Swing it, Salsa!

Question: "[My friend] and I have been regularly eating lots of salsa at a nearby Mexican place.  I always figured that salsa was better for you than other snacks.  But how healthy is it for you?  I guess it'd depend on the brand too."

Short Answer: Yup, salsa has won the prize as perhaps the healthiest condiment.


Long Answer:   Salsa, unless eaten in very large amounts, is not a significant source of nutrients and vitamins.  But it adds a punch of flavor for very few calories. 
Salsa literally means "sauce," and it comes in many forms.   1/4 cup of a basic tomato, garlic, onion, and cilantro salsa will contain 1 gram protein, 2 grams sugar, 0.1gram fat, 0.4 gram salt, and a whopping 17 calories.  It has trace amounts of minerals and vitamins, but not enough to significantly contribute to the Recommended Daily Allowance.


Other variaties will have different nutrient information depending on ingredients and preparation.  The addition of black beans, corn, and peppers will increase calories.  Be aware of added sugar and salt in store-bought varieties.  Nevertheless, salsa is a low-fat, low-calorie, and flavor-bursting condiment.  Salsa is particularly useful as a replacement for higher calorie foods such as dips, dressings, sour cream, and ketchup.  Over the summer my favorite crunchy snack was baby carrots and salsa--the spicier the better!

All calorie and nutrient information are taken from the USDA National Nutrient Database.  Check it out and look up your favorite foods!

http://www.nal.usda.gov/fnic/foodcomp/search/

This is just for fun:  Here's some comparisons between the salsa and his side-kick burrito.     

1/4 cup salsa= 17 kcal
8" flour tortilla= 287 kcal
1/2 cup refried beans= 109 kcal
1/2 cup rice= 102 kcal
2 oz steak= 125 kcal
2 tablespoon regular sour cream= 46 kcal
2 tablespoon guacamole= 45 kcal (estimate)
1/4 cup regular cheddar cheese, shredded= 113 kcal

Total = 844 kcal

When it comes to salsa, I'm a fan.  So find me on the dance floor!
*If you have health or nutrition related questions, please comment or email me (coconutcrumbsblog@gmail.com).  I'll try crack the coconut for you!*

Radiation Outpatient Oncology

Dietetic Internship Rotation #2: Radiation Oncology Clinic
The goal of this rotation is to work with the dietitian and become competent in the nutritional management of patients with head and neck cancers.  Patients receiving chemotherapy or radiation have compromised nutritional status.  They have increased energy needs due to disease and wound healing.  This is usually combined with decreased appetite leading to weight loss, fat los, and muscle loss (cancer cachexia).  Radiation to the head and neck often causes swallowing difficulties and taste changes.  Enteral feeding (liquid food sent into the stomach or intestine through a tube) requires the expertise of a dietitian.

September 23, 30, and October 7.

This brief rotation was filled with "firsts!"
I wore my white lab coat for the first time.
I conducted my first diet recall.
I wrote my first entry in the medical chart.
I witnessed my first nutrition assessment with a translator. 

I learned:
Always read the patient's medical chart before you go into the room for a nutrition assessment.  Try find out what the patient's concerns are, and how you can address those concerns.  Ask the patient why they are here to see you.  It is a horrible feeling to not know why you are talking to a patient, or if your words are relevant. 


Diet recall.  (A diet recall is a technique used to evaluate what a person normally eats and drinks in an average day.)  I remember my second diet recall.  The patient casually stated that he drank 1 gallon of milk per day.  Since I don't like milk, this was a staggering thought.  But a professional must keep a non-judgmental attitude.  Remember to ask portion sizes and use your hands and palms to estimate ounces.  Ask about the frequency of meals.  Detailed is better, but avoid neurotic. 


