Thursday, April 23, 2015

Meal Plans vs Meal Planning

One of my most frequent requests upon people learning that I am a dietitian, is for me to write a meal plan for them. What is requested is a specific menu including all 3 meals and snacks. I have 3 reasons why I always refuse and why I despise and do not use a meal plan at home for me or my family:

  1. Personal likes and dislikes are so different that if I were to develop a meal plan for another person (even my husband), chances are it would be rejected because it wouldn't be according to their tastes. 
  2. My life, and I therefore expect to some degree everybody else's life, does not follow a strict schedule leaving further room for failure and diversion from the meal plan.
  3. Variety is the key to a healthy diet, not any specific foods. Variety is best achieved with flexibility not always available in meal plans. 
My alternative to meal plans is meal planning. In my house, an ideal meal plan is a list of main dishes for the week on one side of a small paper and the grocery list on the other. Sides are sometimes included, but often they are not as I just include a variety of fruits and vegetables to my list according to season and sales and mix and match to what fits my tastes any specific night. Of course, when first starting to meal plan, you might consider including side dishes to ensure you make them each night as main dishes should rarely be served alone. Below are a few of the benefits I find in meal planning:

  1. There is no set schedule. Some meals are fast while others are more time consuming, which allows me to select dishes as my week plays out.
  2. A corresponding grocery list to the dishes you wish to make, ensures you will have the ingredients on hand and enhances the chance that you will make dinner and/or lunch.
  3. Adaptability allows for variety, substitutions and constant introduction of new recipes. 
My basics of meal planning:
  • Ensure protein variety: I plan my main dishes according to the type of protein ensuring that no type is used more than 2 times in a week. For example I might have 2 fish, 1 chicken, 1 turkey, 1 beef, 1 vegetarian (beans, legumes, cheese) & 1 pork meal one week, and perhaps 1 fish, 2 chicken, 1 beef, & 2 vegetarian meals the next week. This can be adapted to your tastes. If you don't like vegetarian dishes add more of something else.
  • Vary your main dishes: I personally like variety and I often try new recipes I find online or in cook books 1-2 times a week. Some are used again in the future depending on my family's reaction to them and others are a one time deal.
  • Balance: I utilize MyPlate to ensure balance which incorporates your protein (1/4 of your plate), vegetables and fruits (1/2 of your plate), carbohydrate (1/4 plate most of which are whole grains) and a side of dairy. If one of my meals is lacking in any of these areas I catch it up during snacks.
  • Snacking: Eat when hungry, but remember to stop when satisfied! As stated above, snacks incorporate any missing food groups from lack of presence at meals or, in the case of my toddler, refusal at meals. For instance if she eats only fruit and yogurt for breakfast I might offer a hard boiled egg, toast or dry cereal for a snack. If she refuses the vegetable at lunch she might get a frozen vegetable or hummus with fresh vegetables for her afternoon snack. 
  • Have fun and incorporate themes: I'm blessed with a husband and daughter who really aren't that picky so trying new things is not only accepted but expected. One thing that can make things fun is an International night planning a meal from a certain country or region, holiday themed dinners or simply eating outside to mix it up. Make meals fun.
  • Involve the family: Kids especially enjoy making decisions and are more likely to eat when they get to choose. My toddler often gets to pick from 2 dishes I'm considering. As she gets older she will be encouraged to supply ideas for the master list.

Friday, April 3, 2015

Vitamin D Supplementation


Registered Dietitian Recommendation: All breastfed infants should be supplemented with 400 IU Vitamin D daily. Supplements are to begin within the first weeks of life and no later than two months of age. All formula fed infants should likewise be supplemented if intake is less than 1 liter of Vitamin D fortified formula (7). Supplementation is to continue throughout the lifespan when dietary intake does not meet RDAs for age (400 IU 0-12 months; 600 IU 1-70 yr; 800 IU >70 yr) at latitudes higher than 33 degrees or when exposure to direct sunlight is restricted (3,5,6). Institutionalized and home bound elderly should be supplemented at 800 IU. Supplements should not exceed the RDA unless directed by a physician in instances with noted deficiency (6).

