Integrative Nutrition

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logoThese days, I often identify myself as an integrative nutritionist.  But just what does that mean?  Technically, many give the words integrative and holistic two different definitions. Integrative suggests the melding of different cultures and belief systems, blending traditional Western medicine with Chinese herbal medicine or acupuncture, for example. And holistic is used to denote an approach that says you cannot separate mind and body and the most productive way to help a patient is to look at all aspects of their being. Both of these imply an alternative approach. For me, these two concepts come together as one under the term integrative, a practice that is simply more practical and productive. Of course you capture more of the picture with a wider lens.

When I assess a patient, I try to learn what constitutes the root causes of her or his problem. It is rarely just one thing or another, a physical matter or a more subtle lifestyle or emotional issue. Most commonly, both physical and psychic or lifestyle issues are linked. Think about diabetes and prediabetes, for example. Elevated blood sugar and the long-term damage it causes is one of the biggest health problems plaguing our country at the moment. About 29 million adults, more than 9% of the population, has diabetes, and roughly 86 million suffer from its precursor, prediabetes.  In the majority of cases, these disease states are associated with obesity. Well, along with diet and exercise, stress and lack of sleep have been proven to affect weight gain.  Is it holistic if I ask a patient about the stress in their life?  Or the quality of their sleep?  No, it’s just part of good nutrition counseling. That’s why my new book coming out in November, The Diabetes Solution, written with Dr. Jorge E. Rodriguez, has large sections on stress reduction, improving sleep, and making sure you get enough physical activity to improve your health in addition to all the medical information you will ever need and a sumptuous dietary plan with 100 recipes. Forgive the plug; I worked on that book for a very long time. and it will be an excellent aid to anyone wishing to lower their blood sugar.

I think of integrative nutrition also as pushing the forefront of evidence-based medicine. By that, we mean science that has been shown to be effective or true in studies solid enough to be published in journals reviewed by other professional experts. Often it takes years for information that has been proven by research to enter standard practice, because not everyone reads the latest medical and nutrition journals, and organizations–not to speak of the government–are extremely slow to change, partly because of bureaucracy and partly because of appropriate caution. The Swiss doctor I worked with, Dr. Thomas Rau, lectured me almost a decade ago about the gut microbiome and the tremendous importance of nourishing our good gut bacteria with proper nutrition. That’s a model I’ve followed since I began my practice, even though it’s only become “fashionable” in the past couple of years. And as I’ve learned both in my practice and in my own life, this sort of integrative nutrition practice is powerful and effective.

On the other hand, sometimes integrative, alternative and holistic are used as titles without being backed up with enough training and knowledge. My dog could call himself a holistic nutritionist. There are no regulating bodies or state licensing agencies as there are for registered dietitians. Good nutrition practice is not magic. If you want to improve your health or want to make sure you are practicing the best form of wellness to ensure healthy aging, I hope you’ll look for a registered dietitian nutritionist ( a newer name for an RD who specializes in nutrition), preferably one with an MS or MPH in their credentials, which denotes a masters degree,  entailing years of extra scientific study.  And given my biases, I suggest you ask them if they have an integrative approach and if so, give it a chance. You’ll be amazed at the power of proper individualized nutrition.

 

 

 

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The Diabetes Solution

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Some people may have noticed I have not posted in a very long time. That is because I simply am not a natural-born blogger. A million years ago, I learned to cook by working my way through both volumes of Julia Child’s “Mastering the Art of French Cooking,” but it would never have occurred to me to publicize that fact. More acts were private in those days. And there was no way of boasting when she came to my house to do Thanksgiving with wild turkey for “Good Morning America,” especially precious to me because she said on the air how much she loved my book “Cooking from a Country Farmhouse.”

So during the past year or so I neglected to document online all the work I have done on my next book with Dr. Jorge E. Rodriguez: “The Diabetes Solution. Together, we’ve put together a volume that addresses everything you need to know to reverse prediabetes or control and alleviate type 2 diabetes. I’ve come up with a structured eating plan that once mastered, makes it easy for anyone to lower their blood sugar, losing the extra weight they need to shed in the process. It’s based on the successful eating plans I’ve used in my private practice, which is so very gratifying.

Rodr_Diabetes Solut#1EF7C2B

So I hope you’ll look for “The Diabetes Solution” when it comes out in November, published by Ten Speed Press. In the meantime, future posts will give you a preview about managing diabetes as well as other chronic inflammatory diseases through the right way of eating and other lifestyle choices. Please stay tuned.

