Slow day...post day...

You know work is slow when it's a double-post kinda day... : )

 Mari asked me a wonderful question about PCOS and what type of diet is best for women suffering from PCOS. Great question, Mari...I hope this is helpful!

Women with polycystic ovarian syndrome (PCOS) are at increased risk for heart disease and diabetes. Many women with PCOS have insulin resistance, causing the pancreas to secrete more and more insulin in order to transport glucose (sugar) out of the blood and into muscle, fat, and liver cells where it is converted to energy or stored as fat. Elevated insulin levels can cause polycystic ovaries, weight gain or difficult losing weight, increased risk of heart disease (elevated LDL-cholesterol and triglyceride levels and decreased HDL-cholesterol levels), and increased clotting factors. The risk of the developing diabetes in women with PCOS can be up to 40% by the age of 40. Most women (50-60%) with PCOS are obese (BMI greater than 30). Weight loss, even as little as 5% can lead to decreased insulin levels which is critical due to the fact that elevated insulin levels promote fat storage [1].

In researching how much carbohydrate a woman with PCOS should consume, I found varying recommendations. Before prescribing a standard 50-55% carbohydrate diet or a low (40% or less) carbohydrate diet, I would want to know a PCOS patient’s fasting blood sugar and HbA1c – a lab value indicating an average blood glucose reading representing 6-8 weeks. Agreeably, women with a higher BMI are statistically more likely to have insulin resistance, in which case a lower (less than 50-55%) carbohydrate diet is probably advisable.

I am of the opinion that to prevent diabetes, one should eat like a diabetic. For most women of normal to overweight size, this would include 30-45 grams of carbohydrates at meal times and 15-30 grams of carbohydrate + 1-2 ounces of protein before bedtime. Emphasis should be placed on complex, low-glycemic index carbohydrates, as well as a diet low in saturated (13 grams or less per day) and trans fat (none, preferably). For women with a BMI greater than 30, carbohydrate and energy needs go up – consult a Registered Dietitian for recommendations.

For example, a 180-pound (81.8 kilograms) female requires roughly 1230-1640 calories a day to lose weight (15-20 calories per kilogram of body weight. In order to find your weight in kilograms, divide your weight in pounds by 2.2). At minimum (30 grams of carbohydrate per meal with a 15-gram carbohydrate evening snack), carbohydrate comprises 26-34% of the daily intake. At maximum (45 grams of carbohydrate per meal with a 30-gram carbohydrate evening snack), carbohydrate comprises 40-54% of the daily energy intake. 

(Note: one gram of carbohydrate contains 4 calories – this is needed for calculations).

Other diet-related suggestions for women suffering from PCOS [1]:

-         Pair carbohydrate-rich foods and snacks with a lean protein or fat high in mono and/or polyunsaturated fatty acids.

-         Consume foods with a lower glycemic index – these foods are typically high in fiber

-         Space carbohydrates out throughout the day. Consuming consistent, moderate carbohydrate levels is best for blood sugar control

-         Consume plenty of decaffeinated, sugar-free beverages, especially water

-         Exercise on a regular basis -- aerobic and anerobic

-         Take a multi-vitamin mineral supplement daily

[1]. McKittrick, Martha. PCOS and Diet. OBGYN.net Publications.

The above information was provided by the above source. The author, Martha McKittrick is a Registered Dietitian and Certified Diabetes Educator. In other words, she is a wonderful resource!

Cookie Taste-Test Results!

The preferred cookie in yesterday's cookie taste testing was the Oatmeal Cranberry White Chocolate Chip Cookies. Hands down. There were only 2 votes NOT for the Oatmeal Cranberry White Chocolate Chip Cookies and they were for the Chocolate Peanut Butter Cookies and the Peppermint Cheesecake Brownies.

P.S. I had 2 late-comers who wanted in so the total participation was 18 employees!

Last night I made deer meat tacos for dinner!

My father-in-law is a bow hunter and provides us with deer meat. Yum!

I had 1 deer meat taco, a dollop of fat-free refried beans, and a bed of shredded lettuce with deer meat, salsa, corn, and homemade guacamole. Mmmm!

