In between meals

Snacks are not my strong suit. An odd statement, surely, from a dietitian who loves to eat. There’s a saying in RD circles that a dietitian can’t leave the house without putting at least two snacks in their bag  – even if they’re only going to get the mail. I am usually no exception to this rule, and on the days that I don’t have a snack plan I’m less human and more sad, irrational mess standing at Tim Hortons, unable to decide which sugar laden treat I must consume immediately. Then the cycle repeats itself 45 minutes later once my insulin has caught up to the sugar rush… but I digress.

Eating the snacks is not the problem, it is coming up with what to put in them. One would think that since becoming  parent I should be adept at doling out nourishments several times a day. But one would be wrong. What I do is food, day in and day out, personally and professionally; I am confident in combining foods and nutrients for good health and satiety, but still I feel vexed by snacks at times. As a result, I always feel sadly inadequate and at a loss when other similarly taxed parents look at me earnestly and ask for my professional opinion on what to feed the children at brunch, lupper, and bedtime.

Just like with suppers, there can be a lot of cultural baggage that accompanies our ideas of what makes a good snack. Uncertainty over whether or not to eat, what foods to eat, and how to present it turn a small portion of your daily calories into a substantial amount of your stress. Rest assured, I have some suggestions to help us all make snacking a little easier.

  1. Eat if you’re hungry, don’t if you’re not. Some people live for snacking, others happily live without it, and, thanks to the pervasive diet culture, many others unhappily avoid between-meal bites. There is nothing wrong with snacks during the day, but it is important to know yourself and your hunger. Snacks can help stave off ravenous hunger later on, helping maintain our emotional and physical wellbeing down the line. Snacks can also be a time killer or distraction that don’t provide the kind of boost or recharge one seeks. Kids, however, always need snacks through the day, even if they claim they don’t. What kids don’t need is a new snack every hour that replaces regular meals.
  2. Think of snacks as small meals. I tip my hat to Ellyn Satter – whose books are helping solve the food battles in our home – for this succinct way of looking at between meal food. Over the last decade, snacking has taken on a life of its own, becoming a meal subcategory with separate and often distinct food choices deemed acceptable. In Canada and the US we love to label foods as to in which meal they belong (why else would we have the category of breakfast food?), but adding additional snack labels does more to constrain our choices and increase confusion than it does to help us eat well. Instead, reframe: meals are to replenish, satisfy, provide energy and nutrients. Snacks, by extension, play the same role on a smaller scale. So snacks=small meals, meals= vegetables/fruits, whole grains/starchy vegetables, protein (meats, legumes, eggs, nuts, etc), +/- additional dairy if not already included. Snacks can even literally be meals – what better way to use up those too-small-for-lunch-tomorrow portions of leftovers? There was never a rule stating snacks must come in packages or be non-traditional meal items, they just need to be filling, nourishing, and something you like.
  3. Ignore the Pinterest-worthy snack game. Making a choo-choo train out of bell peppers and filling it with little veggie people is adorable and I’m sure kids would love it, but if that’s the bar for a decent snack, then most of us should just throw in the towel right now. I am all for visually appealing food, but a solid foundation of planning and nutrition are far more important in the long run. We’re not all food stylists, nor do we realistically have hours to spend dressing our fruit and oat-parfait just right. Keep it simple and repeatable in the amount of time you actually have (not best-case scenario everyone-gets-up-on-time-and-traffic-is-smooth time), and follow the suggestions from #2.
  4. If it is labelled as a “snack” food, it probably isn’t (at least not on its own). Again, see #2. A food company including the word snack in the product’s name is an attempt to convince the consumer that this is a product that will fill the caloric void between meals. The more they emphasize the “snack” nature of the food, the less likely it is something that is filling and nourishing. While tasty, there’s nothing about a Doritos snack pack that is going to keep me satisfied even until the end of the bag. Include these items occasionally if you like, but pair it with something a little more satisfying.
  5. The same rules apply to kids. No where is the term snack food more prevalent than the lunch-box-filler aisle at the supermarket. Based on the sheer volume of products marketed for kids, an unenlightened observer may come to believe that school aged children are incapable of consuming anything other than packaged foods. Even infants and toddlers have their own crackers, cookies, noodles, and fruit squishies. Bright packaging and the promise of no more food battles wins over demanding kids and their weary parents. But so few of these items are necessary; they serve mostly to add additional items to shopping carts and pantries and increase the bottom line of the food companies. There is no such thing as adult food and kid food; we create that distinction by believing the marketing that kids need an entirely separate diet than adults. Aside from a few developmentally specific and fortified items like infant formula or infant cereal, kids are perfectly able to eat any food – so long as we let them. This is a tricky one for parents managing busy lives, peer pressure, and marketing to kids; truth be told it will be hard at first. Remember we’re playing the long game here, for some, the long-long game. Nourishing snacking habits take time and adult consistency to develop. This means giving them the same types  of snacks we would give ourselves, with some of those fun snack foods thrown in here and there to shake up the routine.

