March is National Nutrition Month ®, when the American Dietetic Association reminds us about the importance of healthy eating. This year’s theme is “Improving your nutrition from the ground up”. Now is the time to go back to the basics and build a healthy diet that includes healthy foods from all food groups.  

Despite the variety of nutrition messages over what not to eat plastered all over the media, Internet and from family and friends, many people still don’t have a clear idea of what foods they should be eating. By focusing on the positive components of foods you can help your clients develop a healthful approach to eating that will lead to a well-balanced and sensible diet.  

One way to help your clients make healthy choices is by encouraging them to include nutrient-rich foods into their daily eating pattern. Nutrient-rich foods have large amounts of key nutrients for fewer calories. These foods provide essential vitamins and minerals that the body needs to promote healthy growth, fight illness, increase energy levels and prevent chronic disease. Plus, being lower in calories helps individuals achieve maximum nutrition while still maintaining a healthy weight. Some nutrient-rich foods to focus on are:

• Whole grains, which are high in dietary fiber, B vitamins, iron and magnesium
• Fruits and vegetables, which are a great source of potassium, dietary fiber, folate and vitamins A,C and E
• Low-fat milk and milk products, which provide calcium, vitamin D, protein and potassium
• Lean meats, beans, nuts and seeds which supply protein, iron, zinc, B vitamins, vitamin E and magnesium

The “nutrition from the ground up” theme conjures up images of a backyard vegetable garden which certainly can be an element in a healthy lifestyle. However, you don't have to be a gardener to have a healthy diet. Fruits and vegetables are plentiful in your local grocery store or a farmer's market. Frozen, canned and dried produce provides greater variety and easier storage of foods particularly in winter when availability and access are limited. We can feel good about eating a wide range and variety of fruits and vegetables. 

This March take a new approach to purchasing, preparing and eating foods for a healthier you. For more information on National Nutrition Month, visit www.eatright.org and peruse Dairy Council of California’s downloadable handouts for information you can share with adults and children. 

Trina Robertson, M.S, R.D.

Project Manager

February is American Heart Month. According to the American Heart Association, one in three Americans has high blood pressure. A major part in preventing heart disease, which is the number one killer of American women, is maintaining healthy blood pressure. One dietary intervention health professionals commonly recommend when guiding a client with hypertension is a reduced sodium diet. However, current research shows that we should think beyond simply limiting sodium to help our clients achieve healthy blood pressure. Other factors affecting hypertension that are equally important and often overlooked include lifestyle, diet quality and intake of micronutrients such as potassium.  

Focusing on lifestyle modifications can be a simple yet very effective way to treat hypertension. You can help your clients reduce blood pressure by encouraging them to:

• Adopt the DASH eating pattern, which emphasizes low-fat dairy foods, fruits, vegetables, whole grains, fish, poultry, beans and nuts. This dietary pattern is high in fiber and potassium and low in saturated fat and cholesterol. 
• Be active. Engaging in regular physical activity helps manage weight, reduce stress and control blood pressure.
• Reduce Stress. Turning down the stress response helps the body tune in to good health.
• Limit alcohol and quit smoking.

There are many ways that you can help you clients prevent and/or manage this “silent killer.” First, stay current on the latest research. Check out our recent Health Connections Newsletter which focuses on Managing Hypertension Through a Healthy Lifestyle. Second, encourage your clients to focus on diet quality. This goes beyond focusing on limiting sodium. Try recommending the DASH eating plan. There are many resources online to help them get started. Our partners at Oregon Dairy Council have developed a user-friendly online tool to help individuals incorporate DASH into their daily food choices. Lastly, identify clients who are at high risk of developing hypertension. Risk factors include obesity, physical inactivity, high sodium intake, low potassium intake, excessive alcohol consumption and diabetes. Helping at risk individuals make healthy lifestyle changes can make a difference.

Ashley Rosales, R.D.

Project Manager

Over half of American adults are overweight or obese. The cost of obesity is substantial to our health care system, to communities and to individuals. Healthy Weight Week is January 20-26. This is the perfect time to help your clients focus on ways to maintain a healthy weight or make goals for gradual weight loss.
 