As a newbie, I'll share a memorable learning experience.  The dietitian and I saw a patient who had just started chemotherapy treatment.  She was not eating and needed to increase her caloric intake.  The dietitian left the room, so I was left alone with the patient.  We were talking, and I started suggesting ways to increase calories.  You know, the usual: drink whole or 1% milk instead of skim milk, don't hesitate with the spreads, switch from smartbalance to butter, try calorically dense foods like nuts, eat small frequent meals.  Later I learned that she is a fitness instructor.  I bet half of my advice went in one ear and out the other.  Lesson: know your congregation before you start preaching.

Huh, what's wrong with the food system?

If you live in America and if you eat food, watch this film.  Please.

Food, Inc.

Directed by Robert Kenner

http://www.foodincmovie.com/ Or read the book.

Many people saw Food, Inc. earlier in the year, but once again I fall behind on the bandwagon.  Food, Inc. is currently out of theaters, but it will be released to DVD in a month.  Tonight I attended a viewing sponsored by the Tufts' Friedman School of Nutrition Science and Policy.

Food, Inc. goes beyond the fast food phenomena, and digs deeper to reveal disconcerting trends in the American food system.  Director Robert Kenner  sends a clear message: The food system needs restoration.  Such a restoration will require new public policy, revolutionized agricultural practices, and a different way of eating in America.  Though such changes may seem distant from the lives of individuals, Kenner sends another equally powerful message: American consumers have the power to affect this change as they demand healthful and ethical food.  This demand starts with our shopping carts.  

Perspectives from Michael Pollan (The Omnivore's Dilemma) and Eric Schlosser (Fast Food Nation) added credibility to the movie.  The film also features Gary Hirshberg, the Chairman, President and "Ce-Yo" of Stonyfield Farm (think, yogurts).  After tonight's showing Gary Hirshberg came to answer questions from the Friedman community.  What a unique opportunity.

Hirshberg hopes that Food, Inc. will increase awareness about America's broken food system.  Ultimately, he wants the movie to lead to new conversations, and then those discussions can lead to change.   So far the movie has garnered over 600,000 views in 500 theaters and the book is in it's 7th printing.  Look for the DVD in November!

Tonight's film left me pensive.  As I walked home from the subway I mentally gathered three lessons in my head.  First, I confront sustainable agriculture yet again. Slowly my mind mobilizes from ambivalency to interest.  Yes, I believe farmers markets can make a difference!  But can I support them every week?  I wager, likely not.  

Second, I see the benefits of organic food.  No, I still do not think organic food necessarily has increased health benefits.  (That topic requires a separate post and lots of research.)  But organic food has unarguable environmental benefits.  Tonight Gary Hirshberg quoted, "There's only one reason to not eat organic: price."  Do I agree with this? 

Thirdly.  I learned that food, like any other commodity, has value associated with cost.  This seems obvioius, but Hirshberg pointed out, "The whole food system is based on low costs.  Americans are used to cheap food, but we don't remember to measure the costly externalities."  He mentions the oil costs, the negative impacts on the environment, and the rising cost of obesity and diabetes in the American population.   I need to stop scrimping, and spend the extra buck on fruits, veggies and lean protein.  I am paying for quality and investing in health.  

Tonight Food, Inc. challenged my grocery list and my plate.

Crispy Morning and Crunchy Apples

Nashoba Valley Winery

100 Wattaquadock Hill Road

Bolton Massachusetts 01740

(978) 779-5521

http://www.nashobawinery.com/

The crisp weather set the stage for a lovely visit to Nashoba Valley Winery.  The event was hosted by Massachusetts Dietetic Association's "Socials for Success."  We started with a tour of the winery, at which point I tasted an excellent white Baldwin apple wine.  I do not know much about wine, but I was excited to taste a wine made purely from apples.  Also of note was the semi-sweet cherry wine, the rich blueberry merlot, and the unique Perry pear wine.  Nashoba distilles a variety of spirits and beers (with many fruity flavors), and traditional wine as well.

Then to the apple trees!

Fresh and crunchy, baked, dried, saucy, sauteed?
Now I am looking for creative ways to eat all my apples!

