Vitamin D3 and Me

I finally found a vitamin D3 supplement that I am willing to take for my presumed deficiency. I say presumed because I haven’t actually had my 25-Hydroxyvitamin D serum levels tested. I’m skipping that step because the values haven’t been standardized and, besides, I’d have to self-pay.

But, why wouldn’t I have low vitamin D levels? The most recent National Health and Nutrition Examination Survey (NHANES) estimated that 25% to 57% of adults have insufficient levels of vitamin D. Other studies set the number as high as 70% for some segments of the population.

Vitamin D is made when the sun’s ultraviolet B (UVB) rays hit the skin. There are many reasons why I wouldn’t get enough. I work indoors (UVB rays don’t penetrate glass), live in the northern latitude, often wear sunscreen, and I’m getting older. Those factors push me towards the brittle bones that are conclusively related to a lack of vitamin D. Less conclusive are the links to cancers, heart disease, autoimmune conditions, and, it seems, to whatever else ails you including colds and flu and forgetfulness.

The RDA for vitamin D is set at 600 International Units (IUs) per day from food. That amount meets the needs of 98% of healthy people. But Americans don’t eat nearly enough vitamin D. According to NHANES, average intake is 204 to 288 IU/day for males, and for females, the range is 144 to 276 IU/day. Vitamin D is found in only a few foods: oily fish and cod liver oil are the most important sources, followed by egg yolks, liver, and mushrooms. And while 3-ounces of cooked salmon supplies 477 IUs, one egg has only 40. Milk has been fortified with vitamin D since the 1930s, but 16 ounces supplies a little more than half of the RDA. Some brands of orange juice, yogurt, cheese, margarine, and breakfast cereals are also fortified. Scroll down to see the vitamin D content of selected foods.

I’m Covered

I thought I should take some vitamin D, but I couldn’t stomach another pill. I take a multivitamin, a prescription med, two fish oil capsules, a curcumin capsule, and a calcium tablet sometimes. But then the folks from Nature Made invited me to look at a few of their products, and I accepted the offer because they are big on scientific research and purity, and because we met at 250 Greenwich Street, the new World Trade Center Tower 7. I’m a sucker for a skyscraper with a fantastic view.

Nature Made’s vitamin D3 (the active form) comes in a grape-flavored chewable tablet that tastes like a sweet tart. Each tablet supplies 1,000 IUs, the daily amount commonly advised. The leading vitamin D scholar, Dr. Michael Holick, recommends taking up to 2,000 IU per day (4,000 IUs is the Tolerable Upper Limit.)  And so now, if I get about 250 IUs from milk, 500 IUs in my multivitamin, and 1,000 IUs in one sweet-tart. I am covered.

 Your thoughts: How do you manage to get enough vitamin D?

Talking About Oxtails in Brooklyn

I recently went to the new restaurant, Bar Corvo, on Washington Avenue in Brooklyn. It got fantastic reviews even before it opened – and it is 200 feet from my apartment. Sweet. I went with my lifelong friend, pediatric dietitian Barbara Robinson. (Readers of my blog might remember when we traveled on the BQE back from Rhode Island to New York.)

Everything was perfect at Bar Corvo. We had the Lentil Soup, Warm Farro Salad (with roasted cauliflower, Brussels sprouts, goat cheese, red onion, hazelnuts, and warm sherry vinaigrette), Focaccia, and Trebiano D’Abruzzo wine. It didn’t seem like much food for two people, but we couldn’t finish it all. I can still conjure up the aromas and flavors. A lasting experience is all I ask from a restaurant.

Barbara and I were both surprised by the relatively large number of unusual foods on the menu. Besides lentils and farro, there were dandelion greens, fava bean puree, oxtail ragu’, octopus confit, and roast Amish chickens (wearing little bonnets singing, ’tis the gift to be simple) to pleasure the palates of the foodies on the Brooklyn culinary scene.

Barbara:  “What exactly is an oxtail?”
Mary:  “I guess it’s the tail of an ox.”