Making even small changes with regards to food choices and physical activity can yield big results over time. Studies show that losing weight gradually leads to more permanent results. Help your clients aim for about a pound a week weight loss. This goal is not only realistic and achievable, but is also less overwhelming to your clients. When clients are able to achieve these small goals, it leads to increased motivation and self-efficacy. Here are some tips to aid your clients in their weight loss goals:

• Reduce portion sizes
• Prepare more meals at home
• Be physically active daily
• Eat favorite foods that are high in calories less often and in smaller amounts

Try our Personal Nutrition Planner which is a quick nutritional assessment that provides food and calorie recommendations based on age, gender and activity level. Your clients will learn their current Body Mass Index (BMI) and total calorie expenditure as well as the number of servings needed from each food group. The Personal Nutrition Planner includes a goal planning section which helps them develop a food and activity plan based on personal health goals.
 
It is important to remember that modest weight loss of 7-10% in addition to regular physical activity can reduce the risk of chronic diseases such as diabetes and heart disease. Focusing on prevention by making lifestyle changes will not only help control health care costs in the long-run, but also help improve quality of life, which is the greatest benefit of all. 

Ashley Rosales, R.D.

Project Manager

The start of the year marks resolutions that often include food. There are a variety of factors we take into consideration when purchasing food such as taste, cost, preparation and nutrition value. Newer on the list and rising in popularity is eating a "green" or sustainable diet. It is apparent that implementing a sustainable diet varies broadly and is very personal. I think of it as a continuum with the most devoted growing their own food, composting and purchasing local, seasonal foods. Others dabble in “going green” by recycling plastic bottles and periodically bringing reusable shopping bags to the market.
 
Here are a few simple ideas to consider as you and your clients think about sustainable eating practices: 

• Cook at home. Eating out less often reduces your calorie intake and you can better control food quality. 
• Eat fresh produce in season. Another good option, eat canned or frozen fruits and vegetables which are nutrient-dense since they are processed immediately after harvest. 
• Reduce food waste. Forty percent of food waste is at the consumer level. Plan your meals so you cook the food you buy. Store and preserve food properly. For people who are further in the going green process, compost rather than throw out inedible parts of food. 
• Ditch prepackaged foods. Bite into a piece of fruit rather than a fruit-filled granola bar or crunch on veggies rather than potato chips. 
• Eat less, or eat appropriate portion sizes. Your waist and wallet will thank you. 

Individuals may choose to be more proactive in their quest to be green. With a huge potential list of green options it is useful to think about what is simple to implement and has the largest impact. As a newly emerging field, researchers are still determining how to accurately measure carbon footprint. Some actions have less impact than one might expect. Consider these ideas carefully before diving in. 

• Organic foods. Organic foods are produced without the use of pesticides, herbicides and synthetic fertilizers. However, the majority of organic production is large scale and may have similar food miles and water/soil conservation practices as conventional agriculture. Foods are defined organic based on the process, not the outcome of the product. For example, organic and conventional milk provide the same nutrient value.  Shoppers should feel confident that foods, organic and conventionally grown, available at their local grocery store are healthy choices. 
• Local farmer markets. While these are a great alternative and can be a fun way to shop; the food can be expensive and the hours may not be convenient. You may also be surprised to learn how far the food vendors have traveled to sell at your local market. We should not feel guilty buying produce from your local grocery store. 
• Grow your own food. With time, attention and the right climate you can successfully grow fruits and vegetables. This can be a fun activity that includes the whole family. I live in a very warm and dry climate and wonder whether the amount of water needed to grow a handful of tomatoes each summer is a good use of this precious resource.

Ultimately how to overlay sustainability with the other food and nutrition priorities of individuals and families is a personal choice. It is important however to not eliminate an entire food group from your diet, since each food group provides essential nutrients. All foods can fit in a healthy diet when eaten in the proper quantity. For more information on sustainability and how to advise your patients, read our Health Connections newsletter. Helping your clients think through these issues can help them identify reasonable steps leading to better food choices.
 
