Nutrition Spotlight

The Spring/Summer Nutrition Spotlight is here! Enjoy the articles written by our very own Dietetic Interns. Follow the link to view:

http://issuu.com/sludchs/docs/slu_di_newsletter_spring_2013?mode=window

Sleep: How to Fuel for Slumber

By Max Walker

After a taxing couple of weeks and an especially lethargic weekend, I thought about how difficult fatigue makes optimal functioning. But those living life in the fast-lane have little time for rest and relaxation. My mid-week remedy typically consists of four cups of coffee and a bit of intense exercise. This does me over until about 10; usually the time I muster up enough will-power to start working on projects or studying. Shortly thereafter I end up crashing faster than mid-90's Macintosh.

Animals listen to their sleep cues

By the weekend I'm left feeling like butter spread over too much toast. 

This doesn't fare well when projects, homework, articles, friends and family, and chores pile up on my two days off. So in order to get the most out of what little sleep I get, I went to the world wide web for some answers. 

The overwhelming theme from my initial research: American's don't sleep enough.

According to the CDC, there are an estimated 50-70 million US adults who have sleep or wakefulness disorders (1). This includes dyssomnias, or disorders of either hypersomnolence or insomia, parasomnias, which involve abnormal behaviors, emotions, movements, and dreams, and medical or psychiatric conditions affecting sleep (2).

The National Institute of Health also claims 70% of US adolescents aren't getting the recommended amount of zzz's. Without those 8-9 hours of restoration, it may have a direct effect on the children's development, behavior, and current and future health (3).

Why, exactly, is sleep so darn important?

Well, while sleeping, your body is doing more than just recharging energy. While snoozing, our bodies are hard at work, forming new pathways vital to learning, creativeness, storing memories, and weight management (2,4). Skimping out on such valuable regeneration can lead to some rather serious health issues.

Mentally and emotionally, sleep does wonders to clear the mind and bring about new perspectives.

Consider the adage "let me sleep on it".  When considering important life decisions, I consider it a must to put at least one good night of sleep between first consideration and final decision. Our REM sleep is full of new, creative problem solving. Some of my greatest revelations in life have come from dreams I've had the night I am thinking of a big issue.

Physically, sleep is just as vital as nutrition and exercise. When we don't get enough sleep, levels of leptin, the hormone telling us we are full,  decrease, and levels of ghrelin, the hormone telling us we are hungry, increase (5). This imbalance leads to increased eating and diseases that accompany such behavior, like diabetes type II, cardiovascular disease, and obesity.

Just shout out to those looking to lose some weight, the answer could be in your nice, comfy bed.

So then, what do we need to do to get a better night’s sleep?

Let's first look at some foods/drinks which shouldn't be consumed before sleep.

• Caffeine - A natural stimulant, caffeine may take up to 8 hours to completely wear off depending on how often you consume it. Caffeine creates a situation in the brain similar to that in the intestine when calcium and iron are consumed simultaneously; adenosine receptors have similar affinities for both caffeine and adenosine molecules. When caffeine is present, the receptors uptake the caffeine, and the adenosine isn't able to create drowsiness and slow nerve activity like it should (6). The brain also produces adrenaline when caffeine is present, the hormone responsible for things like this dunk: try sleeping while feeling like you can do that.

• Alcohol - No way! On the weekend this is many of my friends' go to for sleeping on a random person's couch or while watching P.S. I Love You for the 15th time (I'm a guy in dietetics, all my friends are girls). But it is true! In a study released in 2011, it was found that alcohol decreased sleep duration and efficiency, especially in women (8). While the first half of the night's sleep may be deep, the second half tends to be very disrupted (8). A sad day in the college kid's life.

• Nicotine - in addition to being loaded in cigarettes, which already cause a plethora of health and sleep issues, nicotine leads to the activation of nicotinic receptors, which then release several neurotransmitters, including actelycholine, dopamine, serotonin, norepinephrine, and gamma-amino butyric acid (7). It is believed that the combination of these hormones causes disrupted sleep patterns.

