Posts tagged ‘gazpacho’

August 16, 2018

Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?
It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.
But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.
Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

steam trayI’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

July 18, 2016

Dehydration Can Increase Gastrointestinal Symptoms and Joint Pain

treeDehydration can increase gastrointestinal symptoms and joint pain. Today it’s 97º with a heat index of 105º. I’ve been without power for the past 4 days since a tree took down my electric lines in a storm. The air is back on now, but it still feels hot in my house. Even minor activity like wiping out the refrigerator I had emptied early in the outage causes me to break a sweat…inside…in the air conditioning. I keep drinking water, but I feel like I can’t get ahead.

With the constant heat and humidity, it’s a continual battle here to drink enough water in the summer. If you’re not careful, it’s easy to become dehydrated. And for someone like me who has digestive issues, dehydration can make them worse.

One of the early warning signs of dehydration is pain ranging from heartburn to gastroesophageal reflux disorder (GERD). If you have Celiac Disease or are gluten intolerant, this pain can be mistaken for a response to an accidental gluten ingestion.

Another indicator is joint pain. The cartilage in your joints is composed mainly of water and, lacking blood vessels, is dependent on water to deliver the nutrients required for maintenance and repair. Dehydration contributes to abrasive damage that happens when cartilage surfaces glide over each other when you bend your arms or knees. Since the inflammation experienced by those of us who suffer from autoimmune disorders often experience joint pain, this too can be mistaken for a problem other than dehydration.

If you feel extra tired or depressed, it can be a reflection of a lack of sufficient hydration. All I wanted to do this afternoon was sleep. I’m certain this was a result of all the hours I’ve spent in extreme heat the past few days without managing to drink as much water as needed. I have functioned through sheer force of will which is absolutely not the healthiest way to function.

When I get too hot, I don’t notice that I feel hungry or thirsty. Sometimes, I have to stop what I’m doing and eat something salty to trick myself into drinking more water.
So, how much water is enough?

Of course there’s no easy answer. It depends on size, weight, environment, and activity level. Some experts recommend between one-half and one ounce of water for each pound you weigh every day. That’s 9.375 eight ounce glasses per day on the low end and 18.75 eight ounce glasses or 2.34 gallons per day on the high end for a 150 lb person. Hardly any of us drink 2.3 gallons of water each day!

If you notice that your urine is dark, you have a headache, you’re overly tired or experience the other symptoms mentioned above, increase your water intake and see if the symptoms improve.

Also keep in mind that many fruits or vegetables contain a significant amount of water and are refreshing when served chilled. Watermelon, cantaloupe, honeydew, pineapple, raspberries, grapes, cucumbers, zucchini, and spinach are all high in water content. A chilled wedge salad or a cup of gazpacho can fill you up and hydrate you at the same time.

As summer moves toward its peak, we’ll all have plenty of opportunity to be reminded to hydrate. For those of us who struggle with gastrointestinal or joint pain, a little extra water may bring us some unexpected relief.

Bottoms up!

June 20, 2016

Summer is For Ice Cream

There’s no doubt about it, summer is for ice cream! It’s barely summer and we’ve already had heat warnings because it feels 108º outside. To me this means it is important to stay cool. That means lots of icy beverages and a steady diet of cold food.
pour over ice
I love ice cold honeydew, watermelon, steamed asparagus, and gazpacho, but there are days when I think I could eat nothing but ice cream all summer. Of course ice cream comes in many forms with vastly different quality, taste, and calorie counts. My favorite flavors always seem to have the most fat and calories so I’ve been looking for ways to enjoy the cold, but cut the fat and calories.

For instance, I like Häagen-Dazs® Chocolate Chocolate Chip Ice Cream. One half cup serving has 300 calories, 19g of fat and 22g of sugar. I also like Talenti® Sea Salt Caramel Gelato. It’s a better calorie choice with 11g of fat and 240 calories per half cup serving, but it contains even more sugar – a whopping 36 grams.

This is a common problem in American convenience foods. Fat is often replaced with additional sugar. While weight loss diets may measure the desirability of a food based on calories, fewer calories doesn’t necessarily mean healthier. The lower fat gelato also contains gum and natural flavors which I prefer to avoid.

Does this mean there are no good choices other than making my own sorbet or freezing a banana? I hate frozen bananas and I don’t want to make sorbet. I just want to grab something cold that’s waiting for me in the freezer when I happen to be hot and hungry.

I’m in luck! I have frozen yogurt bars in my freezer. They’re not perfect. They contain gum and natural flavors, but they’re only 90 calories with 2 grams of fat, 11 grams of sugar and active probiotic cultures.

There are many brands of frozen yogurt bars. My current favorite is Blueberry Outshine® Simply Yogurt Bars. Yasso® offers a similar blueberry bar with no fat content, 80 calories and 13 grams of sugar. There are additional gluten-free flavors available in the Outshine and Yasso brands, and a variety made by Stonyfield, Yoplait® and Häagen-Dazs®.
yogurt bar
And I’m sure there are more depending on where you buy your groceries. You can choose your best match by reading the ingredient and nutrition profile then sampling the product. Hmmm, sounds a lot like dating these days, but I digress.

I suppose there are other options, but since the obsolescence of Banana Fudgecicles, I really prefer ice cream as my summer staple. On the other hand, I hate feeling guilty about consuming all those calories. I’m thrilled that Greek yogurt bars limit my portion size, provide probiotics, reduce calories, fat, and sugar, and still have the soft satisfying feel of ice cream. It’s my 2016 summer bonus!

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

June 22, 2015

Travel Tip #12 – Cold Soups Vary in Different Countries

BowlIf you maintain a gluten-free regimen, it’s good to know that cold soups vary in different countries. It’s easy to assume that cold soups are lighter and less likely to be thickened with flour than a hot soup. Whether you’re in the US or traveling around the world, that can be a dangerous assumption.

I love a crisp, cold gazpacho. In the US, you really don’t even need to ask if it’s gluten-free unless it’s marketed as a traditional Spanish version or is garnished with croutons. American gazpacho recipes begin with fresh vegetables and most often contain tomatoes or tomato juice as a base.
In Spain, the traditional liquid-salad gazpacho recipes begin with pieces of stale bread blended with olive oil, vinegar, and ice water. They may or may not contain tomatoes. In La Mancha, a hot meat stew is called gazpacho manchego. When traveling in Europe, be sure to ask before you assume the gazpacho is gluten-free or even cold.

In the US, borscht recipes are sometimes gluten-free as many are in Belarus, Latvia, and Lithuania, but some versions in the US are thickened with flour and many variations in Poland and Romania contain rye bread, dumplings, wheat bran, or barley bran. Be sure to verify, borscht before ordering anywhere.

Vichyssoise sounds very fancy and French, but seems to have been invented in the US. This cold mixture of puréed leeks, onions, potatoes, cream, and chicken stock gets its thickness from the potatoes and leeks leaving no need for an additional thickening agent. When you’re outside the US, it’s good to ask since this fact may get lost in translation.
As the weather heats up, chefs around the world create delicious cold soup combinations. The majority are filled with perfect pairings of vegetables, fruits, and herbs. I know you can’t wait to enjoy a taste, but take a moment to ask if it’s gluten-free. It’s still better to be safe than sorry.