Author: Jessie McGinty

My Final Post & Reflections

For my final blog as a contributing writer on Upstream, I’d like to reflect back on the last two semesters and what I’ve learned completing my Interdisciplinary Certificate in Health Communications. First and foremost: communication really is key.

In my Masters of Public Health program, we learn the ins and outs of nutrition basics –what the recommendations are throughout the the life cycle, how to treat difficult medical conditions with food, how to plan impactful public health programs, how to analyze the latest research, and more. In the first part of my internship to become a Registered Dietitian, I also learned firsthand how communication can make or break health promotion efforts, the success of a grant proposal, or a one-on-one counseling session. A recurring theme in all of this is that the communication has to be exceptional in order to see a favorable outcome.

Health communication is a rigorous social science. There are theories (more than I’m able to wrap my head around) trying to predict how communication strategies will affect behavior change. Research looks at how images may affect attitudes and self-efficacy, how visual appeal dictates our trust, how tailoring communications helps make them more effective, how the media promotes but can also combat stigma, and how interpersonal communication can enhance large-scale campaigns. The list goes on.

What I’ve come to find in my short time in the health comm world is that human beings are very complicated creatures, and how (or when or who or why) you communicate health messages to them is extremely important to the success of that message getting through.  Applying this to my future profession in nutrition, you can’t just tell someone to eat healthy and expect results! The same goes for public health efforts attempting to reach people at the population level. This is especially important to remember as a health professional, because the way we think about these topics may diverge from how the general public thinks of them. We should always trust the audience and know that however a message resonates with them is important to the way we design our campaigns and messages.

So thank you, health communication world, for letting me get a glimpse into your complex and necessary world. I hope the things I’ve learned can help me become a better nutrition professional where I can make lasting changes for people who need it.

 

 

Photo source: Virginia Sea Grant via Flickr.com

Hypoglycemia: The Other Side of High Blood Sugar

For National Diabetes Month, I’ve talked about the basics of diabetes and pre-diabetes, including some tips for prevention. Diabetes often focuses on having high blood sugar, which is the general response to the body either not being able to make insulin, or not being able to respond to it properly. However, low blood sugar is just as important for someone who is diabetic.

Low blood sugar, known as “hypoglycemia,” is characterized by abnormally low blood sugar (less than 70 mg/dL). This can result in taking too much insulin or exercising too long and is especially important for insulin-dependent diabetics. If untreated, this state of low blood sugar can lead to unconsciousness or even a seizure. If low blood sugar occurs during the night, a person may be less likely to be awakened from sleep. The best way to know if you are hypoglycemic is to check your blood sugar, but there are a number of signs and symptoms that can help identify this state:

  • Shakiness
  • Nervousness/or anxiety
  • Blurred or impaired vision
  • Sweating, chills, and clamminess
  • Irritability or impatience
  • Confusion, including delirium
  • Rapid/fast heartbeat
  • Tingling or numbness in the lips/tongue
  • Weakness or fatigue
  • Hunger and nausea
  • and more

Fortunately, it’s easy to reverse hypoglycemia if you find yourself feeling any of these symptoms or notice that your blood sugar is low. Simply consume 15-20 grams of glucose or simple carbohydrates and re-check your blood sugar after 15 minutes. Continue this process until your blood sugar levels return to normal. Examples of 15 grams of carbohydrates include 8 ounces of non-fat or 1% milk, 4 ounces (1/2 cup of juice, a tablespoon of honey, or glucose tablets according to package instructions. Do not ever take insulin during a time of hypoglycemia – this will only lower your blood sugar further.

This table from the Joslin Diabetes Center is a great resource for knowing the ideal ranges for different parts of the day. The best way to manage your blood sugar is to think about balance: you want your blood sugar to be in the ideal range – not too high OR too low!

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Photo source: Sriram bala via flickr.com

Controlling Your Blood Sugar & Preventing Diabetes

November is National Diabetes Month, and last week I discussed pre-diabetes. I mentioned that pre-diabetes can be reversed with the appropriate actions, such as eating a healthy diet and getting adequate exercise. Because diabetes and pre-diabetes are becoming to common, it’s likely you know someone that is experiencing the challenge of controlling their blood sugars.