 Nutritional comparison of deer/venison vs. ground beef

(values represent a 1 ounce, raw portion)

- deer meat is 40 calories versus the 72 in ground beef*

- deer meat contains 0.8 grams of fat compared to 5.7 grams in ground beef*

- deer meat contains 7.6 grams of protein compared to 4.9 grams in ground beef

*this is standard 70-80% lean (does not specify)

Question: Have you tried deer meat? Did you like it? Did it taste "game-y" to you?

Fiesta con NUTRITION!

Wow! I was expecting a good turn-out for the giveaway...but the response has far exceeded my expectations! Thank you to my new followers...I look forward to hearing from you and reading your work, as well!

If you look to the right there you'll see my newest poll is asking about your preferred housing for your taco stuffing! This past week I made tacos and came across several options on hand in our house. While I typically go for a corn tortilla, I hate how small they are and how easily they rip. So, I opted for some hard shells you'll see below. I then, of course, got to comparing the nutrition on these taco shells and may have had a change of heart...

I just may be a hard shell chick.

So, let's compare...

1st choice: Mission Life Balance Plus Tortillas

 

Serving size is 1 tortilla.

130 calories, 3 grams of fat (1.5 saturated), 3 grams of fiber, 290 mg sodium

First word on the list of ingredients: "enriched" -- BLASPHEMY!!! And looking at that list, there's TONS of 8-syllable words on there (that's my way of saying "there's way too many preservatives")

 

Choice 2: Old El Paso hard taco shells

My Pick of the week!

 

A MUCH abbreviated list of ingredients and a single preservative 

(can't escape them all, but glad to see it's limited....)

 

First note: the serving size is THREE shells.
150 calories, 7 grams of fat (3 g saturated -- 3 grams MUFA!), 135 mg sodium, 1 gram of fiber.

I love the healthy fat (despite the higher saturated fat), and I love that the sodium is low!!'

Choice 3: Mission Yellow Corn tortillas

 

Serving size is 2 tortillas
110 calories, 1.5 grams of fat (no saturated fat), 10 mg sodium, 3 grams of fiber

So, which taco shell would you choose at my house?

I think the corn tortillas are the most wholesome. I love the fact that they are SOOOO low in sodium, a good source of fiber, and contain NO saturated fat! However, they're too flimsy for me! The ones at restaurants are always better than those in the stores...

C'est la vie that the healthiest option is not my favorite...but I DO think that the Old El Paso hard shells are a GREAT option for tacos shells. I love that the shells are low in sodium and have more than half the fat coming from MUFA's and PUFA's. For a 3-shell serving, they're also the lowest in carbohydrates (important for diabetics!).

The Mission Life Balance are a good source of fiber but higher in calories. They're also packed with preservatives and the main ingredient is enriched bleached wheat flour (noooo!).

In short: soft shell corn, hard shell corn, and last...flour.

 

Have a wonderful Thursday and check back for the winner of the giveaway tomorrow!!

Reader Question: Peanut Butter

I received an EXCELLENT question this morning from a reader. She asked:

Q: I am trying to vary my snack routine, and I keep hearing that peanut butter is a great snack to enjoy on an apple or whole wheat toast. I have avoided peanut butter in the past because it has a lot of fat and calories, but I wanted to get a dietitian's point of view. I would love to see a blog post about the health pros and cons of peanut butter and recommend certain things to look for when buying PB to keep it on the healthy side. Thanks!

A: Firstly, I completely understand the confusion surrounding peanut butter and healthfulness. Peanut butter does have a LOT of calories and fat! However, peanut butter is actually a very balanced food item when used in moderation (i.e. 2 tablespoons). While a serving of peanut butter will run you 190-200 calories, you're getting a lot for the "cost" including plentiful amounts of monounsaturated fats (those are the REALLY good fats), polyunsaturated fats (good fats!), 8 grams of protein, approximately 4 grams of fiber, and a mere 1 gram of sugar. Natural peanut butter is cholesterol-free and low in sodium. Here's a nifty chart from the USDA on peanuts and peanut butter...

 There are a few things to be aware of when purchasing and using peanut butter, however....

- Buy natural peanut butter. Peanut butter containing "hydrogenated oil" or "partially hydrogenated oil" contains trans fat (that's the REALLY BAD kind). Buying a natural form of peanut butter insures that it is trans fat-free. Check your labels and ingredient lists to be sure!

