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Wednesday, 26 May 2010

If you come to a fork in the road, take it. Yogi Berra

I posted this quote on Twitter this AM....story of my life.

I am a person who craves stability. I actually lean toward maintaining the 'status quo' -- especially if it seems to be working. I LIKE sayings like "If it ain't broke, don't fix it". Change really upsets me. I always thought I would be the one whose life went from p to q, as planned perfectly, from my youth to college to university to career choice and mobility, with probably not marriage and kids.

Well, life has progressed as SOMEWHAT planned but many deviations along the way -- many moves, falling in love unexpectedly and with someone who didn't fit MY mold of the mate who would help me follow MY perfect plan, marriage, children, career shuffles and shifts.

Change has been the best thing to ever happen to me. I have grown and learned more than I could ever imagine.My life is full and rich in blessings. I've seen and even lived in countries that I knew only in passing. Being a wife and mother has pushed me to limits that I thought I HAD, but which I HAD to surpass and has enabled me to be the best version of me that I didn't even know I could be. Embracing and pursuing the 'forks' in MY road has required me to reach the depths of my being in order to navigate through them, but, in turn, has graciously allowed me to feel glorious, sometimes dizzying heights of joy and happiness, and often, a sense of complete peace.

When you veer off from your planned course, especially if you're like me -- a planner -- you MAY have one or two regrets -- but they will be minor compared to the vast rewards of taking risks and overcoming with aplomb.

Yogi's right. As fearful, anxious, and frozen as you may feel when the 'forks' come your way -- take them!

I still don't know what exactly is in store for me as a result of some of my 'forks', but I'm sure whatever it is -- it'll be worth every blind spot, stumble,and setback along the way. I can hardly wait!!!

Monday, 24 May 2010

Well Women--Well World

For most of my professional career in dietetics and nutrition, I have worked in university hospitals and tertiary-care settings. In other words, I worked with the toughest cases -- those people that went through primary and perhaps, secondary care, and then, finally, needed to be referred for complicated treatments requiring the skills and resources of state-of-the-art, sometimes innovative therapies. I also specialized in pediatrics -- neonates until late teenage years. It was a wonder for me to see how much of a difference proper nutrition made to the growth and development of babies born highly compromised, as well as to witness how the most complex, rare diseases responded to manipulation of nutrients and diets. If I was skeptical about the role of the dietitian on the medical team before I worked in these settings, as we were often downplayed and outright disregarded by physicians and nurses in those days, well, afterward, I KNEW I added value and had an outright obligation -- sometimes urgent -- in the provision of best care of these compromised patients. I worked long, hard hours. Before long, the doctors -- attending physicians as well as the interns and residents and nurses -- brought me in automatically as patients were admitted. Today, thankfully, in most hospital and health care settings, dietitians are seen as an extremely necessary part of the medical care team and are highly valued and utilized.
In the pediatric wards, the medical team can't downplay nutrition because it's vital for growth and development despite an infant or child having a disease or condition that precludes proper nutrient intake. When I worked in the pediatric hospital, often the docs and nurses were so busy treating surgical or medical concerns that they didn't have the time/knowledge/expertise to BEST know how to nourish their patients, accordingly, so they welcomed my input with open arms. And that was all great UNTIL.....I started to push for more pro-active treatment/prevention of obese and overweight children/teenagers.

Even though, at that time (mid-1980's),the prevalence of pediatric obesity/overweight was less(maybe 1/10-15 children) of what it is today (about 1/3), I thought it was high enough and I KNEW then, that it would rise high and fast, based on my observations on the eating habits of children and what I started to note as a changing environment (family dynamics, foods produced and marketed, burgeoning IT, emphasis on TV and entertainment, safety issues, etc). The docs and nurse practitioners in all specialties referred their obese kids to me because they all got to know that I welcomed the challenge of working with these kids and I had a knack for treating them effectively. In contrast with my colleagues, I LIKED working with obese children. From within the university hospital system and even from the extended greater South pediatric private practices, I was referred all the obese kids. Usually, however, it wasn't for obesity, but for something else -- allergies, hyperactivity, abdominal pain, behavioural problems. But, intuitively, I KNEW that the obesity/overweight/poor fitness/poor eating habits of these kids was probably the REAL problem and origin of some of their secondary symptoms. Not in all cases, mind you, but most.

I designed and developed a protocol for a multidisciplinary pediatric program for the treatment and prevention of childhood obesity and wanted desperately for this university medical center to sponsor this. I was flatly refused from TPTB. Only ONE influential doctor (the VP of the medical school) wanted to push ahead with it and, ironically, he died of a massive heart attack about a week after he agreed to support me in my efforts to get this program executed. At the time, the other directors of the university medical center said they didn't want their center to be known as a 'pediatric fat farm'. Remember, too -- these were the days that doctors didn't even acknowledge that obesity was a key factor in many diseases, even CVD. Before I specialized in pediatrics, I worked in adult hospitals. I often lobbied to get a referral to work with patients who were obese/overweight and who had CVD, Hypertension, sleep apnea, pancreatitis, ulcers/dyspepsia/GERD, myalgias, and other ailments which I KNEW proper dietary manipulation and instruction would improve the outcomes or course of treatment of these patients, and I was flatly refused.