Enjoy your small meals, invest in some snack-size food containers, and happy snacking.

If she can’t help herself, I can’t trust her to help me

Me to my patients: slow down and take the time to eat. Chew your food well, savour it, experience it. Spend some quality time with your meal and engage with your body and the process of eating.

Me at home: (consumes entire plate of dinner within 5 minutes, may not have chewed every bite).

Me to my patients: sit with your children, eat together. You are as entitled to regular meals as they are. By sitting with them, you nourish yourself and you model healthy and nourishing behaviours for them.

Me at home: Thinking, with each hand occupied feeding the children and no hands available to feed myself, “why do I bother trying to eat with them, again?”.

The above may not be a fair representation of every day, or every meal in my life, but to claim it doesn’t happen at all would be dishonest. I may be a dietitian, and counselling on healthy eating habits may be a big part of my job, but I am not immune to the pressures and strains of life, particularly now that I have kids (plural). With both children now eating meals with us, the barriers to following my own advice are larger. This does not mean that I do not try my best, nor that I am forgoing the principles and planning needed for happy, successful, and mindful eating. I am fallible, I have limits to my time, energy, and patience like every other parent and human. I am a better practitioner for it. I can better empathize and help my patients develop plans that will  work for them. I can be supportive if or when their efforts still aren’t producing desired results. I can assure them that challenges are universal; I can build rapport and avoid putting myself on a golden pedestal.

Health care providers, particularly the sort who are paid to engage in behaviour modification advice and education, are often held to a higher standard for the success of the same interventions in their personal lives. Anything less than perfection is failure and all credibility is denied. Our culture’s edited, filtered, snapshot view of what life should look like builds an impossible standard for ourselves and care providers. It reduces complex, interacting, and evolving factors to simple yes or no judgements; it completely denies that success is most often a fluid state that is different for each individual.

Choosing whom to trust with one’s health is not a contest of who has the best testimonial. Credibility is built on evidence-based training, recognized experience in the field, the ability to follow scientific principles and use quality clinical judgement, among other things. Credibility is not the illusion of perfection.

 

 

Happy Dietitian’s Day

I can’t even begin to count the number times I’ve said some variation of “should have been a nurse…” since starting down the path of becoming a registered dietitian. Getting to a place where I feel comfortable in my career and have had stable employment has taken years. The struggle for recognition within and outside of mainstream healthcare feels, at times, a futile endeavour. Keeping up with the constant bombardment of nutritional quackery and charlatan health gurus is exhausting and appears fruitless for all the labour it entails. Why not pack it in, switch streams, at the very least to one where I get paid more to deal with the same things.

At the same time, the longer I practice, the more certain I become that nursing, pharmacy, etc are not for me. I am so fortunate to work with some phenomenal nurses and pharmacists; these are great professions and great people, but that path is just not for me. For every job I’ve held I’ve tallied a fair breadth of experience, and, knowing my cautious self, I may never had pursued this had I settled into a less precarious work situation. The struggle for recognition is draining, but the longer I work, the stronger my conviction the world needs more credentialed  and reliable nutrition professionals. And boy, is debunking nutritional nonsense fun.

I should not have been a nurse. I am where I should be. Talking about food all day is what I do best. Working with patients and other healthcare professionals to keep people healthy and PREVENT ill health is more rewarding than I ever thought possible (even if the long-term outcomes of my efforts aren’t immediately visible). Through this work I’ve met so many wonderful RDs and I learn so much from them every single day; they inspire me to be better and try new things.

Happy dietitian’s day to all my fellow dietitians.

p.s. and yes, talking about food all day does make me hungry. All. Day. Long.