- Measure your portions! Two tablespoons is a generous portion, but peanut butter is easily a food that can get a bit plentiful in portion sizing over time.

- When adding peanut butter to a snack, pair it with a low-calorie food item as to have a healthy snack that's relatively low in calories. Examples: celery, pretzels, crackers, fruit, etc.

- Every thing in moderation. No single food should comprise the bulk of your diet or nutrient intake.

Verdict: Thumbs up! Shop smart and watch portions as always! Personally, I opt for All-Natural Jiff.

As for the diabetic diet, I'm pluggin' along. Yesterday ended up like this:

Breakfast:

1 egg, cooked in Pam (0 carbs)

1 Arnold's bread thin (1 1/2 carbs)

2 Morning Star Vegetarian sausage patties (1 carb)

6 ounces low-sugar toffee cappuccino (1 carb)

     Total: 3 1/2 carbs

Lunch:

1 serving chili (1 carb)

1 banana (2 carbs)

baby carrots (0 carbs)

1 Vita Top Muffin (1 carb)

     Total: 4 carbs

Dinner:

2 cups chicken noodle soup (1 carb)

1/2 acorn squash (2 carbs)

2 tsp Splenda brown sugar (1 carb)

2 Tbsp Smart Balance Light (0 carbs)

     Total: 4 carbs

Snack:

6 wheat tortilla chips (1 carb)

1/3 avocado (0 carbs)

3 more days of diabetic dieting! Have a great night, thanks for reading!

P.S. Meredith: I am not a CDE...yet! I am working on racking up the hours to sit for the CDE exam and I work with a population where I see a LOT of diabetics. I hope to get become a CDE within the next 2 years and I am SO excited about it! As passionate as I am about weight loss, I LOVE working with diabetics. It is fascinating!

Oktoberfest 2009

While my husband has had the pleasure and honor of attending THE Oktoberfest in Munich, Germany...the Tulsa Oktoberfest was no disappointment. Laden with all traditional food, beverage, music, and dance! While I thoroughly enjoy both food and beverage, the highlight was surely the traditional music and dance. I don't believe I can count on my 20 digits alone how many times we did the Chicken Dance. While it was a forbidden "DON'T PLAY" for our wedding DJ, I sure had fun doing it last night with friends and thousands of Tulsans.

Here are some low-quality pictures. Apologies, my camera battery died, so I had to take them with my phone.

 

 Pitchers in the air!

 

Awesome German Band playing traditional German music

Sadly, however, husband informed us that at THE Oktoberfest music is not typically played. Whereas Tulsa's Oktoberfest had lots of tents, of varying sizes, playing a variety of music. Our tent we believed to be the largest and held SEVERAL thousand dancing fools by the time we left.

The food and drink were wonderful as well, but my dietitian tummy was upset after consuming so much FAT last night. I tried the funnel cake and brat with kraut. While it was delicious, it did not agree with me!!

Between the 5 of us we were able to try several traditional beers, too. On tap they had Spaten Oktoberfest, Samuel Adams Oktoberfest (probably not so traditional), Franziskaner, Spaten Pils, Spaten Premium, Spaten Optimator, and Oktoberfest Lager. Mmmm!

Hockey game tonight - excited!

Yesterday ended up like this...

Breakfast:

1 cup oatmeal, prepared (2 carbs)

1 cup skim milk (1 carb)

2 Tbsp pumpkin butter (1 carb)

1/2 ounce pecans (0 carbs)

     Total: 4 carbs

Lunch:

1 1/2 cups chili (1 carb)

6 wheat crackers (1 carb)

8 ounces V9 Fushion Light (1 carb)

     Total: 3 carbs

Snack:

2% cheese stick (0 carbs)

Dinner:

1/3 small funnel cake (2 carbs)

1/2 bratwurst with saurkraut (1 carb)

3 German beers (2 carbs)

     Total: 5 carbs - over!

Snack:

1/2 cup shredded wheat (1 carb)

1/2 cup skim milk (1/2 carb)

     Total: 1 1/2 carbs

Hold the acrylamide, pease!

Here's just one more reason America's vegetable of choice (in the form of chips or fries) needs a closer look.

