function within our routines, including with food and movement.

These questions may be considered using the model of the Window of Tolerance, which is a part of polyvagal theory. This idea explains the arousal mechanisms of the body and brain, and how when activated they can sometimes lead to feeling a loss of control. This includes hyperarousal (feeling anxious, angry, overwhelmed, fight or flight) and hypoarousal (feeling numb, frozen, shut down). At times when you are feeling heightened sense of stress or trauma, our “window of tolerance” for certain emotions can be more narrow. Yet, when we are feeling more connected, safe, and supported, our window of tolerance can be wider. When we are within that window of tolerance, it can feel like the stressors in your life are not overwhelming, and you can handle what comes your way. 

Infographic of the Window of Tolerance

So, what does this have to do with nutrition? When our window of tolerance is more narrow, our relationship with food and body can be impacted, and disordered behaviors and thoughts can be used as a coping tool. It is important to work toward identifying what state you are in and what you can do to widen your tolerance of distress, so disordered eating behaviors are not the default response. Working with your therapist and dietitian can help you understand and identify how this process works for you.

Here are some prompts to help you identify what you may be experiencing, and how to respond: 

Feelings wheel

• What is my current state of regulation (hyperarousal vs hypoarousal) and what are the symptoms that help me recognize this? 

• What may have triggered this state? (You can use the feelings wheel to help you identify the feeling) 

• Where do I feel it in my body?  

• What might this feeling need to become soothed? 

• How will reacting to my behavioral urges impact this feeling right now? In 1 hour? Tomorrow? 

• What else could I do instead to soothe? For example, if eating is soothing, is there an amount of food you could eat that could widen your window of tolerance without causing physical pain or added distress? 

Once you have worked on building awareness of your own thresholds, you can practice adding in other activities that help you regulate and feel connected, to expand your window of tolerance. For example: breathing exercises, meditation, imagery, sleep, reaching out to a loved one for co-regulation, physical movement, creative activities, or any other grounding techniques you may have learned along the way.  

If you are looking to better understand your window of tolerance and improve your relationship with food and body, we are happy to help you on this journey. Reach out to us to schedule an initial consultation or request a free 15-minute discovery call.

Request an Appointment Today

Additional Resources

• I really like this blog post on Mind My Peelings which explores this in depth, along with the importance of recognizing and managing your Window of Tolerance. 

• The author includes worksheets on topics, including Window of Tolerance Awareness, Challenging Cognitive Distortions, and Challenging Automatic Negative Thoughts Worksheet.

• Here is another infographic that can help visualize the concept of the Window of Tolerance.

Asian American Visibility in the Eating Disorder Space

This is a guest post by Simmons University Dietetic Intern Jessica Xu.

Looking back into your own life, it can be interesting to think about your “food story”. What does food mean to you? What was your food culture growing up? Where do your current food rules come from? When did food become more than just food? To many of us, food plays a large role in our lives, such as how it makes us feel, how it impacts the people around us, and how it relates to our culture. In honor of AAPI heritage month, I want to take the time to discuss the impact food has on Asian American populations, along with the impacts of diet culture, body bias, and disordered eating.

Generational Perceptions of Food in Asian American Families

Growing up in a Chinese household, food was practically a love language in itself. It was a way for my grandparents and parents to show their love and care, as they always made sure to check if I was hungry. In response, it was a sign of respect to finish what they gave me, and a level of shame if I didn’t complete what was offered. Food often serves more purposes than just nourishment, but we also have to consider the complications of family expectations, and the social standards of what it means to be “Asian”. Many of us can relate the experience of family members both encouraging us to eat in fear of us being hungry, yet simultaneously fat shaming us and setting the expectation to remain thin.

Looking at the different values of Asian culture, the words that typically pop up are community, family, respect, hard work, and discipline. In many Asian households, parents are oftentimes put on a pedestal to know what is right for us, and it remains our responsibility as the future generation to maintain their expectations. After all, they were the ones who sacrificed so much and worked so hard for a better future for us. These burdens of expectations force us to work harder, usually with the fear of failure looming over us, whether it’s for grades, career choices, and future income. At the same time, we’re also pushed to downplay our struggles, as generations before us struggled even harder, with the notion that we should at least be grateful for the environment we were provided.

But the one failure that doesn’t get enough visibility is the topic of weight. Looking at diet culture today, being “overweight” is seen as being lazy and having a lack of discipline, which goes directly against Asian values. In part of the hardships our parents went through often comes with the trauma of food insecurity. This then ties back to how they show their love, as providing food means they have succeeded in being able to provide for their families, and allows us to be well nourished and healthy. Yet these good intentions suddenly spiral into contradictions and shame the moment we break out of the body norms that are placed on us. Worst yet is growing up observing the body dissatisfaction within our parents and listening to their harsh remarks to their own bodies. The highly critical and hypocritical environment makes it difficult to cherish and love your own body, especially when it’s a learned behavior that comes from our parents.

Perception of Asian Cuisine in America

Throughout my years of living as an Asian American, I have noticed shifts in the way Asian culture is perceived in America, yet so many aspects have stayed the same. I remember starting elementary school, and being ashamed to bring my dumplings, red bean soup, and other traditional meals for lunch, as they were typically labeled as “smelly and weird”. Yet throughout recent years, there has been a new embrace of Asian cuisine. The number of ethnic restaurants have increased in certain areas, and there has been new-found appreciation of certain foods.

At the same time, there are stereotypes that exist against Asian foods, such as the ethics, cleanliness, and healthiness of it all. MSG has always been painted in a negative light, yet there is no concrete evidence that MSG has any impacts on health. When complimenting the Asian diet, it often comes from praising how thin Asians are based on popular media. Simultaneously, there is criticism for the rice, raw foods, sugar, and flavorings that are present within our cuisine. This puts a standard of what “healthy ethnic foods” are, and puts an unfair expectation that the only purpose food has is nourishment. 

Current Statistics on Asian American Eating Disorder Prevalence

In the current research available, Asian populations are seen to have an equal, if not higher, risk of developing eating disorders to their caucasian counterparts. These risks are then increased with biculturalism, where Asian Americans need to balance both cultures. In a society where we are expected to give our best and follow the stereotypes given to us, there is a high amount of pressure we give ourselves to perform. Then we look at the beauty standards in many Asian countries- pale, thin, and dainty. For men, there is also the added expectation to be muscular, but to still maintain the thin ideal. When balancing both cultures and body expectations that are placed upon us, there is no wonder why the prevalence of eating disorders is so high.
Yet even with these increased rates of eating disorders, there are also several barriers to receiving help, and getting diagnosed in the first place. Some studies showed that Asian American populations are 50% less likely to reach out for professional medical help, and this likelihood decreases in regards to mental health. Back to the common Asian values, mental illnesses and eating disorders are seen as a sign of weakness and as an individual issue. Asians have also been perceived as the “model minority” in America, making it even harder to even admit to ourselves that we need help. This AAPI heritage month, I hope to bring increased awareness to the prevalence of eating disorders within the Asian American community. It can be so easy to feel alone in this space, and it’s important to speak out about our experiences to promote seeking out help.