That’s a pretty lame conversation for two veteran dietitians, and so I Goggled oxtails; here’s the poop: ox tails are actually tails – bony and muscular – from cows (there are no oxen left around here.) Oxtails are among  the offals, the internal parts of an animal – the heart, liver, tongue, tripe, brain, kidneys, etc. – that are edible, but not commonly eaten in America today. They are traditionally braised gently and slowly to made an intensely-flavored gelatinous stew. The stew is served in Roman trattorias (like Bar Corvo) and in Jamaican and African restaurants. A few doors down at The Islands, a Caribbean restaurant, the oxtail stew is a very popular dish. In fact, New York City seems to be crazy about oxtails. There are 402 comments at Yelp, New York, Oxtail Soup! I guess it’s only a matter of time before I try them.  I’ll be sure to report back.

Your thoughts: Have you eaten oxtails? Would you?

My Intuitive Eating “Aha” Moment

On LinkedIn, I am a member of the Intuitive Eating Professionals Group, where Evelyn Tribole, MS, RD, group founder, asks us to “share something…that is not included in your profile, perhaps an “aha” moment in your career.”  I am inspired to share my “aha” moment after attending the BEDA (Binge Eating Disorder Association) national conference on Saturday, where I learned that, treatment-wise, not much has changed over the years.

In 1985, I worked in a large gastroenterology practice affiliated with a teaching hospital. I saw lots of eating disordered patients because one of the docs did medical evaluations of patients with bulimia and AN. At the same time, another gastroenterologist performed a procedure with a device called the Garren-Edwards Gastric Bubble. A deflated ‘bubble’ made of stretchable plastic (like a pool toy) was placed by endoscopy in the stomach of a severely overweight patient.  With the pull of a cannula, the bubble was inflated and left in place to fill the stomach while the patient followed a low-calorie diet. That’s where I came in. The bubble was developed by a team at Johns Hopkins. It was all above the board. The hospital asked us to do the procedure, but we stopped after a patient got a small bowel obstruction from the bubble. Those were interesting days. My patients’ eating patterns were all over the map.

But my “aha’ moment came by way of a patient referred by an internist for a simple weight loss diet.  She was a favorite patient, a young woman of my age, overweight but far from obese, with my mother’s maiden name. We were doing the balanced, flexible diet thing with a focus on behaviors when one day, she looked at me and said, “Mary, you don’t understand. I peek behind the curtain, and when my husband drives away, I make a batch of scalloped potatoes, and I eat the whole thing.” Aha! I thought, “they didn’t teach us this in school.” And then I thought, “this is really real.”

I was lucky because psychologists who specialized in EDs would stop into  the office. They turned me on to Susie Orbach, Fat Is a Feminist Issue (1978); Geneen Roth, Feeding the Hungry Heart (1982) and Breaking Free from Compulsive Eating (1986) and, of course, Hilde Bruch. Evelyn’s book, Intuitive Eating (1995), wasn’t published yet and there was no Gurze catalogue. But, I read and read and saw lots of patients, and attended Geneen’s workshops,  consulted with therapists, and taught others how to do it. And now it’s wonderful to see so many dietitians espouse the non-diet approach. But, after all those years, the pills, shakes, meals, stomach stapling (but not swallowing pool toys) are all still here.

Your thoughts: Why don’t more people give up dieting and follow a non-diet approach?

When ‘My Plate’ is a Bowl

Today is the first of March and the start of National Nutrition Month. That’s when my professional association, The Academy of Nutrition and Dietetics (formerly the American Dietetic Association), turns up the volume on eating healthy. This year, their theme is “Get Your Plate in Shape” in keeping with “Choose My Plate,” Michelle Obama’s USDA campaign.

And so, Diets in Review asked several of us nutrition and fitness professionals to share a picture and some words about our own plates. Read their article today, Mary Hartley’s Plate for National Nutrition Month. I kick off the month-long series.

Now, I’ve explained that I don’t take pictures of my food. Like tattoos, it’s a generational thing. And my only camera is the one in my iPhone, which is not the best. And then, wouldn’t you know it, Michelle Obama forgive me, but my typical plate is a bowl. In the article, I deconstruct the contents and reassemble them, so to speak, back onto a plate, and say more about the nutritional content. Read it and see.

