By Jessie Funchion, MS, RD, LDN

1)    How long is it recommended to breastfeed? 

6 months exclusive breastfeeding (according to AAP/WHO/AND), and ideally longer with complementary foods. The AAP recommends at least 1 year and the WHO recommends at least 2 years. 

2)    How long does a feeding session take? How much milk is the baby getting? 

At first, probably each feeding will likely take 30-45 minutes and should occur every 2-3 hours, or on demand. From 0-6 months, the infant will likely get around 25-30oz a day, for a total of 400-600 calories. 

3)    What are contraindications to breastfeeding? 

Mothers who..

–       Are HIV positive in the U.S.

–       Have untreated brucellosis 

–       Have Human T-cell lymphotrophic virus type I or II or use street drugs

–       Use street drugs 

Infants who have galactosemia, an inborn error of metabolism that is diagnosed first few days of life, also should not breastfeed. 

If mothers have hepatitis C or are hepatitis B surface antigen positive, have a fever or take certain medications (See LactMed) or have exposure to low level environmental chemicals, they can still breastfeed! If the baby has jaundice, they can also still breastfeed (it may even help). Occasional alcohol or cigarette use is also compatible with breastfeeding, though not encouraged. 

4)    What is breast milk composed of? 

Breast milk composition changes over the course of the baby’s life, as well as over the course of a feeding. Colostrum is rich in protein and fat soluble vitamins and produced in very small amounts (only 1  tsp/feeding). Mature milk is actually 90% water and 10% macros, and is around 20 calories per ounce. The macronutrient composition is mostly carbohydrate (lactose), low protein (7-8%) and the fat content is variable. 

Breast milk also contains a ton of ‘non-nutritive’ substances such as immune factors, appetite regulating hormones and prebiotics. 

5)    What are the benefits of breastfeeding for babies? 

Breastfed infants have lower rates of gastrointestinal and respiratory infections, ear infections, necrotizing enterocolitis and SIDS. There is also correlation between breastfeeding and lower risk of chronic disease such as type 1 diabetes, Celiac disease, obesity, asthma, dermatitis and leukemia, but more research is needed. 

6)    What are the benefits of breastfeeding for moms?

Women who breastfeed have a lower risk of hemorrhage after birth, post-partum depression and premature return of ovulation. There is correlation between nursing and body weight/weight retention, type 2 diabetes, cancer (breast/ovarian), heart disease and hypertension, but again, more research is needed. 

7)    What supplements should mom and baby take? 

It’s not a bad idea for women to continue taking a prenatal vitamin while nursing, but the biggest nutrients of concern are Calcium, Vitamin D and Iron. Exclusively breastfed babies should receive 400IU Vitamin D each day. 

8)    When should complementary foods be introduced? 

Generally 6 months of age. Some signs that infants are ready for food are…

–       sitting up on his own 

–       reaching for a spoon 

–       not spitting up food 

–       growing teeth 

It’s recommended to start with iron and zinc rich foods such as dark leafy greens, meat, fish or iron-fortified cereals. 

9)    How do I know the baby is getting enough milk? 

–       GROWTH: The infant should be progressing appropriately along his or her growth curve

–       DIAPERS: 1 dirty/1 wet on day 1 of life, 2 dirty/2 wet on day 2, etc., until infant produces around 3-4 dirty diapers each day and 5-6 wet diapers each day. 

–       BEHAVIOR: Infants should appear somewhat relaxed and satiated after a feeding 

10) What should mom include in diet? Avoid in diet? 

 Women’s diets should look pretty similar to their third trimester diets, about 400-500 extra calories a day. Focus on a well balanced diet that includes all 5 food groups. Women should drink to thirst, but aim for 3L total fluids each day. 

Limit caffeine to 300mg/day and seafood to 12oz/week. Alcohol can be enjoyed in moderation, but keep in mind alcohol in milk peaks about 30-90 minutes after consumption. 