Prediabetes

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As high blood sugar becomes more of a national obsession–partly associated with our obesity epidemic, partly linked to our typical Western diet–the term pre-diabetes is being used more frequently. Prediabetes indicates fasting blood sugar over 100 but below 126 (or glycosylated hemoglobin above 5.7 but below 6.5), above which the diagnosis would indicate diabetes.  It is estimated that close to 80 million American adults fall into the pre-diabetic category.

One might wonder if “prediabetes” is comparable to being a little bit pregnant?  Happily, it is not, because while many people diagnosed with prediabetes go on to develop the full-blown disease, the condition is reversible with diet and physical activity. A landmark controlled trial proved that proper diet and regular exercise combined with intensive coaching beat out even the prescription drug Metformin in lowering blood sugar to normal levels.

Reversing the disease before it becomes full blown is important, because diabetes is a disease best treated before it starts or in its earliest, preliminary stage. Once blood sugar regularly rises above 126, it is much harder and often impossible to “cure” the disease  though progression can be largely halted and complications prevented with a lifetime regimen of one or more drugs.

High blood sugar is a much more complicated issue than it often appears in the media. Treating pre-diabetes immediately is important because capillary damage, which usually affects the retina in the eyes and the kidneys first, is silent and painless, and it occurs far earlier than was previously thought. So does neurological damage, which results in the tingling in the bottom of the feet, which many people with high blood sugar experience.

As an integrative practitioner, I counsel very effectively for diet and physical activity.   And I always prefer lifestyle changes over pharmaceuticals when possible. But recent studies have convinced me that this early damage to the microvascular system, which is irreversible, warrants medical treatment immediately.  Then as you work to lower your blood sugar through appropriate dietary practices and increased exercise, you can taper off and hopefully discontinue the drugs if you are successful. The two approaches work best in tandem.

Lest I sound too conservative, in my next post, I’ll discuss insulin sensitivity and a couple of natural non prescription supplements, which have proven helpful in dealing with pre-diabetes and diabetes.

Call Me “Prof”

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What a thrill to announce I’ve been invited to join the faculty of the University of North Carolina at Chapel Hill as an Adjunct Instructor in Nutrition at the Gillings School of Global Public Health. Starting in January, I’ll be teaching a graduate course in Food Science. Being invited back to my alma mater means so much to me because of what the university gave to me. The academic scientific education and rigorous clinical training in nutrition and public health provided  a robust and multi-faceted toolbox to use in treating my patients. To have so much to draw upon has imparted both confidence and competence in my practice at Triangle Nutritional Wellness.

Whether it’s been the effectiveness of my weight-loss program or complicated medical nutrition therapy for complex chronic ills, the combination of evidence-based information, the holistic approach I learned from Dr.Thomas Rau, and my extensive professional culinary knowledge have served me–and my clients–well. It’s no accident that UNC at Chapel Hill is ranked as highly as it is.

If I can inspire even a few students the way the amazing Amanda Holliday, Clinical Assistant Professor and Director of the Dietetics Programs, who was my advisor and teacher, inspired me, it will be an achievement. I look forward to pairing academia with my clinical nutrition practice.

Travel the World – Without Leaving Orange County!

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I recently had the great pleasure of writing the lead article for this fall’s Chapel Hill Magazine 3rd Annual Foodie Issue.  Gorgeous food photos and tasting notes highlight how you can take your palate on a trip around the world – without leaving Orange County! With two major universities nearby, the international talent of the Research Triangle, and a rich multicultural community, maybe it shouldn’t be surprising that we have such a plethora of  ethnic restaurants. But I’d forgotten how good they are. Enjoy an authentic  taste of Italy, China, India, France, Korea, Viet Nam, Turkey, even Ethiopia  with no need for a passport. Thanks to editor Andrea Griffith Cash and photographers Briana and Mackenzie Brough for making my piece look so good. Pick-up a copy today of the Chapel Hill Magazine September / October issue for more details.

Talking Health, Wellness and Food with Chapelboro’s “SideDish”

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This weekend I had the great pleasure of being interviewed by Deborah Miller on her show, “SideDish” on WCHL radio in Chapel Hill, North Carolina.  Deborah is a fabulous full-of-life individual who gets up-close and personal with area chefs, cooking teachers and food and wine experts, and she has a gift for drawing out the best in everybody. I guess I qualified as a cross-over, having been a food and wine expert and now following my passion for nutrition. We talk about my clinical practice, which emphasizes delicious natural foods as the path to good health, and offer several great seasonal recipes for fresh corn and tomatoes.

To listen to my interview with Deborah on her show, SideDish” please visit http://chapelboro.com/pages/13454906.phpI would like to give Deborah and her team a very big, “Thank You,” for having me on “SideDish” this past weekend!

