Feeding Therapy Meets the Ketogenic Diet

Recently I discovered that an article I wrote on guidelines for speech therapists to use in dealing with children on the ketogenic diet is no longer available online.  This article was published in ADVANCE for Speech- Language Pathologists & Audiologists a few years ago.  Due to the publication no longer being available I'm sharing it here.  

Keto SLP article.jpg

When parents first learn about the principles of the ketogenic diet for seizures, many are surprised that the preferred food choices on this plan exist in complete opposition to the American food guide pyramid.  The building blocks of this effective therapy for intractable seizures in children include fats such as heavy cream, butter, oils, and even avocados.  Common foods such as milk, bread, rice, cereal, and pasta are noticeably absent from meals and snacks composed of roughly ninety percent fat.  Through the manipulation of the amount and types of nutrients provided, seizure control may be improved.  For speech therapists, working with a child on the ketogenic diet can lead to increased challenges when utilizing standard interventions.

What Is Ketosis?

Without sufficient carbohydrates present in daily food choices, the human body must switch to breaking down fat for energy.  This conversion to a back-up fuel system induces the presence of ketone bodies in the blood.  Although the complete action of the ketogenic diet remains under investigation, the increased levels of blood ketones, often correlates with a reduction in seizures.  Even if seizure activity is not greatly reduced, neurologists are sometimes able to reduce the number or dosage of seizure medications.  For some children, parents and healthcare workers have witnessed improved development in language and motor skills while closely following the diet.

The ketogenic diet is a delicate balance between fat, protein, and minimal amounts of carbohydrate, calculated and prepared by weight to achieve what is known as the ketogenic ratio.  On a typical 4:1 ratio, each meal and snack provides approximately one part protein plus one part carbohydrate for every four parts fat consumed.  While the average slice of bread may contain fifteen grams of carbohydrate, a child on the ketogenic diet may receive an allotment of less than five grams of carbohydrate for the entire day.

Due to the structured nature of the diet, every child must be closely followed by a ketogenic diet team including a neurologist, registered dietitian, and nursing personnel.  Serum levels of nutrients are closely monitored and vitamin and mineral supplements are mandatory while children are following the diet.

Unlike low carbohydrate diets utilized for weight loss, children’s calorie and protein needs are calculated to provide sufficient nutrition for development.  Growth and seizure activity is monitored closely by the keto diet team and nutrients provided are adjusted in response to each individual child.

While following the diet, even a small amount of carbohydrate can create an imbalance.  For this reason, carbohydrate is restricted in the form of medications, supplements, toothpastes, and even lotions.  Therapists must be careful to adhere to approved products to prevent introduction of excess carbohydrates.

Newer approaches to diet therapies for seizures include the modified Atkins diet and the Low Glycemic Index diet.  Both of these diets focus on the restriction of dietary carbohydrate to a certain level, but food is not weighed on a gram scale and the allotment of carbohydrates is slightly higher than the ketogenic diet.  These diets are often used for teenagers and adults as opposed to the ketogenic diet.

Typical Interventions Can Negate the Diet

For children with dysphagia, the simple addition of a commercial thickening agent or rice cereal to their liquids can have adverse consequences when trying to maintain high levels of ketosis.  For this reason, traditional thickening agents cannot be offered due to the carbohydrate content.  Unlike thickening agents based on modified corn starch, thickeners such as guar gum or xanthan gum are incorporated due to their incomplete absorption by the body.  Pure forms of these gums can be purchased through some health food store or via the Internet.  One commercial example of this type of thickener, Simply Thick, a xanthan gum based liquid, can also be incorporated into the ketogenic diet when a thickening agent is needed.

According to Beth Zupec Kania, RD, CD owner of Ketogenic Seminars and consultant for The Charlie Foundation, “success in maintaining good seizure control during both testing for swallowing issues and upgrading the ketogenic diet is found by working closely with the registered dietitian who is monitoring each child.  Due to the fact that the typical first foods used for swallow studies and therapies are severely restricted in type and amount on the ketogenic diet, foods such as applesauce, must be paired with a source of fat calculated by the dietitian to maintain ketosis.”

Some children may begin the ketogenic diet receiving all or nearly all of their calories from a ketogenic tube feeding such as Ketocal, manufactured by Nutricia or Ross Carbohydrate Free formula by Abbott.  For some children, if seizures decrease and development improves, more calories may be an option from oral sources in the form of snacks or meals.  Small snacks of heavy cream which has been whipped and paired with pureed fruit can be calculated by a child’s registered dietitian.  As children begin to consume greater amounts of intake by mouth, enteral feedings can be reduced if excess weight gain occurs.