Trina Robertson, M.S., R.D.
Project Manager
 

The beginning of the New Year is a time when your clients may be more focused on making healthy resolutions. Losing weight, healthier eating and increasing physical activity are always popular New Year’s resolutions. Many people believe these goals are best achieved with a "quick fix" or drastic plan or program. However, research supports that long-term weight loss and sustained healthy lifestyle changes occur slowly over time. Taking small steps toward goals will yield the greatest results. With the proper guidance, accurate information, realistic goals and personal commitment your client's resolutions can become a reality.

In order to get off to a good start for the New Year, have your clients sign up today for our free Meals Matter Nutrition and Fitness Challenge. This four-week Challenge, beginning January 12th, is designed by registered dietitians to help reduce holiday weight gain and renew healthy lifestyle routine with expert guidance on nutrition, fitness and meal planning. It can be offered as a tool to complement the information you provide in individual couseling or group settings such as worksite wellness.

The Meals Matter Nutrition and Fitness Challenge will help establish a pattern of healthy food choices each week by providing a range of features to make meal planning easier, such as nutrition articles, access to healthy recipes and a meal planner to help plan meals over time. Over the course of the Challenge, participants will complete our interactive healthy lifestyle tools, which allow for customized nutrition and physical-activity recommendations based on your client's unique needs and preferences.

Although the Challenge begins January 12th, clients can register now and connect with others through social-networking Challenge pages found on Facebook, Twitter and LinkedIn. These venues help clients connect with other participants for social support before, during and after the four-week Challenge. In addition, members who complete each aspect of the Challenge by Feb. 19th are eligible for a reward so encourage your clients to join today.

Trina Robertson, MS, RD

Project Manager

Growing older doesn’t have to lead to chronic disease, lack of energy or lack of independence. In fact, by making some small lifestyle changes today, older adults can enjoy more energy, maintain physical mobility, lower risks for certain chronic diseases and prevent bone and muscle loss associated with aging. The best way to do this is by helping your older clients make positive food and physical-activity choices every day. This can be a challenge, given that many older adults experience a loss of thirst and appetite, find meal planning to be challenge and may experience difficulty being as active as before. However, given some simple guidance, many of these challenges can be overcome.  

Here are a few tips to share with your older adult clients:

• Choose a mix of nutrient-rich foods every day from all the food groups to get more nutrients for fewer calories.
• Consume at least three servings of low-fat milk or milk products each day to ensure adequate intake of calcium and vitamin D.
• Make sure to eat foods high in protein with each meal and snack, such as lean meat, poultry, beans, eggs, milk, nuts and seeds.
• Stay hydrated by drinking fluids throughout the day. Water, low-fat milk, 100% fruit juice and decaffeinated tea are good choices.
• Consume foods high in fiber to help with digestive regularity, such as fruits, vegetables, whole grains, beans and nuts.
• Be active for at least 30 minutes per day doing activities that raise your heart rate, such as a water-aerobics class, dancing or walking.
• Do muscle-strengthening activities weekly. Use an elastic band or small hand weights.
• Stock up on the basics so that you always have food on hand for a healthy meal or snack.

In addition to these tips, we have also developed a new, two-sided downloadable handout, Healthier Eating & Physical Activity: Tips for Older Adults for you to use with your clients. This handout is perfect to distribute at a medical office, senior center, or even a health fair. I also suggest using this handout as an insert to our other free nutrition education booklets, such as Activity & Eating—Linking Together for Optimal Health and Fitness or The Calcium Connection—Healthy Bodies From One Generation to Another. By providing relevant and practical nutritional guidance to your older adult clients, you can help them achieve health and well-being as they age.

Ashley Rosales, R.D.

Project Manager

As the end of the year draws near, many people ponder over their options for New Year's resolutions. Many of the top five resolutions occur year after year. Why is this? Resolutions are set with the greatest of intentions, yet the majority are not accompanied by specific goals and action steps that lead to long-term behavior changes. With a little guidance, the right plan of action and realistic goals, you can help your clients achieve their health-related resolutions.  