The My Plate campaign is made to guide eaters of the “Standard American Diet” –  a supper of meat/chicken, with a starch and a vegetable on the side.  I almost never eat like that. When I was a young adult and learning how to cook, I was a vegetarian and those habits stuck. I love to say, in all my years, I have never cooked a steak. Not that I don’t eat steak because I do every few years, but an 8-ounce petite filet lasts me for three yummy meals. I’m just a happy Flexitarian. And my dietitian friends are mostly Flexitarian too, and they are mostly slim and healthy and free of pills.

Here are the recipes for Gypsy Soup and Cheesy Cornbread. The soup is very healthy (thank you Mollie Katzen and the Moosewood Cookbook) and the second is not quite as, but both taste out of this world.  Enjoy!

Your thoughts: What do you think of this year’s National Nutrition Month message?

Dr. Oz + Raspberry Ketones = TV Hype

Gee whiz, I just dissed Dr. Oz as TV hype in an article today, Dr. Oz’s Raspberry Ketones Dismissed by Dietitian as TV Hype. (I’m the dietitian.) It’s an opinion piece for Diets In Review about a product Dr. Oz endorsed, raspberry ketones, a ‘fat blaster you’ve never heard of.’  I called Dr. Oz more showman than doctor. Read my article and see if you agree. But, hey, he’s in the medical info-tainment field. ‘Nuf said.

Show Time

In 2009 when Dr. Oz was first on the air, I went to a show. In New York City, the studio was close to where I worked in the windowless office, and I just had to get away.  On that show, he talked about zinc deficiency, a problem that most Americans do not have. That’s when I saw that Dr. Oz (or rather, his staff) liked food-and-nutrition games. The segment was presented as a game in which three audience members each picked a box, small, medium or large, that contained a high-zinc food and, in one, a special gift. In the small box, the contestant found beef liver with 4.45 mg of zinc in a 3-ounce serving (adults need 8-11 mg of zinc/day), and in the medium box, was 1 cup of sauerkraut, with only 0.27 mg of zinc. (What’s up with that?)  But in the large box, there was a huge pile of king crab with 6.48 mg per 3-ounce serving – along with a cruise to Alaska. The first two contestants had doubly bad luck because Dr. Oz made them eat their selections. Incidentally, oysters have the most zinc with 76.3 mg per 3-ounce serving.

Three years later, Dr. Oz is still playing games. In the segment reviewed, Revolutionary Metabolism Boosters that Blast Fat, ‘fat’ contestants ‘blast’ through a paper curtain to introduce a new product that may or may not work. That’s how info-tainment happens here in New York City.  Perhaps if I’m outrageous enough, I can get on the show.

Your thoughts: What do you think of Dr.Oz and raspberry ketones? 

Talking About “What Not to Do” on the BQE

What not to do on the BQE, Brooklyn-Queens Expressway, Interstate 278, is drive on it if you can help it. It is an ancient highway, constantly under construction, with crazy route number changes, tolls, and traffic. That’s why, to pass the time while driving back to Brooklyn from Rhode Island with my lifelong dietitian friend, Barbara, and her adult daughter, Emily, I asked for help with an assignment for Diets in Review. My task was to write about “Everything That’s Wrong with Your Diet” and the article should “serve as an opportunity to educate readers without coming across as accusatory.”  In January, I might add, the word “diet” means losing weight; it is not about the food that a person habitually eats.

Making a List

Over the years, Barbara and I have seen it all and Emily has too. Our daughters have grown up knowing what and how to eat, taking it in by osmosis. For instance, as a young nanny, Emily told a toddler’s mother, “He’s not getting enough protein from that rice milk,” and I’ve already shown you the contents of my daughter’s cupboard. Suffice it to say, we had no trouble coming up with a list of 20 things people fail to do: not drinking enough water, drinking too much juice, not bothering to cook, eating in restaurants way too often, eating fast food, not expanding their vegetable repertoire, yada yada. You’ve heard them all. (The list is now in the landfill.)

