Forget Talking Turkey; Let’s Talk Tofu

Forget talking turkey; let’s talk tofu!  With an uptick in plant-based diets, along with meat shortages due to the pandemic, tofu has become a more prominent protein in the US over the past year. Sales of plant-based foods the third week of March 2020 were up 90%.

While having enough popularity to be continually consumed in Asia for over 1000 years, the American market has mostly viewed tofu as a tasteless something you really don’t need on your plate. But that take denies some of the health benefits of this soybean product.

Like eggs, tofu is a complete protein. It contains calcium, magnesium, iron, and zinc plus it’s cholesterol free, sodium free, and low in saturated fat. A 3oz serving of extra firm tofu contains about 80 calories, 4 total grams of saturated fat and 8 grams of protein. That’s less protein than beef, but also less than half the calories. A 3oz plant-based burger has about 15 grams of total fat, 15g of protein and 203 calories.

A 2019 retrospective study that included a total of 330,826 participants showed consuming soy/soy products was inversely associated with deaths from cancers and cardiovascular diseases. The authors concluded: “Soy and its isoflavones may favorably influence risk of mortality. In addition, soy protein intake was associated with a decreased risk in the mortality of breast cancer.”

That’s a lot of pluses. Why don’t we like it? Perhaps because it falls into the “tastes like whatever is next to it” category. While that actually makes tofu wonderfully versatile, it also means some preparation is required to bring it satisfying taste and texture when it’s the main focus. But tofu can also be used to add protein to yogurt, smoothies, shakes, and salad dressings.

My sister has been deliberately adding protein to her diet, so my brother-in-law bought her some high-protein snack bars to take to the office. She shoved one in her backpack. Later that morning, she took it out, took a bite, and thought, that’s pretty good. Wonder what’s in it? She consulted the label.

Big mistake! Once she read the words cricket flour and visualized crickets in her food, she was D-O-N-E done…forever. A tofu smoothie would not have elicited the same response!

Not only is tofu good in a smoothie, it can be used as a dairy-free substitute for ricotta cheese in lasagna or as a dairy-free pudding base. It’s also delicious seasoned, baked, and added to stir-fry or bowls.

Should you rush out and buy some tofu? If you’re not familiar and love to experiment, then absolutely yes! If you want to add some quick protein to everyday foods without adding lots of fats, or insects, then yes! If you have estrogen-sensitive breast tumors or thyroid problems, then it may be best to consult your physician first before incorporating soy into your diet.

For most of us, tofu can be a healthy addition to any meal. It can fill gaps when other proteins are not available. And it can round out a plant-based diet. Those are all great reasons to talk tofu!

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?
health
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.
salad
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.
garden
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.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

http://www.cooking2thrive.com/blog/get-know-food/

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.”

You May Need a Nap

If you’re eating well and exercising, but everything feels like a bigger deal than usual, you may need a nap. You may need more than a single nap. You may need more sleep on a regular basis. If you’re under a significant amount of ongoing stress, you may need a good night’s sleep, a nap, and additional down time.
nap
My father-in-law swore by the 20-minute power nap. One of only 3 physicians in a town of 7000, he worked long hours. Every day at lunch, he’d come home to eat and then sleep in his recliner for 20 minutes. He didn’t set an alarm. He just woke up ready to go back to the clinic. He seemed to take the long hours in stride, so I guess naps worked for him.

Each of us has individual sleep needs. A regular 20-minute power nap may work for some while others need a full 8 hours each and every night. Others may function well on 6 or 7 hours during the week supplemented by 10 to 12 on the weekend. Because the particular rhythm is individual, it can be difficult to determine when a lack of sleep first begins to cause problems.

Like many conditions, the effects of sleep deprivation compound slowly over time tricking us into thinking we’re experiencing something normal rather than problematic. Failing to recognize and correct the problem slowly erodes emotional resiliency, the immune system, and our overall health. Early signs could be that you notice feeling more than tired or irritable. Perhaps you feel foggy, forgetful, or have minor hallucinations. Perhaps you feel more anxious than usual or seem to lack the joy that you previously felt. Any of these can be indicators that you are not getting enough rest.

We all have long to-do lists and such an expectation of immediacy that it can be tempting to ignore our bodies’ signals until we reach the point of exhaustion or other health concerns. Obviously, it is better to recognize the signs early and remedy the problem before it affects our immune systems or leads to a chronic condition like diabetes, high blood pressure, or heart disease.

Making the time to slow down is a constant challenge. Meditation and yoga can help, but where can you find time to work them in? And the more pressure you put on yourself, the harder it is to let your mind rest.
big deal
If this were easy, we’d all get enough rest, but according to the CDC almost a third of us are sleep deprived (defined as less than 7 hours per 24-hour period). This is especially true in the eastern and southeastern United States. In my particular state, the lowest rates of sleep seem to fall in the poorest counties.