Losing weight, eating healthier and being more physically active always seem to pop up as the most popular New Year’s resolutions. Yet, with all of the “quick fixes” promoted in the media, many people believe these goals can be achieved with a magic pill or program. As health professionals, we know that long-term weight loss and sustained healthy lifestyle changes occur slowly over time. Encouraging your clients to take small steps toward their goals will yield the greatest results. Our program booklet Activity & Eating—Linking Together for Optimal Health and Fitness can help your clients set realistic goals, overcome barriers and ultimately achieve positive lifestyle changes with regards to food choices and physical activity. This self-instructional booklet also focuses on nutrient-rich foods as the basis of a healthy diet. In a world where simpler is better, we can get caught up in giving “sound-byte” nutrition messages. Although well-intentioned, these messages are incomplete and may harm our clients more than help them. Take some time to read our monograph Unintended Consequences of Simplistic Dietary Recommendations: Good Advice Gone Awry? We also offer this timely information as an online Continuing Education Course.

Dairy Council of California wants to equip you with the right tools and information to help your clients achieve optimal health and well-being by providing you with effective and up-to-date resources, like the ones mentioned above. So this year, when your clients approach you with their resolutions to lose weight, eat healthier and be more physically active, you can set them on the right path to making those resolutions a reality!

Ashley Rosales, R.D.

Project Manager

I uploaded this blog post the other day, then accidentally deleted it. So this is a "repost".  

Time is a limited commodity in health care. Those involved in health education are trying to improve patient behaviors in the least amount of time. That is why I especially enjoyed a presentation about effective counseling techniques at the 2009 Food & Nutrition Conference & Expo (FNCE) held in Denver last month. Using Evidence-based Strategies for Nutrition Counseling outlined the most effective counseling strategies based on published research in the American Dietetic Association's Evidence Analysis Library. I found this information especially useful since I am involved in the development and evaluation of the Dairy Council of California nutrition education programs.   

The health theory deemed most effective is Cognitive Behavioral Theory (CBT). It attempts to change learned behaviors while addressing internal factors such as thoughts and feelings. Goal setting is central to this theory and is most effective when the client focuses on personalizing small steps toward healthier living. Computerized CBT is another option that is found be be effective. The strongest evidence for CBT relates to specific dietary interventions, diabetes prevention and management and cardiovascular disease. CBT works best in group settings and most evidence of success is with short-term interventions lasting six months.

I was pleased to learn that there is strong evidence to support the behavior change techniques included in Dairy Council of California programs. Strategies that received high marks for effectiveness include:

• Self-monitoring, such as using food records, received the highest rating for weight loss interventions. Dairy Council of California programs employ self-monitoring in our upper elementary, middle school and high school nutrition education programs and in the Calcium Connection and Activity & Eating adult programs. 
• The use of open-ended questions, affirmations and exploration of barriers via Motivational Interviewing (MI) is no more effective than usual treatment when used alone. Adding MI at the beginning of a CBT program improved results. MI requires a great deal of training to be used successfully. 
• Meal replacements or structured meal plans that dictate to patients what to eat helps patients control food intake as they attempt to modify their eating habits. Creating a meal plan along with your client to help them plan healthier meals might be a more realistic long-term solution. 
• Interestingly, extrinsic rewards and reinforcement was not effective even in the short-term. Although not studied, the presenters thought internal rewards could be useful.
   

There is a great need for ongoing research to investigate the effectiveness of current and potential counseling methods. Although not as much research is available to show effectiveness, strategies such as problem-solving, collaboration, social support and goal setting all seem appropriate to incorporate to improve client outcomes along with the bulleted strategies with more documented success.  

Dairy Council of California is committed to embedding evidence-based strategies in our print and online programs to help health professionals achieve behavior change with their clients. We strive to create quality, afforable programs that fit the needs of time crunch professionals that value helping patients improve their food and activity choices. I welcome and appreciate comments of what would make our programs more effective in your practice.