• High Fat/Large Meals - The more you put into your stomach, especially when it's high fat, the longer is takes to empty. If you go to bed on a very full stomach, there's chance for the contents of your over-indulged belly to move the wrong direction, back up into your esophagus. This leads to acid reflux, or heart burn. It's not easy to sleep with a ball of fire in your chest.

• Simple Carbohydrates - From personal experience, I've learned to avoid these foods two hours before bed. Simple carbs include foods/drinks like ice cream, cookies, cake, candy, crackers, Chocolate milk/hot chocolate, soda, juice,  kid cereal, and dried fruit. These foods all give you a "sugar rush", and provide virtually no nutrients for their calories. The energy you get from these foods may make you hyper and active, or lead to feeling bad about what was consumed, so you exercise. But exercising too soon before bed can also delay sleep due to that aforementioned adrenaline and some other hormones.

All these things off-limits? Gosh, what the heck CAN I do then? I know, it sounds like I'm being a Mr. Scrooge on your slumber party, but I just want the best night's sleep for you and me both.

What CAN we do?

• Exercise - As long as exercise is taking place a few hours before bed, it actually helps you to get a better night of sleep. A vigorous cardiovascular workout (running, swimming, basketball, biking) 5-6 hours before sleep has been linked with a higher quality slumber (9). This is because when you perform the intense activity, you internal temperature, along with the release various energy enhancing hormones are increased. Then, 5-6 hours later, your body temperature and levels of those hormones begin decreasing. A lower body temperature and the release of "sleep hormones" melatonin and adenosine.  Exercising in the morning has been shown to relieve stress and improve mood for the day (9).

• Evening Snack - Eaten 2 hours or more before bed, lean protein, low-fat dairy, and  fruits or vegetables make up good snack choices. A cup of non-fat Greek yogurt with some blueberries can leave you feeling full until it's time for breakfast, and your body will use the whey and casein protein to help regenerate muscles over night. Or maybe a cup of cubed watermelon. Or my own specialty -Banana Ice Cream. These are just a couple examples of low-fat, lower calorie snacks to help with sleep. Click Here for some other great options!

• Evenly Distribute Meals - This is especially for those with diabetes. Not getting too high or low during the night is very important. If the end of your day is loaded on carbohydrates, blood sugars are going to stay elevated longer than they should. On the flipside, low blood sugars while sleeping can be dangerous. Symptoms can include sweating, elevated heart rate, poor sleep quality, and headache upon waking. One of the snacks mentioned before, eaten a few hours before bed, should stave off an issue like this.

• Relax - Life today is stressful. Everywhere we turn there are things to get our panties all in a bunch, but learning to brush it off and accept life as it comes can be incredibly beneficial to overall health and sleep. Elevated stress levels lead to Heart Rate Variability, which is the time between beats of the heart (10). Some data indicates a decreased HRV is predicative of myocardial infarction (heart attack) (10). Personally, reading is my favorite bedtime activity. It not only takes your mind off the day, it stimulates the imagination and helps with creative problem solving. So finding something that works for you to help release the day's troubles may be a huge step towards great sleep.

Sleep is almost a novel treat in the age we live in. People convince themselves they can get by on 5 hours a night, yet end up a psychological mess and overweight.

Try ending your day an hour earlier than planned. If you normally go to bed at 11, then tomorrow at 9:30, drop everything you're doing and get ready to be in bed by 10. You may be amazed at how great you feel the next morning.

In the never ending pursuit of self-betterment, there is no better place to start than the most comfortable place in your house: that warm, cozy bed.

Nighty night.