And remember, while ‘breast is best’, we’re very lucky in this country to have formula as an excellent back up plan!  


Source: DietitianCentral.com, “Nutrition During Lactation: The First Year and Beyond” 
Resources: https://www.nutrition.gov/subject/life-stages/women/breastfeeding— 

By Elizabeth May, RDN, CSOWM, LDN

This is the time of year when many of us are focusing on our goals and getting back to meal planning, tracking and weight loss. We know that self-monitoring is the single most effective strategy for weight loss, so let’s talk about tracking!

Apps to Track

– LoseIt

– My Fitness Pal

– Calorie Counter

– SparkPeople

– See How You Eat

– Fitbit

– YouAte Food Diary

Journals to Track

  • Today is the Day:A  90 Day Food + Fitness Journal
  • Hello New Me

Other Ideas:

  • Jot down food in Notes section on phone
  • Take pictures of food and create an album on phone
  • Post your food pics on Instagram

How to Make Tracking a Habit:

  • Pick an easy to use method
  • Track immediately after a meal or snack
  • Set an alarm on your phone to remember to track each day
  • Choose favorites in your App to make tracking fast
  • Add friends to your App to keep you accountable
  • Set a goal with your Family Food dietitian to check your App at your next visit

How Does Tracking Help?

  • Keeps you accountable
  • Learn correct portion sizes
  • Creates awareness of food habits (“aha moments”)
  • Allows for a record of your improvements

By Carlie Saint-Laurent, RD,LDN

The new year brings new resolutions and like most of the US population health and weight loss are on top of the list.  Many people are looking to Complimentary Alternative medicine to rid their health condition. Apple cider vinegar (ACV) is one of those natural ancient remedies believed to aid in diabetes, high cholesterol, hypertension, digestion, and weight loss still to this day.

So what’s the truth about apple cider vinegar when it comes to weight loss?

 

One 12-week study had consisted 175 obese Japanese participants split up in to 3 groups. 1 group consumed 1 tbsp, the other group consumed 2 tbsp and group 3 consumed no ACV. The results found both groups consuming ACV had lower BMI, visceral fat, and LDL cholesterol compared to the placebo group.

 

Apple cider vinegar however maybe more effective in managing blood sugars especially in people with prediabetes. The mechanism behind this is the acetic acid in the vinegar impedes the starch enzymes from breaking down therefore ACV (along with any vinegar for that matter) is beneficial when consuming starches like bread and pasta. When the starches are not broken down the blood sugars aren’t elevated, and this in fact could control appetite as well.

 

Nutrition recommendations:

–       Consume foods that already contain vinegar like dressings, pickled foods, condiments like relish or ketchup

–       For best results consuming consistently and regularly is key

–       If going to consume ACV ensure ratio is 1 tablespoon for  8oz of water to avoid damaging teeth, throat, and stomach lining due to the acid

–       Do not exceed more than three times a day of 1-2 tablespoons per serving as it can be harmful

–       For first timers start off with 1 teaspoon to see if any adverse reactions such as nausea occur

–       If one has gastroparesis it should NOT be recommended as delayed stomach emptying can be increased

–       Consume right before the meal where it can have the most synergistic effect

 

Sources:

https://reader.elsevier.com/reader/sd/pii/S0308814616318076?token=6D9B5941533DE6B261116DBDB7B3F41EF6F0B79EE6710D50EBAA6A481B42D30719C736824DB9DFF9DBC74230ED9D83F0

https://edition.cnn.com/2017/07/19/health/apple-cider-vinegar-weight-loss/

https://www.healthline.com/nutrition/apple-cider-vinegar-weight-loss#section7

 

By Jessie Funchion, MS, RD, LDN

A lot of people assume they have to cut out sugar altogether, but I often encourage a more moderate approach. As we all know, complete deprivation often leads to binging. In fact, the Dietary Guidelines for Americans 2015 allows (or maybe just assumes), that we’ll all eat around 150 “discretionary calories” a day. Discretionary calories are excess calories to enjoy once your required nutrient needs are met (think sweets, salty snacks, alcohol).