Trina Robertson, M.S., R.D.

Project Manager

Soy beverages, while wholesome and nutritious, are not the nutritional equivalent of milk. Since soy beverages are naturally low in calcium (about 10 milligrams per serving), manufacturers fortify them with calcium salts to boost the calcium content. However, the amount of calcium salts added is not regulated and may vary from 80 to 500 milligrams per serving. Some soy beverages are not fortified with calcium at all. It is critical that consumers read the food label.

Even fortified soy beverages that contain the same amount of calcium as cow's milk do not provide the same health benefit due to less absorption. Creighton University researchers calculated that the body absorbs about 25 percent less calcium from a fortified soy beverage than from cow's milk. A serving of milk (8 ounces) contains about 300 milligrams of calcium. It would take 500 milligrams of calcium in an 8-ounce serving of fortified soy beverage to equal the calcium in a glass of cow's milk.

A bigger issue is the settling problem in calcium-fortified soy drinks. Most soy beverages have appreciable sedimentation of the added calcium; in other words, it settles to the bottom of the glass. A study conducted by Heaney in 2006 found that in a shaken sample, the mean calcium level was 59 percent of the value shown on the label. Unshaken samples only contained on average 31 percent of the calcium listed on the label. Very few consumers would shake a carton of soy beverage, pour out a glass and then chug it down quickly. It you set the glass aside, even for a few minutes, the calcium settles to the bottom of the glass. Reduced bioavailability and sedimentation combine to make the calcium content in soy beverages far less than in milk.   

Milk is a nutrient-rich food that provides a large number of nutrients relative to the calories consumed. Check this page to see a listing of the major nutrients in milk.

Maureen Bligh, M.A., R.D.

Project Manager

The holiday season is officially underway, which means plenty of tasty treats, delicious cuisine and specialty drinks. We see temptation around every corner and, although a little indulgence is just what many of us need this time of year, too much can pose a problem. Most people think of those few pounds gained over the holidays as a small price to pay in return for weeks of enjoyment, but for individuals with diabetes it can be much more serious. In addition to our national holiday, Thanksgiving, November is also National Diabetes Month. Health professionals can play a huge role in helping clients with diabetes deal with some of the temptations they may face during the holidays, so that they too can enjoy the season to the fullest while staying healthy!

Here are some tips you can share with your clients:

• Fill your plate first with nutrient-rich foods. These foods are higher in nutrients and lower in calories, such as low-fat dairy foods, whole grains, vegetables, lean meats, beans, nuts and seeds. When you fill up on these items first, you are less likely to overeat those “once in awhile” foods.
• Inform your hostess. By letting the host or hostess know your dietary preferences, you can prevent slip-ups. Many times they can do simple things to accommodate you, such as put out sugar substitute with coffee or provide sugar-free alternatives for dessert.
• Plan ahead. If you are going to a potluck-style gathering, you can bring a healthy dish to share. That way, everyone can enjoy your nutritious cuisine and you can too, guilt-free!
• Don't skip meals. Make sure you eat a balanced, healthy breakfast and lunch on the day of a holiday party. When you fuel up on nutrient-rich foods during the day, you will have better self-control and will be less likely to overeat at the party. By choosing well-balanced meals throughout the day, you are better able to manage your blood-glucose levels as well.
• Continue to be diligent in sticking to your blood-glucose monitoring and medication schedule. The holidays can be hectic, so on those busy days set a timer on your watch or on your cell phone to remind you.
• Get moving! Celebrate the holidays with family by engaging in activities like going for a walk or turning on some music and dancing. Physical activity is a great way to keep blood-sugar levels under control and burn off some of those "discretionary" calories.

Offering your clients a little support can really help them stick to their goals this holiday season. Encouraging clients to take a few simple steps to prepare themselves can go a long way. By working together, you can truly help them stay healthy and enjoy all that this special time of year has to offer! 
 
Ashley Rosales, R.D.
Project Manager