Children, Follow My (Eating) Cues

Feeding behaviors are solidified early in life. In general, children are wonderful examples of listening to their hunger and satiety cues. Both of my children are great examples. My son is a really big eater in the morning and into lunch time and then has a tendency to pick the rest of the day. While other days, he eats very little. My daughter, on the other hand, eats a small amount at breakfast and then slowly picks up throughout the day.  Some days, she seems to eat the amount a grown woman would eat!  But I trust she is accurately listening to her own body as remains active and her weight is following a healthy growth curve. Unfortunately, many parents confuse children when they tell them to eat because it is meal time. Parents think, “Surely they should be hungry because they haven’t eaten in several hours.” And not only do some parents make children eat, some make them clean their plates. I recently wrote a letter to a well-known, elite school here in Dallas when one of my pediatric patient’s mother (who happens to be a physician) told me they still practice the clean plate club at their school. Really?! I thought everyone has figured out by now that this is not a good thing to do. The clean plate club trains the body “untrust” its physiological signals to eat or not to eat. This approach may have started back in the Depression when food was scarce, but I see many adult patients that are still trying to unlearn what they were taught by their parents. “Do not get up from this table until your plate is clean.” Or, “If you want that dessert, you better eat everything on that plate.” Dietitians cringe at the thought, although I truly believe parents are very well-intentioned. 

One of the best food behavior gifts we can give our children is the gift of trusting in their own hunger and fullness cues. I credit my own mother for allowing me and my siblings to make our own decisions to eat or not, and I firmly believe this has been one of the foundations to my healthy relationship with food. We ate as a family at the table without distractions (this is key), which helped us in listening to our individual cues. Because of mom, I can have my favorite food under my nose and if I am not hungry, I have no desire to eat it.

Hunger Scale by Paula Ryan, MS, of
Healthiest Regards Blog.
(Click to enlarge)

Paula Ryan, MS, author of the Healthiest Regards Blog, posted a great hunger and satiety scale that I wanted to share with Mommy Dietitian readers. It’s one of the best I have seen because it also lists the consequences of waiting too long eat, or not stopping when the body says it has had enough. If you find yourself eating in the absence of hunger or waiting way too long to eat, consider printing this scale off and going back to the basics. Many people eat for reasons other than hungers like when they are stressed, mad or sad. Deal with those issues directly instead of turning to food. It may be easier said than done for some, but this can be a start to a healthier YOU in 2011. And a healthier you means a healthier family because the children are watching – and doing what you do.

Nutrition For The Sick

Nutrition can play a key role in the recovery of an illness.

It’s that time of year again where all the nasty viruses and infections bring us and our loved ones down for a bit. Proper nutrition can be a major key to recovery. Even still, there are some among us dealing with more serious illnesses where optimal nutrition is even more crucial to the healing process. Our family is still trying to cope with the immense loss of a loved one last month, that despite all nutrition interventions I tried with her, our loved one did not survive her aggressive, brief bout with cancer (see dedication at the end). So yes, I have seen personally that there are times when nutrition is not enough.  While in other instances, medical nutrition therapy is a vital component of a patient’s care, prevention of complications and ultimate recovery. Although this is a subject that could be discussed for days, this post very briefly covers the role of food and nutrition for those who are sick with minor, major and terminal illness.

Minor Illnesses
Most of us will only deal with minor illnesses that pass in a matter of days. My 3 year old son recently came down with strep throat and it was no fun watching him be so uncomfortable in his own body. He ran a high fever for 3 days and during that time, he did not eat one calorie. Ack!  Don't you know, I hated it.  Even when we gave him a fever reducer medicine, he would not eat. Luckily, we were able to get an electrolyte replacement fluid in him throughout the days. If you are your child is sick and unable to eat, make sure fluids are still being taken in. For high fevers or those that are vomiting or have chronic diarrhea, an electrolyte beverage such as Pedialyte, Gatorade or CeraLyte are important to drink over water. When dehydrated, water can actually further the dehydration process since dehydration is not just about fluid loss, but loss of electrolytes as well. Do not worry too much when there is little to no food intake during these brief illnesses because any weight loss can be re-gained after getting better. My son little body lost 2 ½ pounds during strep throat, but luckily he has completed his 10-day regimen of antibiotics and is eating well again. I expect him to re-gain any lost weight.  During any minor illness, consider eating small, bland meals that are easy to digest until you are feeling better.

