Intern Spotlight: Jessica interning with Hy-Vee

I am currently interning at Hy-Vee, which is a Midwest grocery store. I previously worked at Hy-Vee for four years as an assistant manager. My preceptors are dietitians that work for corporate. Some of the big projects I will be working on include hosting cooking classes via Zoom, 3 seminars for Drake University via Zoom, and writing up to 10 articles for the Hy-Vee magazine Seasons. I have also been tasked with setting up a way to be able to go virtual with the elderly population. Hy-Vee is working towards staying as virtual as possible from here on out, but this poses an issue with the older population. It is my task to find a way to make it easier for them to be able to access the Hy-Vee dietitians for their one-on-one sessions. This rotation is unique as I will not be working 40-hour weeks for a month, but rather working with them from January until May on whatever projects they deem fit for me to work on. I am loving my time at Hy-Vee and cannot wait to see what else I get to accomplish!

-Jessica Wilming, LWDI Intern

Obesity and Gut Health

By: Alexis Villaret, LWDI Intern

Ahhh… the holidays festivities have finally ceased. Family gatherings may have not inspired the finest eating moments. Usually, temptations are reserved for an occasional birthday or anniversary but with the consecutive holidays indulgences of eggnog, cookies, cakes, holiday roasts and alcohol are hardly avoidable. We are all aware by now of the guilt felt eating one too many of grandma’s cookies and of course the impact on the waistline. It makes sense right…too many cookies equals extra calories and extra fluff in the midsection. That is no secret. Now that January is here the daunting task of shedding that “winter coat” ensues. The Peloton bike that has served as a clothes rack gets dusted off, the gym membership is renewed and we begin the arduous task of losing the same ole L-B’s we gain every year. However it never has occurred to us that our gut bacteria may be playing a less obvious role. We are all probably familiar with gut bacteria and its significant role in our immune system. However an emerging body of research is exploding that suggests a correlation between obesity and gut microbes exists. 

ROLES OF BACTERIA IN THE GUT 

Understanding the roles in the community of bacteria lining our gastrointestinal tract also known as the microbiota may aid in understanding the mechanisms responsible in weight gain. The microbiota is the ecosystem of bacteria that pertains to the gastrointestinal tract. 

Specifically, the five species of bugs that occupy the gut are called Bacte-roidetes, Firmicutes, Actinobacteria, Proteobacteria, and Verru-comicrobiai. Bacteroidetes and Firmicutes are the most dominate and contribute to the majority of microbiota. Collectively only 10% of the remaining microbes contributes to the overall microbiota population(7). 

These bacteria are vital for good health as they produce B vitamins and vitamin K(3) while assisting in nutrient absorption and storage(4). These microbes also aid in degrading fiber for energy, which simultaneously fuels growth of beneficial bacteria to prevent overgrowth of pathogeneic bacteria. The most well known role of bacteria in the gut is support of a healthy immune system (3).

THE GUT OBESITY CONNECTION

The connection between gut bacteria and obesity is not completely understood. However several animal studies are providing clues. The gut bacteria profiles actually vary in lean and obese animal models and potentially human. Therefore the type of bacteria matters! Specifically within the microbiota, Bacteroidetes and Firmicutes are responsible for breaking down dietary carbohydrates and utilizing them for energy(10).Therefore when there is a disruption in this delicate balance of gut bugs, a condition called dysbiosis, energy production is inhibited leading to weight gain. Other animal studies have revealed depleted Bacteroidetes populations combined with increases of Firmicutes populations were present in obese mice compared to mice of a healthy weight(4). So what does a spiked eggnog over the holidays have to do with all of this? Those indulgences may have also contributed to dysbiosis or a change in your bacteria profile. Animal studies suggest high fat animal based foods coupled with sugar actually increases Firmicutes species while beneficial bacteroidetes are depleted reducing energy production from food (2). 

An additional study of obese mice demonstrated how two different diet patterns (High Fat and High Carbohydrate) common during the holiday season impact gut bacteria. A HFD (High Fat Diet) decreased gut diversity, which lead to dysbiosis. A high fat diet will 

naturally lack adequate fiber (also known as prebiotics) a fuel source for beneficial bacteria including Bacteroidetes. Bacteroidetes have a positive association with adiposity(5). This infers a reduction in good bacteria translates to decreased utilization of food for energy production and subsequently an increased likelihood of energy stored as fat. 

The HCD (High Carbohydrate-Sucrose Diet) was more problematic than the HFD since it promoted the growth of obesogenic related bacteria Acinetobacter,Blautia, and Dorea(7). 