Vitamin D is a hot topic within current research, with suggested associations between adequate levels in the blood and prevention of cancer and autoimmune diseases such as Multiple Sclerosis and Diabetes (1,5,6,7). While it would be inaccurate to suppose that Vitamin D is the sole cause or cure of a specific disease, Vitamin D's benefits should be appreciated and care should be taken to obtain adequate dietary intake and/or exposure to the sun.
Listed below are the known and suspected benefits of adequate Vitamin D levels in the blood:
Known roles/benefits of Vitamin D in the Body:
  1. Bone formation and maintenance (1,5,6,7)
  2. Reduced risk of bone fractures particularly in the elderly (5)
  3. Decreased risk of falls and increased lower extremity function (5)
  4. Increased oral health (5)
  5. Calcium regulation in the blood (1,5,6)
  6. Cell specialization and regulation of cell growth/multiplication (1,5,6)
  7. Decreased risk of Colorectal cancers (5)
Possible health benefits currently under investigation:
  1. Decreased blood pressure (1,5,6)
  2. Autoimmune protection against disease such as Multiple Sclerosis, Diabetes, Arthritis (1,5,6,7)
  3. Increased immunity (1,5) and possible reduction in infectious diseases (6,7)
  4. Increased insulin sensitivity (1,5,6)
  5. Prevention of various cancers (6,7)
The number one source of Vitamin D is sunlight (1,2,6,7), which produces the vitamin within the skin according to need (1). As a protective feature, Vitamin D synthesis via the sun is inactivated within the human body when levels are adequate thus preventing toxicity from that route (1,6). Dark skin further aids in this protection by decreasing the rate of the sun's synthesis of vitamin D in populations characteristically located in parts of the world receiving more direct sunlight. Therefore, when someone of a darker skin tone moves to a higher latitude of increased distance from the equator (either North or South) they need 3-10 times more exposure to sunlight to synthesize adequate levels of Vitamin D (2,5, 6,7). During the winter months all populations in higher latitudes are at greater risk for deficiency as direct sunlight exposure decreases (5). Additional risk for deficiency arises as more time is spent indoors and sunscreen or other protective measures are utilized to decrease direct sunlight exposure during the summer. Of interest, sunscreen with a SPF of 30 will decrease Vitamin D synthesis from the sun by 95% (6). Risk factors other than limited sun exposure and dark skin, include obesity (4,5,6), residence at latitudes greater than 33 degrees (5,6) exclusively breastfed infants (7) and age (5,6).
Maintenance of Vitamin D via dietary intake is also becoming more difficult as consumption of natural sources such as milk and fatty fish (herring, salmon, tuna, sardines) is decreasing. Additional natural dietary sources include beef, egg yolks, cheese, butter and liver. Fortified sources may include yogurt, cheese, margarine, orange juice, bread and cereal depending on the manufacturer (1). When dietary intake fails to meet age specific Recommended Dietary Allowances (RDA) of 400 IU (0-12 mo), 600 IU (1-70 yr), 800 IU (>70 yr) at latitudes greater than 33 degrees or when exposure to direct sunlight is restricted (3,6) supplementation should be initiated to decrease risk of deficiency. It should be noted, that breast milk is not a good source of vitamin D with levels between 25-78 IU regardless of maternal supplementation. Therefore, exclusively breastfed infants should be supplemented with Vitamin D (7). Supplements should not exceed the RDA unless directed by a physician in instances with noted deficiency (6). In correlation with Vitamin D's role in bone health, deficiency is characterized by improper bone development in infants and children identified as Rickets and decreased bone density in adults known as osteomalacia (1,6).

