Beth: Welcome back to Fresh focus, I am your host Beth and I’m sitting here with another Beth! If you listened to Episode 32 you may remember Bethany, a dietitian from the Louis A Johnson VA. Thank you so much for being on with me today.

Bethany: Thank you so much for having me.

Beth: Every year as march rolls around we celebrate National Nutrition Month ® and we as dietitians do receive a lot of questions! So we at Fresh Focus asked Bethany to join me today to talk about some of her top commonly asked questions she gets asked day to day by veterans and family members…. So for all you out there listening you may be trying to figure out #1 is there really aren’t in any particular order but this one probably is the most frequently asked…. So what is what’s the healthiest way to lose weight.

Bethany: Healthy and long lasting weight loss results should include equal parts of diet and exercising. A lot of people think to lose weight you need to skip meals but that’s actually incorrect.
You can cut calories easily by limiting the amount of days you eat out and start to prepare foods at home. You can cook using olive oil or canola oils and add herbs and spices to boost the flavoring of your meals.
I personally like to use Onion powder, garlic, and paprika to make your meals more flavorful.

The first tip that I have is to try to include 3-4 non-starchy vegetables daily, so you can select 2 vegetables at lunch and 2 vegetables for dinner. I would advise making half your plate with vegetables since most of these are lower in calories. Another diet tip would be to write down a goal for yourself weekly such as walk 30 minutes daily on your lunch hour or avoid snacking on simple sugars like cakes, cookies, candy, etc. or have a piece of fruit as a snack daily. It’s always better to start with small goals and then you can add another goal each week.

Another important diet tip make a grocery list before going to the store
if you want something sweet, you can grab a piece of fruit instead of snacking on sweets. I would also advise selecting whole wheat products as opposed to enriched wheat or white flour. The whole wheat products contain more fiber which actually helps you stay fuller longer.
Exercise is also important, if you are able to work out, I would encourage you to walk daily for at least 30 minutes. If you can’t work out, there are some activities and exercises that you can do when sitting in a chair, so I would consult your Physical Therapist for more information.
Don’t get discouraged if you don’t lose weight quickly, just remember to stay with your goal and you will see the results eventually.

Beth: those are some great tips, I know you mention physical therapy as well but here in Marion our whole health department does a lot of classes like yoga and tai chi could be another option to add in exercise too.
I know lots of times we get asked the same times of questions and one of these questions is Does a person need to drink 8 glasses of water daily?

Bethany: It may be hard to believe, but about 60% of your body is made of water. Water plays a role in keeping all of your body systems working well. If you are staying hydrated, it will help reduce your risk of dehydration and developing kidney stones, along with urinary tract infections and constipation. There are many factors that impact how much water you need such as age, gender, activity level and overall health. I have a few veterans that have congestive heart failure and I educate them on limiting their fluid whereas those with renal disease may need more fluid.

Beth: everyone is going to have individual needs with different disease states so we want to make sure that everyone out there listening make sure you reach out own local VA dietitians for some more individualized tips as well

Bethany: exactly, you can get about 20% of water just from the food we are eating. There are several foods that have higher water content strawberries watermelon cantaloupe lettuce and cabbage they contain 90%-100% of water content, for healthy individuals men need closer to 13 cups water daily and women need 9 cups of water per day, the problem is that many older adults do not feel thirsty and aren’t aware they need to drink resulting in dehydration and UTI’s that is a common issue that I see Beth I don’t know about you.

Beth: yes and I also get those questions for each season too like when it’s hot and humid in the summer we remember we need to drink water but we can get just as dehydrated in summer as we can in the winter time too so we need to remember that.

Bethany: I like to give an example too, A quick and easy way to determine if you are staying hydrated is to check the color of your urine output. If you are consuming enough fluids the color will be pale yellow but if it’s a dark yellow or amber color, you may need to increase the amount of water you consume.
At least half of what you drink should be water. Some suggestions that I have would be: water or calorie-free flavored water, vegetable juices, milk, decaffeinated or herbal teas.
Some tips on ways to drink more would be to use large, easy to hold cups, leave a glass of fluid at your bedside or sitting area, choose a variety of fluids based on what you like, drink fluids during and between meals. Personally I love to add fresh lemon or cucumbers to my water I’ll put it in a pitcher in the refrigerator so it’s nice and cold and it’s a natural flavor for me.