The Finished Product

To fit the word limit, I whittled the list down to five things I commonly see people do – with the best intentions – but not doing themselves any favors. To my surprise, the article resonated with readers and other dietitians too. Perhaps you will like it. Anyway, here it is: 5 Things That are Wrong With Your Diet. Please share!

Your thoughts: What would you tell the public if asked, “What’s wrong with your diet?”

The Nutrition Home Visit That Changed My Life

I got a sneak peek at a magazine article featuring Yours Truly making a nutrition home visit with a family in Connecticut. Because the first week of January is the most important time of the diet year, I am sharing this now even though the magazine is not slated for display until March 26th.

The home visit was arranged the public relations agency that contracted with my former employer. The writer needed a nutrition expert to observe a family and suggest ways for them to improve their eating style.

The visit was scheduled for the evening of July 22, 2011, a day of record-breaking heat and humidity. It took several hours to get from Grand Central Station to Stamford, Connecticut because the heat caused the wires above the tracks to sag and get tangled in an arm that connects the trains to electricity. We finally arrived at 8 PM, but not to worry! Anytime is a great time for a nutrition intervention.

The family was so kind and good; I felt such affection for them. The mom commuted four hours into the city on weekdays and the dad was busy with his job, the baby and the preschooler. So much about their eating habits was a mess and they didn’t know where to begin. I have to say we zeroed in on the changes that delivered the biggest bang for the buck, and by the end of the appointment, they were upbeat and raring to go, much to the dad’s pleasant surprise.

You can read the article, From Hectic to Wholesome, to see exactly what transpired. In the final copy, the writer said that a nutritional intervention led by Mary Hartley, RD, MPH is “every overworked American family’s dream.”  Bless her heart.

That home visit made me remember how much I love working with patients.  Before that, I had been working with computer programmers to get nutrition messages out to the masses. I like consulting with programmers and the media work I do, but I love working with patients on their nutrition problems, and now that I’m doing it again, it’s a happy New Year for me.

Your thoughts:  How could you benefit from a nutrition visit in the home or online?

Hello Brooklyn Heights and Cobble Hill!

I am Mary, Mary Hartley, registered dietitian and medical nutrition therapist. This is the homepage of my website and the place where I post my blogs. (There are 15 articles to date.) The blogs usually change, but now that I have a click-through ad running on the Brooklyn Heights Blog, I want to keep a proper greeting up for my new community.  I have a nutrition practice in the lovely, historic 11201 zip code area (and for everyone else, I practice here in cyberspace!), but in Brooklyn Heights and Cobble Hill, my new address is your address because I make house call visits. Read about why I support home visits for nutrition therapy and also read about when it makes sense to consult with a registered dietitian.

I hope you will stay and look around my site.  Please read about my Services and About me. I have been helping people to improve their diets, in sickness and in health, for 35 years.  Please leave a comment (click the thought-bubble next to the title; it’s like signing the guestbook) and feel free to contact me privately with your questions. Or, better yet, make an appointment and consider subscribing to my blog and following me on Twitter.

Business owners in 11201, I’m available for health fares and events. Let’s talk!

Thank you for visiting.

Your thoughts: Introduce yourself wherever you live!

Bring Nutritional Care Home

In last Sunday’s New York Times, op-ed contributor, Doctor Jack Resnick, wrote an article titled, Bring Health Care Home, in an attempt to push Medicare to issue the rules needed to create the Independence at Home Organizations mandated by last year’s health care reform act. Doctor Resnick’s patients are the home-bound elderly and people immobilized by accidents, multiple sclerosis and respirators.  Independence at Home helps to keep patients away from unnecessary hospitalizations and exposure to antibiotic-resistant super bugs.