New "Sunny" Sweetener

Sun Crystals
All Natural Sweetener

Yesterday in Nutrition Biochemistry class my friend gave me a sample of Sun Crystals.  She recieved a complimentary pack in the mail.  I love the bright green packaging, but first I go to their website to check out the claims.
https://www.suncrystals.com/
Sun Crystals is a sweetener that contains cane sugar and stevia.  According to their website, each packet is 5 calories, 1 gram of carbohydrate and 1 gram of sugar.
They also offer a "granulated blend" that can be substituted for sugar when baking.


Stevia is a plant commonly found in Central and South America.  It has very sweet leaves (200x sweeter than sugar) but has an unpleasant aftertaste.  Until recently the FDA considered stevia as a supplement, thus banning its addition to foods.  Then in December 2008 the FDA granted rebaudioside A, an extract of stevia, the GRAS status.  GRAS stands for Generally Regarded As Safe.  With this action the FDA "intended [reb A] to be added as a general purpose non-nutritive sweetener into various food categories at per serving levels." 


The FDA website is hard to navigate, but here's the documentation for the December 2008 stevia approval.  http://www.accessdata.fda.gov/scripts/fcn/gras_notices/grn000278.pdf

Sun Crystals.  I tried it.

Has a sharp, almost metalic, aftertaste.  Very strong.  Not so "sunny" after all.
I don't like it.
*Go to their website if you want to sign up for free samples.*

The Story Behind the Scale

Dietetic Internship Rotation #1: Tufts Weight and Wellness Center (WWC)
The WWC offers weight loss treatment for people with obesity through medical weight loss programs or bariatric surgery.
Sept 7-18th.  *A Brief Recap*
What is it like to be obese, and morbidly obese?
I gained perspectives after my first rotation in the Tufts WWC.  Fortunately this knowledge has challenged my thinking and even changed my views.  (See blog post from September 8th).  I would like to share the thoughts scampering about in my head so that I can document these trite reflections.

I Witnessed: Tufts WWC Immersion Day.  Immersion Day is an introductory class for obese patients seeking bariatric surgery.  From 9am-4pm I sat with 7 other obese patients and discussed the risks and benefits of gastric bypass surgery and gastric band surgery.
Lesson: First, I learned a lot about bariatric surgery.  The clinicians kept saying, "Surgery is just a tool for you to use.  It's all about diet, behavior and exercise!"  I agree.  This 3-pronged triangle should be the aim for everyone.  Second, I learned about support.  These 7 obese individuals were supporting each other as they sought out a drastic solution for their weight.  They were learning together, sharing confessions and offering suggestions.  At the end of the day there was a special cohort in the room.  I was priviledged to be among them.

I Attempted: Partial Meal Replacement Diet.  Yes, I put myself on a meal replacement diet for one week.  During rotation I attending several nutrition education classes for the medical weight loss patients.  These patients were seeking to lose weight by substituting 2 of their meals with high protein shakes or bars.  I wanted to try it too.  But after 3 days,  I failed.

Lesson: Weight loss is hard!  Human beings love food, and any sort of diet proves difficult.  The meal replacement diet was challenging because it took time to plan each meal and grocery shop for the high protein bars.  Also, I got hungry for real food.  But my failure made me respect the WWC patients' motivation and discipline.  Changing habits, new behaviors.  Wow, this is the hard stuff.

I Listened: HOWL Seminar, "Body Contouring After Massive Weight Loss".  I attended a seminar at Tufts Medical Center about plastic surgery after weight loss.  Commonly, individuals will lose 100+ pounds and their skin cannot recover elasticity.  The skin hangs, and people may need the skin removed.  The talk was frank, the images were stark, and my mind was churning with disbelief, shock, and amazement.
Lesson: weight remains a lifetime issue.  There are new challenges every day, even after a successful bariatric surgery or weight loss.  In reality, the perseverance required for bariatric surgery and obesity can apply to all weight loss situations.  My respect for these patients rises yet another notch.  I could use a dose of this type of commitment!

Takeaway points.
Obesity weight loss is not about losing the pounds so much as reducing risk of chronic disease.  Dropping BMI points, increasing exercise, shrinking body measurements, and changing eating behaviors are all valid ways to increase quality of life.