Major Illnesses
Major illness are what I would consider any illness lasting greater than 2 weeks or are chronic in nature. I work with many children and adults that are chronically ill and adequate calorie intake is my most important goal for them. For children, long term weight loss or failure to gain will result in loss of length/height growth. We have a window of opportunity to grow these children optimally so we must do all means necessary to get adequate total calories in them. With adults, a loss of 10% or greater over 3 months or less can cause the immune system to be compromised. Even if they were overweight to begin with, drastic rapid weight loss is not a good thing during major illnesses. Quality nutrition - high produce and antioxidant foods - would be great in a major illness, but many times sick people are very tired and eating is a challenging chore. Adequate calories is the ultimate goal with quality nutrition coming in as a close second.  On my website, I have a free resource page that includes an educational sheet that assists with healthy weight gain/weight stabilization and I also have a sheet on a high calorie liquid diet including smoothies and supplement ideas to maximize calories. In major illnesses, I highly recommend a visit with your local Registered Dietitian to do a full and complete nutrition assessment that will come with a customized medical nutrition therapy plan.  You can find one in your area by going to ADA's Find a Registered Dietitan page.

End of Life Nutrition
End of life and hospice nutrition really is a different issue altogether. All medical efforts have been exhausted and the person is still dying. I have had the honor of working with some of these patients in their homes and what their loved ones need to know is that under nutrition can actually act as an anesthetic. It can dull the senses which can assist with some pain control. In some cases, feeding can actually cause pain if their intestines or complementary organs are not working correctly.  The biggest goal in hospice/end of life nutrition is to comfort the patient. After all, a patient that is dying does not have many decisions they can make so deciding to eat or not to eat should be theirs and theirs only (if conscious). As a dietitian that works in hospice care, we educate on the risks associated with eating certain foods so the patient and their family can make an informed decision. Many of these people are at risk for aspirating food into their lungs, which could put them at risk for pneumonia. If this patient still had a shot at getting better, we would not allow them to eat certain textures. But in hospice care, we allow the patient and/or their families make that decision.

Whatever the illness may be in your or your loved one’s life, know the important use of food and nutrition. It has the power to recover and stabilize in many instances. But in others, allow food and nutrition be an individual’s choice.  In both instances, food can provide nourishment to the soul and that is a good thing.

Stay Healthy/Preventing Illness Resources:
Eat For Immunity using American Dietetic Association’s Public Resources
CDC’s Family Health Page

Kid’s Health From Nemours: Keeping Your Children Healthy
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End of Life Nutrition:

Hospice Foundation of America on Nutrition & Hydration


This blog post is dedicated to what I believe was the best mother-in-law in the world. Oh, I so miss our conversations and special times we had together. You were such a beautiful woman inside and out. It was truly inspiring how you loved your family and how you empowered those around you to be better people. Thank you for being a Mommy Dietitian blog follower and one of my biggest cheerleaders for my nutrition consulting practice.  I am a better wife, mother, woman and entrepreneur from learning by your incredible example.  I will be forever grateful for how you raised your son, my husband, to be one of the greatest men I have ever known.  Your grandchildren miss their Nanny, and are sad you left this world so soon and so suddenly. But we find comfort in knowing that we will see you again someday. We love you, Beverly.

Do Not Fear The Pomegranate

If you have been to the grocery store in the last month, you’ve probably seen the pomegranate displays.  Did you just walk by? It’s that time of year when pomegranates are at their peak season, but the majority of people don’t know what to do with them so they don't even try them. Or, they are stumped on how to cut the seedy, red-staining fruit up without causing a big mess. I recently received some pomegranate in my produce co-op share and I was looking for new ways to eat this seasonal treat. So, let’s explore pomegranates together.

The word pomegranate is French derived from pomme garnete, which literally means “seeded apple.” Favored by the gods in ancient mythology, considered as a symbol for fertility in many cultures, prosperity among Jews and hope among Christians, this unique fruit has only positive origins and references. Nutritionally, it is a rich source of fiber, postassium, Vitamins C, K, B6 and Pantothenic Acid. Pomegranate contains antioxidants like polyphenols, tannins and anthocyannins which effects in removal of free radicals from our body cells. It also helps in repair of cells and boosts the immune system. Pomegranate juice is known to be among the super healthy drinks of today. It is helpful in osteoarthritis and keeping the skin and heart healthy.

Interested yet?  If I have now piqued your interest about pomegranates, you may consider eating one if you gained confidence in cutting one up. The California Pomegranate Council says that there is an easy 3-step process in cutting and de-seeding pomegranates:

1. Cut off the crown, and cut the pomegranate into sections.

2. Place the sections in a bowl of water and then roll out the arils (juice sacs) with your fingers. Discard everything else.