These are all animal studies and this data may not be extrapolated to humans. However a compelling human trial also linked lack of gut diversity and chronic weight gain which was sustained over 10 years (10). 

What we can extract from this emerging data is a prebiotic rich diet is necessary to support growth of beneficial Bacteroides that are associated with lower body fat percentage. Also when Bacteroides are flourishing it does not allow for fat promoting bacteria to survive through displacement. Furthermore prebiotics or resistant starches provide an acidic environment in the gut created through fermentation. Beneficial gut bacteria actually feeds on prebiotics and this may inhibit the growth of pathogenic bacteria and dysbiosis (9).

COMMON PREBIOTIC FOODS 

Vegetables 

artichokes 

asparagus 

beets 

brussel sprouts 

broccoli 

cabbage 

fennel 

garlic 

leeks 

okra 

onions 

peas 

shallots 

Fruits 

apples 

pears 

peaches 

mango 

watermelon 

dried fruit

MYPLATE

In conjunction with prebiotics, a well balanced diet represented by a model such as MyPlate is essential in promoting gut diversity (11). 

MOVING FORWARD 

It may not be a coincidence that high fat, high sugar holiday food that is representative of the Standard American diet is contributing to weight gain, especially post holiday weight gain. It potentially may be an insight into one of the several mechanisms contributing to the nations and worlds for that matter obesity rates. While this research is still in its infancy it serves as one more reason Americans need to ditch SAD (Standard American Diet) and adopt GLAD (Gut Loving American Diet) to potentially thwart weight gain. So yes, dry January is in full effect and do not let that gym membership expire just yet. However, please do focus on including more fiber rich plant sources and do not settle for SAD, get a GLAD. 

REFERENCES

1.Aoun A, Darwish F, Hamod N. The influence of the gut microbiome on obesity in adults and the role of probiotics, prebiotics, and synbiotics for weight loss. Prev Nutr Food Sci. 2020;25(2):113-123 

2. Carmody RN, Gerber GK, Luevano JM Jr, et al Diet dominates host genotype in shaping the murine gut microbiota. Cell Host Microbe. 2015;17(1):72-84.   

3.Davis CD. The gut microbiome and its role in obesity. Nutr Today. 2016;51(4):167-174. 

4. Gentile CL, Weir TL. The gut microbiota at the intersection of diet and human health. Science. 2018;362(6416):776-780. 

5. Gomes AC, Hoffmann C, Mota JF. The human gut microbiota: Metabolism and perspective in obesity. Gut Microbes. Published online 2018:1-18.   

6. John GK, Mullin GE. The gut microbiome and obesity. Curr Oncol Rep. 2016;18(7):45. 

7.Kong C, Gao R, Yan X, Huang L, Qin H. Probiotics improve gut microbiota dysbiosis in obese mice fed a high-fat or high-sucrose diet. Nutrition. 2019;60:175-184. 

8. Lv Y, Qin X, Jia H, Chen S, Sun W, Wang X. The association between gut microbiota composition and BMI in Chinese male college students, as analysed by next-generation sequencing. Br J Nutr. 2019;122(9):986-995.   

9.Mahan LK, Raymond JL. Krause’s Food & the Nutrition Care Process. 14th ed. Saunders; 2016. 

10.Menni C, Jackson MA, Pallister T, Steves CJ, Spector TD, Valdes AM. Gut microbiom diversity and high-fibre intake are related to lower long-term weight gain. Int J Obes (Lond). 2017;41(7):1099-1105. 

11.MyPlate. Myplate.gov. Accessed January 22, 2021.https://www.myplate.gov/   

12.Zhang Y-J, Li S, Gan R-Y, Zhou T, Xu D-P, Li H-B. Impacts of gut bacteria on human health and diseases. Int J Mol Sci. 2015;16(4):7493-7519.t

Portion Control and Eating Your Favorite Carbs

By: Kimberly Cruz, LWDI Intern

A commonly discussed topic among many adults is diets and foods that should be avoided in order to reach a goal. What if I was able to talk to you about all of your favorite carbohydrate filling meals, the ones seen as “off limits” of your “guilty pleasure”.  For example, a few of my favorites include baked potatoes, Mexican rice, and ice-cream. It is possible to lead a healthy lifestyle while still enjoying your favorite snacks and comfort foods. Weight management can be possible through portion control and understanding the appropriate amounts of protein, fat, and carbohydrates (carbs) that an individual should consume.  