In addition to the excessive fat and sodium content of potato chips and french fries, a chemical called arcylamide is also found -- a possible cancer-causing agent. Because acrylamide is found in carbohydrate foods which are cooked at high temperatures, acrylamide is also found in foods such as cereals, baby foods, breads, and crackers [1].

In lab animals, acrylamide is shown to cause tumors and neurological problems. Consumer's in the US are not seemingly phased by the recent discovery of the possible carcinogenic effects of acrylamide. Many

American's are yet to hear about acrylamide despite its presence in nearly 40% of foods. Federal governing bodies in the US, Canada, and Europe are stepping up efforts to reduce the levels of acrylamide in foods [1].

Acrylamide forms when sugars and asparagine (an amino acid) are heated together at temperatures more than 248 degrees Fahrenheit. This effect, which is partly a "Maillard reaction," enhances a food's color, texture, aroma, and flavor [1].

What to do about it? Continue eating a healthy, balanced diet that is low in fat, cholesterol, salt, and added sugar and rich in high-fiber grains, fruits, and vegetables, says the Food and Drug Administration. Joe Schwarcz points out that there is acrylamide in certain foods just like there are aflatoxins in peanuts, ethanol in wine, urethane in sherry, styrene in cinnamon, and hetreocyclic aromatic amines in beef bouillon [1].

It's also important to know that acrylamide levels vary greatly between identical products such as Krispy Kreme donuts and McDonald's french fries.

Just like anything and everything else, watch it. No food should be over-consumed in the diet -- balance is always the goal.

[1]. Deardorff, Julie. Acrylamide: Why french fries shouldn't be overheated. Chicago Tribune. September 18, 2009.

One more reason to decrease the grease...

If you’re not interested in your exercise performance, you are probably interested in preserving your short-term memory, right? New research shows that consuming fatty foods appear to hinder both – exercise performance and short-term memory. In addition, we know that high-fat diets over time lead to weight gain, heart disease, and cognitive function decline [1].

When 32 rats became proficient in running a particular maze, their healthy diets were then switched to a high-fat diet containing 55% fat. Within 4 days of consuming the higher-fat diet, the mice began to double-back and falter on the maze maneuvering indicating a short-term memory error. The rats that remained on the healthful diet experienced no change in their maze maneuvering abilities [1].

Additionally, half of the study rats had also been worked out on a treadmill. After just a few days of the 55% fat diet, the rats performed at a level 30% less than they had previously while consuming the healthful diet. And after 5 days on the high-fat diet, the exercise performance of the rats on the treadmill was half of what it had been previous to the switch to a high-fat diet [1].

Though similar human studies are yet to be published, researchers have produced similar results in humans. While the mechanism for this cognitive and muscular decline are unknown, one theory suggests high-fat diets triggering insulin resistance causing the body to less effectively use blood glucose in the body, important for cognitive function. In regards to exercise performance, fatty foods appear to release certain proteins that essentially make the metabolism less efficient. Dr. Murray states, “It’s thought to be a protective mechanism to get rid of excess fat…But it was making muscles less efficient at using oxygen and fuel to make energy needed to run” [1].

The article by Tara Parker-Hope of the New York Times explains that these findings are of particular interest to the individual who consumes whatever they want…because they exercise regularly. Cough, cough. Noted.

[1]. Parker-Poke, Tara. Fatty Foods Affect Memory and Exercise. The New York Times. August 13, 2009.

Eat This, Not That: Mayo

I had a blog topic request from my amazing mommy. So, mom, here you go!

Her topic proposal: Mayo with olive oil. She said in an email, “I’ve seen it advertised and on the shelf today. Us consumers will need to know it it’s good because it touts the words olive oil. If it is indeed beneficial, how much?”

Simple answer: It’s a condiment that contains calories, fat, and in some cases cholesterol. It should be used in moderation.

Reality, however, is not omission from the diet. So, let’s discuss.

Between the choices offered by Hellmann’s, my recommendation in order of “dietary preference” would be:

1. Hellmann’s Canola Cholesterol-Free
2. Hellmann’s Low Fat
3. Hellmann’s Light
4. Hellmann’s with Olive Oil
5. Hellmann’s Real Mayonnaise

The logic?