Fortunately, many Registered Dietitians (RDs) and other health care providers can become Certified Diabetes Educators by gaining 1,000 hours working with diabetic patients and taking a specialized exam. These health professionals can help someone with high blood sugars make behavior changes to improve their health and well-being, and often reverse pre-diabetes! Here are a few steps to get started:

  • Don’t skip meals! Try to eat a balanced breakfast, lunch, and dinner.
  • Make sure to pair carbohydrate with protein (pairing the foods). The protein will help slow the absorption of the sugars (when the carbohydrate gets broken down) and will help to keep blood sugar from spiking too high.
  • It is also important to eat carbohydrates with high fiber, which also helps to slow the absorption of broken-down carbohydrates. However, anytime you increase fiber you should also increase water intake. Stick to whole grains and non-starchy vegetables.
  • Try to walk for about 10 minutes after as many meals as possible. Physical activity helps with the insulin response and overall blood sugar control. If you can start a regular exercise routine, that has huge impacts on controlling blood sugar and all the other risk factors with diabetes, but that can definitely be difficult to work into a busy schedule and may take time to work up to. Walking for just 10 minutes after each meal adds up to 30 min/day!
  • Cutting out sugar-sweetened beverages may be the one thing to completely get rid of. Not only is it like throwing tons of sugar straight into your blood, but it also makes us more likely to overeat because our brains are less sensitive to liquid calories and their effect on feeling full.
  • Eating out as infrequently as possible. We have no real control of what’s going into prepared foods (even the lower calorie options may have a sauce that’s super sweetened or have some sort of hidden ingredient). That could be really tough for those who work odd hours or travel a lot, so that’s another aspect an RD could help with.
  • Watch portion sizes – another reason to limit eating out since portions from restaurants are usually way too big these days.
  • Checking blood sugar regularly is soimportant so you know how well you’re managing things.

 

These are just a few recommendations to controlling high blood sugar, but long-term behavior change (important to preventing diabetes or progression of the disease) can be achieved with the help of an RD.

 

Photo source: Diabetes Care via Flickr.com 

National Diabetes Month – What is Pre-diabetes?

Continuing the Diabetes theme I began last week in honor of National Diabetes Month, this week will focus on the “elephant in the room”: pre-diabetes.

I mentioned that 86 million people in America are considered “pre-diabetic,” putting them at high risk of developing diabetes with high blood sugar levels. Diabetes results when either your body doesn’t make enough insulin (type 1) to handle the glucose in your blood, or your body has become less “sensitive” to the insulin that is being produced (type 2). Either way, high levels of sugar in your blood can be a dangerous situation. In fact, diabetes can lead to serious conditions such as heart attacks, stroke, blindness, kidney failure, and loss of toes or feet.

Levels indicating pre-diabetes include:

  • Hemoglobin A1c (HgA1c) of 5.7-6.4%
  • Fasting blood glucose (sugar) of 100-125 mg/dL
  • Oral Glucose Tolerance Test (OGTT) 2-hour blood glucose of 140-199 mg/dL

Other factors that increase the risk of developing type 2 diabetes include age (45 years or older), overweight status, family history of type 2 diabetes, physical inactivity, and gestational diabetes (when you have diabetes during pregnancy).

Fortunately, you can work to change your pre-diabetic status and lower your risk of developing diabetes by losing weight (if you are overweight) and exercising moderately (such as brisk walking) 30 minutes a day, fiver days a week. One great way to incorporate this exercise is to walk for 10 minutes after every meal (it also helps your body react to the insulin to decrease blood sugar after you eat).

If you’re worried about developing diabetes, take the CDC’s online quiz to assess your risk!

 

Photo source: Pan American Health Organization, World Diabetes Day via Flickr.com

November is National Diabetes Month!

November is National Diabetes Month, the 75th anniversary attempt to spread awareness of a disease affecting more and more Americans every year. In fact, the American Diabetes Association (ADA) reports that diabetes affects nearly 30 million children and adults in the US – nearly 10% of the population. An additional 86 million have pre-diabetes, meaning they have elevated blood sugar levels and are at-risk for developing diabetes.

Diabetes nearly doubles the risk for heart attack, is the leading cause of kidney failure, and is the leading cause of new cases of blindness among adults. Total medical costs associated with diagnosed diabetes reach $245 million dollars, including direct medical costs as well as indirect costs involving disability, work loss, and premature mortality. Astoundingly, 1 in 5 health care dollars is spent caring for people with diabetes.

The ADA’s theme for this National Diabetes Month is “Eat Well, America!” to emphasize the importance of healthy foods in diabetes management. Every week, ADA will introduce recipes including those appropriate for holidays and special occasions, with trips for preparation, cooking, plating and serving, as well as complete nutritional information.