References: 

Zhou Z, Liew J, Luo W. Acculturation and Disordered Eating among Asian American College Students: The Role of Objectification through a Sociocultural Lens. International journal of environmental research and public health. 2022;19(21). doi:10.3390/ijerph192113967 (https://www.mdpi.com/1660-4601/19/21/13967 )

Zanfirescu, A., Ungurianu, A., Tsatsakis, A. M., Nițulescu, G. M., Kouretas, D., Veskoukis, A., Tsoukalas, D., Engin, A. B., Aschner, M., & Margină, D. (2019). A review of the alleged health hazards of monosodium glutamate. Comprehensive reviews in food science and food safety, 18(4), 1111–1134. https://doi.org/10.1111/1541-4337.12448 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952072/ )

Javier, S. J., & Belgrave, F. Z. (2019). “I’m not White, I have to be pretty and skinny”: A qualitative exploration of body image and eating disorders among Asian American women. Asian American Journal of Psychology, 10(2), 141–153. https://doi.org/10.1037/aap0000133 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737071/ )

Akoury LM, Warren CS, Culbert KM. Disordered Eating in Asian American Women: Sociocultural and Culture-Specific Predictors. Front Psychol. 2019;10:1950. Published 2019 Sep 4. doi:10.3389/fpsyg.2019.01950 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737071/ )

Hong S, Walton B, Kim HW, Rhee TG. Predicting the Behavioral Health Needs of Asian Americans in Public Mental Health Treatment: A Classification Tree Approach. Adm Policy Ment Health. 2023;50(4):630-643. doi:10.1007/s10488-023-01266-x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052246/

Why do we care so much about fad diets?

This is a guest post by Boston University Graduate Student Samantha Gulewich.

There's probably a good chance you're curious to read what we have to say about trendy diets. For starters, there have been many different types of diets offered to date, including those with detoxifying and weight loss claims, those with a Mediterranean origin, those that are low in carbohydrates, high in fat, or high in protein, and many more. Fad diets have been shown to come and go as their popularity fluctuates. Because it is impossible to account for individual needs when adopting any diet, the adoption of many diet trends can often be painful and unsustainable; resulting in the rise and fall of one size fits all diet trends. 

When you’re seeking out a fad diet, a good question to ask yourself is “why am I seeking out this diet?”. There are many reasons why someone would want to seek out one. These reasons can range from health benefits, to body image, to even trying to seek control over something during a period of high stress or uncertainty. Since there isn't a single dietary pattern that works for everyone, following recommendations blindly can have detrimental effects on health.

A healthy and successful outcome needs to start with a healthy and sustainable goal. In order to reach some goals it often happens that people will follow diets even when it doesn’t make them feel good. Sometimes, whether consciously or unconsciously, at the expense of their health. For example, when following the ketogenic diet, it is common to experience several unpleasant side effects; exhaustion, nausea, and gastrointestinal pain are just a few possible reactions. Additionally, the keto diet can negatively impact lipid levels in instances where the diet is observed without careful attention to the types of fats consumed.1 Another recent fad is intermittent fasting. Intermittent fasting can also be associated with a number of common, mild short-term adverse effects, including dehydration, headaches, lethargy, and digestive problems. Without particular attention to individual needs, advantages gained (if any) through the adoption of a fad diet such as keto or intermittent fasting, may come at the price of long term health. Everyone’s nutritional and health needs are different, so diet changes should be based on what your individual health goals are (and that could even mean eating more).

Although many diet trends are known to cause negative health effects: why do people keep coming back to fad diets?

There are many factors that contribute to the persistence and popularity of diet trends. The culture of comparison and hype that permeates social media is one powerful influence. Other contributing factors may be the diet's depiction of weight loss as a guarantee, the dream of rapid, almost overnight transformation that is evidenced by a certain celebrity spokesperson, or the sense that you're doing what's best for your health. It is important to understand that for certain individuals, these diets may be advantageous and healthful, but it's crucial to consider what suits you personally. Weighing the pros and cons with a dietician is always beneficial because formulating a customized meal plan can be complicated. While there isn't an established procedure that must be followed, the maximum benefit is achieved through collecting as much information as possible and tailoring it to individual needs. Healthful eating and living doesn’t have to be complicated or involve following a fad diet; the best diet for anyone should be simple, sustainable and drama free.

Ultimately, one must keep in mind that fad diets are just that—fads—because nobody can maintain a restrictive diet for long. Diets come and go because people keep searching for a silver bullet that doesn’t exist. If you are among one of the many who are considering adopting the latest diet craze, you may want to consider these questions: 

1. Why am I seeking out a fad diet?

2. Why does this particular fad diet appeal to me?

3. What is it that I'm hoping to achieve through dieting?

4. Does following a particular diet help me achieve my health goals?

5. Where did I obtain my information regarding this particular fad diet?

Once you've given these questions some serious thought, it should become clearer why fad diets are so popular and why it's always more beneficial to take the road less traveled when it comes to your health.

---

References:  

Tahreem A, Rakha A, Rabail R, et al. FAD diets: Facts and fiction. Frontiers in Nutrition. 2022;9. doi:10.3389/fnut.2022.960922

 Bostock ECS, Kirkby KC, Taylor BV, Hawrelak JA. Consumer reports of “Keto Flu” associated with the ketogenic diet. Front Nutr. (2020) 7:20. 10.3389/fnut.2020.00020

 Londre R. Intermittent fasting: Fad or valid weight-loss solution? Mayo Clinic Health System. June 17, 2022. Accessed December 2, 2023. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/intermittent-fasting-fad-or-solution#:~:text=Intermittent%20fasting%20can%20have%20unpleasant,go%20away%20within%20a%20month.

Fishing for Reliable Nutrition Information in a Sea of Misleading Messages

This is a guest post by Simmons University Dietetic Intern, Casey McAlpine

Image by RawPixel

In today’s modern world, health and nutrition information is easy to access online, which can be very useful. However, anyone can go online and post an article, make a video, and share on social media. This creates a channel for misleading information to be easily spread. Anyone can post content with flashy titles and eye-catching cover images that reel us in but these could be bait for a trap of misinformation. How do we fish for reliable nutrition information in a sea full of authors, creators, sources, and posts?

There are a number of ways we can evaluate online resources to determine whether they are useful or if we should keep scrolling. It’s time to fill your tackle box with some questions to ask yourself while fishing for nutrition information. 

Where is this information coming from?