Although fruits juices are typically avoided, beverages which are carbohydrate free such as certain flavored waters or a few approved caffeine free diet sodas can be used for oral stimulation.  These beverages can also be frozen and presented at the temperature desired.  Many products labeled as sugar free, including lollipops, still contain carbohydrates which will interfere with ketosis.  Even sugar free gelatin, which contains protein, must be paired with whipped heavy cream to maintain appropriate levels of ketones in the blood.  Zupec Kania states, “One misconception I have encountered is when parents have allowed their kids to taste a food by licking it, thinking that since they are not ingesting it, that it doesn’t contribute calories. They often experience a problem with either ketones and or seizures.”

For swallowing and motility studies calculated snacks should be provided by the family to help prevent immediate cessation of ketosis which can precipitate a seizure.  The radiologic product added to the child’s food should also be free of all forms of carbohydrate. 

Heidi Pfeifer, RD, LDN clinical dietitian specialist with Massachusetts General Hospital emphasizes that every child is an individual and items that are typically used in assessing children by speech therapists need to be modified.  Pfeifer is fond of trying different flavors to provide oral stimulation or increase the volume of food consumed, “Even if a family is not familiar with using spices, the addition of a very small amount of hot sauce to an item such as mayonnaise or ketogenic chicken fingers can help to change the flavor and boost a child’s intake.”  Although commonly used foods may need to be avoided during feeding and speech therapy, using a little creativity and being knowledge about the guidelines of their diet can make a big difference in working with these children and helping to maintain their seizure control.


Food Options for Therapy

The following foods according to Beth Zupec Kania, RD, CD should not be offered on their own, but can be paired by the ketogenic dietitian with a calculated source of fat for feeding therapies.  Children who have a feeding tube can receive their fat source enterally.


Cooked or canned green beans, carrots, or squash, avocado.

            Ripe kiwi with the seeds removed.


Honeydew melon, nectarine, papaya, peach with the skin removed.  Popcorn with the hull removed prior to weighing. 

Dark meat chicken with the skin removed.


Plain cheerios, Rice Krispies, All Bran- although these are very high in carbohydrate, a few pieces can be worked into a meal or snack.


List of resources



Time for Winter Veggies to Take Their Turn

Time for Winter Veggies to Take Their Turn

With temps still dipping into the single digits and the arrival of garden fresh vegetables months away, it’s likely you’re missing out on some servings of fresh fruits and vegetables.  Combining too many hours of indoor sedentary activities along with less than healthy food choices often adds extra pounds to many waistlines before Spring finally arrives.

Dear Future Doctor...what's the best nutrition advice for your patient?

Psst.  Hey you!  Yea, the one in the short lab coat with the big brain.  Recently I referred a friend to the primary care doctor you’re currently training under.  You see, my friend had been complaining about a lot of uncomfortable gastrointestinal symptoms which she had never discussed with a doctor.  Rather than just starting her on a diet for IBS (which as a registered dietitian I very well could have), I sent her in for an appointment to make sure all other medical causes of her symptoms beyond diet were ruled out.  Without even asking her what she was actually eating (and prior to seeing the doctor), you promptly diagnosed her with Irritable Bowel Syndrome and provided a handout from the Internet on the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol diet or FODMAP for short.  Helpful?  Maybe not.

The FODMAP diet has gotten great media attention recently and for good reasons.  For individuals who have IBS it may be the key to finding relief from bloating, diarrhea, gas and other uncomfortable GI side effects which occur when consuming certain foods.  In this situation though, applying a complicated, although well researched diet to a person whose food intake you haven’t actually assessed?  There may be a better approach.

Is it simply lactose intolerance?

Poor digestion of lactose, or the sugar in cow’s milk, is prevalent throughout the U.S. If your patient’s diagnosis is simply lactose intolerance you’ve now advised her to avoid multiple vegetables, fruits, wheat, beans, and various sources of fiber.  Does she really need to limit her portion of avocado or pistachios when she simply needs to swap her two daily glasses of cow’s milk for a lactose free option?


What’s in that bar?

What if the real problem is that every morning at breakfast she’s eating a bowl filled with 15 grams of chicory root fiber or a bar with inulin as the second ingredient? Could the source of gas and bloating be her sugar free ice cream with both mannitol and sorbitol as ingredients? Without assessing her actual food intake and symptoms there would be no way to know that she simply needs to stop consuming those particular products, rather than restricting her intake of more than one hundred food items.

Water, water everywhere?
Could the fact that her caffeine habit, a can of soda twice a day (a source of high fructose corn syrup) along with a fruit smoothie is the cause of the diarrhea?  Fructose intolerance can occur in the same way as lactose intolerance, but is often ignored as a source of GI problems.

Unknown Antibodies?

What if the real problem is celiac disease? By handing her the fodmap diet without testing for celiac antibodies you have now rendered this mode of testing completely inaccurate.  This is the number one reason I ask a primary care physician to check for anti-gliadin antibodies BEFORE we implement a gluten free diet.  Her choice to avoid wheat, rye and barley prior to testing for autoimmune disease will result in a false negative as she has now removed the trigger for an immune response.  But why does this matter if she’s feeling better?  Knowing you have an autoimmune disease versus simply avoiding gluten because you feel better will have significantly different influences on someone’s attitude and future decisions when presented with Grandma Susie’s famous gluten-laden chocolate cake.