References:

1. http://www.cdc.gov/features/dssleep/. Insufficient Sleep Is a Public Health Epidemic.
2. http://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summer12pg16.html. Are You Sleep-Deprived? Learn More About Healthy Sleep. 
3. http://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summer12pg17.html. The Importance of Sleep.
4. The Link Between Sleep and Weight Gain — Research Shows Poor Sleep Quality Raises Obesity and Chronic Disease Risk. By Nancy L. Kondracki, MS, RD, LDN. Today’s Dietitian. Vol. 14 No. 6 P. 48
5. Shi Z, Taylor A, Gill T, Tuckerman J, Adams R, Martin J. Short sleep duration and obesity among Australian children. BMC Public Health[serial online]. January 2010;10:609-614. Available from: Public Affairs Index, Ipswich, MA. Accessed November 11, 2012.
6. How Caffeine Works. by Marshall Brain, Charles W. Bryant and Matt Cunningham. http://science.howstuffworks.com/caffeine4.htm
7. Zhang L, Samet J, Caffo B, Punjabi N. Cigarette smoking and nocturnal sleep architecture. American Journal Of Epidemiology [serial online]. 2006;164(6):529-537. Available from: Global Health, Ipswich, MA. Accessed November 12, 2012.
8. Alcohol at Bedtime May Not Help Your Sleep: Study Finds Fault With Popular Notion That a Drink Before Bed Will Help You Sleep Better. By Courtney Ware. http://www.webmd.com/sleep-disorders/news/20110215/alcohol-at-bedtime-may-not-help-your-sleep.
9. How to Fall Asleep. By Virgil D. Wooten, MD. http://health.howstuffworks.com/mental-health/sleep/basics/how-to-fall-asleep1.htm.
10. Hall M, Vasko R, Buysse D. Et all. Acute Stress Affects Heart Rate Variability During Sleep. http://www.psychosomaticmedicine.org/content/66/1/56.short doi: 10.1097/​01.PSY.0000106884.58744.09Psychosomatic MedicineJanuary 1, 2004 vol. 66no. 1 56-62

Full Circle Ending

By Annie Turner

As the internship comes to a close, I have been looking back at everything I have completed and I am in disbelief that the long journey is behind us and graduation is right around the corner. It has been such a whirlwind of new experiences, challenging courses, professional development and a little bit of fun too!

           

My journey started back in August 2012, but the real excitement started with the first clinical rotation–Diabetes–in early September. I did my Diabetes rotation with 7 other Saint Louis University (SLU) Interns at St. Mary’s Hospital.  At the time, it was frightening to know that I was the one educating people on a diet to manage their disease. But I accepted the challenge, jumped right in, and haven’t looked back since! 

Interns at St. Mary’s Hospital from Diabetes Week

This past week, I completed my final two-week clinical rotation was at SLU Care Obstetrics and Gynecology Outpatient Clinic. While this rotation was very different from first rotation at St. Mary’s, there was one thing in common: Diabetes. Hence, my “full circle ending.” Diabetes is a disease that many people are faced with today. As a Registered Dietitian-in-training, I experienced how Dietitians are instrumental in providing Diabetes education and disease management. 

Photo from http://www.freedigitalphotos.net/. 

At SLUCare, I spent my time with the Registered Dietitian (RD)/Certified Diabetes Educator (CDE) who focuses on nutrition and diabetes management in women with high-risk pregnancies. The majority of these patients have pre-existing Type 1 or 2 Diabetes or Gestational Diabetes. In pregnancy, strict blood glucose monitoring and diet adherence is important for tight control and optimal fetal outcomes.  Glucose crosses through the placenta from mom to the baby and blood sugar “highs” and “lows” are undesirable for fetal growth and development. Patients are asked to record their blood sugars as well as the foods they consume. The gestational diabetic patients are managed first by diet alone, then medication and insulin as a last resort. I found that diet education for these women was very encouraging. They are asked to manage a complex disease for a short period of time. IT’S CRAZY! These women are motivated by the end result: their baby. I was also very intrigued about pre-existing diabetes and pregnancy because I have a new sister-in-law who is Type 1 Diabetic. For women with Type 1 or 2 Diabetes, tight blood sugar control is important prior to conception to minimize risks of miscarriages and birth defects. I am excited to pass along my insights when it comes time for my brother and sister-in-law to give me a new niece or nephew! 

Photo from http://www.freedigitalphotos.net/. 

This internship has taught me a lot about nutrition and medical management, foodservice management, and the importance of community nutrition education. The internship has also taught be a lot about myself. I remember being so nervous walking into a patient’s room at St. Mary’s. Now, I am a confident individual as well as a skilled health care professional. I am looking forward to life as Dietitian!