Just like when we are doing research for school or work, we look for clues that our sources can be trusted. When looking at nutrition and health information online, it is essential to consider how recent the information is, what the goal of sharing the information is, what the biases or opinions in the content are, and which organization or person has published this information. Science and healthcare are always evolving, so it is crucial to find recent and trusted sources online. Notice whether the author or creator has used any additional resources to craft their article or post. References and citations can be an indication that content is being presented as fact. Keep an eye out for, scientific journals, government agency sites, non-profit organizations that conduct research, and professionals that have work experience in the area they are writing about, as these are considered reliable online resources. 

Is the creator or author a registered dietitian?

Registered dietitians are highly qualified, skilled health care professionals who have taken a certification exam, and in most states, obtained licensure to practice. They are not to be confused with nutritionists who do not have the same strict credentials and rigorous qualifications as registered dietitians. Much of the nutrition information we see on the internet, especially on social media, is camouflaged as reliable by being posted by someone with the title “nutritionist”. Registered dietitians follow evidenced based practice where they use systematically reviewed scientific information to provide the most relevant and applicable education and decision-making. Furthermore, registered dietitians are the only health care professionals able to provide medical nutrition therapy, which is the use of nutrition to treat medical diseases. Dietitians are the go-to for nutrition expertise, so keep a close eye out for content posted by registered dietitians. 

Is this information something that will fit in my life?

Even if a social media post or article on the internet is created by a registered dietitian, that does not always mean that it is the best information for you. There are a number of practice areas in nutrition and dietetics, but not all of them lend the same advice. For instance, a registered dietitian that follows intuitive eating and health at every size may not offer up the guidance as a dietitian that uses intuitive eating for weight loss. Additionally, you can look for who follows the creator and who they follow. Is a particular website or social media page interacting with them fairly often? Does the creator share products and discount codes they could be benefiting from? Are they employed by a certain organization that could influence their online presentation? Does this align with my beliefs and values for health and wellness? Evaluating a creator’s background is a key step to determining whether their information is something that will flow well in your life or something that should be steered clear of.  

Can I find this information elsewhere?

Reliable information can be found in multiple sources. When a content creator does not share their sources, it could be a clue for one of two things. 1) It could be a red flag that they are laying a trap of misleading information not backed by science, or 2) It could mean that the information is understood as common knowledge. A quick google search could help to uncover the validity of the information. Using the evaluation tools so far in your tackle box, you can take a look at other online resources to see if the same information shows up repeatedly. If the information shows up only on sources that might not pass the checks we've talked about, that could be a sign that the information is not entirely reliable. Repeated information across many credible resources is a sign that the content is valid.

It can be tricky to navigate the sea of nutrition information out there on the internet, but by asking yourself these questions you will hopefully be able to make some quick decisions on which streams to follow. The attention-grabbing social media posts and fancy websites can be a good source of nutrition and health information when they are reliable and registered dietitian-approved. Keep your tackle box handy whenever you go fishing for nutrition information!

Exercise and Eating Compensation

Why you need to eat more when you exercise, and why you don’t need to eat less if you don’t exercise.

by Maura Donovan, MS, RD, LDN, CPT

As much as we might like to think our metabolism is as simple as “energy in, energy out”, there is so much more to it than that. Metabolism, in its simplest form is the process in which our body converts nutrients to energy. This can then be broken down further into: 

• Basal Metabolic Rate (BMR)

• Thermic Effect of Food 

• Non-Exercise Energy Expenditure

• Thermoregulation

• Physical Activity

Let’s take a look at these a little deeper:

BMR is the number of calories your body utilizes to perform basic life functions such as breathing, thinking, and keeping your heart beating. This accounts for about 65-75% of the energy we use on a daily basis and is largely dependent on genetics, age, sex, and the environment we live in. 

Thermic effect of food is the subsequent increase in metabolism after we eat. That’s right, your metabolism will increase every time you eat. This is due to the fact that the body needs to digest, absorb, and store (or use) the nutrients you just ate. The thermic effect of food will account for about 10% of energy used on a daily basis. 

Non-exercise energy expenditure (NEAT) is the unplanned activity that occurs throughout the day. This could be anything from walking the dog, to doing chores, to fidgeting at your desk. NEAT accounts for about 15% of the energy used on a daily basis, and is dependent on genetics, job of choice, and where we live. 

It is worth mentioning that thermoregulation is a part of our energy metabolism. Thermoregulation is the energy our body uses to keep us at an appropriate temperature (usually around 98 degrees Fahrenheit). That means, in the winter our body uses more energy to keep us warm than it would if it was summertime. Thermoregulation does not play as big of a part as other components, largely because of modern technology allowing us to have heat in homes and clothing that can protect us. 

Physical activity is any planned activity such as strength training, running, hiking, skiing, playing a team sport, or taking a group fitness class. In truth, planned exercise accounts for about 5% of our overall energy expenditure on a daily basis. Which is why it is important to note that when we exercise, our bodies will need more food, but when we do not exercise our bodies generally do not need less food. Our bodies are working hard on a daily basis just to keep us alive and functioning, and they require food and nutrients no matter how much you moved (or did not move) your body that day. 

So what does all of this mean for your own eating plan? Overall, on days you are participating in exercise, work to increase portions in main meals or have 1-2 extra snacks throughout the day in order to account for energy expended. On days you are not participating in exercise, aim to focus on trying to intuitively eat. Focus on consuming enough protein and fiber-rich complex carbohydrates in order to maximize nutrient stores. 

Have more questions about how to fuel your body? Please don’t hesitate to reach out – we would love to work with you!

Resources

1. https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/metabolism/art-20046508#:~:text=Metabolism%20is%20the%20process%20by,your%20body%20needs%20to%20function. 

2. https://www.hsph.harvard.edu/obesity-prevention-source/energy-balance/#:~:text=Thermic%20effect%20of%20food%3A%20It,and%20fat%20has%20the%20lowest

Staying grounded during uncertain times

by Allegra Egizi, MS, RDN, LDN

Like many of our clients, you might be struggling with the desire to use eating behaviors as a way to feel productive, grounded, and safe during a very uncertain time. And to be honest, we don’t blame you for entertaining these thoughts! 

Given how stressful, isolating, and uneventful life has become during the COVID-19 pandemic, it makes sense if you might have noticed a tendency to fall back into behaviors and old habits that once provided a sense of accomplishment, purpose, and promise. Though we understand how this has happened for you, we’re also here to remind you that there are plenty of other (less harmful) ways to fulfill your needs, even amidst a global pandemic. 

Let’s take a look at some of these alternative ways to continue feeling excited, productive, and grounded during COVID-19, completely independent of your eating disorder:

1. Explore new and old hobbies: Maybe you’ve been wanting to learn how to play an instrument, or perhaps get back into reading, writing, singing, or meditating. Whatever it may be, now is the time to explore some of your passions, both new and old. Not only are hobbies enjoyable, but they’re often a great way to challenge the brain and leave you feeling accomplished. Not sure where to start? Make a list of things that interest or excite you and come up with a few ways that you can incorporate them into your day-to-day, especially as you’re spending more time at home. 