Healthy Eating Is Good Eating: Do-Ahead Dinner Party Lamb

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It always puzzles me why we tend to do all or nothing.  Eat only vegetables or be meat and potato fanatics.  Food is so pleasurable, and every ingredient has something different to offer. Why not embrace them all? That’s why I think that while a preponderance of a variety of fresh vegetables should constitute the backbone of everyone’s diet, a little red meat now and again is not a bad idea. Choose lean and organic or hormone free, if possible. Red meat contributes high-quality protein; iron, an essential mineral in appropriate quantities; B12, which is hard to come by in completely vegetarian diets, as well as B1 and B6. Lamb contains one quarter to one third of an adult’s daily requirement for zinc.

Rack of Lamb with Herbed Garlic Crust is one of my favorite dinner party dishes, because it can be completely assembled in advance. While the chops on the plate you see look hefty, they constitute at most 4 ounces of meat, albeit so flavorful and well seasoned, the satisfaction level is high. And notice, as recommended by the powers that be, three quarters of the plate are filled with vegetables.

I like this recipe primarily because it is so delicious, but also because its do-ahead aspect removes as much fat as possible from the lamb and the smell from the initial browning will disappear by the time your guests arrive. For my plate, I’ve included Yukon gold potatoes roasted with onions, roasted beets, and steamed baby broccoli and asparagus. You can choose your favorite accompaniments.  And look for dessert in an upcoming blog.

Rack of Lamb with Herbed Garlic Crust

Baby racks of lamb from New Zealand are available in most parts of this country.  Because they are from young animals, the flavor is mild, and if you allow one rack for 2 to 3 people, portion size is appropriate.  Those prepackaged at Trader Joe’s are already heavily trimmed. Whole Foods also carries them, but be sure to ask the butcher to trim off any excess fat.You can brown the meat, layer on the crust, and finish the dish in the oven within an hour and a half of serving; or brown ahead and refrigerate until one to one and half hours before dinner.       Serves 2 to 3

  • 1 rack of baby lamb (12 to 16 ounces)
  • Sea salt and freshly ground pepper
  • 3 tablespoons extra virgin olive oil
  • 1/2 cup panko bread crumbs
  • 1/2 cup flat-leaf parsley sprigs, tough stems removed
  • 3/4 teaspoon minced fresh rosemary
  • 2 garlic cloves, minced
  • 1 small shallot, chopped
  • 2 to 3 teaspoons Dijon mustard
  1. Trim any visible solid fat from the lamb. Season  all over with salt and pepper. Heat 1 tablespoon of the olive oil in a cast-iron or other heavy ovenproof skillet just large enough to hold the rack. Add the rack meaty side down and brown over moderately hot heat for about 3 minutes. Turn over and brown the other side for 2 to 3 minutes. Remove the lamb to a plate. Pour off all the fat from the skillet, and carefully wipe it clean with paper towels. If you’ve done this preparation well in advance, cover the meat and refrigerate.  If you are within an hour and a half of serving, set aside to cool slightly.
  2. Preheat the oven to 400 degrees F.  In a mini-food processor, combine the panko crumbs. parsley, rosemary, garlic, and shallot. Pulse, then process, until the parsley is chopped and the breading evenly mixed.
  3. Paint the meaty side of the rack and the ends with the mustard.  Spread the seasoned crumbs over the rack and onto the sides, pressing it firmly but gently with your hands to help it adhere.
  4. Return the rack to the skillet and roast until the center of the meat registers 139 degrees F for medium rare, about 15 minutes, or slightly higher if you prefer it better done. (The flavor is best if the meat is pink.)  Remove from the oven and let stand for 3 to 5 minutes to finish cooking.  Divide into double chops to serve.

Move It or You Won’t Lose It

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There’s nothing like personal experience to drive home a lesson. I always tell my clients physical activity is a major component of good nutrition. I even pass out free pedometers, explaining how moving skeletal muscles not only speeds up metabolism, but perhaps more importantly, facilitates transport of glucose from the bloodstream into the cells, where it’s used for energy, without any action of insulin. But do I practice what I preach?

Zipper

I walk my dog Zipper for up to an hour every day, but he zips only occasionally and stops and sniffs a lot. There’s no room for my treadmill where I live now, and I dropped membership in my health club when they moved farther away. My yoga mat, well used most of my adult life, remains rolled up and tucked away. I use the same excuses as all the people I’m trying to help.  Too busy: the computer and stove, work and responsibilities take up all my time, as does life.

So no surprise my own recent efforts to drop a few pounds hit a wall. First I gave up bread and booze, an easy first-line strategy. Dispensable calories, at least in the short run. Bingo: 3 pounds in 3 weeks—an optimal weight loss rate: slow, steady and often permanent.  But then, the numbers just wouldn’t budge. Granted, it was a casual diet, and after a few weeks, I wanted a glass of wine. I made further changes, eating lighter, including even more vegetables than usual, creating more salads, some of which you’ll find elsewhere on this blog. The food was delightful and I felt great, but still, no more pounds came off.