Additionally, if you have a Fitbit to track your activity, you can join the Fit for Good challenge, starting TOMORROW, to help count your steps towards one of 3 charities (one is the American Diabetes Association). The winning charity will receive $500,000, so sign up today to help combat diabetes!

What are Community Health Workers (CHWs)?

Going to a doctor’s appointment, I often feel a variety of emotions: anxiety, apprehension, worry, confusion, and, hopefully at the end, relief. And I’m a student in a health profession! While this may not be the case for everyone who uses health services, imagine if English wasn’t your first language or your literacy skills were limited, if you had a cultural distrust of doctors, or you had other challenges and barriers you had to face in order to receive health care.

That’s often the case with more vulnerable members of the population, such as immigrants, who are also susceptible to significant health disparities compared to the rest of the population. As a way of reaching traditionally underserved individuals and “combatting ethnic and racial disparities in health care,” Community Health Workers (CHW) are being utilized more and more frequently. According to the American Public Health Association, CHWs are defined as: a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community being served. CHWs are recognized in the Patient Protection and Affordable Care Act (ACA) as “important members of the health care workforce” and are meant to bridge the gap between community health and the traditional medical system. CHWs are able to communicate and connect with patients more deeply than many physicians may be able to by speaking the same language and often having shared experiences.

Some may be concerned over the fact that CHWs don’t have formal medical training, but they coach patients on their diagnoses. However, they often get several months of training, including on background on disease management, medications, and behavior change. This means CHWs can benefit patients by scheduling follow-up appointments and making sure they take their medications. Medicaid now reimburses for providing preventive services as long as a licensed practitioner (such as a physician) recommends the use of a CHW.

Recently, the American medical system has experienced rising costs, mediocre health outcomes, and isolated medical specialties. Interdisciplinary teams employing community health workers are a great way to better reach vulnerable patients and improve the quality of patient care, and states around the country should follow in the footsteps further develop the CHW workforce.

 

Read more from the Kaiser Health News story on L.A. Community Health Workers 

Photo source: Community Eye Health via Flickr.com 

#Instagram & #obesity

You’re at your favorite restaurant. You sit down, sip on some water, glance at the menu. After careful deliberation, you order your meal with anticipatory excitement. Finally, a beautifully arranged plate of food arrives for your dining pleasure. You dive in – but not before taking a picture.

Where does this photo go? Likely not in your family photo album or printed for a framed display in your living room. No, more likely this photo goes on social media (but not after a good filter is applied) for everyone in your network to see and salivate over.

It’s no surprise that the visual appeal of food has a significant impact on our enjoyment, as our brains have evolved over centuries in order to find nutritious foods to sustain our bodies. In the 21st century, however, we not only have food advertising plastering billboards and television commercials, but we can also digitally capture images on devices that never leave our side. Researchers now question whether this “onslaught of appetizing food images” may be having an impact on our eating behaviors – and subtly contributing to our obesity epidemic.

When you see a beautifully hashtagged photo of your friend’s dessert last night, is it a cue for you to think about the ice cream in your freezer? Do you develop “visual hunger”? While research continues to elucidate the neural networks underlying visual food cues and whether or not your “food porn” is making your friends fat, there’s one thing for sure: put down your phone and enjoy your meal, every flavor and texture. We can all practice a little more mindful eating and a little less digital connectedness.

 

Photo source: Mae Rice via Groupon articles

Low protein bad for bones?

Like many runners, I experienced a stress fracture in a foot bone a couple months after my first half marathon. Being winter in New England, my physician attributed it in part to a lack of enough Vitamin D, which helps your body absorb dietary calcium. Without enough vitamin D to absorb calcium, your body must access its reserves – from your bones. This has implicated calcium and vitamin D as the dynamic duo when it comes to preventing osteoporosis, the most common disease of the bones.

Now, preliminary research findings are connecting low-protein diets to calcium malabsorption in young women. Because the best time to take action to prevent osteoporosis is when you’re young, this research could have important consequences for those at risk (genetically, or otherwise) for osteoporosis.

The study, conducted by researchers from the University of Connecticut and the Yale University Bone Center, hoped to fill a gap regarding dietary components such as protein and its association with bone health. The research aimed to examine the impact of low-protein diets in young Asian and Caucasian women, two groups with higher risks for osteoporosis later in life.

