Hit the Reset Button Part 2: Healthy Eating in 2019

Three PA Experts Suggest Ways to Tackle Post-Holiday Eating

January 9, 2019

By PAs Karli Burridge, Ellen Mandel and Corri Wolf

These three PAs have experience and expertise at counseling patients on healthy eating. So, what do they advise other busy PAs about hitting the reset button after the holidays?

Part 1: How to get back on track, thoughts on trendy diets and effective programs.
Part 3: What balanced eating looks like, how to fuel your body before a workout, and snack ideas.

What is your advice about added sugar?
Corri– I am all about moderation. However, I see no need to consume sugar-sweetened beverages such as soda which provide empty calories and lead to weight gain. Adults should keep their added sugars to less than 10 percent of their daily calories. I would save that for a small piece of birthday cake rather than a beverage. Replace that sugary drink with water or a piece of fruit.

Karli– Eat as little of it as possible. Eighty percent of processed foods have sugar added to them, even though they may not taste sweet, which causes most of us to consume way more sugar than we realize. To become more aware of your sugar intake, read labels, track your food and beverage intake for a few days with an app like MyFitnessPal, and avoid processed foods as much as possible. Remember, the healthiest foods don’t have a label, so don’t fall for the marketing ploys of food companies that try to convince you that their product is “healthy;” be your own judge!

Ellen– Very few foods may be characterized as essentially “bad” or “good.” As the adage goes, it is not what you eat but how much. So, added sugars are a quantifiable adjustment for 2019. One level-measured teaspoon (not a soupspoon) contains 15 kilocalories. Sugar packets contain as little as one half to 2 teaspoons/packet. So, using a commonly found 1 teaspoon/packet amount: Four packets per day equals 60 added kilocalories, which if used daily for one year equals 6.3 pounds of body weight (using 3500 kilocalories/one pound of body weight). If you want an easy way to cut caloric intake, then reducing added sugar to coffee or tea is a good step. The next step might be to search for added sugars on convenience foods. This is easier now as the USDA is requiring food manufacturers to include added sugars on food labels, and all companies, large and small, must comply by January 1, 2021.  Getting savvy with food labels goes a long way toward improving personal health and can be easily applied in the patient exam room.

What are healthy substitutes for high fat and calorie foods such as butter or sweets?
Ellen- I am not a fat-hater. Good fats serve an important role in our overall nutrition. Butter in small amounts makes food so much tastier as does some sugar. I practice the M word: moderation. Keep in mind that a low carbohydrate eating approach encourages higher fat and protein intakes as there are only three macronutrients adding up to a maximum of 100 percent. I am a big fan of dried fruits such as apricots, cranberries, raisins, and figs. They provide fiber, great flavor, a nice “chew,” travel well, and feel like a treat. Give them a try.

Corri– If you are looking to spread something on your toast, nut butters are a much healthier choice. While nut butters such as peanut butter and almond butter do contain fat, they are high in monounsaturated fat –the healthy kind. They are also packed with protein as well as some vitamins and minerals. When looking for something sweet, grab a piece of fruit. Eat an apple, pear, peach, or plum with the skin on. Not only will it curb your craving for something sweet, but you will also increase your dietary fiber intake, which is beneficial for your cholesterol, blood sugar, and weight.

Karli– I generally don’t discourage people from eating fats, as long as they are healthy fats, and I would include grass-fed butter as a healthy fat. Eating healthy fats increases satiety and prevents us from getting hungry between meals. However, trans fats and the cheap processed oils used in many packaged foods should be avoided. I recommend fats like extra virgin olive oil, avocados, coconut, nuts and seeds, and grass-fed dairy. Salad dressings typically use cheap oils that cause inflammation, so I recommend making one’s own salad dressing, which can be done with just a few simple ingredients and whipped up in less than a minute. As far as healthy substitutes for sweets, I would recommend nut/chocolate treats (see Part 1: What are your best tips for getting back on track after the holidays?), or some berries with whipped cream or dark chocolate-covered strawberries. A small piece of dark chocolate can do the trick, too!

How much water should you be drinking daily?
Karli– It depends on the individual, their activity levels, their diet, and the time of year (hello Arizona or Texas in the summer!) Also, there isn’t a lot of solid evidence for the amount of water that people should be consuming. However, if we are looking for a general recommendation, I usually recommend at least 60 ounces of fluids a day, which can come from any fluid source, including coffee, unsweetened tea, and other unsweetened beverages. I advise avoiding drinks with artificial sweeteners, though for some people this can be a way to transition off sodas. We always discuss eventually weaning off the artificial sweetened beverages as well, since they do tend to trigger cravings for more sweetness, and can affect the health of the microbiome, among other things.

Corri– That is a simple question that has a not-so-simple answer. Daily fluid intake recommendations vary by age, sex, pregnancy, and breastfeeding status and water can come from foods, plain drinking water, and other beverages. The National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is approximately 15.5 cups (3.7 liters) of fluids for men and 11.5 cups (2.7 liters) of fluids a day for women. Twenty percent of that will come from food but the remainder is meant to come from plain drinking water and other beverages. This is more than the old saying, “drink 8 8-ounce glasses of water a day” and although that may not be entirely accurate, it is still a reasonable goal.

Ellen– Simple answer: If your urine is not close to clear in color (this does not apply if you are taking vitamins which often color urine), then you are not well-hydrated and need to drink more. I am an anti-bottled water person. Some of this is my generation when somehow, we did not need access to water 24/7. Tap water in most US locales is safe.

Here is a handy calculation from Good Housekeeping.  Although not derived from hard research, it seems to fit the general range for adults.

1. Take your weight (in pounds) and divide that by 2.2.
2. Multiply that number depending on your age.

• If you’re younger than 30, multiply by 40.
• If you’re between 30 and 55, multiply by 35.
• If you’re older than 55, multiply by 30.

3. Divide that sum by 28.3.
4. Your total is how many ounces of water you should drink each day. Divide that number by 8 to see your result in cups.

Read More

Hit the Reset Button Part 1: How to get back on track, thoughts on trendy diets and effective programs.
Hit the Reset Button Part 3: What balanced eating looks like, how to fuel your body before a workout, and snack ideas.

More Resources

Primary Care Obesity Management Certificate Program

PAs in Obesity Medicine special interest group

Authors: Karlijn (Karli) Burridge [email protected], formerly with Baylor Scott & White Health Metabolic and Bariatric Surgery Center, Grapevine TX, recently moved to Chicago, IL, where she is looking for a new opportunity. Ellen D. Mandel, DMH, MPA, MS, PA-C, RDN, CDE, is Clinical Professor, Pace University, Physician Assistant Studies-Lenox Hill Hospital – NYC, [email protected]. Corri Wolf, PA-C, MS, RD, is Associate Professor, Academic Coordinator & Assistant Chair, Department of PA Studies, New York Institute of Technology, [email protected].