An Over-Extended Family’s Dream

That would be a visit from me. :)

Meet the Sharkey family, a working couple with two small children. I helped them to make over their family diet. They were in “damage control” mode and they couldn’t see the forest from the trees. I teased out the issues and then recommended small, simple, specific changes that added up to something significant. Now, they are practicing forever. (Join the club.)

You can read about the Sharkey family intervention, “Hectic to Wholesome,” in Consumer Reports Food & Fitness, a magazine devoted to family health. See my lifestyle suggestions, product recommendations, and “kid friendly” recipes.

Want to schedule an appointment with me? Read about my services.

Your thoughts: Can you relate to the Sharkey family?

How Sugar-free Peeps Saved the Day

Aunt Jean: “You have to call your Aunt Pauline. They told her to eat white bread. What’s going on? She doesn’t know what to eat. ”

Mary: “Her kidneys are failing and so she can’t have much potassium. Brown breads have a little more potassium. I’ll visit.”

You would think we dietitians always preach the conventional paradigm of healthy eating, but that is not the case. When the body’s major organ systems fail, we modify our advice.  For example, my Aunt Pauline’s kidneys are on the fritz. She can’t remove excess potassium, so the level builds up. Too much can cause an irregular heartbeat and even sudden death. And so, Aunt Pauline was prescribed a low potassium diet, also low in sodium for swelling, without excessive protein for the kidneys again, with her blood glucose levels in mind for diabetes, well controlled on pills.

Aunt Pauline had two low-potassium diet sheets listing what to and what not to eat. Both sheets were a little different and, on my laptop, another sheet from the National Kidney Foundation was a little different still. The lists agreed upon the very high and very low potassium foods, but the middle range was questionable. Cooked cabbage? Maybe yes, maybe no. The same was true for whole wheat bread. Believe me, I know what it’s like to make those lists. The results depend on the makeup of the committee and the time of day.

For breakfast, according to the lists, Pauline could choose oatmeal, puffed rice, a bagel, or white toast. Oatmeal is fine, but every day? What about other cereals? The paper didn’t say. That’s when we had to look at the real numbers and make decisions case-by-case. The rule: be wary of foods with more than 250 mg of potassium per serving. Puffed rice, 6 mg of potassium, 1 mg of sodium (“too bland”); raisin bran, 357 mg of potassium (not an option); yada-yada, try this and that, and then bingo! Rice Krispies, 30 mg of potassium, 190 mg of sodium. That will do. And food-by-food, we went down the list. How much, how often, what’s it worth to you? It’s the only way to get buy-in to the diet therapy.

And, to keep life sweet, we make room for indulgences, also a personal thing.
Mary: “Check it out: Marshmallows have zero potassium and 6 mg of sodium; I’ve seen sugar-free marshmallows made with sugar alcohols. You could make Rice Krispies Treats.”
Aunt Pauline: “Really? I would like that…But what I’d really like is Peeps.”
Mary: “I’ve seen sugar-free Peeps made with sugar alcohols. You can have those too.”
Aunt Pauline: “This diet isn’t so bad after all.”

Sugar-free Peeps save the day, junk food that they are.

Your thoughts: Do you know someone who is confused by his/her medical 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?

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?