 

Try and stick to these ground rules:

  • Have it once or twice week, 100-200 calories or less each time
  • Fruit is always best
  • Pre-portioned/single serving desserts are second best
  • Plan for it. Don’t let desserts ‘happen’ to you. Build them into your diet and enjoy them!

 

Try and nix dessert if:

  • Your 150 discretionary calories have already been used up that day (on beer, margaritas, chips, Cheetos, etc.)
  • You know it’s a slippery slope
  • You’re having trouble reaching your goal weight

 

Here are some of my go-to suggestions: 

  1. Dark Chocolate. My new favorite brand is Theo’s.
  2. Single serve ice cream bars (Skinny CowYasso). Individually wrapped desserts are guaranteed damage control!
  3. Banana ‘nice cream– basically frozen and blended banana chunks with any assortment of toppings.
  4. One piece of fruit, or 1 cup chopped fruit. This one may get an eye roll (surprise surprise, a dietitian is suggesting fruit for dessert, but you never know!)
  5. Parfait – Low-fat Greek yogurt with ½ cup berries. This one is sweet and has some staying power, thanks to the fiber and protein.
  6. Edy’s Outshine Fruit Bars
  7. Half a whole wheat English Muffin with a single serve Hazelnut Butter
  1. Healthy Cookie Dough Balls

 

By Jessie Funchion, MS, RD, LDN

Tis the season! For cookies, cakes, pies and more. Did you know that the average American consumes about 22 teaspoons of sugar a day? For most people, that amounts to nearly 150 pounds of added sugar a year! This far exceeds the recommended daily intake of added sugar of 36 grams (9 teaspoons) a day for men and only 24 grams (6 teaspoons) a day for women.

1) Swap out the sweet drinks

Sweetened drinks are the most common source of added sugar in American diets. To start, skip sugar in your coffee and add sweetness with a sprinkle of cinnamon. Also, nix sweetened iced tea and sodas, and switch to fruit-infused water or flavored seltzer.

2) Switch to natural sugar sources

Sugar in the form of whole fruit (fructose) or dairy (lactose) is a healthier alternative to sugary foods. Fruit and dairy come packed with fiber, protein, fat, and/or phytochemicals (the antioxidants found in fruits and vegetables). Add fruit to your oatmeal or cereal or enjoy 100% fruit juice in controlled portions (4-8oz/day). And if you must splurge for dessert, try to limit yourself to one 100-calorie treat a day or less.

3) Log your food intake for a few days 

You may be surprised to find you’re consuming way more sugar than you realized. Tracking helps increase your awareness and helps you find ways to cut back. Apps like My Fitness Pal allow you to track the nutrition content of the foods you eat.

4) Check food labels for sugar content

Some foods that you THINK are healthy are often loaded with added sugar. The worst offenders include:

  • Instant oatmeal
  • Breakfast cereal
  • Yogurt
  • Jarred pasta sauce
  • Condiments like ketchup and barbecue sauce
  • Salad dressings, especially fat-free dressings
  • Granola bars

As a general rule, add up the grams of fiber plus the grams of protein per serving—the number should be greater than the amount of sugar. Or, simply stick to foods that have less than 5 grams of added sugar per serving.

5) Drink some water or take a nap

You may not be surprised to hear that you crave sugar when you’re tired. But, you MIGHT be surprised to find that you crave sugar when you’re actually just thirsty. Think about whether you need to rest or simply drink a cold glass of water before you reach for the sweets.

 

By Elizabeth May, RDN, CSOWM, LDN

Researchers at the University of Guelph found an interesting link between hunger and mood. Read more about the study published in Psychopharmacology here.