Most of us think that we can catch up by sleeping late on a Saturday morning here and there. If we still feel exhausted, we assume there must be a different problem. This can mean we continue to exhaust ourselves.

It can take weeks to fully recover from sleep deprivation. Adding an hour or two per night over a longer period of time will give you the most benefit and if you can sustain the extra hours, prevent the problem from recurring.

That doesn’t mean there aren’t times you just need to shut things down. If you have reached a point at which you cannot function well, it is time to take more drastic action. Pretend you have a 24 or 48-hour virus. Go to bed and don’t do anything you would put aside if you really had that virus. Giving yourself permission to do this will help quiet your mind and put it in sync with your intention of resting.

Temperature, bed quality, light, and noise can all affect sleep quality. I learned long before smartphones existed that a digital clock with a red display disturbed my sleep. I had to go back to a clock with a face with hands. Now I move the laptop out of the room because the pulsing sleep indicator is disruptive.

Alcohol will give the illusion that it helps you sleep because you may fall asleep more easily, but it can interfere with REM sleep resulting in daytime sleepiness and performance impairment. I’ve heard plenty of self-diagnosed insomniacs complain about their lack of sleep while touting alcohol use as the solution to the problem. They don’t seem to realize that they’re still complaining about insomnia. If alcohol were fixing the problem, wouldn’t that complaint be gone?

I fall asleep easily and usually sleep well, but during times of extreme stress, I require additional hours of rest. I can’t get by with 6 or 7 hours for two nights followed by 8 for two nights. I need a full 8 – 9 hours each night and maybe a nap or two on the weekend. I don’t know whether my need is more physical, mental, or emotional, but I know it’s important to shift all systems into neutral in order to feel restored.

The irony is that I most need more rest when I least feel I can afford the time. Nonetheless, I am learning to tell myself the minute I feel I have to push myself, “You may need a nap!” 

https://www.livescience.com/52592-spooky-effects-sleep-deprivation.html

https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/

https://www.cdc.gov/sleep/data_statistics.html

https://hbr.org/2006/10/sleep-deficit-the-performance-killer

https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm

http://www.cooking2thrive.com/blog/wrap-it-up/

Get to Know Some Other Breakfast Foods

Last week we learned about cereal, now let’s get to know some other breakfast foods. More than 80% of us eat breakfast at home. If you’re like me, you eat it in pjs with a cup of hot coffee in hand. There’s no end to the possible breakfast options, so we’ll take a look at some of the more popular items we choose at home.
eggs
Eggs
Eggs are king of the traditional American breakfast. Simple to cook in a variety of ways in only a few minutes, an egg is packed with protein and low in carbohydrates. One egg has 70 calories, 6 grams of protein, 1 gram of carbohydrate, and 65 mg of sodium. The high protein and low carb content make eggs an ideal choice for diabetics.

Unlike most foods, eggs contain all 9 essential amino acids that cannot be made by your body plus iron, vitamins A,D,E, & B12, folate, selenium, lutein, zeaxanthin, and choline. Eggs also provide the primary source of cholesterol in the American diet. One egg has 195 mg.

Because blood cholesterol has been of concern in heart disease, for many years Dietary Guidelines recommended limiting consumption of cholesterol thereby giving eggs a bad rap. This changed in 2015. The Guideline regarding cholesterol was removed because it is now recognized that dietary cholesterol plays no role in blood cholesterol.

With that concern removed, it’s hard to find a better food to get you going in the morning.*

Ever drink a glass of orange juice with your eggs?
Apparently a lot of us do. About two billion dollars worth of orange juice are purchased in the US each year. The largest selling brand is Tropicana Pure Premium.

Orange Juice

An 8 oz glass of Tropicana Pure Premium No Pulp Orange Juice has 110 calories, 2 grams of protein, 0 fat, 0 sodium, 450 mg of potassium, 22 grams of naturally occurring sugars and a total of 26 grams of carbs. A glass of this juice also provides 120%** of the recommended daily allowance of vitamin C, 2% of the daily value for calcium, 10% for thiamine, 4% for riboflavin & niacin, 6% vitamin B6, 15% folate, and 6% magnesium.

oranges
How does that compare with an orange?

Orange

One large orange has about 86 calories, 2 grams of protein, 0 fat, 4 grams of dietary fiber, 17 grams of sugars and 22 total grams of carbs. It also has 163% of the RDA of vitamin C plus naturally occurring calcium (7% RDA), vitamin A (8%), and iron (1%).

Looks like an orange has less calories, more fiber, more calcium, more vitamin A, more iron and 43% more vitamin C, but lacks the added thiamine, riboflavin, niacin, vitamin B6, folate, and magnesium.