There are other organs of digestion?

A few years ago a client that had been struggling with significant abdominal pain for 15 years told me she was sent to my office as a “last resort.” Seriously? During so many years of suffering, seeing a registered dietitian was never suggested by her physicians.  And guess what? Fodmap didn’t fix her.  We tried three different approaches to her diet and I played food detective for several weeks until we discovered the answer.  In the end, a low fat diet was the perfect match for her undiagnosed bile reflux and persistent nausea.  Her message thanking me for helping her escape the abdominal pain that had been plaguing her for 15 years was truly a blessing.  Could I have resolved the issue without assessing her food choices and symptoms?  Probably not in the next 15 years.

No diet will work if someone isn’t equipped to follow it.  Inevitably if someone doesn’t truly understand and apply the diet guidelines accurately they won’t feel better.  And if they don’t feel better they typically won’t continue with any of it.  Six months later you’ll encounter someone who is still having issues. Is handing someone a paper a good substitute to reviewing food and beverage choices thoroughly with a client for 30 minutes?  The answer is no.

As the only healthcare providers that extensively study food science along with medicine and evidenced based nutrition guidelines, registered dietitians understand thoroughly the subtle differences in how foods are digested and in this case, how they affect gastrointestinal symptoms.  Medical nutrition therapy doesn’t center on handing someone a paper or pulling a diet out of a hat.  In that hour that I spend with a patient I will assess, evaluate and educate on the most appropriate foods to choose based on that individual.  I’m not a gambler, but I would put money on the fact that my training and experience may just trump your google search.

As a future physician you will be the authority figure among healthcare professionals.  You will also be the gateway to comprehensive care.  If you only have five minutes to truly help someone, why not hand them information about making an appointment with a registered dietitian nutritionist? Have them see an RDN and let us collaborate with you to truly help your patient.  That’s what we’re here for!

Anyone can consult with and find a registered dietitian nutritionist at http://www.eatright.org/find-an-expert

Better your breakfast with some easy swaps

What’s your go-to breakfast option?  Maybe it’s a doughnut or other sweet pastry.  Puffed colorful cereal with milk?  Or perhaps you’re someone who opts for nothing at all. 

Research continues to support that having a meal within 1 to 2 hours of getting up from sleep is a healthy habit with many benefits including less snacking at night, better weight control, and increased focus on mental tasks compared to breakfast skippers. 

But let’s face it- that sugary pastry is never going to stick with you until lunch.  And that raging physical hunger from a poor choice or skipping all together? You’re probably not going to make a healthy choice at lunch.  You may catch yourself tossing in the towel, ordering a greasy burger and fries and vowing to do better tomorrow.  

Newer research continues to support having breakfast, but several studies have shown promising results on both appetite, weight loss, and eating habits when 20 to 30 grams of protein are included as part of that healthy breakfast.  Protein does not turn into blood sugar until about 1.5 hours after you’ve eaten it, offering a more long lasting energy source than just carbohydrates alone. 

These are a few combinations below which equal 20 to 30 grams of lean protein:

·       3 to 4 eggs or 6 to 8 egg whites would provide 21 to 28 grams protein.  Everything has protein though (Fruits only have a tiny amount) so pairing the eggs with veggies or whole grain toast would also contribute protein without getting it all just from eggs.

·       8 oz of low fat Greek yogurt equals 20 to 22 grams (many small cartons are only 5 to 6 ounces).  Pair with 1 cup of seasonal berries and 2 tablespoons chopped nuts or flavored pumpkin seeds.

·       Four to 4.5 ounces of any meat or fish would provide 28 to 31.5 grams of protein.  What differs is that a chicken breast with 4.5 ounces meat would provide 210 calories while the same amount of steak, depending on the fat marbling, may offer up 310 calories. 

·       Peanut butter or other nut butters are actually fats that contain protein.  To reach 30 grams of protein from just peanut butter or any other nut butter you’d need to eat a whopping 8 Tablespoons! You’d use up a big chunk of your calorie budget with 840 calories worth of nut butter!  Although you may not reach the protein goal with only a tablespoon of peanut butter the high fat content may help you feel just as full when paired with a banana or whole grain waffle. 

·       If you’re a cereal fan consider having less cereal and a small amount of protein with it.  Some turkey sausage links have 10 grams of protein per serving.  Choose low sodium if you have heart disease. 

·       For vegetarian options consider hummus, tofu in your smoothie, or other bean recipes for a protein addition to the morning.

If you’re not used to eating within several hours of getting up a liquid breakfast like a shake containing protein or a Greek yogurt is a good way to start training your stomach to tolerate food. 

Looking to prep ahead for the week?  Try this tasty, low carb and high protein egg breakfast recipe. 