The Basic Gist
Rats were given glucose blockers to induce hypoglycemia (low blood sugar). When the rats were removed from this chamber and injected with some water, they avoided going back in the original chamber where they experienced the hypoglycemic reaction. When researchers checked the rats, they found elevated levels of corticosterone (stress indicator). The rats were apparently stressed from the hypoglycemic experience. Not surpisingly, the rats were also more sluggish after being given the glucose blockers. However, when the rats were given antidepressants, they weren’t sluggish.
The rats experienced both stress and depression when given the glucose blockers. Researchers pointed out that hypoglycemia could have a negative long term effect on depression or even on causing depression. Nutrition yet again plays such a huge role in health!
How To Manage Hypoglycemia
  • Eat 5 to 6 small meals or snacks each day rather than 2 or 3 large meals to help steady the release of glucose into the bloodstream.
  • Eat consistent amounts of carbohydrates at meals and snacks each day and avoid skipping meals.
  • Spread carbohydrate foods throughout the day. Include protein foods and vegetables at each meal for satiety and extra calories, if needed.
  • Avoid foods that have a lot of sugar and carbohydrate, especially on an empty stomach. Examples are regular soft drinks (sugar-sweetened beverages), syrup, candy, regular fruited yogurt, cookies, pie, and cake.
  •  Avoid beverages and foods that contain caffeine. Caffeine can cause the same symptoms as hypoglycemia.
  • If you choose to drink, limit alcoholic beverages to 1 drink per day for women or 2 drinks per day for men. Drinking alcohol on an empty stomach and without food can cause hypoglycemia.

By Elizabeth May, RDN, CSOWM, LDN

Frozen meals have their time and place in a healthy eating pattern. They can be convenient, affordable and if you are careful, they can still be relatively healthy!

Frozen meals can even be effective for weight management. The Academy of Nutrition and Dietetics Weight Management Position Paper  recommends utilizing 1-2 meal replacements a day as a weight loss strategy. With this in mind, let’s get to know some good options that are out there.

Brands to Look for: 
  • Healthy Choice Power Bowls
  • Health Choice Cafe Steamers Simply (low carb)
  • Health Choice Cafe Steamers
  • Lean Cuisine
  • Weight Watchers Smart Ones
  • Amy’s
  • EVOL
  • Kashi
  • Luvo
  • Sweet Earth
  • Caulipower Pizzas
  • Gardein
  • Red’s Natural Foods
  • Green Giant Steamers
  • Some Trader Joes meals (with discretion)
General Nutrition Guidelines for Frozen Meals:
  • <500 calories
  • <500 mg sodium
  • 0 g trans fats / no hydrogenated oils
  • >15 grams protein
  • >4 g fiber
  • No added sugar (read labels)
  • <4 grams saturated fat
Other Tips for Meals:
  • Meal Components: Protein (beans, poultry, lean meat, fish, edamame) + Veggie + Whole Grain/Starch (brown rice, corn, sweet potatoes, quinoa, whole wheat pasta, etc.)
  • Meal Balance: >1/2 cup veggies, 3-4 oz protein, small portion starch/grain
  • Look for lean meats (pork tenderloin, chicken, turkey, fish)
  • Skip fried foods, meals with gravy and cream sauces and pasta/carb heavy meals
  • To add more veggies to the frozen meal: Add side salad or pop a frozen bag in the microwave
  • To add more protein to the meal: Add beans, an egg or slices of chicken
  • To add healthy fat to the meal: Add some avocado
  • Omit the sauce from the frozen meal or use less of it
  • Wanting dessert after the meal? Choose some fresh fruit like berries with SF whipped topping or grill apples/pears or eat a few dried dates

By Jessie Funchion, MS, RD, LDN

 

1)    Eating before Trick-Or Treating. Hitting the streets with a hungry belly will mean lots of snacking throughout the night. Have a regular dinner with your family before trick-or-treating. Protein (think chicken, fish, beans) and fiber (veggies and whole grains) are especially satiating and will hold you over until that last doorbell rings.