If you are choosing orange juice for vitamin C, you’ll get significantly more from eating an orange plus the benefit of 4 grams of dietary fiber and 5% more calcium.

Before choosing store bought orange juice, you should also be aware that in spite of the “not from concentrate” verbiage on the label, this type of orange juice is processed by having the oxygen removed so it can be stored in vats for up to a year. This process removes the flavor. A flavor pack is then added so that when it’s bottled it will taste like orange juice. Because the flavor pack is made from orange by-products, it is not considered an ingredient, and therefore isn’t required to appear on the label despite the fact that the by-products are chemically altered. 1)

yogurt

What about yogurt for breakfast?

Up until two years ago, Greek yogurt sales were skyrocketing. While the growth has now slowed to a moderate level, you can’t pass a dairy cabinet without seeing a wide array of single serving yogurt options. Many of those convenient cups are occupying our breakfast tables, but not all single serving yogurt is created equal.

The top selling brand of yogurt is Chobani, so let’s start there.

Non-fat Greek Yogurt
Chobani 5.3 oz non-fat Greek yogurt contains 80 calories, 15 grams of protein, 0 fat, 10 mg cholesterol, 55 mg sodium, 4 grams of sugars and a total of 6 carbs, 15% of the RDA of calcium, and 6% of potassium. This yogurt is also full of probiotic live and active cultures that help your digestive tract.

That’s twice as much protein as an egg for only 10 additional calories. Plain Greek yogurt is also low in carbohydrates and has a significant amount of calcium making it another good choice for diabetics.

Plain yogurt? Yuck! What about flavored yogurt?

Blackberry Yogurt
One 5.3 oz container of Chobani Greek Yogurt with Blackberry on the Bottom contains 120 calories, 12 grams of protein, 0 fat, 5 mg cholesterol, 50 mg of sodium, 16 grams of sugars and a total of 18 carbs, 15% of the RDA of calcium, and 6% of potassium. Like plain yogurt, this version is also full of probiotic live and active cultures that help your digestive tract.

While blackberries may account for some of the sugar listed on the label, evaporated cane sugar is the 2nd ingredient, meaning that many of the 16 grams of sugar come from added sugars. The sugar adds most of the 40 additional calories. Although the protein content is still high at 12 grams and the probiotics are present, added sugar makes this yogurt less healthy in general than plain yogurt and doubly bad for diabetics and those with heart disease.

I understand why flavored yogurt is tempting. Yogurt can be a bit tangy on its own. I eat 1/3 – 1/2 cup of plain Greek yogurt for breakfast most mornings. Rather than adding sugar, sweetener or honey, I top it with about a tbsp of golden raisins and 10 raw almonds. As a breakfast, this is crunchy, filling, and just sweet enough. The nuts and raisins both add protein, the nuts add fiber, and the raisins add carbs. This combination is also quick and doesn’t require cooking.

While I find Greek yogurt convenient, many people prefer the portability of breakfast bars. The top selling nutrition/health bar is Clif.

Clif Oatmeal Raisin Walnut Bar

In one Clif Oatmeal Raisin Walnut Bar you’ll find 250 calories, 10 grams of protein, 5 grams of fat, 150 mg sodium, 7% RDA of potassium, 5 grams of dietary fiber & 4 grams of insoluble fiber, 20 grams of sugars and 44 grams of total carbohydrates. It is also fortified with vitamins & minerals.

Although this bar offers a good amount of protein and fiber, the calorie count is high and the total amount of carbohydrates is very high. These bars are not an option for those who are gluten-free, and they cannot be characterized as a good choice for those who are diabetic or at risk for heart disease.

Of course there are other breakfast bars with varying amounts of protein, fat, and sugar so you may find one that fits your eating plan. You won’t find one that beats eggs or plain Greek yogurt in nutrition per calorie.

Of all the foods we’ve learned about so far, eggs and non-fat plain Greek yogurt offer the best high protein, low fat, low carb breakfast choice.

Next up, we’ll look at some popular on-the-go breakfast sandwiches and then we’ll be ready to move on to lunch and dinner.

Should we explore coffee? Probably, but right now I’d rather just have another cup. Until next week…

*Eggs are one of the 7 top allergens. Approximately 2% of children are allergic to eggs, but 70% outgrow the allergy by the time they’re 16. http://acaai.org/allergies/types/food-allergies/types-food-allergy/egg-allergy If you have an egg allergy, please avoid eating eggs and products containing them.
**Percent of daily values listed are based on a 2000 calorie diet. Your DV may be higher or lower based on your calorie needs.
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.”

1)http://www.foodrenegade.com/secret-ingredient-your-orange-juice/
http://www.huffingtonpost.com/2011/07/29/100-percent-orange-juice-artificial_n_913395.html
http://gizmodo.com/5825909/orange-juice-is-artificially-flavored-to-taste-like-oranges