Lamb Burgers

Ingredients

1⁄3 cup pine nuts
1 pound ground lamb
1 egg
1⁄3 cup raisins
1/2 teaspoon ground cumin
1/2 teaspoon kosher salt
1/4 teaspoon freshly ground black pepper
4 ciabatta rolls
Fresh arugula
Feta yogurt sauce (optional)

Directions

1. Combine all the ingredients except the rolls, arugula and yogurt sauce. Mix gently.
2. Shape into 4 patties.
3. Grill or cook in a skillet 4 minutes per side.
4. Serve on rolls with fresh arugula and feta yogurt sauce.

Nutrition Information

Serves 4 (Serving size: 1 burger)

Calories 519; Total fat 26g; Sat. fat 8g; Chol . 124mg; Sodium 615mg; Carb . 46g; Fiber 2g; Sugars 10g; Protein 29g; Potassium N/A; Phosphorous N/A

Ginger-Teriyaki BBQ Chicken Meatballs

Ingredients

Meatballs

2 pounds 98-percent fat-free ground chicken
1 egg
1 tablespoon fresh ground ginger (or ginger paste)
1 teaspoon garlic powder
Ground pepper
Olive oil spray

Sauce

1 6-ounce can tomato paste
1/2 cup teriyaki sauce
1/2 cup apple cider vinegar
1⁄3 cup brown sugar
1 teaspoon ground ginger, dried

Directions

1. Preheat the oven to 400°F.
2. Spray 2 large 9×11-inch Pyrex pans with olive oil.
3. To make the meatballs, combine the ground chicken, egg, ground ginger, garlic powder and ground pepper in a large mixing bowl. Evenly mix the ingredients together. Create 30 meatballs each the size of a table tennis ball.
4. Place meatballs in the pans, spacing them evenly. Cover the pans with foil and bake for 15 minutes.
5. Remove foil and bake for another 15 minutes until meatballs are slightly browned and have an internal temperature of 165°F.
6. Meanwhile, combine all of the sauce ingredients in the slow cooker. Add the cooked meatballs and coat evenly with sauce. Cover and cook on high for 1 to 1½ hours until meatballs are fully glazed.
7. Serve meatballs as an appetizer on their own, or serve on a whole wheat hoagie roll.

Nutrition Information

Serves 15 (Serving size: 2 meatballs)

Calories 110; Total fat 2g; Sat. fat 1g; Chol . 46mg; Sodium 493mg; Carb . 9g; Fiber 1g; Sugars 8g; Protein 14g; Potassium 263mg; Phosphorous 123mg

A Dietitian’s Dream: Healthy Fried Food

Fried foods traditionally have been limited in healthy dietary patterns. But when you use small amounts of healthy unsaturated oils and the technology of an air fryer, fried foods can be back on the menu.

I tested the Philips Viva Collection Airfryer, equipped with “TurboStar” rapid-air technology that functions similar to a convection oven. The fryer’s air speed is what allows foods to cook quickly and crisply with minimal fat.  The fryer is easy to use and comes with a basket and rack, which are both dishwasher safe for easy cleanup. However, the bottom of the fryer, where fat collects, requires cleaning by hand.

Additional accessories are available that can turn the fryer into an oven or a grill pan, and a free app provides a wealth of information including tips for use, shopping lists and recipes. I was struck by the large size of the product, weighing about 12.8 pounds and roughly the size of a coffee maker.

Testing the Fryer
I experimented with chicken wings, Southern-fried chicken tenders, bacon and vegetables, including fresh and frozen potatoes. No preheating was necessary — a simple spritz of oil on the rack and the food was all it took to get started with the fried foods. My best results were with the vegetables.

I quickly learned that the trick to achieving fried foods that are crunchy on the outside yet still tender on the inside is not overcrowding the basket. Philips claims the fryer can be used to prepare food for a family of four, but my best results came when I used amounts to feed one to two people. When the basket was overloaded, despite shaking and turning the food, it resulted in foods that either did not brown or were overcooked to achieved proper browning, and wet-battered foods tended to stick to the rack even when both the food and rack were sprayed with oil. An additional double-layer rack can be purchased to double the basket’s capacity.

Bottom Line
If counter or pantry storage space is not an issue, the Philips fryer is a fun investment. It’s a bonus that this product can multitask for those living without a full kitchen, such as college students. The sweet spot for me was enjoying guilt-free French fries. Although other vegetables were delicious, I’ve achieved similar results with minimal oil and oven-roasting at high temperatures.

How Ethiopia Safeguards Its Native Ancient Grain

Visit any Ethiopian restaurant, and you’re bound to receive a generous serving of injera, a spongy, fermented flatbread commonly found in Ethiopian cuisine.

Increasing in global popularity due to the expanding diaspora and interest in ethnic cuisines, injera is arguably one of the most recognizable African foods on the international scene. Each day, thousands of ready-made pieces are exported from Ethiopia to expats and restaurateurs in the United States, Europe and other African countries. However, it is teff — the grain from which injera is made — that is making ripples in the international health food arena and poised to rival quinoa as the top healthy ancient grain.

