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Healthy Eating: It All Boils Down To 3 Pieces Of Advice

I’m proud to have been selected as the national, nutrition (“mind”) coach for the Boys & Girls Clubs’ Triple Play Fit Family Challenge. This is a 6-week challenge – five families (you can meet the families on the Fit Family Challenge blog) will compete for a grand prize: an all-expenses-paid vacation!

My job is to support the families with evidence-based nutritional information that they can use to establish lifelong healthy eating patterns. Proper nutrition is one of the most critical components of preventive medicine, and can help to reduce the risk for America’s top 3 killer diseases: heart disease, cancer, and stroke (not to mention type 2 diabetes, osteoporosis, and high blood pressure). If these families help their kids to adopt healthy lifestyles now, they will have a lower lifetime risk of many major diseases. And I hope that the kids will also become evangelists for healthy eating to their peers!

I’ve been thinking a lot about what I’ve learned over the years as a nutrition journal editor, avid foodie, and rehab physician, and I think that (to begin) I can truly boil down all we know about American eating habits into these three pieces of advice (note that these are based on HHS’s Dietary Guidelines For Americans, 2010):

1. Do not let yourself become very overweight or obese.

2. Eat MORE: fruits, vegetables, seafood, whole grains, and low-fat and fat-free dairy products.

3. Eat LESS: trans (animal-based) fats, cholesterol, salt, sugar, and refined grains.

I think that this is a great starting point for healthy eating. Notice that the advice doesn’t include super foods, magic berries, or miracle supplements – because a healthy diet doesn’t rely on those faddish things.

For the next 6 weeks I’ll be sharing my thoughts about nutrition with the families here on the Better Health blog (and at the Fit Family Challenge Blog) so everyone can benefit from the process. In my next post I’ll talk about what we can learn from the National Weight Control Registry – a database of people who managed to lose a substantial amount of weight and keep it off for a minimum of 1 year. (In fact, USA Today just published a story about this database here).

I’ve also chosen to use Dr. Eric Marcotte’s book, “Food Truths, Food Lies” as background reading for the challenge. I think it’s an excellent, practical manual – especially for those of us who need to lose weight.

Thanks for joining the challenge – let me know if you have any questions along the way!

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3 Responses to “Healthy Eating: It All Boils Down To 3 Pieces Of Advice”

  1. Carolyn Thomas says:

    Hi Dr. Val
    Love these three oh-so-basic pieces of advice! And this program Triple Play sounds like a cool and attention-getting way to get some important nutrition awareness information out there.

    But am I the only one out here feeling a bit squirmy by seeing that Coca-Cola logo splashed all over a nutritional awareness pitch as one of the program’s corporate sponsors? Coke’s been a supporter of Boys & Girls Clubs for 50 years (as they are happy to point out on their website). Of course they are – this is precisely their target market, and it fulfills a corporate mandate for social cause marketing strategies.

    This is also why fast food companies sponsor health-focused sporting events, teams and leagues. McDonald’s, for example, ponies up sponsorship dollars for the NHL, Olympic Games, and the FIFA World Cup among countless others. And as Australian researcher Dr. Sandra Jones - co-author of the report “I Eat Milo To Make Me Run Faster” - warns:

    “We can and should prohibit the sponsorship of children’s activities by fast-food companies and manufacturers of nutritionally poor foods (i.e. those that are high in fat, salt and/or sugar) because we are talking about children and the development of food-related attitudes and behaviours that have the potential to influence their health and well-being for the rest of their lives.”

    More on Dr. Jones’ work:…/uow091751.pdf

  2. Carolyn Thomas says:

    PS Oops that link to Sandra Jones paper may not work. Here’s the study info: Jones, S.C., Mannino, N.L. & Green, J. (2010). ‘Like me, want me, buy me, eat me’: relationship-building marketing communications in children’s magazines. Public Health Nutrition, 13 (12), 2111-2118.

  3. Dr. Val says:

    Thanks for your thoughtful response, Carolyn. My view is that fast food companies will produce whatever is selling – and if consumers demand healthier options, Coke & McDonald’s et al. will provide it. Fast food is not going away, so the best we can do is teach consumers how to select and request healthier options – Coke owns Dasani water, and McDonald’s has apple slices and salads on their menus… so their products are not “whole cloth” unhealthy. I think it’s great that they give some of their profits to worthy causes – and we may eventually be able to use that funding to change their product lines through nutrition education. In the end, big business is most concerned about their bottom line – we have the purchasing power/collective clout to influence what we’re offered. I think we can win this through education… and if Coke sponsors that, so be it. ;-)

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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