Egg Cups- Makes 12 muffins

Ingredients: 12 eggs or 1 carton egg beaters

·       Splash of milk

·       Vegetables of your choice to add to egg mixture—recipe analyzed with 2 cups chopped, raw baby spinach and ½ to 1 chopped red pepper

·       (can use fresh chopped salsa, or other vegetables instead like mushrooms, onions or broccoli)

·       Salt and Pepper, to taste


Heat your oven to 375F. Spray a 12-cup muffin tin with non-stick cooking spray REALLY WELL (these will stick!). Beat eggs and add the splash of milk. Season with pepper and salt if desired. Put vegetables into each muffin cup. Then pour the egg mixture on top of vegetables equally among the muffin cups. Bake for about 20-23 minutes, or until the egg cups are well set. If a tester/toothpick inserted in the center comes out clean they’re done! Keep in a closed container in the refrigerator. To freeze egg cups, let cool completely then wrap each egg cup individually in plastic wrap and place in large container or freezer bag. Freeze up to one month. Reheat each cup in the microwave.  Remove from the plastic wrap before placing in microwave!  Three egg cups will normally heat to the right temperature in less than 1 minute. 

The nutrition facts are using eggs, chopped raw spinach leaves and red pepper with no cheese.  Each egg cup is 75 calories, 1 gm carb, 6 grams protein, 5 grams fat.  A small amount of shredded cheese can be melted on top when microwaved. 


 Egg cups are super easy to prep ahead.  Keep in a container in the refrigerator until time to reheat in the microwave. 

Egg cups are super easy to prep ahead.  Keep in a container in the refrigerator until time to reheat in the microwave. 

Don't Go Gluten Free Before You Consider This

May is celiac awareness month.  Celiac disease (CD) is an autoimmune disease once thought to be rare in occurrence.  Even just ten years ago, anyone diagnosed with celiac disease was rushed into the dietitian’s office for appropriate counseling A.S.A.P. on label reading, food options, mineral supplementation and emotional support to tackle this significant change.  The rarity of the diagnosis necessitated a full workup on vitamin and mineral levels in the blood and clear direction provided by licensed professionals.  A friend of mine who was recently diagnosed with celiac disease was simply told over the phone by a doctor’s office staff member that she had CD with no direction on the next step forward.    While it may seem more commonplace within the medical community and more individuals may know the word gluten, CD is a chronic medical condition and is no less serious than it was a decade ago.

No one is born with celiac disease, but it can occur at any age.  Like other autoimmune diseases, the body decides to overreact and attack itself with an immune response.  In susceptible individuals, damage occurs to the small intestine in response to consuming gluten. Gluten, a protein found in wheat, rye, and barley is obviously a common food ingredient in the United States. Gliadin, a part of gluten, cannot be fully broken down by the intestine in those with CD, and may pass through the barrier of the intestinal wall causing an inflammatory response.  Over time as damage to the small intestine occurs from ingesting gluten, the ability of the small intestine to absorb nutrients is decreased.  Experts believe that many cases of celiac disease remain undiagnosed, but according to studies in the United States and other countries, the prevalence is approximately 1 in 80 to 1 in 300 individuals.

Although physical problems related to CD can vary, signs and symptoms may include abdominal pain, abdominal bloating, diarrhea, constipation, gastrointestinal reflux, or vomiting. .  Lactose intolerance can occur for many reasons, but it is often present in undiagnosed celiac disease due to the damage the body has inflicted on the area of the small intestine that produces enzymes which help us break down and absorb our food. 

If the gluten free diet is not closely followed it may lead to nutrient deficiencies, specifically calcium, vitamins D and B-12, iron, folate, and zinc which can lead to poor growth in children, anemia, irregular periods and fertility issues, along with low bone density.  More than 50% of people with CD have been found to be vitamin D deficient which effects both immune system health and increases risk of weak bones. 

Testing for CD focuses first on blood markers of an immune response while on a diet that contains gluten, specifically high levels of IgA and IgG antibodies.  The gold standard of testing though is a tissue biopsy of the gastrointestinal tract done by a doctor specializing in gastroenterology.   Genetic testing is also available which also may help tell the difference between CD and a gluten intolerance.  If an individual goes on a gluten-free diet prior to testing, the results of any blood or tissue tests are completely invalid.  Celiac disease is actually the only autoimmune disease where the trigger for the disease is known and can be avoided.  Once a person has one autoimmune disease or certain medical conditions it is likely that another may occur.  This is why it is recommended that certain people with diagnoses of Type 1 diabetes, rheumatoid arthritis, Down syndrome, Turner syndrome and others routinely be screened for celiac disease. 

Medical nutrition therapy for CD is vital as this currently is the only known treatment that helps to decrease damage which occurs when the small intestine is exposed to gluten.  Patients must avoid all sources of gluten including wheat, rye, and barley including small amounts such as malt flavoring and cross contact in the home or in processed food items.  Vitamin and mineral supplementation may be needed to correct deficiencies.  Life time compliance with the gluten free diet is essential for health. 