Grown by both smallholder and commercial farmers in Ethiopia and some parts of Eritrea, teff is a relatively low-risk, sustainable grain that thrives in both wet sands and dry desert conditions. A staple in many Africans' diets, wholegrain teff is an essential source of calcium, fiber, protein and iron.

While the international food market recognizes whole-grain teff as a nutrient powerhouse, its versatility as a gluten-free grain has piqued the interest of foodies and fostered its expansion beyond East Africa. Recipes using teff as a nontraditional substitute for wheat range from gluten-free pasta and bread to cookies and porridge, and to thicken soups or add texture to salads.

In 2006, years before the rise of quinoa, the Ethiopian government sought to improve domestic food security in a country that, years before, had been plagued by severe famine. It placed an embargo on the exportation of teff grain and teff flour, both which played an important role in overall diet quality. Only cooked teff products (such as injera) could be exported. Despite the ban, traditional practices of growing teff could not meet the demands of the growing population and prices continued to increase.

Although Ethiopia is the largest producer by volume, the embargo has prevented the country from benefitting from the international teff trend, and most of the teff found in U.S. stores is from non-indigenous sources, such as U.S., India, Canada and the Netherlands.

Recognizing the opportunities teff can bring and to obtain much needed foreign currency to improve the overall infrastructure of the country and advance traditional farming procedures, the Ethiopian government lifted the embargo and implemented a pilot program to export teff. The first shipments of Ethiopian teff are projected to begin in January 2016.

In order to safeguard the grain for locals, the pilot will start with 48 commercial farmers commissioned to grow the crop while adhering to strict international standards. Once harvested and milled, the entire product from these farms is projected to represent less than 1 percent of the country’s overall teff production.

The remaining teff will continue to be made available to Ethiopians. Outside of commissioned farms, the ban on teff exportation will continue. As the pilot proceeds and overall teff production improves, the country plans to gradually increase the allotment for exports.

Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease, or NAFLD, is the buildup of excess fat in the liver that is unrelated to alcohol consumption. It begins with simple fatty liver and can progress to life-threatening liver cirrhosis, in which the liver is loaded with scar tissue and can no longer function properly. NAFLD is the most common form of liver disease in the developed world.

In the United States, at least 30 percent of adults and as much as 10 percent of children older than 2 have NAFLD. With obesity as a common comorbidity, the prevalence of NAFLD has doubled in the last two decades and may soon surpass hepatitis C infection as the leading cause for liver transplantation in the U.S.

The Disease Spectrum

NAFLD is a non-specific title describing several variations of the disease with differing levels of severity. In simple NAFLD, there are no symptoms, only steatosis, which is an excess of triglycerides in the liver. As many as 30 percent of people with NAFLD will progress to non-alcoholic steatohepatitis, or NASH, a severe form of fatty liver characterized by inflammation. There often are no symptoms related to NASH, though some sufferers complain of fatigue or discomfort in the upper right abdomen. Many people with NASH go on to develop fibrosis or scarring of the liver. As fibrosis progresses, cirrhosis develops, which can lead to progressive chronic liver failure, liver cancer and death.

Risk Factors and Causes

NAFLD is more common in people who have obesity or Type 2 diabetes. At least half of people with Type 2 diabetes and approximately 90 percent of people with body mass indices of 35 or higher have some form of NAFLD. Insulin resistance is common among these conditions and often is expressed as metabolic syndrome.

NAFLD is widely considered the liver manifestation of metabolic syndrome. Insulin resistance leads to excess free fatty acids in the blood stream and increased fat deposition in the liver. Furthermore, metabolic abnormalities spur the liver to produce and store high amounts of fatty acids. Most people with NAFLD have at least one feature of metabolic syndrome, and about one-third have all five features: elevated blood sugar levels, high blood pressure, low HDL cholesterol levels, elevated triglyceride levels and increased waist circumference.

Additional risk factors for NAFLD include high cholesterol levels, polycystic ovary syndrome, sleep apnea and underactive thyroid. These conditions share risk factors and complications such as weight gain, inactivity, diabetes and poor diet.

Less common causes of NAFLD include medications, infections, genetic disorders affecting metabolism, malnutrition and rapid weight loss.

NAFLD Progression and Cardiovascular Complications

Progression of patients throughout the spectrum of NAFLD is not well-defined. Continued or worsening insulin resistance likely plays a role in the advancement of liver abnormalities, as do oxidative stress and inflammation. Zachary Henry, MD, assistant professor of gastroenterology and hepatology at the University of Virginia, notes that for most of his patients, as metabolic syndrome worsens, so does NAFLD. To make matters worse, the progression to NASH may cause a vicious cycle of increased insulin resistance and faster progression through the NAFLD spectrum.

Not all patients progress in a typical fashion. “There are subsets of patients that likely have a genetic predisposition to progress regardless of metabolic syndrome,” Henry says.