At the time of graduation, our beloved director, Karen Steitz is retiring and starting the next chapter in her life. Best of Luck to you, Karen! Thank you for everything you have done for us!!

Detox and Cleanse Diets

By Katrina Skurka

Detox and cleanse diets are becoming more and more popular. These diets claim to remove harmful toxins from the body and promote weight loss. Often they require fasting with juices, others use laxatives or enemas to cleanse the colon. Most require the purchase of some special supplement only available through the author’s website. The most famous of these diets is the Master Cleanse, which requires that you only consume a mixture of water, lemon juice, maple syrup, and cayenne pepper for days.

So do these diets actually work? Well yes and no. Since most require a drastic reduction in calories, they will often lead to weight loss. Unfortunately the weight loss is water and muscle so as soon as you start eating normally again the weight will come back on. The truth is our bodies are already designed to remove toxins through our kidneys, liver, and colon. So if you wanted to help your body cleanse itself of toxins, the best way is to eat foods that help these organs work at their best. Below is a list of foods to add to your diet if you want to detox.

• Beets- Beets are full of vitamins B3, B6, C and beta-carotene, they're also a valuable source of iron, magnesium, zinc and calcium -- all necessary to promote optimal detoxification and elimination.
• Watercress- This is a powerful cleansing agent, improving the digestion and nourishing the skin, while its diuretic properties help to flush out toxins and excess fluids.
• Sea Vegetables- These amazing foods house powerful antioxidants that help to alkalize the blood and strengthen the digestive tract. The algin in seaweeds absorbs toxins from the digestive tract the same way a water softener would remove the hardness from tap water.
• Dandelions- They provide super antioxidants that support cleansing of the digestive tract and offer great liver support.
• Broccoli- Broccoli and other vegetables in the broccoli family contain important phytochemicals which all have a specific effect on detoxification.
• Lemon- This wonderful fruit stimulates the release of enzymes and helps convert toxins into a water-soluble form that can be easily excreted from the body.
• Tumeric- This spice, often found in curry, has anti-inflammatory and infection-fighting properties, helping to rid your body of unwanted bugs and accelerate toxin removal
• Apples- Apples contain a flavonoid, phlorizin, which is thought to help stimulate bile production and helps with detox as the liver gets rid of some toxins through the bile.

So instead of trying some quick fix detox diet, try adding some of these foods to your diet, eliminate processed foods, and drink plenty of fluids. Also try the recipe I developed in my community rotation at Des Peres Schunck’s grocery store for their deli department.

Detox Salad

Ingredients:

• 2 broccoli crowns
• 1 head cauliflower
• 1 medium carrot
• 18 brussels sprouts
• 1/3 cup parsley, finely chopped
• 1/2 cup sunflower seeds
• 1/2 cup sliced almonds
• 1 cup raisins
• 2 apples chopped
• Juice of two lemons
• 2 tablespoons rice vinegar (or other mild flavored vinegar)
• 2 tablespoons pure maple syrup
• 2 tsp grated ginger
• Salt & pepper to taste

Wash and rinse all your vegetables, then cut the broccoli and cauliflower into florets and trim the brussels sprouts. In a food processor shred the broccoli, cauliflower, and brussels sprouts until fine and add them to a large mixing bowl. You may need to do this in batches. If you do not have a food processor you can chop all the ingredients.

Process the carrot the same way and add to the bowl. Stir all ingredients to combine.

Add the rest of the dry ingredients to the bowl, and mix with wooden spoon until fully combined. Add lemon juice, ginger, vinegar and syrup and toss to coat.

Oh Deer! Does it Really Work? Deer Antler Spray as a Performance Enhancer

By Austin Thomas, MS

Ever since Baltimore Ravens’ Ray Lewis denied supplementing with Deer Antler Spray this past football season, sales have reportedly skyrocketed. So what is the supplement that the football star was accused of taking for the rehabilitation of his triceps injury?