2)    It’s not ALL about candy. Costumes, contests, games and music are all festive ways to get into the spirit.

3)    Portion control. Ever heard of eating off of a smaller plate to reduce portion size at dinner? Use this same trick for trick-or-treating. Swap out that XL pillowcase (which seems bottomless) for a smaller plastic bag. A full small bag is still less candy than a partially full pillowcase.

4)    Don’t plan ahead. Stocking up on Halloween candy weeks in advance is never a good idea. Chances are you’ll go through that stash and have to go buy more anyway. Instead of having that temptation in the house, buy your treats just a day in advance.

5)    Set some rules. Figure out what works best for your family, but here are some ideas…

  • Only take one piece of candy per house
  • Have X amount of candy on Halloween night, then X amount each day after. (i.e. as much as you want that night, and one piece a day after that)

6)    Smart Storage. Out of sight, out of mind. Try storing the excess candy in the freezer, or in opaque jars or containers. If it’s out in easy to access bowls or clear jars, it will be a constant source of temptation.

7)    Throw it out. Sometimes enough is enough. What’s that? Food waste? I hear you. But isn’t it a ‘waste’ of calories to fill your family on empty, sugary calories?

8)    Be mindful. Even the most health-conscious family should indulge in their favorite sweets every now and then. When Halloween comes around, enjoy your candy mindfully. Eating mindfully means focusing and enjoying your food. Turn off the TV/phone/game, eat slowly, and focus on the smells, textures and tastes of your favorite treat.

by Carlie Saint-Laurent, RDN

Did you know headaches, specifically migraines, effect 12% of the adult population?  This equates to 30 million adults! This negatively affects the productivity of the economy, significantly. Migraines occur between the ages of 10-40 and wean after 50 years old.  Headaches can be accompanied with nausea, vomiting, vasospasm, sensitivity to light or sound, increased coagulation, and visual disturbances.

Let’s first  note the different types of migraine:

1)Migraines with aura (MA), also known as classic migraines,  are headaches causes by visual and sound disturbances.

2) Migraines without aura, also known as MO, which is more prevalent.

Awareness of the type, severity, and the symptoms of the headaches could help us provide better recommendations for clients.

The possible causes and associations of  migraines are; decreased sleep and food intake, fatigue, stress, anxiety, melatonin disturbances, exposure to light, celiac disease, women on their menstrual cycle due to lowered estrogen levels , and certain medications and supplements like black cohosh, ephedra, and sibutramine.  Furthermore, a BMI greater than 25 increases risk and/or worsens migraines.  It’s important to keep in mind that headaches can be multifactorial and vary case by case.

Supplements and herbs that have little to no evidence but may help:

  • magnesium
  • Coenzyme Q10
  • riboflavin
  • ginger
  • red pepper
  • evening primrose
  • feverfew
  • red pepper
  • Melatonin
  • vitamin D

 

Nutritional considerations:

  • Keep a Diary/ record of foods consumed with onset headache. This can provide your Family Food Registered Dietitian with valuable data.
  • Monitor symptoms aftereliminating a potential food trigger from diet
  • Detect any onsets with foods containing tyramine, histamine, nitrites, nitrates, aspartame, monosodium glutamate, phenylethylamine, and sulfites
  • Get adequate sleep/relaxation and overall self care (exercise, smoking cessation, meditation, ect)
  • Regular mealtimes and patterns, as skipping meals can lead to headaches
  • Moderation of caffeine, According to the American migraine foundation, coffee consumed sporadically can reduce migraines and recommends less then 100 mg of caffeine.