Nutrition House Call Visits

Some of you know that I made the decision to see patients again – it’s the most authentic thing I can do – but, this time, I don’t plan to have a bricks and mortar office. Instead, I plan to visit patients in their homes. And why not?  A nutritionist needs almost no equipment and the service should be near to the food supply.  Here are a few more reasons why I embrace nutritional care at home:

  1. It Cuts Down on Lying
    Let me put it another way. Research shows that it’s easier for people to bend the truth when they are detached from their interlocutor. Let’s face it: it’s hard to look someone in the eye and tell them a lie. But lying is so expected in nutrition histories that it has a name, the Eye-Mouth Gap. The phenomenon explains why obese people report only half to one third of what they eat. Communications research shows that people fib in writing and email more than on the telephone and there is more fudging on the phone than there is face-to-face. Look, I just want to set the stage for an honest, long-term relationship. We can follow-up by telephone and email and with home re-visits as needed but, for now, let me see your cupboards and fridge. Busted!
  2. Everyone Can Be There
    Spouse/partner, children, parents, and friends – we are in this together. By meeting informally with every stake holder, everybody owns his part (including no part if we all agree that is best.) Group visits are great for filling-in the nutrition history and tying-in the genetic and environmental components. There’s something about the camaraderie that alleviates stress and builds understanding.  People get a lot from group visits and, again, we can follow-up by telephone and email.
  3. It Helps Older Folks
    As Doctor Resnick wrote, a lot of people just can’t get around, and so it’s better to travel to them. One thing I love about Brooklyn Heights, my new practice area, is the population of senior citizens there. Older people with chronic medical conditions are my specialty, and they shouldn’t be walking on those uneven sidewalks anymore often than need be.
  4. The Office is in My Computer
    My office is actually an iPad. Handouts, homework, articles to read; I used to be at Staples all the time.  But now, I have a digital office at Organized Wisdom. All of my papers are in one place ready for you to read. If you happen to need a printed copy, I’ll pop into Staples, or better yet, your loved one can copy it at work.

Finally, and this is not your concern, but getting out of the office helps me. I have reached my lifetime quota of being seated at a desk hunched over a computer screen. My hips need to recover and I need fresh air. Walking in one of America’s Most Beautiful Neighborhoods to see my patients suits me well.

And so that’s why I want to bring nutritional care home. I’ve limited my visit area to zip code 11201 because I can’t go running hither and yon.  For everyone else, it’s digital and telephone visits. I just hope my patients don’t lie.

Your thoughts:  Would you want a Nutrition House Call Visit?

Ten Reasons to Consult an RD

Here are 10 common reasons to consult with a registered dietitian courtesy of the American Dietetic Association:

    • You have diabetes, cardiovascular problems or high blood pressure. An RD serves as an integral part of your health-care team by helping you safely change your eating plan without compromising taste or nutrition.
    • You are thinking about or have had gastric bypass surgery. Since your stomach can only manage small servings, it’s a challenge to get the right amount of nutrients in your body. An RD will work with you to develop an eating plan for your new needs.
    • You have digestive problems. A registered dietitian will work with your physician to help fine-tune your diet so you are not aggravating your condition by eating the wrong foods and you are re-balancing your intestinal tract with the right food.
    • You need to gain or lose weight. A registered dietitian can zero in on the root of your issues and tweak (or overhaul) your diet and activity patterns to get results. An RD helps you to set  sensible goals and keeps you accountable so that you see results.
    • You’re caring for an aging parent. A registered dietitian can help with therapeutic diets, food and drug interactions, proper hydration, and the changing taste buds and digestion patterns and frailty that comes with aging.
    • You’re pregnant or trying to get pregnant. A registered dietitian can help make sure you get all of the nutrients you need to keep you healthy as you grow a perfect baby, and then get back into your jeans.
    • You need guidance and confidence for breastfeeding your baby (while trying to get back into your jeans.) An RD can help make sure you’re getting enough iron, vitamin D, fluoride and B vitamins for you and your little one.
    • Your teenager has issues with food and eating healthfully. A registered dietitian can assist with eating disorders like anorexia, bulimia and overweight issues.
    • You want to eat smarter. A registered dietitian can help you sort through misinformation; learn how to read labels at the supermarket; discover that healthy cooking is inexpensive, learn how to eat out without ruining your eating plan and how to resist workplace temptations.
    • You want to improve your performance in sports. A registered dietitian can help you set goals to achieve results — whether you’re running a marathon, skiing or jogging with your dog.

Your thoughts:  How can an RD help you?