3. Strain out the water, then eat the arils whole, seeds and all.

You can blendarize the arils and seeds to make juice, or use the nutritious seeds as a topping to oatmeal, yogurt or salads. For recipe reference, one medium pomegranate yields about a ¾ cup of seeds and ½ cup juice.

If you want to start slow, try this wonderful nutritient-rich recipe that mildly uses the sweetness of just one pomegranate, but mixes it with bolder flavors of lime, jalapeno and salmon.  As a proud Texan, this is my kinda flavor!

Roasted Salmon with Pomegranate and Avocado Salsa

Roasted Salmon with Pomegranate and Avocado Salsa

 

2 teaspoons ground coriande
2 teaspoons sugar

Salt, as needed

1 pomegranate, seeded (see above for process)

1/2 cup thinly sliced green onion

3 tablespoons fresh lime juice

2 teaspoons finely chopped jalapeno pepper or to taste
1 large clove garlic, chopped finely
2 avocados, preferably Hass, cut in 1/2-inch dice
1 head hearts of Romaine, about 7 ounces
4 center-cut Salmon fillets the same thickness, 6 to 7 ounces each
1 lime, cut in eighths for garnish

Mix coriander, sugar, and 1 teaspoon salt; reserve. Up to 4 hours before serving, mix pomegranate seeds, onion, lime juice, jalapeno, and garlic; gently fold in avocado. If holding more than 30 minutes, put plastic wrap against the surface of the salsa, then tightly cover; store in the refrigerator. Remove about 30 minutes before serving. Separate the romaine leaves; wash, then dry thoroughly. Reserve 4 of the most attractive leaves for garnish. Slice the remaining leaves crosswise in thin shreds; reserve.

To prepare the salmon, rub a generous teaspoon of the reserved seasoning mixture over each piece. Arrange the salmon on a baking sheet, skin-side down. Roast at 500˚ F about 11 minutes for medium rare (salmon should be spongy when pressed with a finger at its thickest part.) and 13 minutes for medium-well (salmon should be just firm when pressed with a finger at its thickest part.).

Do you have a favorite recipe that uses pomegranates?  If so, I would love to hear from you!
 
Some information provided in this post came from the California Pomegranate Council website.

Operation Halloween Candy: Party's Over!

If the leftover Halloween candy is causing a struggle in your
home, consider teaching a valuable community service
lesson to your children by donating it.

Our family has way too much candy leftover from Halloween.  We didn't get as many trick or treaters this year so we have bags of chocolate bars.  Plus, my kids received tons of candy that has been taunting them daily.  Is it the same scenario at your house?  Although I encourage each of us to continue teaching our children about the proper behaviors around candy, we also must consider environmental triggers.  I think candy donations to our military troops can be a great way to teach our children about community service and giving to others while also eliminating candy overconsumption in the household.  At our house, we are putting together a care package that includes our candy along with handmade cards from our children thanking the troops for how they protect our country.  Of course, we will be sure to include a message that encourages the troops to enjoy their candy in moderation so they can maintain a healthy lifestyle!  My brother served two tours in Iraq and he said that it was wonderful to get candy in the mail because it was not available where he was stationed.  Apparently, this is the case in many places soldiers are stationed in different parts of the world.  Although I am not a fan of candy (I'm a salt vs. sweet kinda gal), I understand that others like it and would appreciate having some sent over for an occasional treat.

If you want to donate your candy, here are a couple places:

Operation Gratitude
Operation Shoebox

Halloween is fun because it comes once a year and then it's over.  So don't let Halloween candy eating continue on and on to where the treats do a "trick" on your healthy lifestyle.  Donate your candy this year!  If you have any other great ideas on what to do with Halloween candy other than eating it all until it's gone, I would love to hear about them.

Trick or Treat -- Candy, Please!

Yep! Candy is mostly sugar.  Good thing
Halloween only occurs once a year.

The reality is that the Halloween tradition is about children receiving candy as they go door to door in their Halloween costumes.  Halloween only occurs once a year, so I say, let the children enjoy some candy.   Don't get me wrong.  I love the healthier ideas out there, especially the toy and sticker alternative.  But remember, candy is not the root of all evil – it is the frequency in which it is consumed that could pose a problem.  We live in a world where our children are already around lots of candy, so we must teach them proper behaviors around eating it.  I see Halloween as a wonderful training opportunity on proper eating behaviors.  So let the kids enjoy their Halloween candy, but don’t let it be consumed endlessly after the holiday.  I allow my children to have more candy than usual on Halloween.  In fact, I let them have all the candy they want this one night per year.  My daughter has already learned firsthand that too much candy will give her a tummy ache.  We had a great discussion when she was feeling sick after eating too much icing one time that too much candy will make her body feel bad.  After Halloween comes and goes this weekend, the frequency of candy consumption will go back to how it normally is at our home – a maximum of once or twice per week.  So, my take on Halloween?  Let the kids have their candy.  And remember to use this time to teach them about the place that candy should have in their lives every other day of the year – as an occasional treat. 