Beth: yes you could do lemons or limes, a lot of times its experimenting what you like you may actually not love icy cold water you may like room temperature water and that’s ok too it may just be experimenting on what you like.

Bethany: exactly

Beth: ok so next question, are you still with me?

Bethany: yes
Beth: ok, how do I get enough calcium if I don’t drink any milk.

Bethany: Healthy adults between 19 and 50 should try to get 1,000 mg calcium per day. Older adults need more calcium because bones lose calcium as we age. After age 50, adults should get 1,200 mg of calcium per day.
Dairy products like milk, yogurt, and cottage cheese, cheeses such as: cheddar, mozzarella, or swiss) are rich in calcium and also tend to be the best absorbed sources for calcium. But don’t worry there are some other good non-dairy sources such as: fortified cereals, calcium fortified orange juice, dark green leafy vegetables (like kale, spinach, collard greens), canned fish with soft bones, tofu, sardines, almonds, white beans, broccoli, baked sweet potato, frozen yogurt or ice cream too and fortified plant based beverages like soy milk are an excellent source of calcium.

Beth: and again remember just, you know always if you have any questions or if there was something on that list of foods that you aren’t getting enough of reach out to your local dietitian and PCP too if you have any questions on any supplementation.
So how can a person get more vegetables into their diet?

Bethany: this is a question I get asked a lot of, especially when we talked earlier about weight loss, I push getting more vegetables in for weight loss and I do educate veterans on adding a bunch of vegetables into their diet.
You can add cucumbers, peppers, spinach and onions to sandwiches. You can just pile almost any vegetable on a sandwich. Any vegetable goes.

Beth: that is so true, I say this all the time any time you go out and get a sandwich you get all these fun toppings lots of vegetables on their bell peppers, banana peppers, onions lettuce spinach but if we have just a sandwich at home what do we have just meat and bread we need to work on adding more of those good colorful vegetables on our sandwiches at home.

Bethany: absolutely I always recommend starting your meal with a salad. You can add many toppings on your bed of greens such as celery, corn, cucumbers, mushrooms, beets, peas, carrots, peppers, broccoli, or cauliflower. You can toss a bit of salad dressing or balsamic vinegar to add a little flavor, but a healthier dressing is most people know it’s just olive oil and apple cider vinegar.
Beth: it’s so good.
Bethany: In the mornings it can be difficult to get a lot of vegetables in the mornings but I recommend when making scrambled eggs or an omelet or a quiche, it’s easy to add any vegetables. When I make an omelet, I add peppers, onions, broccoli. The important thing to remember is to try to have a colorful plate at each meal.

Beth: that is also a good way to use up any leftovers so if you have leftover broccoli or cauliflower or carrots from night before throw it in your omelet the next day or egg scramble it’s a good way to use up all the things from the fridge.

Bethany: I like to buy fresh raw vegetables. I wash, cut and portion them into plastic bags to use for a quick grab and go snack during the week. You can have celery, baby carrots, radishes, ( I don’t prefer them) cauliflower, broccoli, or cucumbers. Dip these vegetables into hummus dip or make your own yogurt dip or some people may just use ranch dip for their vegetables.

Another suggestion would be to try dried vegetables if you want something crunchy instead of potato chips. I love snacking on kale chips, have you ever tried those Beth?

Beth: yes they are so good.

Bethany: and you can also make beet or carrot chips which are delicious!

Beth: and if you are out there listening like of course the dietitians are telling us not to eat potato chips but you can also just start with if you are going to have a snack today or sometime this weekend and have chips and salsa and guacamole have a little bit of chips but add in add some of these fun vegetables like red bell peppers or cutting up zucchini or yellow squash and carrots and you are still able to enjoy the dip and have that crunch and eating the salsa and guacamole but you aren’t eating a ton of chips.