Oh, how the times have changed.

More than 25 years later, I now know that the university hospital and medical center that I worked at, now has a multidisciplinary pediatric obesity treatment program as well as a whole research foundation dedicated to nothing more than childhood obesity.

Ten years ago, I lobbied to get better access THROUGH THE SCHOOLS for kids with obesity or who were overweight or who just needed attention on how to improve their diets and nutritional status. THEN, I was told that this was 'too political' -- education boards would never go for this. The division of the CDC that deals with adolescent and child health refused to undertake the research proposal that I had sent to study the school-dietitian option to try to get data for the evidence (or not) of such a proposal, because they said the CDC didn't take on these types of studies. My own professional organization didn't even respond to me when I had sent the proposal to the person there who was in charge of vetting research proposals. Perhaps, I sent my proposal to the wrong places. Perhaps, I should have pushed more exhaustively and extensively to other agencies. I heartily admit that I was partially to blame for dropping the ball, so to speak, after I felt that I wasn't getting anywhere with the agencies and organizations that I thought, at the time, would be my best bets for getting the project noticed, and executed to some degree. Maybe I could have done more than I did. It does no use to look back. Last month, thankfully, a project is underway to not only get dietitians working with obese/overweight/unfit kids in school settings, but to study and document the results of such access/intervention.

So, at least it took less than 25 years!

So what have I learned from all this?!

Well, NOW, after all this time and after having experienced all the above, I have learned that it is never too late to concentrate on the pediatric population. I am truly happy and totally relieved that the efforts that I had tried to get pushed forward many and several years ago,are NOW just finally coming to fruition, I must not feel rejected or jaded. For some and several reasons, these programs needed all this time to sink in and mature in the minds of TPTB. I am not a powerful person and I never wanted to be. I only saw needs and tried to answer to them. I only feel sad that childhood obesity has reached such proportions. I also feel sad that it took the medical profession so much time in acknowledging the role that diet plays in prevention and effective intervention for so many diseases. But, as I said, better late than never.

NOW, I MUST acknowledge that I feel VERY STRONGLY that if we start to really concentrate on the wellness, fitness, and healthy lifestyles of WOMEN -- this will have a great impact on the wellness, fitness, and health of total populations. Women are mothers, wives, girlfriends, sisters, and, NOW,powerful and influential professionals.
The health of women pre- and during pregnancies has a great impact on the health of offspring-- in the womb, during, and after delivery. It has now been shown that quality of health pre-, during, and after delivery has an impact on the health, wellness, and FITNESS of offspring for their whole LIFETIME!.
Despite more working women, it is still clear that women remain the primary caretakers in the home -- cooking, shopping, and delivering meals. When women have healthy eating and fit habits, the probabilities go up that the whole family does, too.
The eating and fitness habits and opinions of wives, mothers, female co-workers,and girlfriends affect the eating and fitness habits of husbands, children, male co-workers, and boyfriends.

Over the past 20+ years, I have continued to work with the pediatric population as I always have. But,I have also focused heavily on working with women -- educating them, demonstrating what healthy diets look and taste like, enabling them to get motivated and tuned in to healthy eating and fitness, monitoring them, and doing all that I can to make sure they execute and sustain healthy attitudes, cognitions, and behaviours in regards to balanced diets, nutrition, and fitness. Indeed, I have CLEARLY witnessed that when women are well -- their children, husbands, boyfriends, and everyone around them are or get well.

I'm impressed with the campaigns now to tackle the childhood obesity epidemic -- long needed and long overdue.

However, I would also like to see vast and improved efforts on addressing the myriad concerns and needs that WOMEN have in gaining better access to care for dietary/ nutritional, fitness, and overall wellness concerns.

So, right now, in the community setting I work in, I strive to be the practical link from nutritional science to healthy diets and lifestyle habits -- mainly for WOMEN. I strongly believe if I can help WOMEN to understand, to practice healthy dietary and fitness habits, and to change and sustain changes until they master healthy habits, then they are on the right path to wellness. The people around them -- children, husbands, boyfriends, families, co-workers --will do likewise.

WELL WOMEN! The WORLD will be much better off and WELL, as a result!

Thursday, 13 May 2010

A Bit of Salt -- if it's iodized--is important

Western diets notoriously are high in sodium. There's been a new push to decrease our sodium even more than ever so as to help prevent exacerbation of incidence of hypertension, stroke, and other sodium-high sensitive conditions and diseases.