Heart disease is the top killer among people with NAFLD, especially for those who have progressed to NASH. It is unclear if this is an association related to metabolic disturbances or if liver abnormalities cause heart complications. Research suggests NAFLD may lead to heart disease by contributing to blood vessel dysfunction, systemic inflammation, oxidative stress, and worsening cholesterol and triglyceride levels.

Screening for and Diagnosing NAFLD

Screening starts with a blood test to measure liver enzymes, but diagnosis requires imaging of the liver, typically by ultrasound. Health care providers frequently order imaging tests for patients with elevated liver enzymes in the presence of high-risk conditions such as Type 2 diabetes, metabolic syndrome, obstructive sleep apnea and a BMI of 35 or higher. However, the disorder likely is under-diagnosed because many patients with NAFLD have normal liver enzyme levels. Henry favors imaging everyone at high risk, but because this puts a heavy burden on the health care system, many providers order diagnostic procedures only when liver enzymes are elevated.

A liver biopsy is necessary to learn if a patient has simple steatosis or if the disease has progressed to NASH, fibrosis or cirrhosis. Under a microscope, the sampled liver tissue looks identical whether the patient has fatty liver from alcohol consumption, insulin resistance or some other reason. The diagnosis of NAFLD is made by ruling out excessive alcohol intake.

Treatment of NAFLD

There currently are no FDA-approved medications for treating NAFLD. The treatment trifecta is weight loss, healthful eating and physical activity — the same lifestyle interventions that treat other conditions associated with insulin resistance.

Inspiring difficult lifestyle changes for a condition without symptoms is challenging, but early intervention can prevent progression and even reverse NAFLD, says Kristin Kirkpatrick, MS, RD, LD, manager of Wellness Nutrition Services at Cleveland Clinic and author of Skinny Liver (Da Capo Press 2017). The key, she says, is to learn what motivates each individual and to focus on comorbid conditions such as elevated blood sugar levels.

WEIGHT LOSS. As with other conditions related to insulin resistance, even moderate weight loss improves NAFLD. At the University of Virginia Health System, Mary Lou Perry, MS, RDN, CDE, works with a multidisciplinary team to encourage healthful lifestyle habits and weight loss of 7 percent to 10 percent of starting weight. Perry notes that the degree of improvement is proportional to the amount of weight lost. However, rapid weight loss of more than 3.5 pounds weekly, with its greater flux of fatty acids to the liver, may worsen inflammation in NASH and accelerate disease progression.

HEALTHFUL EATING. Research has not identified an ideal diet or macronutrient distribution for the treatment of NAFLD. Thus, following recommendations of the 2015-2020 Dietary Guidelines for Americans is reasonable. One option gaining traction among health professionals is a Mediterranean-style diet. In a small crossover study, a Mediterranean-style diet produced greater reversal of both insulin resistance and liver fat content compared to a low-fat, high-carbohydrate diet even without a change in weight.

The following food items deserve special attention because they affect the progression of the disease or because patients frequently ask about them:

Alcohol: Moderate alcohol intake is associated with less heart disease and greater insulin sensitivity. However, it is unknown if these benefits extend to patients with NAFLD or if small amounts of alcohol are harmful. The American Liver Foundation and some physicians advise people with NAFLD to completely avoid alcohol. In the absence of clear guidelines, patients with NAFLD should adhere to the American Heart Association’s defined daily limits of one drink for women and two drinks for men.

Coffee: Limited data suggests coffee consumption may reduce the severity of NAFLD through anti-inflammatory and antioxidant properties.

Green tea: With its rich polyphenol content, researchers propose that drinking green tea may improve NAFLD. However, there have been no randomized controlled studies in humans.

Sugar-sweetened beverages: Research suggests drinking sugary beverages is associated with greater risk of NAFLD.

Dietary supplements: There is little evidence for the use of dietary supplements in treating NAFLD. Vitamin E shows some promise, but other studies link vitamin E supplements to increased mortality. Although some people may try unproven therapies such as milk thistle and green tea extract, unsupervised dietary and herbal supplements cause 20 percent of liver toxicity cases.

Find Your Couples Cooking Style

Cooking for two has been something I have been helping clients with since I started my career. A lot of recipes are written for 4 servings, and cooking a big meal for two people is not always what you want to be doing.

Whether you are newly married or empty nesters, my tips for finding your couples cooking style below can help!

Healthy Tips When Cooking for Two
Plan your plate. Focus on making 50 percent of your plate vegetables, 25 percent lean meat and 25 percent whole grains. This can look like a plate with some roasted chicken, brown rice and green beans or combining a dish into a stir fry with shrimp over whole wheat linguini.

Make a plan. Avoid trigger foods and situations by making a meal plan for both of you for the week! Go through recipes and cookbooks together, compare calendars and assign cooking duties for the week. What day will you choose to meal plan together?

Choose recipes for 2 servings or choose 4 servings with leftovers. There are a lot of healthy cookbooks featuring recipes for two, and several websites now are interactive with a feature to change the servings.

Look for one-dish meals. This will make it easier to prepare and clean up. Who wants to be doing dishes all night?! Some great options are sheet pan dishes, skillets and one pot dinners — one of my favorites is chicken parm with Italian veggies!