2. Organize your space: One perk of being at home during this time is that it may allow you to tackle certain spaces that you’ve been wanting to organize. Cleaning and organizing your living space can actually be quite relaxing and cathartic, especially once you get into a groove! And organizing doesn’t have to be boring. Turn on your favorite playlist, have your favorite drink nearby, and consider involving the kids or partner to make it an activity for the whole family.  

3. Engage in joyful movement: Though we’d caution against engaging in excessive or “forced” exercise, as this type of movement generally does more harm than good (mentally and physically), we totally understand that you can have the genuine desire to move, and that’s absolutely okay! Just make sure the intention behind the movement is coming from a place of body respect and self-care, rather than a place of dissatisfaction and attempting to change or control your body. If exercising adds MORE stress to your day..consider another form of self-care instead. Rather than choosing an exercise influenced on external factors, like calories burned, heart rate, distance, or pace, we encourage you to choose ones based on internal cues such as how your mind and body feels, and your energy levels. 

4. Establish (flexible) structure: While being too rigid with yourself isn’t healthy, establishing a loose and flexible schedule during this unusual time can help you  maintain some normalcy in your life. Fill your schedule with a variety of enjoyable and fulfilling activities throughout the day to keep you occupied, yet relaxed, and remember that even amidst the chaos, your body still needs to be nourished consistently! Having meals and snacks planned loosely throughout your day can help maintain some structure and continue to take care of yourself.

5. Practice self-care: Although it might feel like you have to “do more” in order to feel productive, taking time to slow down, unwind, and make a bit of time for yourself can be extremely grounding, helping you feel taken care of during this stressful time. And remember that self-care can look different for everyone, whether that be taking a midday nap, listening to music, taking a bath, going for a walk, baking a treat, going to bed early, calling a friend, watching a movie, turning off your phone, or simply taking a few deep breaths. Whatever it may be for you, we encourage you to start incorporating self-care into your daily routine and see how it can positively change the way you think and feel.

We hope that this post gave you a few ideas of ways to continue feeling productive and grounded during a very unfamiliar and chaotic time, and we encourage you to continue exploring more ways that work best for you. Although using eating disorder behaviors may help you feel short-term control, it’s important to consider how far you’ve come, and how these behaviors are serving you in your recovery. Above all, remember that you deserve to have a healthy relationship with food!

Have questions or comments for us? Please don’t hesitate to reach out - we’d love to hear from you.

Folate vs. Folic Acid - What's The Difference?

This post was written by Rochelle Louis - a senior at Boston University working towards becoming a Registered Dietitian with the long-term goal of making healthy, plant-based food and nutrition more accessible and affordable. If you have any questions about nutrition for pregnancy, or concerns about your supplements, feel free to contact Jennifer for a nutrition consultation, or speak with your doctor.

Folic acid and folate are two forms of vitamin B9. The two names are sometimes used interchangeably. It is important to note the difference between the two forms because they can have different effects on the body.

What is Vitamin B9?

Vitamin B9 is an essential nutrient that is naturally found as folate. Vitamin B9 is “essential” because it plays many important roles in the body.

• Formation of DNA, the body’s genetic material.

• Helps in cell growth.

• Aids the body in the utilization of amino acids, the building blocks of proteins.

• Maintains the proper functioning of the heart.

A deficiency in vitamin B9 can cause:

• Birth Defects - Poor levels of folate in pregnant women can cause neural tube defects and congenital health defects in infants.

• Heart Disease - Low levels of vitamin B9 can result in elevated concentrations of homocysteine which causes an increased risk of heart disease.

What is Folate?

Folate is the naturally occurring form of vitamin B9. The recommended daily intake of folate in the US is 400 mcg.  

What is Folic Acid?

Folic acid is the manufactured, synthetic version of vitamin B9 often found in fortified foods and supplements. Folic acid must first be converted to its active state to be absorbed by the body.

What Are The Concerns When Taking Supplements?

The main concern with folic acid supplements is their bioavailability, the amount of a substance that the body can actually absorb. The difference among prenatal supplements is the source of folic acid. Supplements may be in the form of folic acid or L-methylfolate, the bioavailable form of folic acid. The bioavailable form of folic acid becomes essential in people who have mutations in the MTHFR gene, the gene that converts folic acid to its bioavailable form L-methylfolate. Around 40-60% of the population has a genetic mutation in the MTHFR gene, making the conversion of folic acid to L-methylfolate inefficient.

People who have the MTHFR gene mutation or, those that have a history of Neural Tube Defects are recommended to take L-methylfolate supplements because the body can absorb this without needing to convert it to another form.

If you have concerns about your supplement, or would like to learn more about MTHFR, please consult your doctor or obstetrician.

References:

1. Greenberg, James A., and Stacey J. Bell. "Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and L-Methylfolate." 2011.

2. Patanwala, Imran, Maria J. King, David A. Barrett, John Rose, Ralph Jackson, Mark Hudson, Mark Philo, Jack R. Dainty, Anthony Ja Wright, Paul M. Finglas, and David E. Jones. "Folic Acid Handling by the Human Gut: Implications for Food Fortification and Supplementation." The American Journal of Clinical Nutrition 100, no. 2 (2014): 593-99. doi:10.3945/ajcn.113.080507.

Introduction to Mindful Eating

This post was co-written by Kyra Arsenault, nutrition student at University of Massachusetts Lowell. 

When was the last time you spent moments intently aware of and focused on what you are doing? In today’s fast-paced living, constant media exposure, and multi-tasking culture, it can be difficult to not be distracted doing any task. If you can relate to this, you may also find it to be hard to sit down and enjoy a meal or snack - something we may do several times a day.

Mindfulness is the ability to be present, and aware of the moment you are in. Allowing thoughts to pass through your mind, recognizing them, and letting them go without judgment, like a branch drifting down a river. Being aware of sensations. What you physically feel, see, hear, smell, and taste.

According to The Center for Mindful Eating, Mindful Eating is “choosing to eat food that is both satisfying to you and nourishing to your body, acknowledging your responses to food (likes, dislikes or neutral) without judgment, and becoming aware of physical hunger and satiety cues to guide your decisions to begin and end eating.”

Many folks are interested in learning how to become a more mindful eater. Here are some suggestions for you to get started:

• Try starting with a simple snack, rather than an entire meal.

• Sit down while eating.

• You can turn off the TV, or silence your phone

• Look at the food, without making judgments about it. Just appreciating it for what it is: nourishment for your body.

• Take a moment to recognize it, show gratitude for it, and appreciate what it took for you to get the food or prepare it.

• Throughout this process, if you hear a judgment coming on the food or yourself, or even an irrelevant thought, instead of getting frustrated, let it go by and continue to remain in the moment.