Deer Antler Spray comes from the “velvet” or “hair” that is found on the antlers from various species of deer and elk. Antlers are the only known mammalian appendage that can fully regenerate – this is linked to a substance known as IGF-1 (insulin-like growth factor-1) that is found in the antlers, and more specifically the “velvet”. IGF-1 is also naturally found in humans and is also attributed to enhanced physical performance. IGF-1 is a proven performance enhancer and helps stimulate muscle growth and is related to increased endurance through the production of red blood cells (which carry oxygen throughout the body), however supplemental use with IFG-1 is banned in both NCAA and professional athletes. Some research shows that supplementation may lead to negative side effects such as an increased risk of cancer.¹ Since small amounts of IGF-1 are found in deer antler spray, it is banned substance. Even if deer antler spray wasn’t banned in competitive athletics, is the substance even proven to work?

Many of the claims and positive performance enhancing benefits, such as increased muscle mass, anti-inflammatory properties, and increased endurance come from ancient oriental usages. Oriental medicine has been using deer antler spray to treat ulcers, arthritis, anemia, and infertility for thousands of years and has been taken to prevent heart, nervous system, and endocrine system disorders.² Broeder et al performed research in recreational athletes and concluded that supplementation with deer antler spray may have a positive effect on body composition, and may be responsible for improving VO2 max in these athletes.³ However, it needs to be taken into consideration that this study did not account for the possibility that the experimental group also consumed more protein on average than their placebo counterparts, according to their dietary records. The difference in protein consumption in combination with the exercise-training program that was followed by all participants could have been responsible for these findings. Research has proven that increased protein consumption along with weight training improves body composition.³ Other research found that there were no significant changes across those who supplemented with deer antler spray or those who did not.⁴ Broeder et al also found that LDL was significantly lowered in the group who supplemented with deer antler spray, but did not provide any potential reasons for how the two may be correlated.

Although this does improve health and decrease risk for heart health, it is not a direct measure of physical performance enhancement. When applied to a real world setting with male and female rowers, aerobic capacity, potential enhancing hormonal changes, and improvement in race times were not significantly different in those who supplemented vs those individuals who did not.⁵

Some research suggests that deer antler spray may be beneficial for individuals who suffer from osteoarthritis.⁶ At three and six months, when compared to the individuals who did not take the supplement, deer antler spray was associated with pain improvement. It was also associated with an improved physician assessment of the patients’ arthritis. While this obviously benefits athletes who suffer from osteoarthritis, it may also explain Broeder et al’s results of increased strength of a six rep max squat. There were no hormonal or blood chemistry results to correlate with this improvement, so the deer antler spray may cause a numbing/pain reducing effect in the athletes.³

For now there is no clear evidence that deer antler spray has a performance enhancing effect in athletes. Most of the claims reported still come from ancient Chinese and oriental medicine, and more controlled studies are needed to determine if there are significant benefits to supplementing with deer antler spray.

Resources:

1. Lucio S, Graziani G. Doping with growth hormone/IGF-1, anabolic steroids or erythropoietin: is there a cancer risk? Pharmacological Research May 2007;5(5):359-369.

2. Sleivert G, Burke V, Palmer C et al. The Effects of Deer Antler Velvet Extract or Powder Supplementation on Aerobic Power, Erythropoiesis, and Muscular Strength and Endurance Characteristics. International Journal of Sport Nutrition and Exercise Metabolism. 2003. 13:251-265

 3. Broeder C, Percival R, Quindry J et al. The effects of New Zealand deer antler velvet supplementation on body composition, strength, and maximal aerobic and anaerobic performance. AgresearchNZ: Advances in Antler Science and Product Technology. 2004. 161-165.

4. Cribb P, Williams A, Carey M & Hayes A. The Effect of Whey Isolate and Resistance Training on Strength, Body Composition, and Plasma Glutamine. International Journal of Sport Nutrition and Exercise Metabolism. 2006;(16)494-509.