Cook once, use twice. Plan meals so that you can use the extra food in new dishes (or lunches). Cook brown rice, quinoa or whole grain pasta for one meal and use the remainder in a dish on another day. Same goes for meats — try baking all of the chicken for a meal and use the leftovers in sandwiches, salads and soups.

Decide who’s chef. Take this time to catch up and build upon your relationship. Instead of having one person cook while the other one watches TV or does work, designate the “chef” and the “sous chef” of the meal. Same goes for dishes — one washes and one dries!

Curate your dinner playlist. Make dinner and cooking fun by creating a playlist of songs you love to listen to while cooking and eating dinner. This keeps meal time more mindful by keeping the TV off, and it also helps build your relationship.

How Hurricane Maria Helped Me Use Devastation as Motivation

On September 20, 2017, Hurricane Maria hit Puerto Rico, just two short weeks after Hurricane Irma impacted the island. The amount of devastation I saw the morning after affected me emotionally, spiritually and physically. As a student, I found myself at a crossroad: I was in my last year of college, which had come to an indefinite halt, and I was left at home with no communication, no water and no electricity. FNCE was just one month away. I had no way of communicating with my advisor about the final payment of the trip and all flights were canceled at the airport.

About two weeks after the hurricane, I was able to go to Puerto Rico’s capitol, San Juan, where I finally got cell reception, paid my FNCE registration and confirmed that our flight to Chicago was possible. It was a breath of fresh air. The day we left, I was sad knowing I was leaving my family behind on a completely devastated island, but I was comforted by the fact that I was one step closer to reaching a dream: attend FNCE and network with future professionals.

FNCE was a dream come true and the recognition that we got by the Academy of Nutrition and Dietetics was pure and greatly appreciated. The students who represented the University of Puerto Rico received an acknowledgment by the president of the Academy, Donna S. Martin. I met a lot of nutrition and dietetics professionals who encouraged me to keep going, expressed their sympathy regarding my island’s trouble, and motivated me to keep applying to internships and master’s programs.

There have been a lot of natural disasters this past year all over the continental U.S., as well as in the Caribbean. It is a time when we feel lost and confused. But the Hurricane Maria experience was the impulse I needed to keep going and to fight even harder for my dream of becoming a registered dietitian nutritionist.  Times get hard and it may seem like there’s no end to this agony, but there is. When we find ourselves in these difficult moments, we are not alone, and that is exactly how the Academy of Nutrition and Dietetic board members made us feel last October. And for that, we express our most sincere gratitude.

Easy Baked Shakshuka with Fennel and Goat Cheese

If the really cool name does not draw you already, the taste definitely will! Shakshuka, also seen spelled as shakshouka or chakchouka, many say originated in North Africa, however you will see it in Middle Eastern and Mediterranean cuisine as well. The name simply means “all mixed up.” The recipe is so versatile, which makes a great dish for using leftover vegetables and spices.  I decided to add fennel for the winter season and yes, because I had some leftover in my refrigerator!

Low in Iron?
Eggs may not contain the highest amount of iron, but in two servings of large eggs providing 2mg, it does add up throughout the day. What makes this dish an excellent iron absorber is the high amounts of vitamin C in the tomatoes. Vitamin C enhances the absorption of iron, especially nonheme iron — a form not as easily absorbed and mainly found in plant-based and egg products. Heme iron sources on the other hand are more easily absorbed and can be found in animal products, such as meat, fish, and poultry.

What also makes eggs so egg-cellent? They are an excellent source of choline! An important nutrient our body needs for brain development (yes I am talking to you pregnant ladies!) and muscle activity. Two large eggs provide 294mg alone; it is recommended that we aim for 425 to 550mg per day for males and females (even more for pregnant mamas!).

In this Easy Baked Shakshuka Recipe …
This recipe makes a balanced meal for breakfast, lunch or dinner; just try adding your favorite whole grain (gluten-free or gluten-containing such as a baguette). Not a bread fan? Try creamy polenta, corn tortillas or quinoa (all are gluten-free!). If you prefer more vegetables, add some fresh spinach or arugula! Want more protein? Sneak in some chickpeas before placing in the oven. However you choose to create this versatile dish, I hope it is enjoyed with good company!

Easy Baked Shakshuka with Fennel and Goat Cheese
Ingredients

1 tablespoon extra virgin olive oil
½ medium onion diced
1 bulb fennel chopped
2 cloves garlic crushed
1 teaspoon smoked paprika ground
1 ½ teaspoons cumin ground
1 28 ounce can diced tomatoes no salt added preferred
6 large eggs
2 ounces goat cheese crumbled or sliced
1 tablespoon fresh rosemary chopped
Instructions

Preheat oven to 400°F.
In a 10″ (or larger) cast iron skillet, heat olive oil on medium heat. Saute the onions and and fennel cook until softening, about 5-7 minutes.
Stir in garlic and spices and cook for an additional minute to make aromatic.
Add the tomatoes and bring to a simmer. Cook until the liquid thickens, up to 10 minutes. Crack the eggs over the pan and distribute evenly over the pan (can do 5 eggs around the edge and 1 egg in the middle).
Sprinkle the goat cheese and rosemary on top. Slowly transfer the dish to the oven. Bake for up to 10 minutes or until the middle of the eggs are set. *Check at the 5 minute mark if you prefer runny eggs. For harder, cooked eggs cook a little longer than 10 minutes.
Top with additional fresh rosemary or other herbs.