Learn More
  1. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. 5th ed. Belmont, CA: Wadsworth Cengage Learning; 2009.
  2. Weishaar T, Vergili JM. Vitamin D status is a Biological Determinant of Health Disparities. J Acad Nutr Diet. 2013; 113 (5): 643-651.
  3. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2011.
  4. Au LE, Rogers GT, Hariss SS, Dwyer JT, et al. Associations of vitamin D Intake with 25-Hydroxyvitamin D in overweight and Racially/Ethnically Diverse US Children. J Acad Nutr Diet. 2013; Article in Press. Accessed September 2, 2013.
  5. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, DawsonHughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18-28.
  6. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-1930.
  7. Wagner CL, Greer FR. Prevention of Rickets and Vitamin D Deficiency in Infants, Children and Adolescents. Pediatrics. 2008; 112: 1142.

Optimal Sugar Intake

RD Recommendation: Added sugars are to be eaten in moderation not to exceed 5-10% of total dietary intake in order to assure consumption of essential nutrients and to help prevent chronic disease. The following are tips for maintaining appropriate sugar intake:
  1. The 90/10 rule- eat healthy foods full of nutrients at least 90% of the time and eat treats or foods high in fat and sugar no more than 10% of the time. 
  2. Save high sugar foods or treats for holiday celebrations and special occasions rather than general everyday use.
  3. Drink only 100% juice and do not give to children until after the age of 1 (1,7).
  4. Limit juice intake to 1/2 - 3/4 cup daily from age 1-7 years old and 1 - 1 1/2 cups daily from 7 years of age into adulthood (6,7). 
  5. Omit or restrict to occasional use all other sugary beverages including soda pop, energy drinks and sports drinks (5,6,7). 
Sugar naturally obtained from a healthy diet (found in fruit, milk and grains) is sufficient to meet the body's needs for energy and for glucose essential in brain function (1). Additional sugar added to foods in production or at the table, provides no nutritional benefit and can displace essential nutrients for proper growth and development in children (1,4,7). The following childhood and adult health problems have also been linked to excess sugar intake:
  1. Dental cavities (1,6)
  2. Obesity (3,5)
  3. Insulin resistance (3)
  4. Heart disease (3)
​Sugar is an integral part of American society, and is often used at social gatherings and at holiday celebrations important for mental and social health. It is therefore important to accept a general practice of eating sugar in moderation rather than total elimination of all added sugars from our diets. Parents should teach their children by example that there is a time and place for sugar consumption rather than free daily intake, and they should provide healthy alternative treats (such as fruit) and drinks (including milk, small portions of 100% juice and water) for everyday use (7).

Learn More
  1. US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. Accessed September 12,2013.
  2. Briefel RR, Wilson A, Cabili C, Dodd AH. Reducing Calories and Added Sugars by Improving Children’s Beverage Choices. J Acad Nutr Diet. 2013;113:269-275.
  3. Kosova EC, Auinger P, Bremer AA. The Relationships between Sugar-Sweetened Beverage Intake and Cardiometabolic Markers in Young Children. J Acad Nutr Diet. 2013;113:219-227.
  4. Ruottinen S, Niinikoski H, Lagstro¨m H, High Sucrose Intake Is Associated With Poor Quality of Diet and Growth Between 13 Months and 9 Years of Age: The Special Turku Coronary Risk Factor Intervention Project. Pediatrics. 2008;121(6):1676-85.
  5. DeBoer MD, Scharf RJ, Demmer RT. Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old ChildrenPediatrics. 2013; 132(3): 413-20.
  6. Marshall TA, Levy SM, Broffitt B, Warren JJ, et al. Dental Caries and Beverage Consumption in Young ChildrenPediatrics. 2003; 112(3): 184-191.
  7. Gidding SS, Dennison BA, Birch LL, Dietary Recommendations for Children and Adolescents: A Guide for PractitionersPediatrics. 2006; 117(2):544-59.