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Nutrition Experts Podcast Episode 20 You Are Not A Source of Information with Ashley Koff, RDN

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Ashley Koff RD is your better health enabler. An award-winning nutrition expert, Koff knows better nutrition powers better health. During her two decades as a dietitian, Koff identified a BIG issue – the tools we are using to assess nutrition aren’t better, and that keeps people from getting better results. She’s created better nutrition tools, to help identify what your body really needs and how to get it in more often. The Better Nutrition Program is your one-stop shop for digital better nutrition tools. A practitioner first, Koff regularly shares her better nutrition message with millions via national media, social media, and speaking engagements. For more about Ashley or to check out her better nutrition tools visit www.TheBetterNutritionProgram.com

Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Ashley Koff on the show today. Ashley welcome to Nutrition Experts. I’m excited to have you on the show and share your expertise with my tribe.

Ashley Koff: [00:00:48] Thank you so much for having me. I am so excited to be connected with you personally and learn your story. And this is going to be a lot of fun so, thank you.

Mathea Ford: [00:00:57] Yes! I know my listeners are going to love learning cause your tools are for both consumers and you find a lot of health care professionals. So let’s start with telling my listeners a little more about you and what you do.

Ashley Koff: [00:01:09] Sure. Well I never wanted to be a dietician. I wanted to be. I’m probably going to date myself here. I wanted to be Angela Bower from Who’s the Boss. I loved advertising. I thought it was amazing to go to work you know in New York City and come home to hunky Tony Danza was taking care of the house right? So that was my vision and I actually went to work in advertising. I worked like in New York City. My client was Kellogg’s and a couple of others. But I had my own health issues and I had been somebody who had tried my whole life to figured it in and out. Really for me it was to focus on my belly and I could never lose it, it was always with me. And every day I tried every diet and I tried to do things perfectly. You know I would follow Jenny Craig or Weight Watchers; I would go see a psychiatrist to psychologists, the fitness professionals like every different angle. And it wasn’t until I met an integrative gastroenterologist who helped me understand that it was all the antibiotics I had as a child that just made me get loaded. I wasn’t allergic or even intolerant to most foods. My digestive system just didn’t have what it needed to run better than I became so excited and passionate about what I call better nutrition. And I do feel we have to define better nutrition today that it’s giving your body what it needs to run better without giving it things at all irritated an overwhelming disrupted. And so I started in on this mission about 25 years ago to learn about nutrition. And where we are today and this is really it brings me to where I am. So, I’ve been a practitioner for about 20 years. The base of my practice was in Los Angeles. I got to a lot of celebrity were gone but we all know that their health issues are just the same as any of ours. As well as you know things like TV shows and stuff like that. But when I start to realize is there are a lot of people talking about nutrition today and when we any of us practice we know as a dietician the first thing we’re taught is to ask questions you have to learn about your patients. And today there’s so many different ways that people are getting in nutrients. They could be taking supplements, they could be eating whole foods or they could be eating food products that have fortifications or this whole area of like functional foods. And now there are creams and sprays and just all these different ways to get the nutrients. And I realized that we really don’t have a good system for assessing that. We have our RDAs but a lot of the nutrition assessment tools don’t assess what somebody is actually taking in most often. And so in the last three years I’ve worked very hard to create those tools. I’ve got about 50 of those tools everything from protein and magnesium to your trace minerals to water, fiber and I make those tools available to practitioners as well as individuals to help them just as a starting point. Whether you’re going to do genetic testing or lab testing or you know the whole nine yards or just a couple yards it is really important as we know to know from a foundational standpoint what your body is getting or what it’s not getting more often and that way we can get better outcomes. So I’m on a mission to change the way we assess nutrition in the country so we can get better outcomes.

Mathea Ford: [00:04:13] I think that’s a great explanation. Yeah you’re right. So many people with all the different fad diets and everything people are eliminating complete categories and nutrients. And it’s just really hard as a dietitian to make sure that you ask all the questions that are going to get down to what’s actually happening for that person so that you can actually help them.