Edamame: A Baby Bean Comes Out of its Shell

Our snack-friendly culture has embraced edamame, a Japanese bean often eaten like unshelled Southern boiled peanuts. A type of shell bean, edamame contains immature soy beans within each pod that can be served whole and squeezed from one end to release slippery, crisp beans.

Product labels typically designate both whole and shelled forms as edamame, although “eda” means branch and “mame” means the whole pod.

In the Kitchen

Inside furry pods, lime-green edamame beans offer fresh pea and subtle sweet-nutty flavors. Early harvesting, at about 80 percent maturity, results in beans with lower levels of gas-producing oligosaccharides and a sweeter taste.

Most legumes have a chalky, grainy or creamy texture, but edamame beans have a lower starch content and al dente texture, making them less appropriate for some bean recipes. For example, they are not malleable, absorbent or creamy enough for bean dips, purees or as soup thickeners. However, the springy, supple texture of edamame beans invite many culinary options.

Cooked and shelled edamame can be pickled, added to bean, grain or noodle salads, or incorporated into classic dishes such as vichyssoise or guacamole. Warm edamame dishes include appetizers of roasted beans, fritters, dumplings and meals or sides such as pasta primavera, succotash and rice pilaf. Substitute edamame in recipes calling for snap peas, fresh shelled peas or baby lima beans.

To serve whole pods as a snack or appetizer, briefly steam, boil or warm them in a microwave, then season with salt and splashes of tamari or rice vinegar.

Edamame also can be used in recipes, including Sweet Curried Edamame Crunchers and Spicy Edamame Slaw with Orange Dressing.

In the Clinic

Edamame is an excellent source of fiber, magnesium, folate and protein, and a good source of potassium. What sets edamame apart from other legumes are its nine essential amino acids, present in quantities that make it a high-quality protein source. Edamame also is high in lutein and zeaxathin, important nutrients for slowing the progression of macular degeneration.

Because soy is one of the top eight food allergens in the United States, the Food Allergen Labeling and Consumer Protection Act of 2004 requires that packaged foods containing soy that are sold in the U.S. must clearly state the presence of soy in the product.

In 1999, the U.S. Food and Drug Administration approved an authorized health claim for soy, allowing product labels to state that diets low in saturated fat and cholesterol that include 25 grams or more per day of soy protein may reduce the risk of heart disease.

This protein quantity equates to about 1½ cups of shelled edamame, making the fiber content (about 12 grams per cup) an easier selling point for heart-related benefits. In October 2017, the FDA released a statement explaining a proposal to revoke the authorized heart disease health claim due to inconsistent evidence. The health claim may be demoted from authorized to qualified, which requires a lower standard of evidence and will allow manufacturers to continue using the claim with a qualifier explaining the limited evidence.

In Quantity

In the U.S., edamame is primarily available in frozen whole or shelled options; in Japan, it’s seasonally available in more than 200 fresh varieties.

Frozen beans are available in bulk quantities for foodservice institutions to store for several months before simmering in salted water, cooling in ice and refrigerating until ready to use. Some U.S. farmers, particularly in Arkansas, are responding to demand by growing soybean plants specifically to sell as edamame, which could increase options for fresh edamame in the future.

Micronutrients: Choline

Often described as “vitamin-like” for its water soluble vitamin properties, choline is a unique micronutrient that is crucial for many biological functions.

Despite its importance, choline is seriously overlooked. Data from the National Health and Nutrition Examination Survey suggest only 8 percent of American adults meet the adequate intake for choline; in the 2010 Dietary Guidelines for Americans, it was identified as a shortfall nutrient; and the 2015-2020 Dietary Guidelines for Americans estimate most Americans consume less than the adequate intake level.

Roles in Health

Choline is essential throughout the life cycle and is critical for brain and spinal cord development. Beginning in utero and continuing throughout childhood, choline is crucial for brain development and cognitive learning. Some research shows choline can improve memory by slowing cognitive decline in older adults.

Beyond the brain, choline is part of acetylcholine, a neurotransmitter important in muscle control, memory, mood and nervous system functions. Choline also plays a role in the stabilization of DNA, transportation of fats and (with folate) possibly the prevention of neural tube defects.

Choline’s role as a neurotransmitter signaling muscle cell activity may enhance athletic performance, according to preliminary research.

Some research shows choline may be cardioprotective, yet other studies have found conflicting results. Further research is needed to investigate the link between choline and cardiovascular disease risk.