You would think that the increased awareness of gluten would be a helpful to those who truly need to avoid gluten.  In many ways it is as there are many more food products available.  On the other hand, well-meaning individuals may not realize how careful one must be to avoid allowing any gluten from coming in contact with gluten free food.  Those with celiac disease can not eat a salad that once had a handful of croutons resting upon it or “cheat” on their gluten free diet every now and then.  An immune response can’t be felt.  We don’t feel our white blood cells attacking a cold or doing their awesome immune magic, so for individuals with celiac disease consuming even small amounts of gluten can have effects on the body without a physical outward sign.  The root of what causes the signs and symptoms in celiac disease is the damage that has occurred because of the immune system attacking the gastrointestinal system, not the gluten itself

There are many items in food and especially highly processed options with amped up fiber counts that can lead to poor digestion.  If you have GI problems such as bloating, diarrhea, or heartburn it is a poor choice to start a completely gluten free diet prior to being tested for celiac disease.  Once gluten is removed the body will stop producing antibodies against gluten and a test for celiac disease would come up negative.  It’s important to know the truth about your diagnosis as celiac disease is one medical condition in which mineral supplementation is often needed, bone density can be effected, and the gluten free diet must be adhered to 100% of the time, 365 days a year, for a lifetime.  Not knowing celiac disease is present may encourage someone to not be as vigilant at sticking to gluten free choices. 

Dear dieter....

Dear dieter,

I hope you’re well! Just wondering how that miracle diet is going?  You know, the diet you started New Year’s Day that was going to fix every one of life’s issues, including your emotional eating?  Oh, not so good? 

Despite how we try to feed it, mental stress does not actually require any additional calories.  Food does not really fix the boredom, sadness, sleepiness, or anger that is the true underlying challenge.  Eating (or not eating) for emotional reasons still leaves behind the trigger for negative feelings often along with guilt for trying to soothe the emotions with food.  Strict diet plans don’t address the fact that a contributor to the weight gain was eating for emotional reasons rather than hunger. 

Everyone has different habits and interaction with food.  Everyone also has stress, daily activities you’d rather not do, and emotional ups and downs.  What differs though is how individuals justify their behavior and also their rewards in the form of food.  How often are your rewarding yourself for daily activities you’d have to complete anyway?  Do you find yourself saying, “I completed that work” or “I had a hard day” so I deserve this ice cream? 

The first week in March is part of eating disorder awareness week.  Disordered eating comes in many forms.  Sometimes the strength of the relationship between eating behaviors and emotions aren’t strong enough to classify it as a true eating disorder, but many habits are not conducive to a healthy relationship with food.  In 2013, the American Psychiatric Association (APA) formally recognized Binge Eating Disorder as a diagnosis making it the most common eating disorder in the United States.

If most of your weight gain came from eating from grief, sadness, or anxiety a strict diet is not going to take away those emotions.  It will just prolong the time frame until you turn to food again for comfort.  If you feel like you don’t know where to start, then seek out professional help.  A licensed behavioral counselor can help you address the emotional aspects of your eating and develop alternative coping methods for your stress. 

If you feel like your habits could improve when it comes to your eating and emotions consider these tips to get started. 

Start by listening to your body and trusting it.  Our stomachs try to send us signals that we’re full.  Eating an entire, oversized portion at a restaurant and adding on a dessert because it’s offered has very little to do with our feelings of fullness.  We eat because it looks good, smells good, and tastes good.  Those are all important parts of enjoying a nice meal, but is your stomach actually full?  Consider wrapping up part of your food at a meal.   You can enjoy it twice, save money by not having to eat different food later, and decrease your overall calorie intake by spreading out the food.  Start by serving less on your plate, but in your mind consider thinking “I’ll start with this,” rather than “This isn’t going to fill me up.”

Consider eating for your health and not just your weight. Remember all those fruits and vegetables you keep hearing about?  Consider adding servings in every day because they provide good building blocks for our immune system and help our cardiovascular system, not just because they are on every diet plan.  Skip the lemonade, iced tea, and soda because there’s more sugar in each cup than your body possibly needs for energy. 

Plan your food.  No, it doesn’t have to go to the extreme of one of those photos on Pinterest with twenty-one meals all neat and tidy in a million, itty bitty containers.  A human body typically needs to refuel every four hours.  If you don’t feel yourself and allow yourself to get overly hungry you’re likely to grab something quick and overeat.  Take some food with you that will last without refrigeration like a banana, a pouch of nut butter, and a granola bar with minimal ingredients. 

Move your body.  And ENJOY it!  For some dieters exercise is only done as a punishment or during complete deprivation.  Being hungry and pushing through another few steps on the tread mill is a sure way to suck all the enjoyment out of physical activity.  Formal exercise programs certainly have their place, but if you haven’t stuck to an exercise routine, just try to move more.  Put on music and get a groove on!  Exercise is an anti-depressant backed by multiple studies showing positive effects on mood and attitude. 