Ashley Koff: [00:04:39] Exactly! And you know on the flip side you have things that are out there where somebody says “oh broccoli that’s a great source of protein” and it’s an oversimplification. Sure there are amino acids in there but how much broccoli would you need to eat? And we all know it’s not a complete source of protein. So, we need to do a little bit better with helping people understand but we also don’t want to make it too difficult. So I’m really trying to help connect the dots between the individual and their health care practitioners. And we all know as practitioners when we have more information about our patients. We do better. And definitely you know for doctors and even fitness professionals. People where it’s outside their scope and one of the areas that I said have done a lot of studying in and over the last 15 years for my nonprofit Ashley Koff Approved. I’ve evaluated over 150,000 products and it started off because I was very clear that not all multivitamins accrued are are the same.

Ashley Koff: [00:05:32] I want to make sure that we could that we had a way to say you know “hey! What are you actually taking in?” Because there’s a difference if you’re taking in 200 milligrams of calcium versus if you’re taking in 400 milligrams of calcium. So I’m trying to help people pull all that together.

Mathea Ford: [00:05:47] What types of tools do you see that consumers are using the most? Which of your tools?

Ashley Koff: [00:05:52] Sure! And you know I really looked at what tools already exist out there and why don’t I think that they’re helpful? So, for example there are a lot of different whether somebody is writing down and I think through journaling is still be the best thing you can do. So I created a food journal a digital one and a hard copy one. But then I turned around and said “Yeah! but These apps are having people count a lot of calories and we need to know what those calories are.” And so one thing that I created was a nutrition plan to help people understand where your different calories come from is going to make a difference. So we all know that 150 calories if it’s all from carbohydrate is going to impact your body different than if it’s 30 percent carbs, 30 percent fat, 30 percent protein and I’m just… Those are arbitrary therapies right? And so because that’s not even add to a hundred. Anyway. We all know what I mean. Right? And so when I was really focused on statistics. So, for example 70 percent of women, 80 percent of men are not meeting their RDA for magnesium. And I said “Well, that’s an interesting thing.” You know I could go on Dr. Oz and I do or I could go on the local news or I could go on you know wherever I’m going to go and talk to healthcare practitioners and say “hey! We need to get more magnesium because magnesium turns off that stress response and that’s so important for digestion and all these other things.” But they need to then turn around and have advice and I don’t want to just turn around and say “So, everybody needs a magnesium supplement. What about just eating some chocolate? What if you change your milk chocolate to dark chocolate you know or what have you learned that when you actually eat a whole grain instead of white flour you increase your magnesium intake by several grams. And so one of the ones that people are using very often and in particular psychologists and also my practitioners that are dealing with people with sleep, weight loss, anxiety. So you can start to see why this one is really popular. They’re using that magnesium tool. Now what I did was I had to treat you know there are different ways and I think the way you said it is so smart is that people don’t necessarily think about dietitians as having specialties. My specialty is definitely in digestive health because I know that we are not what we eat; We are what we digest and absorb. And I believe that if your digestion is not working better then you can’t get any health outcome that you’re looking for. And so I focus even on that part and so what I did when I created the tools was I also put them into packages. So you have your digestive health package, your heart health package, you have your kids package, your hormone health package and us dietitians if we look behind the scene, you’ll see a lot of redundancy behind all of them right? But the way that people consume information today or think about their own health they’re not thinking about their overall body as much as they’re thinking about specifically what they’re trying to address. So I focus on the tools on that part.

Mathea Ford: [00:08:43] I personally struggle with migraines and I use magnesium and try to make sure I’m consistently getting a decent amount of magnesium because that helps with that condition for me at least. I can see how that’s a popular one and I also see people do tend to have this focus on individual nutrients. But how do you help your clients or your consumers to have kind of a better overall diet? Because really I think that’s where some of we start focusing on one nutrient and then we forget about other ones. So, how do you help them to build a more well-rounded diet that’s good for them?