Current Recommendations

In 1998, the Food and Nutrition Board established adequate and tolerable upper intake levels for choline. Requirements begin at 125 milligrams per day in the first six months of life and advance to 550 milligrams per day for males 14 and older and 425 milligrams per day for females 19 and older. Pregnant and lactating women require 450 milligrams per day and 550 milligrams per day, respectively.

Food Sources

The U.S. Food and Drug Administration recently set the daily value for choline at 550 milligrams per day for adults and children 4 and older based on the updated Reference Daily Intake values. Foods containing 55 to 104.5 milligrams (10 to 19 percent of the DV) of choline per serving can be declared a good source and foods containing 110 milligrams or more of choline per serving (20 percent or more of the DV) are an excellent source.

Supplements are usually necessary for pregnant and lactating women. Choline supplements are available as a single nutrient, with B vitamins and in some multivitamin mineral products in amounts ranging from 10 to 250 milligrams.

Signs of Deficiency

While most Americans fall short of meeting choline requirements, deficiency is rare in healthy, non-pregnant people. A choline deficiency can cause muscle damage and nonalcoholic fatty liver disease from abnormal deposits of fat in the liver.

Toxicity

Exceeding the tolerable upper intake level of 3,500 milligrams per day of choline for adults has been associated with vomiting, increased sweating, low blood pressure and fishy body odor. Further, the FNB warns that individuals with liver or kidney disease, Parkinson’s disease, depression or inherited trimethylaminuria may be at increased risk for severe side effects when exceeding the tolerable upper intake level.

Populations at Risk

Choline’s role in brain and spinal cord development makes its consumption vital for pregnant and lactating women. However, many prenatal supplements contain little choline. In June 2017, the American Medical Association recommended that prenatal vitamins increase the amount of choline from 0 to 55 milligrams to the adequate intake of 450 milligrams daily.

Individuals with genetic alterations also may be at higher risk of deficiency.

Bottom Line

The mounting evidence of choline’s importance makes it essential that registered dietitian nutritionists remain up to date on this critical nutrient. Throughout the life cycle, RDNs can help clients meet choline requirements for good health. Food manufacturers also may take note and start fortifying choline in foods to help consumers meet requirements more easily.

Why Does Nutrition Advice Contradict Itself?

One day coconut oil is a cure-all, the next it will kill you. Coffee is good! No, it’s bad. Carbs are evil and then they are a necessity. Why is there so much contradiction when it comes to nutrition advice? It often results in confusion and mistrust, so I thought I would address why these contradictions occur and what you can do to make sure you are getting the most accurate information possible.

The Media

Most people obtain their nutrition information from a media source. When it comes to getting views and clicks, the more sensational the headline, the better. The media is prone to use hyperbole when reporting on scientific studies. For example, when a study found that butter had a neutral effect on cardiovascular disease risk when compared to other foods, the TIME magazine headline read, “Butter is Back!”

When the media overstates results of studies, this lends to the confusion that consumers experience. One day butter will kill you, and the next day it will save you. When you read the actual studies behind the headlines, the authors are much more reserved in their analyses.

The Nature of Evidence-Based Advice

Often the media will take one small study and run the result as if it is absolute fact. However, the way that good evidence-based advice is formed takes time and a multitude of studies. In this way, a good case can be built for giving a nutrition recommendation.

The types of studies also matter. There is a “hierarchy of scientific evidence” that classifies which study designs are strongest. For example, a randomized clinical trial holds much more weight than a case study. Unfortunately, study design is not always considered.

Finally, recognize that nutritional science is constantly evolving. Evidence builds upon itself and nutrition advice sometimes needs to be clarified, modified or completely changed based on the progression of evidence.

When taking nutrition advice, whether it be from a professional or a media outlet, be sure that it is built on sound scientific evidence. Confirm that supporting references point to peer-reviewed literature. Ask critical questions about supporting studies, including their type and reproducibility.

Bias

Bias exists in most all situations. To arrive at good nutrition advice, all of us must do our best to eliminate as much bias as possible. For example, good scientific studies try their best to eliminate bias on the part of the researchers. Researchers are human, after all, and can be biased toward a particular result or perhaps influenced by a funding source.

In addition, most of us have some level of “confirmation bias.” This means that we tend to favor evidence that upholds our pre-existing beliefs and ignore evidence that contradicts them. When we become aware of this quality of human nature, we can approach life with a more open mind. Be aware that your own bias affects your ability to accept and process nutrition advice as well. This goes for RDNs, too — we also can get entrenched in some rigid views of food, weight and health.

Source

It can be difficult to discern which news sources to trust. Almost anyone can label themselves a nutrition expert and share advice. It’s pretty easy for anyone to start a blog, Facebook page or Twitter account and start handing out advice.

Be wary if the source of the information also is trying to sell you something, even if they are a professional. For example, one well known TV doctor dishes out advice that is credible on one segment and out of left field on the next. Even though he is an MD, he is in entertainment and the producers of his show are looking for content that will sell.

Seek out nutrition information from sources that strive to be unbiased and based on scientific evidence. One example is the Academy of Nutrition and Dietetics. Academic institutions usually are reliable sources as well.