5. Syrotuik D, MacFadyen K, Harber V, Bell, G. Effect of Elk Velvet Antler Supplementation on the Hormonal Response to Acute and Chornic Exercise in Male and Female Rowers. International Journal of Sport Nutrition and Exercise Metabolism. 2005;(15):366-385

6. Edelman J, Hanrahan P, Ghosh P. Deer Antler Cartilage in the Treatment of Arthritis: Results of a 6 Month Placebo-Controlled double blind study with Cervusen in 54 Patients with Osteoarthritis. APLAR Journal of Rheumatology. 4(2): 95-100.

Passing the Torch: Some Tips for Next Year’s Interns

By Leslie Stovall

It was around this time last year that I, a newly accepted SLU dietetic intern, stumbled upon this very blog. I was on a quest to find out everything I possibly could about SLU’s program; I had “liked” it on Facebook, read and re-read every word on SLU’s Nutrition & Dietetics pages, and still had so many questions! So, on the suspicion that at least a few of next year’s intern have also found this page, I’m dedicating this post to you. I’ve compiled a list of a few things I wish someone had told me a year ago!

1.  Congratulations...

            Hopefully, you actually have already heard this one from your friends and family. They’ve seen how hard you worked to keep your grades up, volunteer at hospitals, write the perfect personal statement, and navigate DICAS and D&D. But, as you’ll find during the next year, the general public doesn’t often know what a dietetic intern is, let alone how competitive it is to become one. I’m still not convinced my parents even know what exactly I’ve been doing over the past 9 months! So when people ask you what your plans are for next year, and you see their brow furrow when you tell them you’re starting a dietetic internship, don’t get discouraged. You’ve accomplished something remarkable by getting here.

2.  but don’t get too comfortable!

            I know that “senioritis” is probably hitting you hard right now, and now that you’ve been matched it’s tempting to coast for the rest of the year. Resist the urge to let that work ethic slip. The content you’re covering in class now will definitely be relevant to the dietetic internship. Slacking off now will only make the internship more challenging. Do yourself a favor now and finish your senior year on the right note!

3.  Enjoy your summer...

            There’s no denying that the dietetic internship will be one of the most challenging 10 months of your life. Even if you are a superstar student who has never had to study for a test and never gotten less than an A- in any class, you will be challenged. Even if time management is your forte and you don’t know the meaning of the word “procrastination,” there will be times during the internship when it will seem impossible that you will get everything done before May! (Note: It will all get done. I promise.) Since this is an unavoidable fact of internship life, enjoy a relaxing summer while you still can. Make an effort to spend time with your friends and family, because this will become more challenging next year. And spend some time on yourself, too. Catch up on your sleep now! That rest will come in handy, because you will hit the ground running during orientation weeks.

4.  but get prepared, at least a little bit!

            Of course, it’s a good idea to use this summer to gear up for internship. Use your free time to stock up on cheap school supplies (plenty of binders, highlighters, clipboards, printer paper and cartridges will all come in handy), clothes (business casual is almost always required on internship, and don’t forget your lab coats!) and get all those pre-requisites taken care of (food safety certifications, immunizations, and the like) so you’re not stressed about them once internship starts. It will feel good to start internship knowing you’ve already completed some of the requirements.

5.  You don’t need to have your whole life figured out yet...

            I wish someone had reassured me that I didn’t need to have all my career goals set in stone as I entered the internship. I had some vague ideas about what I wanted to do in dietetics, which I described in my personal statement and matching interview, but these were just educated guesses at best. One of the best aspects of SLU’s internship is the wide variety of sites and rotations that every intern gets assigned. The different sites allow us to explore fields that we think we will love, hate, and have never even considered before! While I thought I would never be happy working in a hospital, some of my favorite rotations were in clinical sites. I would encourage you to come in with an open mind.

6.  but some ideas might help!

            On the other hand, having some ideas about your career goals can help direct and shape your internship experience. If you think you would like to work with patients with eating disorders, college athletes, or in a grocery store, let the faculty know! They will do their best to accommodate these interests and make sure you get the experience you want. After all, this is your  internship, and you want to get the most out of it! While you’re preparing this summer, I’d suggest brainstorming a list of all the career fields in dietetics you think you’d like to try out.  SLU’s faculty has been very helpful in making sure I got all the experiences I hoped for over the course of the internship.