The lowest option calorically is the low-fat Hellmann’s measuring in at 15 calories and 1 gram of fat per serving (1 tablespoon). The problem with it is the ingredients – water and modified cornstarch being the two main ingredients. Also, the sodium (while not high) is higher than any other Hellmann’s product. It is also the lowest in “good fat” – mono and polyunsaturated fatty acids (MUFAs and PUFAs).

Hellmann’s Canola Cholesterol-Free comes in as #1 in my book because it is 50% lower in calories than Hellmann’s Real Mayonnaise, contains no saturated fat, no cholesterol, and is lower sodium than the Hellmann’s made with olive oil. The olive oil product contains 5 more calories than the canola product and 5 milligrams of cholesterol, as well as 0.5 grams of saturated fat. Also, the olive oil product is not made of pure olive oil, but also contains soybean oil. Further, when you log-on to www.hellmanns.com, the olive oil product is asterisked and noted to not contain olive oil. If that’s confusing and unclear to a dietitian, it’s certainly unclear to consumers.

Canola oil is a heart-healthy oil and inexpensive. It offers similar MUFA and PUFA content as olive oil, and can be used diversely in cooking and baking.

Mom: Buy the Hellmann’s Canola Cholesterol-Free. Love you!

The DL on Panera

Did you know “Panera” translates to “time of bread” in Latin? But, of course!

Even in the current economic state, with most restaurants suffering the worst quarterly decline in 28 years, Panera is experiencing otherwise. Since 1981, the franchise has opened 1,264 stores in 40 states. There’s another 80 stores opening this year, which is about the same number as last years’ openings. Panera has even raised two menu item prices: bagels and soup. There is also a new addition to the Panera menu: a $7.59 chopped cobb salad [1].

While Panera sports hefty prices, I continue coming back for more. Those baguettes are worth fasting for breakfast in order to fund the addiction (I’m only half kidding…we should all eat breakfast). Though Panera is known for the use of wholesome ingredients and lack of fried foods, the menu still very much so requires navigation in order to be healthy.

Q: What does the RD order at Panera?

A: You-Pick-2: ½ smoked turkey on sourdough (light on the mayo) with Garden Vegetable or Black Bean soup.

Top 5 “best” picks:

1. Panini: Turkey Artichoke Panini (750 calories, 27 g. fat, 7 g. saturated fat)

2. Signature Sandwich: Asiago Roast Beef (710 calories, 32 g. fat, 13 g. saturated fat*)

3. Café Sandwich: Mediterranean Veggie (610 calories, 13 g. fat, 3 g. saturated fat)

4. Salad: Classic (170 calories, 11 g. fat, 1.5 g. saturated fat)

5. Soup: Vegetarian Garden Vegetable (120 calories, 1 g. fat, 0 g. saturated fat)

Top 5 “worst” picks:

1. Panini: Chicken Bacon Dijon (940 calories, 36 g. fat, 13 g. saturated fat*)

2. Signature Sandwich: Chipotle Chicken on Artisan French (1070 calories, 55 g. fat, 15 g. saturated fat*)

3. Café Sandwich: Sierra Turkey (970 calories, 54 g. fat, 12 g. saturated fat)

4. Salad: Chopped Chicken Cobb (490 calories, 35 g. fat, 8 g. saturated fat)

5. Soup: New England Clam Chowder (450 calories, 34 g. fat, 20 g. saturated fat*)

Crazy, huh? Just this week I made a “Which is the better burger?” handout for my patients on the local burger hot spots like Sonic, McDonald’s, Carl’s Jr., and Burger King. While not a single burger exceeded 1,000 calories, the Chipotle Chicken on Artisan and the Sierra Turkey reach that 4-digit mark…one we probably want to avoid at all costs. Similarly, not a single burger exceeded 2,000 mg of sodium, while every sandwich on Panera’s menu met or surpassed that amount**. And while Carl’s Jr.’s Famous Bacon Cheese Six Dollar Burger comes in at a sickening 950 calories and 1980 mg sodium, Panera keeps up with the best of’em in keeping us with excess poundage [1].

Want to check-out the damage in your usual order? Check it out: http://www.panerabread.com/menu/cafe/.

*Exceeds the recommended daily allowance.

**2,300 mg of sodium is the recommended limit while 1,500 mg of sodium is recommended daily for those with hypertension

[1]. Horovitz, Bruce. Panera Bakes A Recipe For Success. USA Today. July 23, 2009.