Conclusion

4 Tips to Beat the Post FNCE Blues

By now, you’ve probably come off the FNCE adrenaline rush, having been surrounded by motivating peers in the nutrition field, and are now eating your post-FNCE blues away with the free samples you received. However, now is the time to put your new skills and connections to work!

FNCE is the Food & Nutrition Conference & Expo that occurs annually across the country bringing dietetic and nutrition professionals together around the world. This is a time to be surrounded by the coolest people (no bias here) and greatly expand your network by interacting in various capacities at the expo, sessions or events. FNCE allows attendees to gain knowledge and skills that will improve interventions, patient participation and results, as well as build upon existing knowledge with emerging research and innovative tips and tricks of the trade.

Following FNCE be sure to:

Start Sending Those E-mails!

Send e-mails and follow up with those you met. Fostering relationships is key to having a successful career. Thank the people you interacted with for sharing their advice, tips and research with you.

Put the New Information into Play

Use the newly acquired skills and information gained by modifying interventions, adjusting research questions or starting new projects after being inspired by the experts you met.

Remember: Follow Your Passions

Say yes to things that excite you, take hold of opportunities that come your way and be patient!

Take Care of YOU

Being involved in multiple projects and various sectors within the nutrition field is great, but to optimally perform we need to get adequate sleep, fuel ourselves properly and maintain our social health. Although most RDNs or future RDNs are Type A and want everything to be perfect, the most important thing you can do for yourself is to take care of you.

And now you can look forward to entering the next 100 years of the Academy of Nutrition and Dietetics with your robust network and newly acquired skills!

See you next year at FNCE in the nation’s capital where after the conference we will storm the Hill to advocate for the profession.

How to Throw a Party for All Dietary Preferences

My gluten-free, dairy-free aunt and dairy-free cousin recently threw me the most spectacular baby shower. They thought of every detail — including how to please the more than 30 guests with various dietary preferences.

First, they had a “mom-osa” bar, which I appreciated greatly since alcohol is a thing of the past for me right now. I enjoyed sipping my sparking water with a splash of pineapple juice and fresh berries. Champagne was available for those who wanted to imbibe.

They also had a buffet of Greek food including hummus, baba ganoush, tzatziki sauce, pita bread, fresh cut vegetables, tabbouleh and stuffed grape leaves. It was the perfect light meal for a shower and the buffet-style service allowed people to pick and choose the foods that were appropriate for them.

My aunt made two desserts. A scrumptious zucchini spice layered cake with traditional buttercream frosting and a platter of gluten-free white champagne cupcakes, which meant everyone could enjoy a celebratory treat.

If hosting a party — and this is the time of year when many of us do — you are likely to have guests with dietary restrictions or food allergies, and the last thing you want is for them to be left out of the food festivities. At the same time, trying to please everyone can be exhausting.

Follow these four tips to help you throw a party for all your guests, no matter their dietary preferences:

Get the Details

RSVPs aren’t just for confirming attendance. They also are important to gather insight on any special dietary needs. Whether guests call, text or email their response to your invitation, be sure to have them include any food allergies or preferences so you can plan accordingly.

Explore Your Options

Once you know the dietary needs you’ll need to consider when creating a menu for your party, it’s time to jump on the computer and find recipes that will work. Find collections of recipes online that are devoted to dietary preferences and also explore cookbooks designed for specific diets.

Allow Guests to Customize Their Plates

If you have guests with various dietary needs, it may be easier to offer a deconstructed menu and let guests build their own plates with foods they prefer. The key is to provide a variety of add-ins, condiments and toppings. For example, you could have a build-your-own yogurt parfait bar with various fresh berries and fruit, regular Greek yogurt, coconut yogurt, nuts, gluten-free and regular granola, honey and cinnamon. A salad bar or taco bar also are easy meal options that give guests options.

Offer Two Variations of the Same Meal

You also can create two variations of one meal to please all your guests, such as a regular and a vegetarian chili. It may be more work for you, but your guests will appreciate the time and effort you put into making sure their needs were met. This also is a good option if the party calls for a specific or traditional meal.

Your pregnancy and baby guide

Am I pregnant? What should I be eating? Is it normal to be this tired? How can I help my partner during labour?
Whatever you want to know about getting pregnant, being pregnant or caring for your new baby, you should find it here.
You'll find detailed week-by-week guides and lots of expert videos, parents' tips and interactive tools to explore.
Before you start, why not:
work out when your baby is due with our due date calculator 
log in to create your own personalised birth plan
Want to know if you're really pregnant?