Then recently, with the weather absolutely perfect and a little more time on my hands, I took a long hike with my good friend graphic designer Suzin Purney. We let the dogs off their leashes and kept a brisk pace up and down hills for about an hour and a half. The next day, I picked up my tennis racket for the first time in at least a decade. Another dear friend, Mary Ann Kendall, who is a pro at the local tennis club, gave me a lesson. Miraculously, the muscle memory was there, and it started to come back. It felt great to hit the ball and run around the court. I kept up the pace for another few days.

Well, at the end of the week when I stepped on the scale, there were two more pounds gone. I’d reached my goal.  But it was only achievable when I added some rigorous physical activity to my dietary plan. It’s not trivial that in the biochemistry of nutrition, we study exercise physiology along with calories, carbohydrates, protein, and fats. Proper diet and physical activity go hand in hand. You cannot achieve optimal health with one without the other.

Avocado and Arugula Salad with Blueberries and Melon

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Ok, I’m on a salad jag. What can I say?  All the vegetables and fruits in the market are so beautiful, they call out to me. So why not put them together? Technically avocado is a fruit, but most of us think of it as a vegetable, so that’s how I’ll refer to it.  Rich in healthful mono-saturated fat, avocados are nutrient dense, providing vitamins K, C, E folate and most of the B vitamins as well as fiber, lutein and magnesium. While we usually associate vitamin K with blood clotting, it is essential to building strong bones. Calcium cannot do it alone.

This pretty salad can serve as a first course. Or you can transform it easily into a light main-course with a sprinkling of sunflower seeds and a few tablespoons of crumbled ricotta salata, dry white goat cheese, or feta cheese. For the meat eaters out there, which includes me upon occasion, a paper-thin slice or two of prosciutto wouldn’t hurt, either.  Serves 2; recipe doubles easily.

  • 2 cups arugula, tough stems removed
  • 1/2 cantaloupe or honeydew melon, sliced, rind removed
  • 1 small avocado, peeled and sliced lengthwise
  • 1/4 cup blueberries
  • 1 tablespoon fresh lime juice, Banyuls vinegar, or white wine vinegar
  • 4 teaspoons extra virgin olive oil
  1. Arrange 1 cup of arugula on each of 2 salad plates.  Decorative arrange the melon and avocado slices on top. Scatter the blueberries over the salads.
  2. Drizzle the lemon juice or vinegar and olive oil over the salads. Serve at room temperature or slightly chilled.

    Avocado and Arugula Salad

Fresh Zucchini Salad with Parmesan Cheese and White Truffle Oil

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 Who ever said good nutrition has to be dull?  Raw zucchini is highly alkalizing, rich in fiber and low in calories, containing only about 20 per cup.  It provides a little incomplete protein (2 grams), which the cheese in this recipe will boost, roughly one-third of the RDA for vitamin C, a bit of vitamins A and K, two important carotenoids—lutein and zeaxanthin—some B2 (riboflavin) and B6 (pyridoxine), potassium and manganese.

Romanesco zucchini

This refreshing, sophisticated recipe, which I picked up on a hot afternoon at Ristorante Leo in Florence, is best made with Romanesco zucchini, the ribbed variety that produces all the flowers.  It is not as prolific as more commercial types; so look for it at farmer’s markets and specialty produce stores, or grow your own. It has marvelous flavor and a firm,crisp texture, which holds up well even with cooking. Also, choose the youngest, sweetest onions you can find and shave them paper thin.  Serves 4 as a first course.

  • 3 small or 2 medium zucchini
  • 1 or 2 small sweet white onions, about 2 inches in diameter
  • 3 tablespoons fresh lemon juice
  • 2 tablespoons extra virgin olive oil
  • Sea salt and freshly ground pepper
  • 2 ounces shaved Parmigiano Reggiano, aged Pecorino Romano or Manchego
  • 2 to 3 teaspoons white truffle oil (optional but desirable)
  1. Using a mandolin, a swivel-bladed vegetable peeler, or the slicing blade of a box grater, shave the zucchini lengthwise into very thin, wide ribbons. Thinly slice the onion.
  2. Toss the zucchini and onion with the lemon juice and olive oil. Season lightly with salt and generously with freshly ground black pepper.
  3. Arrange the salad on 4 plates. Scatter the cheese over the zucchini and drizzle the truffle oil on top. Serve at room temperature or lightly chilled.

    Zucchini Salad with Parmesan Cheese and Truffle Oil