• Notice the colors, the aroma, and the texture of your food.

• Taste each item on your plate, and describe it to yourself. Is this bite sweet? Salty? Sour? A combination of flavors? What does the texture feel like? Is it crunchy or creamy? Dry or moist?

An important thing to remember when practicing mindful eating is not to judge yourself if it does not feel "perfect”. There is no perfect way to eat mindfully, and sometimes mindful eating can be a challenging or uncomfortable process.

By practicing mindful eating, you are allowing yourself to see how food is a gift of nourishment, without judgments  It helps you to become more in tune with your body, and encourages you to listen to your needs for nourishment and satisfaction from food.

If you are interested in learning more about mindful eating, here are some great resources to get started:

The Center for Mindful Eating

8 Steps to Mindful Eating

The Mindful Dietitian Resources List

Food & Nutrition Magazine article: Mindful Eating: Resources for Mindfulness and Meditation

Does your diet in pregnancy influence baby's taste preferences?

If you are pregnant, take a moment to think about the last meal you ate. It might just be influencing your baby’s taste preferences!

Over the past few decades, research has shown that flavors from the pregnant mothers’ food can be tasted by babies through the amniotic fluid and human milk[1],[2]. This begins early in the second trimester, when your baby is busy developing their taste buds.

As if there weren’t enough reasons to eat well, your baby’s experiences with healthy food while they are in utero may be shaping their preferences for those foods later on in life. Studies have shown that when infants are introduced to solid foods that their mothers ate while pregnant, they winced less than those infants that were not exposed to those foods in utero[3]. So when you are eating broccoli and spinach during pregnancy, your baby can also enjoy those flavors and may be more likely to eat their veggies at the dinner table!

Just like you, pregnant women around the world are eating foods common to where they live. Whether you love spicy ethnic foods or prefer simply prepared meals, you are gearing your baby up to accept the culinary traditions of your family. After all, chances are high that what you are eating now will be what you feed your child in the future. 

The 2015 Dietary Guidelines for Americans encourages a healthy diet full of vegetables, fruits, whole grains and lean proteins, while limiting excess salt, fat and added sugars[4]. So if you are concerned if your child will eat their vegetables or will be a picky eater, you may want to focus on these foods while pregnant, since we know your diet can help establish preferences for healthy foods later in life. Flavor exposure also continues for babies through breast milk. So if you plan to breast feed, your baby will also share the spicy, sweet, sour or bitter flavors you’ve eaten between feedings[5].

Next time you hear someone say you are “eating for two,” what they might actually mean is that your baby tastes all the flavors of your food with you! So go ahead and enjoy a healthful and varied diet - for the both of you!

[1] Mennella JA, et al. Vegetable and Fruit Acceptance during Infancy: Impact of Ontogeny, Genetics, and Early Experiences. Adv Nutr. 2016 Jan; 7(1): 211S-219S
[2] De Cosmi V, et al. Early Taste Experiences and Later Food Choices. Nutrients. 2017 Feb; 9(2): 107
[3] Mennella JA, et al. Prenatal and postnatal flavor learning by human infants. Pediatrics, 2001 Jun;107(6):E88
[4] U.S. Department of Health and Human Services and US. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
[5] Beauchamp GK, Mennella JA. Flavor Perception in Human Infants: Development and Functional Significance. Digestion, 2011 Mar; 83(Suppl 1): 1-6.

Celebrating nutritious choices every day

March is National Nutrition Month! This year the theme is “Put Your Best Fork Forward” - which emphasizes that we should consider how we make healthy choices with each meal we eat.

The Dietary Guidelines for Americans help define a healthy eating pattern to meet nutrient needs and maintain a healthy body weight. Of the leading causes of death in the United States, heart disease, stroke and diabetes are strongly impacted by nutrition. Following an eating plan that focuses on vegetables and fruits, whole grains, low-fat dairy, lean proteins, and healthy fats is the first step in protecting your health against chronic disease.

If you want to learn how to protect your health and put your best fork forward, consider working with a dietitian. Check out this article about what a registered dietitian can do for you  to find out the many ways working with an RDN can guide you towards healthy choices. Working with a licensed, registered dietitian nutritionist will give you a personalized experience based on scientific evidence and high standards of practice. There are many RDNs that specialize in specific areas. I focus my practice on digestive disorders and maternal and family nutrition; while there are other RDNs that focus on eating disorders, sports nutrition, weight loss, etc. Make sure to ask your preferred provider about their qualifications and specialties to make sure your RDN is a right fit for you.

Have any questions? Feel free to reach out to me or make an appointment. Happy National Nutrition Month!

Preventing Peanut Allergies in Children

It seems like there are more and more children these days struggling with peanut allergies. Many classrooms are now peanut-free zones to help prevent a possible allergic reaction. Peanut allergy is a serious health threat, estimated to affect 0.4% of children and 0.7% of adults in the United States[1]. Recent research now suggests there may be evidence to prevent peanut allergy from a young age.

A clinical trial called Learning Early About Peanut Allergy (LEAP) enrolled more than 600 infants at high risk of developing a peanut allergy. Participants had severe eczema, egg allergy or both, and the group was divided into two groups: one was asked to avoid peanut-containing foods, and the other was asked to eat peanut foods regularly. They followed the infants until they were 5 years old and what they saw was a reduction of peanut allergy by 81 percent in the group that consumed peanuts starting from 4-6 months of age! That's significant!

The current guidelines can be viewed on the National Institute of Allergy and Infectious Diseases website, and I have summarized the guidelines below:

1. If your infant has severe eczema, egg allergy or both, they should be introduced to peanut-containing foods as early as 4-6 months of age. Check with your healthcare provider before feeding your infant peanut-containing foods. You may want to have a blood test or a skin prick test to determine if and how to introduce peanuts to your child’s diet. The provider may suggest testing peanut-containing foods at home or in their office. However, the testing could suggest that your child may already be allergic to peanut, and therefore should avoid it.
2. If your infant has mild to moderate eczema, they should be introduced to peanut-containing foods as early as 4-6 months of age. Check with your healthcare provider to determine the safest way to introduce peanut-containing foods in their diet. The study suggests that introducing peanut around 6-months of age may reduce risk of developing an allergy. Your provider may suggest testing peanut-containing foods at home or in their office.
3. If your infant has no eczema or any food allergy, you can freely introduce peanut-containing foods into their diet. This can be done at home with age-appropriate foods.

Bamba is a popular peanut puff snack for children in Israel. If you live in the Northeast you can find it at Wegmans. 

So what are these age-appropriate peanut-containing foods? Well, definitely not whole nuts! Giving infants whole or even chopped peanuts can cause possible choking or even inhalation of food pieces. This can lead to an emergency department visit and infections. And peanut butter is sticky and can cause choking if it gets stuck in the throat or palate.

Try powdered peanut butter mixed in with plain yogurt or pancake batter. 