However, it has been observed that just because sodium or salt intake is high doesn't necessarily mean that people are getting their necessary requirements of iodine.

Iodine is an essential component of thyroid hormone and functioning and brain development. Very few foods naturally contain iodine. The best sources are seawater fish, seaweed, and dairy products. But the amount of iodine we need, especially women, during pregnancy, requires the addition of an iodized salt to our daily diets. We don't need ALOT -- about 1/2 teaspoon per day and it's important to mention that TOO much can and DOES result in exactly the same symptoms as too little! So, just 1/2 teaspoon TOTAL per day. This yields about 200-300 micrograms of iodine. Our daily requirements of iodine range from 600 micrograms/day in childhood to 900/day in adults (18 y.o -- 70 y.o)and 1100 micrograms in pregnant women. If children, teens, and adults are eating a balanced, healthy diet that includes milk and other dairy products and fish, chicken, and other lean meats -- then with the 1/2 teaspoon of iodized salt, they should get the iodine necessary to stave off conditions associated with deficiency or overload -- goiter, hypothyroidism, low metabolic rate,sluggishness, chronic fatigue, poor mental function. Pregnant women will need additional iodine provided from their multivitamin/mineral supplement to offset the risk of having a baby born with cretinism.

Iodization of salt was started only in the 20th century as the detrimental effects of iodine deficiency were so widespread and iodine deficiency was unequivocally determined to be the cause of mental underdevelopment, especially in poor nations, but also in developed countries. Many salt-producing companies have schemes in developing nations to deliver iodized salts and studies have shown marked improvement in mental development and functioning of these populations, but also in overall growth and health of children.

Ironically, with the production and marketing of designer salts and salt blends in recent years, it has been shown that iodine intake has dropped by as much as 50% in wealthier nations. Many of these rock salts, kosher salts, and other fancy blends are not fortified. Even 'sea salts' don't have appreciable amounts of iodine.

To assure receiving necessary iodine in your daily diet, do the following:

Use iodized salts -- at least to 1/2 tsp/day. This does not mean a license to use salt freely. Remember there still IS a need to limit use of too much salt in the diet -- whether it is iodized or other salts.

Include 2-3 portions of dairy products daily.

Include seawater fish at least 1/week, preferably more, if possible.

Look for and consume other good sources of iodine -- seaweed, sushi, eggs.

If necessary, take multivitamin/mineral supplement that contains iodine -- only up to 100% of requirement.

N.B.!!!! You DO NOT need therapeutic doses of any vitamin or mineral supplement unless PRESCRIBED -- EVER. Overdosages of iodine and any other nutrient can cause exactly the same results as a deficiency of nutrients

Monday, 10 May 2010

A rock, in your window!

Everything was going so well! You were pumped up, you were following a healthy eating plan, you were exercising and even pushing yourself to the next level! Wow, you were actually feeling like "I can do this!! -- I can shed these mounds of chubb and have THAT body -- dress in THOSE clothes -- BE THAT person I'm meant to be!" And then, BOOM! Frustration hits you -- just like that -- like a rock in your window!!!

You hit a plateau, you get bored, you feel blah, or you just feel plain sick and tired of the whole thing. So, what to do?

You know, if you REALLY feel it would help you to have a treat or to fall off your plan -- then ok -- just don't let it get you back to that mindset that you're not destined to become your best self. AND you really have to decide ahead of time that you'll get RIGHT BACK on your healthy lifestyle living. OK?

OR, what I find much MUCH more helpful is to just let go and immerse myself in OTHER things that motivate, inspire, energize, and INDULGE me -- whether it's slacking off time to enjoy nature, going for a quiet stroll, getting a massage or facial, watching a favorite TV show or movie,or for me, it's reading and contemplating poetry. I can get as obsessed with poetry as I do with food. It's much much better for me to 'incessantly nibble' on poems and the thoughts that arise from these works than on junk food. I can get very withdrawn and retreat into myself when I'm feeling down on myself and I become very quiet. So poetry is a wonderful way for me to channel the negative parts of my 'funks' than comfort eating. Both are activities where I can indulge my need to be alone. I've decided that there IS a part of me that is hard-wired to be obsessive, so I had to learn to flow with that -- just had to find something better for my body and soul to obsess about. Please allow me to share a poem, ABOUT OBSESSION of all things, from one of my favorite poets, Mark Nepo -- it might help you like it did me.

Especially when you just don't feel like hearing from someone like me!!!!:


Everyone is after me
to stay positive, but
tonight I feel like
pissing on a rock,
like hearing good
advice and doing

Everyone wants me
to kick ass, though
I don't know
what to kick.

They say I'm
too quiet, but words
taste like armor.

I want to be
with my Godchild
who is obsessed
with the moon,
who is too young
to speak.

I want to be obsessed
with a rock of light
that rises through the dark.