It is important to first consider the role of carbohydrates in the body, along with protein and fats. Carbohydrates supply the body with readily available energy for use in normal body functions and physical activities. It is beneficial for people to understand what carbs look like and the difference between complex and simple carbs. Complex carbohydrates are foods like whole grain bread, pasta, potatoes, or squash; they take more time to digest which will release energy slowly into the body. This is due to the slow process of the breakdown of fiber, a nutrient found in most complex carbs, which promotes extended periods of energy. Simple carbohydrates are foods like table sugar, fruit juice, or syrup. Simple carbs give the body a quick burst of energy that lasts for a short period of time.

Portion Control 

Food Pyramid Replacement - MyPlate: The USDA's Food Recommendations
Figure 1

The prevalence of obesity has doubled over the past 40 years. Rates continue to rise creating a worldwide healthcare crisis. Becoming overweight or obese usually occurs when a person’s intake of calories from food exceeds energy expenditure. Overtime, excessive weight gain can lead to other co-morbid conditions such as diabetes and heart disease.  Introducing portion control could be the start of a healthy lifestyle and provide an alternative solution rather than dieting or surgery. MyPlate is shown in Figure 1 above. This is a representation of what a plate should look like at every meal. Half the plate is made up of fruits and vegetables. 

Helpful tips to guide portion control by simply using your hands can be found in Figure 2 below. Tips and tricks like these can help an individual better understand how to portion food and make it easier to enjoy your favorite foods. If chicken alfredo pasta is one of your favorite meals but trending diets have made you think it would not fit into your diet, the chart below could be used to help with portioning. Looking at Figure 2, a good portion size for pasta noodles are about the size of your fist which can be equivalent to one half cup. The chicken used for the pasta could be measured by the palm of your hand; the sauce could be measured by using the portion size of the cheese model. No foods are forbidden! Practicing portion control allows you to still have, and enjoy, your favorite foods without feeling guilty.

Portion sizes | Daily Mail Online
Figure 2

Plate Size Matters

Figure 3

Over the last few decades, the standard size of a dinner plate has increased from 9 inches to 12 inches; this difference is illustrated in figure 3 above. The actual plate size however is not where the problem is, the problem is people fill those extra three inches with food. A lot of people are taught they need to consume everything on their plate in one sitting. So, the larger plate size, combined with this mentality, has led to an overall increase in food consumption. Plate size has the potential to reduce how much food is put on a plate and therefore consumed.  

Plate sizes have the potential to reduce how much is consumed from being self-selected. 2 Using a smaller plate is one strategy that can aid in reducing portion size. It has been shown people usually eat more when given larger portions.3 Bigger portion sizes grew over time and has been taught through family and friends. Some research has shown that an individual’s portion size may potentially be influenced by friends and others they are surrounded by when they eat. Certain people may benefit from sharing meals with a friend group or having a support system to help them on their journey to a healthier lifestyle.

Where to go from here?

Portion control can help provide an understanding that carbohydrates, fats, and protein should all be included on your plate to achieve a healthy, balanced meal. Tips and tricks used for portion control can not only help overweight and obese populations, but also those who struggle with diabetes and other health conditions related to dietary habits. It is important to build a support system with people who want to take this journey on with you and be a source of encouragement. Being more aware of how much you eat instead of what you are eating can help to see food from a healthier perspective. Eating intuitively, having balanced portion sizes, and being aware of different plate sizes are all factors that can help someone lead a healthy lifestyle.

References 

Maartje P. Poelman, MSc, Emely de Vet, PhD, Elizabeth Velema, MSc, Michiel R. de Boer, PhD, Jacob C. Seidell, PhD, Ingrid H. M. Steenhuis, PhD, PortionControl@HOME: Results of a Randomized Controlled Trial Evaluating the Effect of a Multi-Component Portion Size Intervention on Portion Control Behavior and Body Mass Index, Annals of Behavioral Medicine, Volume 49, Issue 1, February 2015, Pages 18–28, https://doi.org/10.1007/s12160-014-9637-4

Hughes, J.W., Goldstein, C.M., Logan, C. et al. Controlled testing of novel portion control plate produces smaller self-selected portion sizes compared to regular dinner plate. BMC Obes 4, 30 (2017). https://doi.org/10.1186/s40608-017-0167-z

Versluis, I., & Papies, E. (2016, May 06). The Role of Social Norms in the Portion Size Effect: Reducing Normative Relevance Reduces the Effect of Portion Size on Consumption Decisions. Retrieved October 23, 2020, from https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00756/full

Publishing, H. (n.d.). Carbohydrates – Good or Bad for You? Retrieved October 23, 2020, from https://www.health.harvard.edu/diet-and-weight-loss/carbohydrates–good-or-bad-for-you

MyPlate Graphic Resources. (n.d.). Retrieved December 01, 2020, from https://www.choosemyplate.gov/resources/myplate-graphic-resources

Living with Type 2 Diabetes in an Alcohol-centric Culture: Simple Guidelines to Follow for Safely Balancing Cocktail Hour and Diabetes

By: Amanda Rugg, LWDI Intern

Being able to enjoy alcoholic beverages while managing diabetes often seems intimidating at first. These simple tips will guide you to safely enjoying your favorite diabetic-friendly cocktail just in time for the holiday season! 