Got any of the signs and symptoms of pregnancy? Read our guide on finding out if you're pregnant.
Find out about pregnancy tests, or your next steps if you've had a positive pregnancy test.
Also, find out more about getting help if you're not getting pregnant.
Keeping well in pregnancy

everything you need to know about a healthy pregnancy diet and supplements in pregnancy
smoking and drinking can harm an unborn baby – read our stop smoking and alcohol pages for help trying to quit
Antenatal care and the baby's development
find out as much as you can about what's happening inside you in the first few weeks of pregnancy
how to cope with all those common pregnancy problems, like morning sickness, tiredness and headaches
find out all about the ultrasound scans and checks and tests you'll be offered as part of your antenatal care, including screening for Down's syndrome
Vaccinations in pregnancy
Why it's recommended that women have the flu vaccine in pregnancy and whooping cough vaccine in pregnancy.
Labour and birth

Find out all you need to know about labour and birth, including where you can have your baby – for example, either in a hospital, midwife-led unit, or at home – and what pain relief is available, such as gas and air (entonox) and epidural.
Your new baby

When your baby arrives, you can find advice on all the essentials of baby care, including breastfeeding, bottle feeding, changing nappies, and washing your baby. Plus:
find out how to cope with a crying baby and get tips on settling them into a good sleep routine
as a new mum, find out about the possible changes to your body and your relationships, and know how to spot the symptoms of postnatal depression
if you have twins or multiples, find out about feeding, getting out and about, and sleep issues
Feeding, teething and tantrums
find out about all aspects of parenting, including support and services, keeping fit, and going back to work
know the signs of serious illness in babies and the symptoms of infectious illnesses such as chickenpox
find out how to keep your baby safe and what to do if they have an accident
at six months old your baby will need to start solid foods, so be prepared with our weaning tips and first food ideas
as your baby becomes a toddler, get tips on teething, the importance of play, temper tantrums and potty training
Want to share your pregnancy and baby experiences?

Connect with others who can offer practical and emotional support about any pregnancy and baby issues on the HealthUnlocked NCT forum.

Going dry for a month boosted my health

Joanna Munro describes herself as the typical mother who enjoys a well-earned glass of her favourite tipple at the end of a trying day.

As someone who drank no more than a couple of glasses of wine a day, Joanna, 45, was by no means a heavy drinker. But one day, she realised that "wine o'clock" had become more of a habit than a pleasure.

She gave up alcohol for a month for Dry January to prove to herself she was still in control but she tells how she soon started noticing unexpected health benefits.  

Pleasure or habit?

"Back in December, I was a typical example of the mother who reaches for her first glass of rosé while simultaneously burning dinner, tripping over the dog, emptying the washing machine and resolving conflicts between the kids. Then I realized that "wine o'clock" had become an automatic reflex that wasn’t so much a pleasure as a habit. 

"I didn’t find an answer to my question on the internet, but I did find Alcohol Concern’s website and a challenge called Dry January. I liked the idea – an opportunity to prove to myself that I had more self-control than a four-year-old who’d been left alone in a Cadbury’s warehouse. If I was hooked, I’d be clawing my way up the curtains in despair within days.

"So I signed up. Over the month, my resolve was considerably strengthened by Dry January’s Facebook page and the determination and solidarity of those taking part. The challenge worked a charm because people can encourage each other and be accountable to each other.

"The aim was simple on paper: give up alcohol for one month. As I’m an eternal optimist, I added an hour of exercise every day for good measure. I quickly worked out a circuit through my local village. When attempting abstinence for the first time in 12 years, sunshine and great countryside proved ideal to lift this trainee teetotaler’s spirits."

Health benefits

"The first week, I rode the virtuosity wave. I was a disdainful diva, even declining champagne on the beach to toast in the New Year. By the middle of the second week, however, the queen of self-control and restraint was glowering, Gollum-like, over her glass of Perrier and lime as hubby savoured his beer.

"After two weeks the cold turkey wore off, and the first benefits kicked in. I was in bed snoring shamelessly before 10 and was awake before the alarm at 6.15am. My skin was looking better. I had more energy, and was proud of myself for sticking at it.

"Although weight loss wasn’t a decisive factor for me, I lost 5lbs (2.3kg) in the first month and I have now lost nearly 10lbs and banished three inches (7.5cm) of muffin top from my waistline. Like many other people on Dry January’s page, my problem was the inexplicable desire to replace my evening dose of wine with snacks in front of the TV.

"Yet in the long run, less wine meant less nibbles. I realised how alcohol opened up my appetite and made me reach for those salty nibbles.

"Less nibbles meant less weight. Not exactly rocket science, but a winning equation nevertheless."

Homemade Sweet Tea Pickles

Sweet Tea Pickles

Serves 12

Ingredients

• 3 medium pickling cucumbers, sliced into thin disks
• Lemon slices (optional)
• 1 cup water, divided
• 2 black tea bags
• ½ cup apple cider vinegar
• ⅓ cup sugar

Instructions

1. Add cucumbers and lemons (if using) to 16-ounce glass jar or container with lid.
2. Bring ½ cup water to a boil in a small saucepan. Pour boiling water over tea bags in a heat-safe bowl and steep for 5 minutes.
3. Combine remaining water, vinegar and sugar in medium saucepan and bring to a boil. Remove from heat.
4. Discard tea bags and add tea to vinegar mixture.
5. Pour over cucumbers and cool to room temperature on counter.
6. Cover and refrigerate at least 2 days and up to 2 months.