Haunting Tales....From The Buffet Line

Don't let amazing buffet designs divert your attention
from the temperature your food should be served to you!
(cool watermelon design on one of the cruise buffets)

Thanks to my food microbiology class several years ago, buffets scare me like a teenage girl going through a haunted house. It may also be because I have had food poisoning on more than one occasion and it is no fun. I can look at blood and guts all day long, but seeing food with mold on it makes me want to shriek! It’s all about bacteria overgrowth here. Now that you know my phobia, you will giggle to learn that I just got off a cruise ship filled with buffets! There was so much food the entire week and much of it was indeed served buffet-style. My first shot at the buffet line, I said to myself, “OK, you can do this, Angela. All those stories you hear about foodborne illnesses on ships – it’s the exception to the rule.” So I boldly fill my plate with all kinds of food, including some grilled fish. I sat down at the table and began to eat. All the food was lukewarm at best. The grilled fish was cold! That’s it, I’m done. Stick a fork in me.


My food bacteria fear will one day cause me to bring a food thermometer with me to buffet lines – I can feel it coming. After all, the temperature danger zone (TDZ) is between 40-140 degrees, because this is the range in which most common bacteria love to grow. If you arrive at your holiday party without your handy temperature gauge (as most of us do!), make sure the foods that are normally in the refrigerator are actually cold and the foods that are supposed to be served hot, actually are hot. A good rule of thumb is to stay clear of any hot or cold food that has been sitting out longer than 2 hours. If you are entertaining this holiday season, do us bacteria phobes a favor and review the safe guidelines provided by the USDA.  The USDA provides an entire website devoted to food safety, so keep your family safe this year by reviewing their guidelines and techniques.

You may wonder how I survived my 5-day cruise. Well, I am happy to report that I survived all the buffets. If only I hadn’t eaten at the authentic Mexican restaurant in Veracruz! All of us got sick on that one. Thanks a bunch, Montezuma. Grrr.

Fall Fun With Pumpkins

Halloween is a great time to encourage family fun
with food - by playing and eating pumpkins!

With the Fall season in full swing, we are approaching the fun times of pumpkin patches and pumpkin carving - such great activities for families with small children.  What a wonderful time to allow your kids to learn about and play with pumpkins.  Afer all, the more comfortable and interested they are in this nutrient-packed gourd, the more likely they are to eat it in varying forms.  Pumpkins are thought to have originated in North America.  The word pumpkin comes from the Greek word "pepon" which means "large melon."  Pumpkins are packed with great nutrition to fuel our child's growing bodies.  They contain carotenoids, lutein, and zeaxanthin, which are all antioxidants or anti-cancer properties.  Pumpkins also contain iron, zinc and fiber.  Talk to your children about these interesting facts and more as you have fun picking and carving your pumpkins.

I love those farms that allow you to pick pumpkins right off the vine, although they are harder to find these days.  Many of the pumpkin farms have them already sorted by size and price.  Allow each of your children to have their own pumpkin, if possible, so they can design their own.  Give your child an ice cream scoop or large spoon so they can be part of the messy fun after they draw their own whimsical faces and designs.  I personally like the ideas on Kaboose's pumpkin craft page.

After you have carved your pumpkins, what to do with the pumpkin "guts?"  Don't throw that wonderful nutrition in the trash!  No, continue the fun by baking or cooking a recipe with your children.  You can substitute canned pumpkin in any recipe for fresh pumpkin.  Simly remove the pumpkin seeds and set aside (to lightly salt and roast for their own separate treat later).  Steam the pumpkin pieces and pulp with a bit of water in a pressure cooker, or in a pot using a steaming basket.  When it's done, blendarize your pumpkin and it's ready to be added to your recipe.  These are the recipes that look interesting to me this Halloween:

Eating Well's Pumpkin Cookies or Pumpkin Apple Soup

Taste of Home's Pilgrim Pudding

All Recipe's Pumpkin Bread

Family Oven's Pumpkin Breads & Muffins

What is your family's favorite pumpkin recipe?  I would love to hear from you.  This season, make time to have some family fun with pumpkins!