 

Women’s work

International women’s day is upon us, as is the #daywithoutawoman general strike. To all women in all countries, of all colours, of all religions (or none), of all orientations, I salute you in your endeavours. We are strong, brave, capable, and smart. We must believe that we are a force to be reckoned with, and no amount of laws, policies, brutality, and lies can hide that truth.
Hats off to all the women who went on strike today. As I’m currently on maternity leave, I chose not to send my child to daycare (which is staffed by mainly women of colour – but the day remains paid so their wages will not be affected) and limited my unpaid work at home. The fact that so many more women wanted to strike today but felt that they couldn’t – either because it would cause undue hardship to themselves or another woman who would be forced to take their place – shows just how necessary this strike action is. Society still expects women to consider the needs of others before themselves and to put their own agendas aside. Society sees large and important actions like a women’s strike as merely an inconvenience. Society expects that life should continue uninterrupted when 50% of the population (doing more than 50% of the paid and unpaid work) remove themselves for a day. Society disproportionately forces women into situations where they have to choose between feeding/sheltering themselves and their dependants and speaking out against the system that causes the problems. Society is too cowardly to admit that those with the most power would not be where they are without the work , which they happily deride, of women and marginalized peoples.
Women’s rights and the celebration of women’s contributions to society hold a special place in both my personal and professional lives as 95% or more of registered dietitians identify as women. The workplace inequalities women face are apparent on a daily basis in my field, be it through inadequate positions, stagnant wages, or near constant workforce departures due to parental leave or family member care. I would wager that our seemingly eternal struggle to be seen as THE health care experts in the field of nutrition is not insignificantly impacted by the small representation of men and our roots in home economics . And still, while shouldering our societal burdens, these talented women in nutrition are running businesses, providing excellent patient care, managing health care and food services, creating policy and law, educating future health care providers and conducting research. And they are doing a damn fine job.

Nutrition information you can swallow: on avoiding food fads and bad advice

We live in an amazing technological age with access to information and education unprecedented in human history. The internet in particular is such an important vehicle in information sharing: in most places it is open to all to explore and it provides a platform for anyone, including me and this blog, to discuss and publish nearly anything they like. With a few words typed into a search bar the average human is presented with thousands of items to peruse; if there is a question, there is also an answer or a thousand. The abundance of information with accompanying lack of vetting is often a double-edged sword, and the world of nutrition and lifestyle information is no exception. On one side it is wonderful to see some many people interested in eating well; the more people who get as excited as me about nutrition and food, the better. The other side is innumerable claims that lack evidence, plausibility, and good science. I would wager that nutrition has it worse that many other topics for a couple of reasons. First, every human needs to eat in one way or another to survive (sorry breatharians), so we all have a stake in food and nutrition, while we don’t all, for example, have a stake in astrophysics or small engine repair. Second, we westerners tend to judge ourselves and others by the foods that we choose, thus the focus on eating well and choosing the “right” foods. All told, there is still a lot of great nutrition info written by dietitians, health professionals, scientists, and health enthusiasts alike, the trouble is figuring out what is advice worthy of following, what is questionable, and what is downright dangerous.

Below is a list of 5 questions to ask when consuming nutrition information, adapted from this resource.

  1. Is the person or product promising a quick fix like fast weight-loss or a miracle cure? If it sounds too good to be true, then it likely is. If there’s one thing we know about being healthy, it’s that there’s no magic pill that will get you there. If there’s two things we know about being healthy, it’s that a person’s health is the outcome of the interactions of hundreds of different factors in both their body and their environment. It is anything but simple. Simple solutions are not going to “fix” systemic problems. Accredited health professionals don’t make these kinds of promises because we know they’re false, and we’re legally not allowed to do that.
  2. Are they trying to sell you products such as special foods or supplements? Do they make claims that sound something like “you can’t be healthy without this herb/supplement/etc.? Do their claims make you feel as though you’re failing for not already using this product? Beware the salesperson (whether you are aware that that’s what they are or not) who pitches your ailment and miraculously also sells the “cure”.
  3. Do they provide information based on personal stories (i.e. testimonials) rather than on facts? Although it’s nice to hear about a success story from a celebrity, it’s not proof that something works or is true. Always keep in mind: the plural of anecdotes IS NOT data. One hundred “it worked for me” stories without credible evaluation tell us nothing about a products/program’s efficacy or safety. Paid testimonials need to be taken with a large rock of salt because these people have a vested interest in making the product look good. Finally, never underestimate the power of investment bias. The more a person has to lost from using a product/service, the more likely they are to give that thing a positive review, deserved or not.
  4. Is their claim based on a single study or a few research studies? A single study is not sufficient evidence on which to base treatment recommendations (in the vast majority of cases). Were the studies with animals or humans? Many of the most appealing and attention-grabbing headlines refer to studies conducted in vitro and/or in animals. These types of studies are important and fascinating but score low applicability points. Are you similar to the humans that were studied (age, sex etc.)? If not, you may not experience the same or any effect as claimed. The stronger the study design (blinded, more participants, proper controls in place) and the more studies available that draw the same conclusions, the stronger the evidence that something it true.
  5. What are the person’s qualifications? Remember that anyone can call themselves a nutritionist, a nutrition expert, a culinary guru, a nutrient savant, and any other official-sounding title you can think of. Their education in human nutrition can range from non-existant to university training. Some may even be non-nutrition health providers. Only dietitians have accredited degrees and practical experience specifically in nutrition. Calling one’s self a “nutritionist”, having a medical degree, or adding a fruit or vegetable to one’s name does not bestow the authority of nutrition advice provision on that person. Make sure whoever the source, their training is science-based and from a reputable and accredited source.