Tuesday, 4 May 2010

Thankful for my obesity???!!!!!!

Growing up obese was often humiliating and painful and really took away from having a full experience as a 'healthy' child and teenager,in many ways. I remember walking home from school in second grade, probably up to the 5th grade, and hearing the taunts of the boys, the giggling of the girls, and even the gasps from gawking adults. I remember nights of anguish and feeling ultimate sadness at the tender age of 17 because I just felt so freakish, ugly, and abnormal. Don't get me wrong, I had a wonderful, loving, and close family. But my 1st generation Italian-American parents and my Italian immigrant grandparents, in their quest to exude 'success' and to show love to us, just plain over-fed us. Now, some of the kids and grandkids probably inherited the mix of genes that protected them from getting overweight and ended up fine. Some of us, however, got the fat-predisposing genes. And then as we were chubby and teased, we were further protected by our loving parents and grandparents by being mollycoddled, perhaps keeping us more inactive, than the normal-looking siblings and cousins, and dare I say, maybe even fed even MORE 'treats' to make us 'feel better'. It was not the intention of our families to make us suffer.

But, you know, I also possess those very Italian genes that all my gorgeous siblings and cousins and relatives have that yield -- the smooth olive skin, the fine bone structure, the strong bones and teeth, the green-blue almond-shaped eyes, the sharp mind, and the penchant for all things beautiful -- clothes, art, music, opera, drama, and yes, even food! And after being led into the field of nutrition and dietetics BECAUSE of my obesity and then losing the weight, I transformed into a beauty -- full of health and vitality.

BUT I've never forgotten what it was like being 'invisible' to humanity because of being obese.

MY obesity has enabled me to empathize with others who similarly struggle and to TRULY understand HOW to best help them. Had I not had my weight problem, there's a great chance I would have been yet another 'perky', slim, pretty-faced person in the world who wouldn't be able, for the life of them, to understand how a person could be obese or even ALLOW themselves to get that way, or who could stand to be that way,etc. etc. Or, like many folks, maybe I would even ABHOR overweight and obese people. These are the feelings that I have experienced from others. This disdain I have carried around on my back at a time or two in my life, as I know many others who are obese do. It's heartbreaking. It is not helpful to the people who are the objects of these feelings -- in fact -- it can be downright harmful. It alienates and ostracizes folks even more and could trigger even more negative behaviors in these individuals and feelings of self-loathing. I'm not at all making excuses for obese people for their overeating or lack of exercise or self-pitying behaviors or low self-esteem. I'm just making an observation that people who don't have the problem often (not always, of course) don't understand and shouldn't judge or presume. No one knows better than an obese person himself/herself how they look or come across, for the most part. It does absolutely no good to rub it in. Ok, there are times when obese people could be moved to positive action because of the disgust they feel they invoke from others, but this response is not the usual one.

I used to cringe (and sometimes still do) at some of my colleagues who would treat overweight and obese people, while counselling them and trying to 'help' them, as if they were slow or incapable mentally. Or these professionals would make recommendations that were CLEARLY so different/foreign from the client's preferences, lifestyle, and usual habits. Is it any wonder that success was elusive for these clients and continues to be for a large portion of populations in many countries of the world where obesity continues to prevail and even increase despite all the knowledge and expertise we possess.

I am a dietitian who looks at obese people as PEOPLE. I see them as beautiful and clever and full of life. I also see how so much of their beauty and talents and life within them is often hidden from the world around them or unexpressed, because of extra weight and fat tissue that encumbers them. I also KNOW that they are putting themselves at great health risks and I explain plainly and honestly these facts to them. But eating and physical activity habits and lifestyles are such personal issues and I would never impose or intrude upon their personal choices and their dignity by whacking them with a total and complete overhaul of their lifestyles in one fell swoop. Now, some people need AND want this and can handle it very well. Most people need a kinder, more unobtrusive approach while still being correct, appropriate, and effective. Both approaches are results-oriented and possible to achieve desired health benefits as well as aesthetic goals. The key is to monitor and continue to CARE for the person and work through an effective treatment until a person MASTERS whatever they need to SUSTAIN their optimal fitness for their health and looks.

Had I not been obese, I would not have achieved the excellence I have in my personal and professional endeavors and accomplishments. I would not be the 'go-to' dietitian for people that I am for both clients themselves and for doctors who need to refer patients to me when they need TRUTH, ACCURACY, and SUCCESS in helping treat obesity when the myriad of other programs, diets, 'magic bullets', pills, potions,and fads, books, and self-professed gurus, fail.

I am thankful for my history of obesity. It has made me a strong, truly helpful nutritionist/dietitian to best serve others.

'To keep me from becoming conceited...., there was given me a thorn in my torment me....But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness."...For when I am weak, then I am strong.' 2 Corinthians: 7, 9, 10.