Instead, you can offer your baby a small amount of peanut butter or powdered peanut butter mixed into plain yogurt, or add some to pancake batter and give your baby soft pieces to chew. You can also blend peanut butter into a thinned-out smoothie with banana and milk. One of my favorite snacks, Bamba, is a popular infant snack in Israel, and is like a cheese puff but with peanut butter instead of cheese – basically the snack of dreams.

Don’t forget to talk with your pediatrician if you have any questions about introducing peanuts to your infant, especially if they already have eczema or egg allergy.  

[1] Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases – sponsored expert panel. Ann Allergy Asthma Immunol. 2017; 118 (2):166-173.

FNCE 2016 Recap

This past week nearly 10,000 dietitians came to my hometown of Boston to attend the annual Food and Nutrition Conference and Expo, also known as FNCE. This was my second time attending FNCE – last time it came to Boston I was a wee baby RD2Be!

It is always exciting to be at a large conference, and FNCE is no exception. Where else can you be surrounded by thousands of colleagues from across the country to talk about the most current nutrition science and have educational opportunities from culinary nutrition to FODMAPs? My inner nutrition geek was ready to learn and the business side of me was ready to network.

I actually was able to get complimentary admission to FNCE by volunteering for the information booth. It was a fun job and I had a chance to spend some time with other RDs from Massachusetts and get to know fellow MAND board members better! The Boston Convention Center is HUGE, and trying to inform attendees about where everything was located was a challenge at times, but I think I am pretty much an expert in the BCC after this weekend!

I am proud to say that I was featured in a video during the opening session called Food Is Love. In my cameo I was able to show the world what I do as a dietitian at Jewish Family & Children’s Service and UMass Lowell. I had butterflies in my stomach as I saw myself on GIGANTIC screens that filled the expo hall, but I felt an immense sense of pride when I saw the amazing dietitians I was fortunate enough to share the screen with. I loved when Andrew Doherty from University of Minnesota Extension SNAP Ed Program said his goal was to “work [himself] out of a job, to be so good of a dietitian that they don’t need [his] services anymore”. How great is that! If only we could reach every American and empower them with the tools we have to improve their health through nutrition.

I was able to attend several great sessions, including one featuring Kate Scarlata, a local dietitian who is one of my nutrition heroes. She talked about the physiological effect of FODMAPs on the gut and how to individualize a low-FODMAP diet for clients. I also went to a culinary nutrition session where I was able to get some great ideas for connecting nutrition principles to food – something that we as dietitians need to focus more on. Overall I really enjoyed the sessions I went to, and it was fun to walk around the expo hall and run into friends as we sampled our way around avocadoes and pulses, and even got a chance to try out virtual reality with Food and Nutrition Magazine!  

Next year FNCE will celebrate 100 years of the Academy of Nutrition and Dietetics in Chicago. I don’t know if I will be able to attend, although I am already hearing about really fun activities that might take place! If you haven’t been to FNCE yet and have always wanted to go, I would recommend making 2017 the year you check it out!

To watch the video I was featured in, go to http://www.eatrightpro.org/resource/media/multimedia-news-center/videos/food-is-love and don’t forget to leave a comment below if you went to FNCE and what you thought!

Spice it up for spring!

This week has been unseasonably warm - I actually wore shorts and a t-shirt! Okay, so I was a little chilly, but I couldn’t resist the chance to get some much needed vitamin D.

Warm weather also has me thinking about how to plan my herb garden for the summer. Last year we had so many herbs we couldn’t eat them all! We love to incorporate herbs whenever possible to add flavor without adding salt, but fresh herbs can be so expensive in the grocery store. If you have the space in a backyard or a windowsill to grow your own herbs it can help save money at the checkout line, and add a decorative element to your home

I love to travel with my taste buds. Some of my favorite spices take me to exotic places. Cumin is a popular spice around the world, from Africa to the Mediterranean, and Asia to South America. It comes from the seed of a plant in the parsley family. You might see cumin commonly as a seasoning in chili powder, adobo and curry spice mixes. It has an earthy flavor and is not spicy but pairs well with spicy dishes. It is one of the most used spices in our cupboard, and we use it to season a lot of our Mexican- and Indian-inspired recipes.

There are tons of recipes online for spice mixes. Here is a recipe for Moroccan Spice Blend from Epicurious that uses some common ingredients you might already have in your cupboard and can add interesting flavors for your next weeknight chicken meal.

Basil is one of my favorite dried herbs to have around the kitchen. In a pinch, when fresh basil is not available, a little dried basil can go a long way. I add it as part of a dry spice rub, in sauces, stews, stir fries and salad dressings, or just simply sprinkle some on fresh tomatoes with a little olive oil for an elegant yet simple appetizer.

Dried herbs and spices are just as healthy as fresh, and can be used as a replacement in most recipes. Just remember that the flavor of dried herbs and spices may be more concentrated, so you might need to use a little less if you are substituting with dried.

I’d love to hear about some of your favorite spices in the comments!

My top ten kitchen tools

Enjoying a meal with friends.

Last weekend it was upper-60's, sunny and bright here in Boston. That means t-shirts and shorts to many who have had to endure that long and arduous winter. For me, it meant opening day for the grill and breaking out the hammock for relaxing in the backyard! We had a fun-packed Sunday, which included working, then working out, making lunch for friends, going for a hike in our neighborhood and then hosting our impromptu first barbecue of the season! Lucky for me my friends were so kind to bring vegetables, so we marinated some tofu and chicken and my neighbor came down and made us fabulous cocktails to round it off. It was a wonderful day, and it got me so excited for more days of hiking and hanging out with good friends in our backyard. 

Chris conquering the last snow pile in our front yard. 

With spring comes spring cleaning, and I LOVE cleaning out my kitchen and feeling like I am starting fresh. Over the past few weeks I have been trying to eat my way through all of the dry foods, sauces and condiments to make sure we don't keep things around past their expiration date. I also went through my kitchen tools and gadgets to try to make room in our cramped cabinets. It was then that I thought about my Instant Pot. Even though I had been having so much fun with the pressure cooker all winter, I found I really don't rely on it, and it takes up a TON of space on my counter top (and is sort of an eyesore). I began to wonder if I really wanted to keep my Instant Pot or try to sell it on craigslist. Chris was able to convince me to keep it - he loves using any kind of technology in the kitchen - so it will live another season in the Heinen Household. But this got me really thinking about what my favorite kitchen tools are and what I could not live without. 

When I began making my list of cooking tools I would hypothetically bring with me if abandoned on a deserted island, I realized I rely on a small number of low-tech tools for most of my home-made meals. This might be because I was taught to cook with these utensils, but I think it is because these are essential to anyone! Fancy, expensive gadgets and contraptions are not needed to make a good chef. Rather, a few classic utensils are all that are needed to make nearly everything. Nearly. I would never willingly give up my Kitchen Aid mixer that has been in my family for 30+ years even though I only use it once a month (if that). But I'm assuming the deserted island doesn't have outlets. 