While this research is in it’s early stages, the association certainly warrants further research and consideration. Osteoporosis causes almost 9 million fractures each year – in fact, 1 in 3 women over age 50 will experience osteoporotic fractures. Men aren’t off the hook though – 1 in 5 over the age of 50 also experiences fractures related to osteoporosis. Although most Americans don’t have trouble getting enough protein, many older adults consume inadequate protein due to an increased need and sometimes lack of appetite. Young and old – make sure you’re getting at least 1.0 gram /kilogram of body weight and adequate calcium and vitamin D to keep bones healthy for life!

 

Photo source: Quinn Dombrowski via Flickr.com

Compromising Children’s Health

On the brink of another potential government shutdown, school lunches weren’t exactly an urgent priority for Congress. However, they probably should’ve been. The Healthy, Hunger-Free Kids Act (NNFKA) was scheduled for reauthorization by September 30th and Congress allowed it to expire, which means the Child Nutrition Act (CNR) will not undergo any significant updates to improve its effectiveness or efficiency in feeding millions of America’s children.

To back up, the Child Nutrition and WIC Reauthorization Act is a law that governs nine federal nutrition programs, including the well-known National School Lunch and Breakfast Programs, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 5 other programs serving children and older adults. Congress reviews the CNR every five years as a way to strengthen the programs and make sure they are meeting the needs of the country’s children. The last reauthorization resulted in the NNFKA legislation, which was championed by the First Lady and sought to improve the nutritional quality of meals served in schools and preschools.

There’s no doubt the quality of these meals has improved and the CDC has the data to prove it. However, since the NNFKA took effect in 2012, it’s been a mixed bag in terms of implementing new nutritional standards. The School Nutrition Association (SNA) holds the position that the requirements are too strict, and many components should be rolled back due to increased food waste and decreased profits. The SNA is in favor of suspending further sodium level reductions, reversing the requirement that students have to take a fruit or a vegetable, and restoring the initial requirement that at least half of the grains offered be whole grain (rather than 100%).

In order to address some of these concerns, researchers have conducted studies to examine whether or not the new standards have actually affected food waste and consumption. In a study of middle schools in 12 schools in an urban, low-income district, researchers found that overall there was a positive response to new lunches. In fact, they determined that students actually consumed more fruit, threw away less of the lunch entrees and vegetables, and consumed about the same amount of milk. However, the study does not directly address the whole grains component of the standards. A study from the Harvard School of Public Health also found that the new standards significantly increased fruit and vegetable consumption.

So, what should be done? Should there be compromises made so that schools can have a smoother transition when implementing these standards? Or should they be encouraged to give it time and allow for students to get used to the changes? Either way, it’s clear that the CNA deserves more respect from Congress than to let the reauthorization deadline slip past. When over 21% of children live in poverty and food insecure households, millions of women, infants, and children participate in WIC, and over 500 million meals are served in CACFP homes, there should be an urgency to review the laws that help feed these vulnerable groups.

 

Photo source: USDA via Flickr.com 

Calorie Labels: Appropriate for Every Setting?

In recent years, restaurants have begun to display calorie content on their menus as a way of combatting the growing obesity epidemic. In fact, the US Food & Drug Administration (FDA) actually requires chains (restaurants with 20 or more locations) to comply by the end of 2016, so you’ll likely see this become even more commonplace. As Americans tend to spend nearly half of their food budget on food from outside the home, policy makers see this as an opportunity to affect purchasing behaviors. This requirement includes meals from sit-down restaurants, take-out food, drive-through windows, bakeries, coffee shops, and foods you might purchase at a movie theater or amusement park.

Due to the increasing compliance over the next year or so, researchers are looking into what will actually influence consumers the most. A new study in the Journal of Public Policy and Marketing compared the effectiveness of using traffic light graphics (with red, green, and yellow images) to indicated the approximate calorie content versus traditional numbers, and found that they are “just as effective.” These results suggest that it is not the exact number of calories that influences consumer choices, but whether or not they believe the option to be lower in calories.

However, is this calorie labeling appropriate for all settings? Some university cafeterias have adopted this model and others have abandoned it. Why? While the idea of the “Freshman 15” persists, it is also true that unhealthy weight loss practices are common among college students, especially women. Even “normal” dieters often progress to unhealthy behaviors to shed pounds. According to research by the National Eating Disorder Association, prevalence of eating disorders in college students can be as high as 32% in females and has risen over the years.

Calorie labeling may be an effective way to reduce caloric intake, but may not be appropriate for all settings. Should future research examine alternative point-of-purchase prompts, putting less emphasis on calories and more focus on simply nutrient-dense options?

 

Photo source: Province of British Columbia via Flickr.com