Asking these 5 questions before absorbing nutrition advice can help steer clear of money grabs, lies, and potentially harmful practices, all of which go a lot further to keeping you well than many foods fads.

 

Exclusively yours

To my dear babe as you start solids,

Nursing you has been a joy and a test, for which I was unprepared. You are not my first child to nurse, but just as a parent has a unique relationship with each child, so too was our nutritional bond. I had been to the trenches and back nursing your sister and while I wouldn’t want to relive those days, I am forever thankful for all that I learned through them. With you, I knew what was worth my worry and what would simply take some time. I learned that I am capable of producing ample, at times excessive, milk to nourish a growing infant, something I was not sure was possible the first time around. And you loved to nurse, day and night, more than anything else. I was overcome with the fulfillment of those moments, the simplicity of knowing there was (almost) no problem that could not be solved with nursing. It was easy in so many ways: you and I, together, and all was right with the world.

If only the world could have conformed to that idyllic vision, the demands of life and daily schedules and other family to be ignored indefinitely. While I loved those moments of togetherness, they began to weigh me down. Your tiny body in my lap, so warm, so sweet, so innocent, became an anchor keeping me in the storm. The responsibility of being your only lifeline, your only comfort became crushing. After our peaceful moments, when reality would rush in, I was overwhelmed and lost. I was losing me, who I was, who I needed to be for myself and for others. I love our bond, I love that I could be your everything; I do not love that I could be only your everything.

Today you happily eat every bite-size morsel in sight. I love your eagerness to expand your palate while you continue to enjoy nursing. I looked forward to this time for so long, for the freedom it would inevitably bring. I am happy and feeling myself again, but it is bittersweet all the same. For better or worse, there is no going back. I will never again have the answer to all of your problems, but I have more of me, and others behind me, to help you through any struggle.

No longer exclusively yours,

Mom

Nutrition Month 2017: take the fight out of food

March is special for many dietitians in many ways: fiscal year-end at many of our workplaces, renewal time for College and national association memberships, a mad scramble to get in those last few continuing education points (or find the paperwork for those lunch and learns you’re certain you did THIS year). Oh, and nutrition month! A month to spotlight the importance of good nutrition for every person; a month to showcase dietitians and the wonderful and varied work they do throughout the country. Many local municipalities and provincial/territorial governments release official proclamations for this month every year, and nutrition month events can be found almost anywhere a dietitian works.

Have you heard of nutrition month? Maybe you’ve seen the posters in a local healthcare provider’s office. Did you know that each year there is a new theme? This year the focus is all about renewing our relationship with food, whether that means figuring out where to find safe and trustworthy nutrition advice, making mealtime and food decisions less of a battle ground (for yourself or for others), or learning to eat in a way that is both pleasurable and helps manage your health conditions. Because eating well doesn’t (and shouldn’t) mean forbidden foods, unsafe diets, mealtime meltdowns, or bland and boring meals. There are so many great resources to check out, including the official Nutrition Month 2017 materials at www.dietitians.ca, the Nutrition Summit 2017 at www.nutritionacademy.co, your favourite dietitian’s blog (don’t have one yet? find a new one here), and I’ll be doing my part to make nutrition the star of the month.

Bon appetit!