Here is my top ten list of essential cooking tools: 

1. A really sharp chef's knife

I pretty much use this every day, multiple times a day. I have two 10" chefs knives in my kitchen, which I use for cutting vegetables, meats, chopping garlic and herbs, cutting cakes and pies. Pretty much any reason you'd have to cut something in the kitchen I am using my chef's knife. The only things I do not use the chef's knife for is cutting bread (I have a separate serrated bread knife for that) and de-boning fish (which I don't even really do that often). If I had no other tool at all and had to only pick one for my deserted island fantasy, I would definitely bring my chef's knife. 

2. Wooden spatula

Do I mean wooden spoon you ask? Why no, I meant what I said - wooden spatula. I got one in a package of wooden utensils for our wedding (or a birthday, or Christmas... can't really remember) and I never really thought I needed so many different shapes of wooden spoons. But after a while of experimenting I am using the spatula much more than I ever imagined. It does the same work as a wooden spoon, but has a larger surface area for scraping bits off the bottom of the pan, turning wide scoops of food in a pot and can scoop a larger amount of food onto a plate when I am done cooking, which reduces the amount of things I need to wash! And of course, you can also use it as a regular spatula, but it might be too thick for things like pancakes and other small, thin foods. 

3. Tongs

I first learned how critical tongs were when I worked in restaurants in New York. I was not a chef, but I saw how my chefs used them almost as extensions of themselves, like they were their fingers, gently lifting up anything in a pot, pan or on a grill. I now own two tongs - one metal and another with a silicone tip - and use them pretty much daily for everything. Grilling. Sautéing. Mixing salad greens. Stir-frying. Checking the done-ness of something in the oven just out of reach... its uses are endless!

4. Peppermill

This seemingly unimportant kitchen staple has helped make almost every savory dish even more spectacular. I LOVE black pepper. I find myself blindly adding it to almost everything that is not sweet. I mean, there's a reason why waiters ask if you want fresh pepper on your entrees at restaurants! I recently purchased a Peugeot grinder and love the way it looks and grinds. Fresh ground pepper instantly boosts any dish in my opinion.  

5. Peeler

When you eat as many vegetables and fruits as we do, you need a good peeler. My sister had an amazing vegetable peeler, a simple, no-frills flat peeler with a black handle, and I use it often to help me quickly prep my produce for recipes. I also recently found out the best way to prepare mangos is by peeling the skin and then slicing the flesh off the pit. Now I'll never live without a peeler (especially if my deserted island has a mango tree). 

6. Thermometer

A well-calibrated working thermometer is important if you want to make sure you are cooking your meats to the proper temperatures. A thermometer takes the guessing game out of cooking meats, and if you are looking to protect yourself from food-borne illnesses because you are immunocompromised, consider this tool critical. If you are interested in learning more about proper cooking temperatures, click here. 

7. Strainer

Not exactly a colander, but it also works as one. And if you had to pick one tool that can separate liquid from solids, this one does the trick but better. It catches smaller pieces of food that a colander will not, and you can also use a fine mesh strainer for sifting flour, confectioners sugar or cornstarch in recipes. 

8. Citrus juicer/reamer

I love adding citrus to sauces, dressings, marinades and beverages. Citrus juices provide flavor without sodium and also give a brightness to most vegetable side dishes. Citrus cuts through the fishiness of most seafood and adds a lovely zing to homemade salad dressings. The fresh juice from a lemon or lime is so much better than concentrated juice, and a cup of fresh-squeezed orange juice adds an extra touch of love to your breakfast in bed. And if you have a reamer and want to avoid pulp or seeds in your juice, use your strainer (see #7) to keep out any pieces!

9. Microplane

This has been on my "want" list for a loooooong time. Perfect for grating fresh lemon zest (see citrus love above) or adding a dash of parmesan to finish pasta or chicken, or even to shave some chocolate finely onto the top of a frosted cake, a microplane can do the job of a grater and a zester all in one easy-to-hold minimalist kitchen tool. Consider using a Microplane for grating fresh nutmeg or ginger, garlic or anything else you want to have fine, fluffy shreds of. 

10. Immersion blender

Ok, I know - my hypothetical deserted island doesn't have outlets! But I love my immersion blender and I have had it for almost 11 years so it is hard to give up. I find myself reveling in adoration of how fast and precise it works to blend to a pulp my soups and whip together cream for dessert. I do also have a blender and a food processor, but I often choose my immersion blender because it is so easy to clean. I don't need to muck up other equipment and attachments and spend an extra 10 minutes washing dishes instead of enjoying my soup. Sometimes it isn't just the way the tool is used, but how easy it is to use it that makes it so valuable. 

Now that I have shared my top ten kitchen tools with you, what are yours? I would love to hear in the comments!

10 Ideas to keep you moving this winter

It’s mid-February. The snow won’t stop falling, and there’s no clear end in sight. Without being able to see the pavement how are we expected to exercise? When it’s so cold out, why would I ever trade my pajamas for spandex? Well, there are many tricks up my sleeve to share with you on how to kick off the winter doldrums and get your daily dose of physical activity!

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1. Do something you enjoy

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When it’s too cold outside, find a fun winter activity to enjoy. Getting a workout in when you’re doing something fun makes it so much easier to get out of bed! Activities such as snowshoeing, skiing, dancing, indoor rock climbing, spinning or yoga will keep your heart pumping and keep you warm during the cold and dark days.

2. Dress the part

It’s easy to feel cold when you aren’t wearing enough layers! Treat yourself to a new pair of compression pants, a neck warmer and new running gloves if you want to feel comfortable doing anything outside. Ever since I began living in New England I have learned to forgo fashion and embrace dressing warmly in the winter. Luckily for me everyone around here loves to run in the winter and cold-weather gear is a must-have in any good Bostonian’s wardrobe.

3. Set the right mood music

Throw together some of your favorite booty-shaking songs to a workout mix so you can keep your groove going. I love to use Spotify, which I can access from any of my devices, and I have a “pump-up mix” that I continually add songs to. Think Katy Perry, Justin Timberlake, Taylor Swift… yes I shamelessly love pop music when I’m at the gym! Sometimes I will listen to the mix in the car to get me psyched before I get there. It works!  

4. Work Out while you work

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If going to the gym every day after work is just not possible for you, try to make the most of your day by fitting in fitness wherever you can. At work or at home, take the stairs or a brisk walk around the office, do a few squats wall pushups or wall sits at your desk. Some recent studies have shown that there are some serious consequences to sitting all day, including increasing risk for diseases and mortality. 