So, future SLU interns, I hope this list has helped introduce you to the crazy, rewarding year that will be your dietetic internship! It will be challenging, yes, but it can be done. As my internship is coming quickly to an end, I can’t believe how quickly this year has gone, and how much I’ve grown as a student and future nutrition professional. In just a year, you’ll be where I am now! Congratulations, and good luck!

Some of the 2012-2013 interns enjoyed a show at the MUNY in August 2012.

(Bonus tip: Don’t forget to have fun!)

An RD Challenge: How Well Do You Know Your Whole Grains?

By Rachel Randazzo

As a food and nutrition expert “in-training,” I love to eat, cook and grocery shop. Oh yes. If you happen to shop at the Dierbergs on Clarkson and Manchester on Sundays in the near future, and notice an unusually happy girl walking up and down every aisle exploring new foods, it is more than likely me. In fact, I like to grocery shop so much that I willingly join the “after- church crowd” every Sunday, in the exhilarating rat race to Dierbergs to stock up on items that I know I will need to survive a new week of rotations. Crazy, I know.

Well just a few Sundays ago, I was cruising down the bread aisle at Dierbergs, when I noticed that my mom had added a new brand of bread to my grocery list. Assuming that she likely heard about this brand from Dr. Oz, I sighed as I looked at the enormous wall of bread staring back at me. Could it be any more overwhelming? As I zoomed in closer on the package labels, I finally spotted the fancy “Seven-Grain” bread that she had requested. Unconvinced, I grabbed the loaf and quickly began to scan the ingredient list on the packaging for its promised, seven grains. As expected, the ingredient list did not contain seven grains, or any whole grain ingredients at all.

Without hesitation, I shoved the loaf of bread back onto the crowded shelf and grabbed my usual, non-fancy 100% whole wheat bread and headed towards checkout. Already 20 minutes passed my usual time spent at the grocery store, I paced in the checkout line reminiscing over the events that had just occurred; a soon-to-be Registered Dietitian was almost fooled into purchasing an overpriced loaf of bread with minimal nutritional value. Almost. My blood pressure continued to rise as I began to think about the millions of Americans who are fooled every day into purchasing overpriced, packaged foods stamped with misleading product labels such as “Multigrain,” “100% Wheat,” or “Seven- Grain.” I began to question how food-manufacturing companies could get away with such deceptive tactics, when it suddenly occurred to me that food- manufacturers are not hired to educate consumers about the nutritional value of their product; rather, they are hired to do whatever it takes to attract consumers to purchase their product, while staying within the FDA guidelines. So who is left to blame?

Gulp! Registered dietitians, of course! As food science experts, registered dietitians (RD’s) are responsible for educating clients far beyond the health benefits of whole grains in the diet or reading food labels. Yes, it is imperative that RD’s educate clients on how to properly identify whole-grain foods at the grocery store, but what about clients who are unaware of what the term “whole grain” even means? It is the role and responsibility of an RD to educate clients on the science of whole grains, and further compare the differences between whole grains and refined grains before educating clients how to be a smart grocery shopper.

Now I am no policewoman, nor do I intend to police any RD’s client education on whole grains. Instead, I present a challenge for those of you in the dietetics community who are aspiring dietetics professionals, students, interns, or licensed RD’s. Have you evaluated your client education lately? Do you include the three portions of the whole grain kernel (germ, bran, endosperm) in your diet education, and discuss the minimum requirements for packaged food items to be considered “whole grain?” Have you assessed the knowledge base of your clients lately, to see if they understand what a whole grain even is? I challenge you to put yourself in the shoes of your clients today. Would you be happy if you spent 20 minutes searching for a loaf of 100% whole wheat bread, only to find out later that you were deceived into purchasing an expensive, frilly product that is not even considered whole grain?

Here is the good news. As a dietetics community, we can come together and break this barrier of whole grain misconceptions by fine- tuning our client education. If we all pitch in, and use our knowledge to teach others not just about the importance of whole grains in our diet, but more specifically about the science of whole grains and how to find good sources of whole grains at the grocery store, we can ultimately increase whole grain consumption nationwide!