Bethany: absolutely, and I will also say another way to add vegetables when I’m making soups, I find it easier to add canned, pureed, or cooked frozen vegetables to make the soup heartier. Stir fry is a good idea as well. I personally enjoy making healthy smoothies in the mornings.

Beth: oh I love smoothies

Bethany: I do some sort of green smoothie and add in kale, spinach, even avocado, sometimes I will add in celery, and cucumbers. It’s a quick easy go to get in a lot of vegetables in .

You can also add in some onions, celery, peppers, carrots, and mushrooms with any protein like hamburgers, meatloaf, meatballs, omelets or soup beans.

You may notice that most grocery stores are trying to enhance their vegetable selections by offering spiral vegetables that are both fresh and frozen.
I have tried the spiral zucchini and butternut squash and they are great. They also have beets, sweet potatoes, and carrots available too. You can add these to any meal that you’re cooking or a salad.

The last few suggestions I have would be to make grilled vegetable kabobs, or add extra vegetables to top your pizza, or even make your stir fry colorful with broccoli, mushrooms, peppers, snow pea pods, etc. Growing up my parents let us select a new vegetable to try in the grocery store, so it was always fun trying turnips, eggplant, collard greens, parsnips among others.

Beth: right, right try a new food or something definitely in season try a locally grown item you haven’t tried before. Or it’s been a long time. You can also check out the VA healthy teaching kitchen YouTube channel. Go to YouTube, search VA healthy teaching kitchen, lots of fun recipes and they have a grilled vegetable kabob video on there. Lots of good things you can find on there too. I know a lot of us with us working with older population and especially with you working in HBPC you may be getting this question from a family member or care taker or caregiver especially in the older population but how can we prevent muscle mass loss?

Bethany: you know Beth I get that a lot, I always tell my veterans, if you don’t use it…you lose it. As we age, we naturally lose some muscle mass. Age related muscle mass loss is called sarcopenia. I read an interesting statistic that said after the age of 30, people that are not physically active can lose an estimated of 3 to 8% of lean body muscle per decade.
Muscle mass allows us to stand, walk, balance, and lift. If you are not building and maintaining muscle mass, you are at a higher chance of having back pain, overall weakness, mobility issues, and falls.

Beth: It’s something that is hard to think about when someone is 30 and younger and it’s like oh I can walk fine and I’m not having any mobility issues but we want to work on that and prevent falls forever. That is a really good point.

Bethany: Resistance training may help prevent osteoporosis which is a condition that effects your bones making them weaker. Sarcopenia and osteoporosis occur gradually because of having inadequate nutrition and lack of physical activity. It’s important to make sure you are getting enough Calcium, Vitamin D, and protein consumption along with resistance training and weight bearing exercises to help prevent muscle mass loss.

You can simply do exercises in your house such as pushups, squats, planks, side lying circles, standing balance, laying on your back and lifting one leg up at a time. I have a veteran that isn’t very mobile but I encourage him to do some leg lifts just lift his leg up while sitting in a chair and do some sets of those each day. Yoga is also a good way to improve not only balance but help build muscle mass by increasing flexibility and not to mention decreasing your stress level.

Beth: absolutely and go back and if you are listening and are dealing with a lot of pain issues and not able to increase exercise go back to our Fresh focus series on pain management and inflammation lots of great information there and whole episodes with exercise and information and ways to add in so be sure to check that out.

Bethany: I did want to add in that The Physical Activity Guidelines for Americans recommends strength training two to three times a week. For individuals that want to go to the gym, you can use weight machines, free weights and resistance bands, but you want to make sure you are selecting the proper weights to use, so you do not cause additional injury to yourself. Ideally, it is recommended to complete 8 to 12 repetitions and work up to two or three sets to help improve strength. Like we said start small and move up.

Beth: right absolutely, you can even start with using water bottles as weights, you can Start anywhere some activity is better than none.

Bethany: water bottles is good I have a couple of veterans that even use cans. So whether you are exercising in your home or at the gym, the important thing to remember is regular resistance training is crucial for maintaining healthy muscles and bones while improving muscle mass loss.