And last, but not least- Skip the awful self-talk.  Don’t say things to yourself in the mirror that you wouldn’t say to your best friend.  Love your body and start to acknowledge all the wonderful things it can do!


Never Eat Out of a Box of…..

Researcher Brian Wansink, relays some important findings about how Americans eat in his book Mindless Eating. Through Wansink’s experiments (some rather funny, like the ever filling soup bowl) researchers determined that basically, if there’s food in sight- we’ll eat it, the bigger the food container, the more we’ll eat out of it, and if the food keeps coming, we’ll keep on eating.

Everyone is born a “mindful eater.”  A child normally stops eating when their stomach is full.  As we grow older we learn to eat for reasons other than hunger and to follow other cues when it comes to stopping. When we make food choices based on habits or emotions, whether it be boredom, stress, or sadness, we can end up eating more than our bodies actually need. 

Food is everywhere and if you’re not skilled at passing it by sometimes, it’s bound to end up as unwanted weight gain.  Whether it’s in your office or your own home, fight back against mindless eating by setting a few rules for yourself. 

Start by eating on a better schedule.  Eat sensibly and drink water at set intervals throughout the day. Most people need to eat every four hours.  Chaotic eaters don’t make time for regular meals and then overeat when they do take time to eat. 

Set a specific time for 1 snack between meals if you need it.  Watch the clock or set an alarm on your phone for snack time.  Until then, look forward to eating, drink a big glass of water and tough it out for another 30 minutes or an hour until you can have that one snack.  When snack time does come, check with your stomach and see if you are actually physically hungry.  Get comfortable with not eating as an activity. 

Hide food from yourself.  If you are prone to eating just because food is available, having tempting foods in sight will make it much more likely for an overindulgence to occur.  Ditch the candy jar, doughnut box, or big plastic tub of pretzels in the office.  If you don’t see it you won’t want it as much. 

If you’re going to bring a treat to work, bring one portion, not the entire bag.   Keeping your favorites in your desk can be really tempting if you’re trying to avoid a deadline or are stressed out.  If you’re not getting anything done anyway, take a brief walk to get refreshed rather than grabbing another snack. 

Never eat out of a box of…..fill in the blank.  Maybe for you its crackers, or cookies, or M & M’s, or even dried fruit.  The bottom line is --don’t eat directly out of a food container that contains multiple servings.  If your brain sees more food it’s not as likely to cue you to stop.  Snacking does not lead to weight loss if you’re eating more than what your body needs.  Get out a set portion and hide the rest away for later. 

Focus on today’s eating.  Many people indulge today, justifying the choice and saying that tomorrow will be different or the “diet” starts next week.  Cutting down on mindless eating today can help your health tomorrow. 


Got pumpkins?

On my front porch, there are three sad looking Jack O'Lanterns and one large pumpkin hanging out from Halloween.  If you've got pumpkins too, don't toss them into the trash. There’s still a lot you can do with your fall pumpkins! 

Pumpkin is somewhat of a magical character in menus.  It can be savory, sweet, or just give a health boost to a recipe without even knowing it’s there.  Cinderella certainly knew how versatile a pumpkin could be!

Like many dark orange vegetables, pumpkins are jam packed with a plant form of vitamin A called beta carotene.  At only 50 calories per cup, this true super hero of nutrition is a great source of potassium, vitamin A, and fiber.  Dark orange vegetables like butternut squash, sweet potatoes, and pumpkin can meet your full day’s Vitamin A needs in only one half cup serving. Canned pumpkin has no added sodium and requires no cooking. You already know there’s pumpkin flavored everything, but there are lots of ways you can use real pumpkin.

So how can you tell whether it’s decorative or edible?  With more than 40 varieties, most pumpkins are actually edible, but can vary in their flavor and texture.  Jack O’Lantern pumpkins are developed more for size and shape, not taste.  Complaints about cooking that variety include that it can be flavorless and watery.  As long as it’s not a decorative gourd (which really contains no flesh) you can try to use pumpkins you’ve already spent money on.  Don’t try using a pumpkin though that you’ve already carved and sat outside with a candle in it. 

Whether meal or snack, there’s a pumpkin recipe that will fit.  If you take time to make pancakes or muffins from scratch, pumpkin is a super easy, tasty edition.  For more savory options utilize pumpkin puree for a thickener for soup or chunks of pumpkin in a chili. 

If you have little ones at home you can make an ooey, gooey mess having kids sort through the pumpkin guts for the precious seeds.  Remove as much of the pumpkin strings as possible.  Put about 4 cups of water on to boil.  Add the seeds and boil for 10 minutes.  Drain and spread on a clean kitchen towel to dry.  Seeds usually toast best if you toss them with a little oil or melted butter.  After heating the oven to 250 degrees, spread on a shallow pan or cookie sheet and place in heated oven.  You will need to toast the seeds for about 35 to 45 minutes.  Stirring every 10 minutes can help them toast evenly. 