Alcohol & Diabetes: 

Understanding Main Factors Contributing to Blood Glucose Levels:

The effects of drinking alcohol are important to consider for diabetes. Drinking alcohol alters liver function and impacts blood sugar levels. 

The main functions of the liver include producing and releasing blood sugar, storing energy, and eliminating toxic substances.1 After drinking alcohol, it is recognized as a poisonous substance. The liver is only able to perform one task at a time and too much alcohol can block production and release of glucose from the liver, causing your blood sugar levels to drop.1,2,3

Type 2 Diabetes Medication Interactions with Alcohol:

If combined with enough alcohol, the effects of diabetes medications including oral medication (sulfonylureas. meglitinides) and insulin could often result in hypoglycemia, or low blood sugar.2,3,4

How to Drink: 

Tips to follow when preparing to enjoy cocktail hour safely with diabetes that help you drink smarter-not harder:

  • Have your blood sugar under control 
  • Inform your friends that you have diabetes 
  • Have some form of Diabetes identification with you 
  • Drink with a meal or carbohydrate containing snack
  • Drink slowly 
  • Continuously monitor your glucose levels: Before, during, and after the meal 
  • Come prepared! Pack a snack in case of low blood sugar4:
    • granola bars with protein, nuts, dried fruit 

How Much to Drink?

According to the American Diabetes Association’s recommendation for adults with diabetes: 

  • Women should have no more than 1 drink per day 
  • Men should have no more than 2 drinks per day4
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Ordering from the Drink Menu: 

Cocktail Favorites:

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References

1. He X, Rebholz CM, Daya N, Lazo M, Selvin E. Alcohol consumption and incident diabetes: The Atherosclerosis Risk in Communities (ARIC) study. Diabetologia. 2019 May;62(5):770-778. 

2. Steiner JL, Crowell KT, Lang CH. Impact of Alcohol on Glycemic Control and Insulin Action. Biomolecules. 2015;5(4):2223-2246.

3. Cryer PE. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia. Diabetes. 2017;63(7):2188-2195.

4.Introduction: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S1-S2. 

5. Diabetes and Alcohol. Diabetes Teaching Center at the University of California website. Accessed September 25, 2020. https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/diabetes-alcohol/

The Importance of Early Detection and Prevention of Type 2 Diabetes

By Ryan Jeannotte, LWDI Intern

Ninety to ninety-two percent of people with diabetes have type 2, which is largely preventable. This means that with early detection, nutritional interventions, and an increase in physical activity we can prevent the condition and symptoms associated with uncontrolled diabetes from occurring. Intervening when an individual has a pre-diabetes diagnosis can significantly reduce the risk of developing a variety of serious health conditions.

Intern Spotlight: Kenzie

Here’s how LWDI intern and Tennessee Tech University grad, Kenzie, will add “something extra” to the dietetics world:

“My background in personal training and working with clients has helped me prepare for incorporating fitness and nutrition together. I would like to show the community the benefits of not only nutrition, but fitness as well and incorporate them together.”

In addition to this, she is adding “something extra” to her current outpatient rotation by creating an awesome pumpkin bread recipe with a healthy twist! Check out her recipe by visiting https://balancenutritioncounseling.com/…/fall-recipe…/

Great work Kenzie!

Intern Spotlight: Liat

Here’s how University of Tennessee grad, Liat, will add “something extra” to the Dietetics world!

“Hello, my name is Liat Koenig and I am a dietetic intern at Lagniappe Wellness. I believe good nutrition is key to a healthy lifestyle and can prevent many common illnesses. As a future Registered Dietitian, I would like to work with children and young adults challenged by obesity, diabetes, and other nutritional issues, which can be managed through nutritional interventions and lifestyle behavior change. Something extra that I will bring to the Dietetics world is my love for cooking! I would like to share my cooking skills and show how cooking healthy meals can be accessible, simple, and tasty.”