Beth: so this question we get asked quite a bit is really good following talking about muscle mass loss, do we need to eat meat to get iron.

Bethany: The quick answer to the question is that you don’t have to get iron strictly from meat sources, but Heme iron which is found in animal products like meat and poultry are easier for your body to absorb. If you eat heme iron every day, you can get the proper amount of iron needed in your diet.

Nonheme iron comes from plant sources. It is found in vegetables, grains, and other plant foods.
Some examples of iron rich foods in plant-based products are: beans, English muffins or bagels, fortified cereals like oatmeal and grits, prune juice, lentils, spinach, tofu, and tomato products like tomato sauce or tomato puree.

I also recommend my veterans to pair a high vitamin C food such as oranges, pineapple, strawberries, broccoli, and peppers when having an iron sourced meal because this helps increase the absorption of iron in the body. It’s something good to know typically, most men who are 19 years and older and women over the age of 51, need 8 mg of iron daily while women aged 19 to 50 need a little more iron which is 18 mg of iron daily.

Beth: last one is what are some tips to reduce sodium in the diet.

Bethany: Sodium is a mineral found naturally in small amounts in foods such as meat, dairy, poultry, and vegetables. Most of the sodium we eat is in the form of sodium chloride (salt).
Sodium plays many important roles for the human body to function properly. Eating too much sodium raises blood pressure, increases the risk of stroke, can reduce the effect of some medicines, and can cause fluid to build up in the body which can further damage your heart, liver, and make your kidneys work harder. A little side story, I have a veteran that said he wasn’t salting his meals but didn’t understand that he was eating a lot of high processed foods like frozen entrees, ham and turkey lunch meat sandwiches daily, having some snack foods like chips and granola bars, cheese and not to mention adding condiments daily to foods whether it was like soy sauce, barbeque, mayo and gravy all of this was contributing to his edema. So I had to educate because even though he wasn’t adding salt to his food, he was still getting so much sodium in his diet.

Beth: and he was doing great by not adding in extra salt to his foods but there is still a lot of salt/ sodium than we don’t even realize when we aren’t looking and paying attention.

Bethany: exactly I really had to educate because and this goes for anybody we really need to read the Nutrition Facts Food Label to see how much sodium is in the products you are eating because sodium adds up very quickly.
It’s important to remember that products that state reduced sodium or lower sodium may still be high in sodium, so you need to look at the Nutrition Facts Food Label because companies may be tricking you into thinking that the product is lower when it is not.
The best method of limiting sodium in your diet would be to cook from scratch if you can. You can control sodium intake by using fresh or frozen fruits and vegetables. Fresh meats compared to processed foods like sausage, ham, and hotdogs which are very high in sodium. When cooking your meals, feel free like we talked about earlier to add other seasonings such as onion or garlic powder, spices, citrus and vinegars in replace of salt. There are salt substitutes that contain potassium instead of sodium, but I would recommend to speak with your doctor or dietitian before taking it because too much potassium can cause serious problems.
It’s also important to remember to drain and rinse canned foods such as beans, tuna, and vegetables in a strainer to remove the excess sodium.
When you are eating at restaurants, you will want to choose carefully because restaurant foods can be high in sodium. You can ask for your food to be prepared without extra salt. Also, make sure to taste your food before adding salt

Beth: taste it first!! everybody out there listening

Bethany: when looking at the menu, try to avoid foods that state pickled, smoked, cured, soy sauce, things like that will be high in salt. You can also ask for salad dressing and sauces to be served on the side. Lastly, remember to control your portion sizes, a smaller portion equals less sodium and you can take the rest home for another day.

Beth: absolutely that helps food budgeting when you go to a restaurant you eat half of it and eat the rest of it for lunch the next day. I love all of your tips thank you for coming on talking about the most common questions we get as dietitians, reach out to your PCP at the VA or your local dietitian to help best guide you in planning your plate and personalizing with your individualized needs. Thank you all for listening, thanks again for Bethany for joining me today don’t forget to like and subscribe to this podcast and leave a review.