5. Register for a springtime challenge

That Couch to 5k app will only work if you get off the couch! Find a race in your area that gives you a goal to work towards. There’s no motivation like knowing that you’ve paid for registration at an upcoming event! Looking for a bigger challenge? Check out obstacle races like Tough Mudder or Spartan Race to test your wits!

6. sign up for a fitness class

You may not need a gym membership to take fitness classes. Sometimes your local community center will also offer Zumba or yoga classes at a low rate. With each class you will feel yourself getting stronger, which helps keep you motivated for the next challenging class! 

7. or look to the internet for your next workout

You can find anything online! Check out sites like The Daily Burn or Fitness Blender to give you a wide selection of different workouts to do from the comfort of your living room. YogaGlo is my favorite website for online yoga classes, and a monthly membership is the same price of a single class at the studio! On Demand will also have workout videos of the day available to you, so check with your local cable company for availability.

8. grab a friend

Workout buddies are essential ingredients to motivation! If you have a friend waiting for you at your next spin class, or if you are meeting up for a run early in the morning there is less chance that you might decide to bail on your workout. And besides, sweating it out with a friend is always more fun :)

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9. make it a date

We rarely forget to put a doctor visit or a business meeting in our calendar. Why should we treat our daily exercise any differently? If you are like many who find it difficult to stick with your plan, put it in your planner! Set time aside as you would with any other appointment and you may be more likely to remember it’s on your agenda. And remember, one hour of exercise is only 4% of your day – changing your way of thinking about this time may help you make space in your calendar for it.

10. set a goal

And then reset your goals… and then reset your goals... Never stop setting new goals! Make sure your exercise goals are specific, measureable, timely and attainable – if you don’t think you can physically achieve something – such as running a half marathon for the first time next month – then find a goal you are able to achieve. Maybe try running a 5k next month, and then a 10k… you get the idea. If you don’t think you’ll actually go to the gym because you hate the treadmill, then pick a more fun activity (see tip #1). And when you’ve accomplished that goal, set a new one to keep you challenged and interested in staying active.

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I hope these tips help you find ways to get more movement in your day. Do you practice these already or have any other tips I didn’t mention? Drop me a line in the comments!

Ten Tips to Planning Meals In Advance

I am a planner. When I was younger I wanted to be a wedding planner (thank you, J. Lo) and when I got older I thought I do a really great job as a project manager. I live by my Google calendar and Clear, and I love setting 5- and 10-year plans. When it comes to vacations, I usually take the helm at figuring out where we go and what we do. Call it what you like, my propensity for planning is part of why I am sometimes lovingly referred to as “Type-A”, but it also is one of my strengths, especially when it comes to feeding my family healthy foods.

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Write a list of the week's nightly plans to get an idea of how many meals you should plan ahead of time. 

Planning meals in advance is one key to a healthy diet. It all starts with taking time to think about what you are eating, which is something many people will say is not easy. Especially with family, house chores, work and social obligations, it can be one task that gets put off until too late. You will soon realize that on the days and weeks you have not been able to plan meals it is easier to cut corners, order takeout, make a frozen pizza or whip together blue box mac and cheese. 

Meal planning can help you save time in the kitchen, reduce stress, cut food waste and thus save you money as well. It is a great habit to get into and requires practice! Here are some tips to get you started with planning meals in advance for you and your family:

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Use a meal planning template to help you write down your ideas for the week's meals. You can make one yourself or purchase one like this, made by Knock Knock Stuff and available for purchase here. 

1. Set one day each week to plan meals
   One day a week my husband and I discuss what our schedules look like and decide what days we will be cooking at home. This usually is on a weekend when we have the time to sit down together!
   
   
2. Look at your week’s schedule in advance
   If we know that we will be eating at home 4-5 days out of the week we will try to plan 4-5 meals. If you know you have a busy day and may not have time to cook, you can plan to make extra for leftovers or use a super fast and easy recipe that night.
   
   
3. Plan meals around the protein
   Protein keeps you feeling satisfied and prevents you from reaching in the cupboard for a late night snack. Look at your local grocer’s flyer for coupons or what is on sale that week to get your creative juices flowing.
   
   
4. Incorporate seasonal vegetables and fruits
   Eating seasonally makes meals interesting and prevents boredom from using the same ingredients every week. Sometimes these foods are also on sale! If you can’t get fresh ingredients, frozen can be just as healthy and usually very affordable.
   
   
5. Save recipes you want to try
   Put that Pinterest to good use! Save recipes you think look delicious and easy to your email, Pinterest, Evernote or just print it out and keep it on hand. Add the recipe to your weekly meal plan. Who knows, it may become a family favorite!
   
   
6. Keep a list of “tried and true” recipes your family loves
   If you aren't feeling particularly motivated, reach for the recipes that are always a winner and usually take less than 30 minutes to prepare. Keep a list, highlight them in your food journal, or file them under “easy” in your recipe box - whatever you do, keep them handy! On days you don’t want to think about dinner you can quickly pick a reliable recipe you've already mastered.
   
   
7. Use a grocery list
   Save money, reduce waste and make your grocery trip quicker by writing down what you need to purchase. There are hundreds of apps you can use, or good ol’ pen and paper will do!
   
   
8. Create a “triage tray” in your refrigerator to reduce waste
   I have been doing this for years but didn't even realize it! Lifehacker has an article that suggests using a box to put food into that needs to be eaten soon. I usually organize my meals by shelf in the refrigerator, and keep my “soon to be expired” foods at the top shelf. This will help you know what ingredients you need to use up in your next recipe and prevent waste!
   
   
9. Do prepwork in advance 
   Pre-cut veggies, mix marinades, or purchase cut fresh or frozen veggies to reduce barriers to cooking healthy foods during the week. The 30 minutes you spend on Sunday night can expedite the process during the week and reduce the feeling of burden.
   
   
10. Consider how you can use leftovers in other dishes
    Have a surplus of chicken but don’t want to eat the same dish all week? You can re-purpose most foods into other recipes, such as grilled chicken into chicken salad, sandwiches, chopped and put over a bed of greens, tossed with spaghetti… so many options! Doing this will speed up your meal prep throughout the week and can help reduce waste.

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I hope these tips help you stay inspired and make meal planning easier! Do you have any tips for meal planning? Let me know in the comments!

Greetings!

Hello world! Thanks for visiting me in my little corner of the internet. I am so excited to share my ideas, experiences and nutrition advice with you. I hope that you find Nourish For Life to be a great resource for reliable food, health and wellness information.

Check back often, as I will be writing about my favorite foods, recipes, nutrition tips and ideas for living happy and healthy! As a Licensed Registered Dietitian, I also provide personalized services for all of your nutrition needs. Whether you are looking for an assessment of your current diet, a tour of your local grocery store, one-on-one coaching or someone to come speak at your next event, you can rely on Nourish For Life to be your resource.

Email me with questions, or connect with me via social media! I would love to hear your feedback and requests for blog topics. Until then…

Healthy Regards,

Jennifer