So what do you need to know? I have listed an example (below) of a whole grain education, intended for a client that has little to no knowledge about this subject.

Why Should We Consume More Whole Grains in Our Diet?

How Much Should We Consume?

The 2010 Dietary Guidelines for Americans recommend increasing whole-grains in the diet by making at least half of your total daily grain intake, whole grains. Whole grains are an important part of our diet because they provide us with nutrients, such as iron, B vitamins, and dietary fiber. Not only do whole grains provide us with an abundance of nutrients and fiber, but also moderate research evidence has shown that whole grains provide us with other health benefits, such as reducing our risk of developing heart disease and type 2 Diabetes, and even having a lower body weight! 

Whole Grain vs. Refined Grain

A common misconception is that most Americans are actually eating enough total grains. But what Americans do not know is that the majority of grains they are consuming are not whole grain, they are actually refined grains. So what is the difference between a whole grain and a refined grain? See the table below to learn more!

	Whole Grains	Refined Grains
Contains entire grain seed?	✔
Contains dietary fiber, iron and B vitamins?	✔
At least ½ of recommended total grain intake should be?	✔
Often found in foods that contain added sugars, fat, and calories?		✔
Found in foods such as brown rice, oatmeal, wheat bread, popcorn?	✔

What Type of Whole Grains Should I Be Consuming?

Yes, there are more whole grain options to choose from than brown rice! Any of the grains listed below, if consumed in a form that includes the entire grain seed (bran, germ, and endosperm) are considered whole grain foods and flours!

• Barley- use in soup, as a side dish, baked in bread, or as flour in cake or cookies! Looking to increase your fiber? Barley is the highest source of fiber when compared to other whole grains!
• Buckwheat- often used in pancake mixes and is nutty in flavor. Buckwheat is also a good source of protein (second to oats) and is the only grain known to have high levels of rutin—which is an antioxidant!
• Corn- yes, corn is a whole grain! Corn is considered a whole grain, regardless of its form (i.e. corn on the cob, popcorn, corn cakes, polenta, tortilla)
• Oats- most often consumed as “old-fashioned” or “instant.” Fun Fact: When reading an ingredient list on a food label, if “oats” or “oat flour” are listed, the food product will almost always be a whole grain!
• Quinoa- small, round grain that is often added to soups, salads and baked food items. Quinoa is also packed with protein!
• Rice- whole grain rice is not always brown! It can also be black, red, or purple. Whole grain rice is easy to digest and is popular amongst those on restricted diets or with gluten intolerance.
• Sorghum- sometimes used as a substitute for wheat flour in casseroles, pastas, pizzas, and baked goods. Sorghum is also gluten- free!

What to Look for When Choosing Whole Grains:

The front of the food label should look similar to this:

The side of the label should have a “Whole Grain” stamp from the Whole Grains Council that shows the amount of whole grains the product has per serving.

 One serving of whole grains is 16 grams.

In the ingredients list you should see…“Whole Grain” listed as the first or second ingredient listed after water. If additional whole- grain ingredients are listed, these should appear towards the top of the ingredient list.

 On the Nutrition Facts label you should see… high fiber, and little to no added fats, sodium, sugars or calories!

If the term “Whole Grain” is listed on the front of a package, it may or may not be a healthy choice. The healthiness of a food product depends not just on the amount of whole grain ingredients listed on the label, but also on the presence of less healthy ingredients such as sugar, fat, and high-fructose corn syrup that may be present in the ingredients list. Therefore, keep an eye out for the 100% Stamp and the Basic Stamp when quickly shopping for whole grain foods, but read the Nutrition Facts label in order to make the most informed and nutritious choices.

Now that you have refreshed your knowledge of whole grains and discovered the importance of using comprehensive client education when discussing whole grains, join the rest of the dietetics community and I in the battle against whole grain misconceptions! Check out the listed resources (below) for more detailed information about whole grains!

Sources:

Dietary Guidelines for Americans 2010

Article from Today’s Dietitian, “Deciphering Whole Grain Food Labels: Separating Fact from Fiction” By: Lindsey Getz

http://wholegrainscouncil.org