You don’t necessarily have to remove the skin before you tackle roasting the pumpkin.  Give your pumpkin a very through bath using dish soap.  After you’ve gutted the pumpkin you can cut it into large chunks which can be roasted, microwaved or boiled.  Roasting takes the longest time at up to 60 minutes, microwaving or boiling will take about 10 to 15 minutes.  You can also use a slow cooker but it will take about three to four hours to get rid of the crunchy bite of uncooked pumpkin. 

Pumpkin puree can be used for all sorts of dishes.  To make pumpkin puree, you simply have to scoop the flesh from the skin after cooking and then run it through a blender or food processor.  You will get roughly 1 cup of puree for every pound of pumpkin.   Make it easy by freezing the pureed pumpkin in 1 cup servings.  It will last about six months in the freezer and a week in the refrigerator. 

If you think you don’t like squash, but you like pumpkin pie you might be in for a surprise.  Canned pumpkin is typically made using blends of butternut, hubbard, and other squash as it is less stringy and more flavorful than pumpkin alone.  The term pumpkin can be used loosely to include over forty different varieties of pumpkin and squash. 

And if you don’t want to eat your pumpkins?  Toss the pumpkin somewhere where it can grow in the spring.  Squash family plants don’t like to be disturbed so be sure to toss it in a spot where it can break down, release it’s seeds, and turn into a glorious vine in the spring.  

Why eating “Clean” doesn’t always equal getting “Lean”

All foods have energy.  Energy in food is known as…… Go ahead, take a few seconds to make a guess. 

If you said “What is a calorie?” you should be on Jeopardy.  No really, if you guessed calories you were right. 

As a licensed nutritionist, I occasionally encounter a client who has made many wonderful strides to choose healthier foods and improve the quality of his or her diet.  Whether it’s opting to include less processed food, increase natural sources of fiber, or just boost up vegetable intake at every meal, making improvements in the quality of the food you’re eating is one of the best things you can do for your health. 

But then the client looks at me with a frown and blurts out, “BUT, I’m not losing weight.”

Unfortunately eating for health doesn’t necessarily mean eating for weight loss.  Let’s look back at those pesky calories again.  Despite some foods being healthy and nutrient dense (a term that means you get lots of vitamins and minerals in one place), some foods that nourish us well also provide a lot of energy in a small package. 

Take for example:

An entire avocado has 230 calories

Half a cup of nuts clocks in at 380

And that healthy 1/2 cup of dried fruit?

It’s going to set you back 280 calories—with nearly every one of those calories coming from sugar. 

These are exactly the healthy foods we recommend when athletes or children need to gain some needed weight.    

So let’s talk about four terms that are confusing when it pertains specifically to weight loss. 


According to a survey released in 2014 by Consumer Reports, two-thirds of Americans believe “natural” means the food contains no artificial ingredients, genetic modification, or pesticides.  Take it a step further and I would add that many consumers equate the word “Natural” with “Healthy.”  In actuality the FDA has not been able to even define the term.  Typically natural means that there have been no colors, artificial flavors or synthetic substances added that would not be normally found in that food.  Because this term is used so loosely and holds no technical definition, natural foods may or may not be healthier than their commercial counterpart.  The term natural does not have an influence on how much energy our body gets or stores from the food or beverage so eating more natural foods does not lead to automatic weight loss. 


Decreasing processed foods and opting for more natural foods, also called eating “clean” can decrease sodium intake and increase natural sources of vitamins and minerals.  What surprises some people is when they gain weight following a plan that promotes lots of unprocessed meats, vegetables, nuts, and certain oils.  Unprocessed food still has energy, so if portions are excessive, or exercise is non-existent, whole foods can still be stored as weight gain or not lead to weight loss.  If a cake is made from honey or coconut sugar, coconut flour, dried fruit, and seeds, it’s still going to be considered a dessert or a treat.  Making a recipe from these nutritious foods doesn’t mean that it is a freebie just because it isn’t made from white sugar, refined oils, or flour. 


Organic basically means that the food was grown and processed without the use of certain pesticides, synthetic fertilizers, or growth hormones.  In several studies examining head to head comparisons of the vitamin and mineral content of organic plants and conventionally grown there was little difference in the actual nutritional content of the produce.  http://www.organic.org/home/faq#faq6

The choice to buy organic items is a personal decision based on many factors, but weight loss benefits shouldn’t be one of them.  When it’s comes to weight loss, an organic item isn’t going to lead to weight loss any more than conventionally grown items.  For example, organic apple juice has the same amount of naturally occurring sugar and calories as conventionally grown, 100% apple juice. 


Although the finger has been pointed at gluten for every ailment for the past few years, the solid research just isn’t there for many of the claims that the average person should avoid gluten when it comes to weight loss.  If a muffin or cookie is gluten free it simply means that it is made with a grain other than wheat, rye, or barley.  Sometimes it may actually contain more carbohydrates and calories than the wheat filled goodie.  The impact on your waist line is still dependent on your overall energy intake and activity level, not whether a food product contains wheat. 