I've realized how harsh I can be in judging people by their weight or appearance.  Every person faces the same personal struggles of balanced food intake, mindful behavior, and active living.  We are all seeking healthy and happy lives.

The WWC taught me that it's not the number on the scale or the pants size that matters, so much as the story behind each person.

My First Nibble: Sustainable Agriculture

I am completely ignorant.  That is, on topics of farming, food security and community supported agriculture.  But I am interested!  Today I had my first taste, and I think I'll be coming back for seconds.
The following provides my hastily jotted notes from the lunch seminar I attended today.  As someone with no background in the sustainable agriculture movement, I found the topic fascinating.  New vocabulary, new ideas, and a peek at a whole culture that is sweeping America.  Don't judge me for my ignorance as I proceed to share my thoughts and scribbles.

John Carroll, Professor of Environmental Conservation, Univ. of New Hampshire
Pastures of Plenty: The Future of Food, Agriculture and Environmental Conservation in New England.
Hosted by the Friedman School of Nutrition Science and Policy, Tufts University
.....
Carroll started his lecture with two quotes.
"Agriculture is going to come back to the center of the American way of life in a way that we couldn't imagine."--James Howard Kunstler, The Long Emergency

"Agriculture is the first victim of peak oil."--Kenneth Deffeyes, Beyond Hubbert's Peak: The End of Oil.

New England used to be an agricultural region, until grazing declined and ended in the 1960s.  However grazing will be the centerpiece for food security in this region.  (err.. which states are New England?  NE: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.  Thank you, dictionary.com)

The Social Movement for Local Foods
1. The Explosion of Farmers Markets. (oh yeah!, I have noticed this.)
This is not wholesale markets, like Haymarket.  (*shock* Oh no, I like Haymarket!)  This is the direct interaction between farmers and consumers.  Farmers markets provide a substantial transfer of revenue to the farmer.  For the economists, this poses endless frustration.  Economists cannot measure exactly how much money is exchanged at farmers markets, nor how much food it produces.
 
2. The Rise of Gardening.
This includes home gardens, community gardens, and urban gardens.  Community Supported Agriculture, CSA.  http://www.localharvest.org/csa/

3. Livestock Revolution.
Particularly chickens.  Surprisingly, urban areas may be the forefront for this increasingly widespread practice.  Did you know Arlington passed a  law allowing 6 chickens per household? (Arlington is a town 6 miles northwest of Boston.  Population 42,389 as of 2000).

Benefits of Local Food
1. Food Security
Currently diesel powered trucks rely on the deteriorating infrastructure of highways and roads to deliver foods from long distances.  Quality produce may travel over 3,000 miles from California (yay, CA!), and we are increasingly transporting food from China as well.  Local foods can avoid these transportation insecurities.

2. Fresh
Local food is fresh, and fresh food is nutritious.  Yes, fresh food is usually more expensive.  Currently Americans spend about 9% of their income on food.  What if we were willing to spend 20% of our income on food?  In Europe they spend 18-23%.  If we were willing to invest in food, we would not have a problem with farmers markets or CSA prices.  (Hmm good point.  Although right now I am still a grad student.  Meaning, no income!)

How does New England become locally sustainable?
1. Pastures.
New England must get back to grazing, also called "grass farming."  Vermont leads the region with their Grass Farmer's Association.http://www.uvm.edu/~pasture/?Page=vgfa.html
2. Intensive Rotational Grazing
This type of farming requires an intimacy between the farmer and the land.  No absentee farmers. 
3. Biointensive Agriculture.
(This point went way over my head.  oops!)
....
I am happily shopping and munching at my local Trader Joe's and Shaws market, while all around me the currents of a social movement called "Local Food" ebbs stronger.  I want to learn more.  As a future dietitian, I must learn more.  I need to prepare for the day when the values of sustainable agriculture and the values of nutrition intermingle and meet.  Oh wait; that date has already passed.