Possible headache-causing foods

Alcohol  
Caffeine: Soft drinks, coffee, tea
Chocolate  
Fermented foods: Red wine, chicken livers. Sauerkraut
Fruits: Bananas, figs, raisins, some citrus fruits
Gluten  
Histamine-containing foods: Avocados, aged cheese, spinach, tomatoes, yogurt cider, dried fruit, eggplant
Ice cream: If sensitive to the cold
Monosodium glutamate (MSG)  
Nuts, peanuts, soy foods: May contain vasodilators
Processed Meats: Hot dogs, bacon, ham, jerky, corned beef, salami,
Sulfites: Shrimp, dried fruits packaged potato items, salad bar items
Tyramine: Fish, chocolate, soy sauce, cheese, alcoholic beverages, processed meats
Vegetables: Onions, pea pods, lima beans

 

Sources:

Escott-Stump, S. (2015). Nutrition and diagnosis-related care. Philadelphia: Wolters Kluwer.

Halker, R., Ailani, J., Dougherty, C., & Slavin, M. (2016). Migraine and Diet. Retrieved from https://americanmigrainefoundation.org/understanding-migraine/migraine-and-diet/

Shaik, M. M., & Gan, S. H. (2015). Vitamin Supplementation as Possible Prophylactic Treatment against Migraine with Aura and Menstrual Migraine. BioMed Research International, 2015, 1-10.

Whitney, E. N., & Rolfes, S. R. (2011). Understanding nutrition. Boston, MA: Cengage Learning.

 

By Jessie Funchion, MS, RD, LDN

 

Back to School… 

It’s that time of year! Summer is practically over and school is back in session. A healthy lunch can be tricky with kids, so here are some ideas to get you started.

First option – school food. While cafeteria food rarely gets a great rap, these days school lunches are strictly regulated and actually must require a specific combination of fruits, vegetables, whole grains, lean protein and dairy in order to qualify for federal reimbursement. So, while they may not be the tastiest options, school provided lunches are relatively well balanced and nutritious.

 

Second option – packed lunch. Couple things to keep in mind…

  • Think Food Groups. MyPlate is the latest food graphic published by the USDA, and can make a great guide for parents as they pack lunches. Try to include at least 3 of the 5 food groups at each meal.
  • Pack at least one fruit or vegetable.
  • Keep it simple. School lunches are not the time to get adventurous and introduce a new food to your child. Try to pack mostly foods you know they will like, and maybe one riskier pick.

 

Here are a few ideas…

 

1)    Healthier PB&J – Instead of spreading sugar-packed jam or jelly, try mashing fresh berries or slicing banana onto the nut butter instead. If allergies are a concern, sunbutter is a safe nut free option. Whole grain bread has more fiber than white bread, which will make it more filling.

2)     Quesadillas – Choose whole-wheat tortillas, low fat cheese, and a protein source like black beans or grilled chicken. Bonus points for sneaking in some veggies! Kids love hand-held food, and quesadillas hold up relatively well overnight.

3)    Veggies and Dip – If veggies are a tough sell, try packing a dip or spread such as hummus, salsa or yogurt-based dressing. These dips provide flavor without a ton of extra fat or salt.

4)    Skewers – The options are endless here. A classic combination is tomato, mozzarella and cucumber, but you could make skewers with chicken, tofu, and any fruit or vegetable your child likes.

5)    Pasta salad – Grain based salads hold up well in a cooler, and can be eaten chilled or at room temperature. Pick a pasta shape your kid will like, and mix in vegetables and protein source like chickpeas, chicken or cheese.

6)    See our Pinterest page for more dietitian-approved ideas.

 

If some of these seem a little adventurous, parents may find it helpful to get kids involved with the packing process. While this will take a little extra time at first, kids are more likely to try a food if they’ve picked it out themselves or even helped prepare it. Kid friendly tasks include mashing berries, ripping up lettuce or spinach leaves, sticking fruit on a skewer, or stirring dressing into a pasta salad. Picky kids often require repeated exposure to food before trying it, upwards of 30 times! So we encourage parents to be patient, continue offering new foods, and get their little ones involved with the process.