It is entirely possible to have an organic, clean, gluten-free, natural weight loss diet, but just swapping one food for another to meet these specific terms isn’t going to naturally lead to weight loss.  Portions, exercise, and balancing food groups plays the biggest role in whether a diet based on healthy foods actually leads to weight loss. 

High blood pressure doesn't take a holiday

For someone with congestive heart failure, problems with retaining fluid, or other health issues affected by salt and sodium intake one meal can provide two to three times the sodium they should take in.  For some individuals that excessive sodium intake can have serious effects on health. 

Doctors often encourage patients to restrict to less than 2,000 milligrams per day.  In very sensitive people that limit is sometimes reduced to less than 1,500 milligrams per day.  The average American though is estimate to consume upwards of 6,000 milligrams per day!  If 2,000 milligrams is spread over 3 meals and snacks, most meals should not exceed 500 milligrams at one time.  If you are prescribed medications to lower your blood pressure your doctor wants you to also follow a low sodium diet.  If you have someone in your family that needs a low sodium meal this holiday season here are some tips to lower the amount while still enjoying some tasty fare. 

Just the Facts

If you check out the Nutrition Facts label be sure to start with the serving size.  That’s an amount that all the numbers on the label pertain it.  So if your serving size is half a cup, but you eat an entire cup you’d have to double the numbers listed.  Or better yet, choose a natural food item that doesn’t come in a package.  Whole foods that haven’t been processed are lower in sodium that items in cans, covered in a sauce, or ready to go in a microwavable container.  The exception is frozen vegetables with only one ingredient- the vegetable itself!

Avoid using cured meats in recipes. 

A potential low sodium food like green beans or Brussels sprouts sky rockets in sodium when you add bacon, sausage, or ham.  Using toasted nuts like hazelnuts in a vegetable recipe offer tasty flavor, but very low sodium.  Nitrate free or uncured meats have become popular in recent years, these products are often cured with salt and naturally occurring nitrates found in celery salt.  Just because an item is organic and nitrite free does not automatically mean it is a low sodium product.  Always compare your labels if you want to be sure. 

Don’t believe the hype. 

Sea salt has the same sodium content as table salt.  Let me repeat that, Sea salt has the same sodium content as table salt.  It’s been said that ‘all salt at one time came from the sea.’  Compare the nutrition facts next time you’re at the store.  One fourth teaspoon of table salt with iodine (a needed nutrient for our endocrine system) has 590 milligrams of sodium.  The sea salt?  It clocks in at 590 milligrams per teaspoon which equals exactly the same as the table salt.  But what about those extra minerals claimed to be beneficial in sea salt?  Good nutrition is not only about the types of foods we eat, but the amounts.  If I eat half a strawberry, the amount of vitamin C I actually get would be very minimal compared to an entire cup of berries.  In the same way the micro or trace minerals in sea salt do not provide a good source of magnesium, phosphorus, zinc or copper unless you would consume A LOT of sea salt which really would not be beneficial when your body needs a low sodium diet. 

Make it yourself

Skip the premade microwavable mashed potatoes or microwavable macaroni and cheese.  For food safety purposes and for taste manufacturers add salt to prepared foods.  Processed foods are the number one source of sodium in the American diet.  While a whole baked potato prepared in your microwave would have less than 20 milligrams of sodium, a half a cup of premade microwavable mashed potatoes has 560 milligrams!  If cooking for yourself, why not wash and microwave a whole potato or sweet potato in the microwave for eight minutes, remove the peel, and add a little milk and butter while mashing with a fork?   

Even low sodium products can be high in sodium.  Check your Nutrition Facts label even on lower sodium products.  Low sodium broths for example are better than regular broths, but can still exceed someone’s recommended intake.  Consider slowly simmering a batch while you’re cleaning the house for guests.  Food & Nutrition Magazine, a publication of the Academy of Nutrition & Dietetics offers some basic recipes like this homemade broth that can provide a flavorful base for soups, gravy, or mashed potatoes.


Choose your recipes wisely

When planning a holiday meal for someone on a low sodium diet start with recipes that keep health issues in mind.  Low sodium recipes rely on flavor from holiday spices like cinnamon, cardamom, ginger, and garlic.  To find out what spices you can use to create flavor without salt search for recipes with heart healthy guidelines in mind.  Some reputable sources include:

The American Heart Association offers a free Holiday Healthy Eating Guide at http://bit.ly/AHAHolidayGuide2015

Divita dialysis offers thousands of low sodium, low potassium, recipes for people with kidney problems, but the recipes are also appropriate for anyone needing to follow a low sodium diet http://www.davita.com/recipes/tag/christmas

Making a few modifications to try to stay within low sodium diet guidelines can make a difference for your health this holiday season.  We can’t change our bodies, but we can modify what goes in it!