Ashley Koff: [00:09:23] Yeah! You are so spot on. Within the tool, the reason these tools are unique literally if they existed I would just be using them instead of having it create them because it’s not a lucrative business to create and to create all these tools and make them work. Maybe someday but it certainly is it right now. And so what I looked at is so every tool goes through what foods could you be getting a nutrient from. Then, also are there any that might interfere with the absorption of those in or conflict with the absorption and how much of those foods do you need to be getting into your RDA? And then I go into the supplements phase and I also go into a space about you and your health. And so for example, when I’m asking and the other nutrients base and the magnesium evaluation and I focus as much on calcium. Because one of the reasons that we have an issue not only are people not getting in their RDA for magnesium, we have people who rightfully so has listened to a lot of you know health care practitioners and really focusing on calcium but a lot of people have turned to supplemental calcium instead of calcium rich food and as a result they’ve been throwing out of. I call it almost it’s a conditional deficiency or conditional challenge. The more calcium you get in the more magnesium you need because calcium I like to make a bicep calcium as a muscle contracter and magnesium is a muscle relaxer. So, I was actually just talking to a woman yesterday and she switched to she’s getting an almond milk. She was not having any dairy but she was also not having the almond milk before. Well, now she’s getting and you know and it says on the package 50 percent more calcium than dairy milk. So, she’s actually getting in a lot of calcium and had not adjusted her calcium supplement or magnesium intake. So your point is if we are going to focus on nutrients we better focus on nutrients overall. But I always start people a step back which is thinking about what is your overall objective. So it’s the digestive evaluation or with heart health. What I try to focus on and again behind the scenes of any dietitians looking at this you’re going to know “Oh! This is just an assessment for better nutrition. What are your carb? Where are your carbohydrates coming from? What kinds of proteins are you taking in? You know what healthy fats are you getting in? Are you getting into too much of an unhealthy less healthy fats? What are you doing from a water intake?” You know those kinds of things I’m always asking those questions so that we can make sure that somebody doesn’t think that their solution is just one nutrient. But I think your question is really such an important one and it’s a challenge to a lot of us nutrition professionals. So, I look at it as two things. One I’m not going to change the fact that people are doing these bad diets. So for example I just did a webinar on If You Are Doing a Ketogenic Diet, Here Are The Things You Have To Do because your body still needs certain nutrients. So, if you’re skipping which blows my mind. But people are doing it and it’s not for me to judge. But if you’re skipping a lot of vegetables because of their carbohydrate content then you need to make sure that you are getting those in. And so I went through in my opinion what are better sources. You know whether it’s a powder that you’re adding or whether it’s you know in your malt tea or these kinds of things on as a way to make sure that you’re not missing out on those core nutrients. And then we also know we have patients who sometimes are just challenged because of something that’s going on to get something in. And so then this is a good way to help them around it. So, I always just come back to we know what better nutrition is and isn’t. And that’s in every package that I have of tools, there’s always the better nutrition plan which explains why better nutrition looks like you know which is a balance of nutrients and trying to reduce your intake of things that could be irritating.I mean when we just take it too much it’s overwhelming to the system but really great question.

Mathea Ford: [00:13:11] That kind of leads me a little bit to think about where are consumers looking for information on healthier diet? So, they’re not necessarily going “I need a better health, need better nutrition assessment searching for that but where are they looking for information on a healthier diet? And then part two, how can are these be part of that discussion?

Ashley Koff: [00:13:35] Oh! This is my favorite. So remember I told you I want to be Angela Bower so I started I love marketing. So, please if you ever want marketing help that is something that I love to talk about and you a lot of talking to probably because I enjoy it. First and foremost nobody wants better nutrition. Let me be super clear. It is the name of my company. Nobody wants it. So we all want better health and the outcome is what we want. And so you have to from a marketing standpoint be very clear that nutrition and in particular better nutrition and your better nutrition, what your body needs is the vehicle, a vehicle, a very dominant vehicle to getting better health. So in your messaging as a dietitian if you focus in on I see this all the time that your deliverable is nutrition, is better nutrition, you will improve someone’s nutrition, you will help them with this nutrition wise. You are actually not going to engage them because nobody wants it. In reality, if we could just fix it. Some people are like “hey! If I never had to eat any food but I could be healthy, I’d be happy. You know I’m a total foodie that would be a disaster to me. But if I could just eat whatever I wanted to eat and be healthy which is what we thought probably for many people up until probably like in the 80s and 90s then it was like an era like oh oh we actually do have to pay attention and oh by the way there is something better nutrition.” So my one of my kind of emerging part one and part 2. But one of my strongest recommendations in any of your communications is to think about what does the person who you want to talk to to have a conversation. How do they express better health? So, is it that their energy is crashing. Is it that their skin looks dull and dry or is it that their bellies bloated no matter that they just finished a marathon or feel like they eat very well like what’s the thing that day or is it that they really care about the health of someone else and have concerns and so they’re stressed about it and where we’re going to interact. So, in today’s world we’re really lucky because we have a lot of tools that we can use from a marketing standpoint to help us like with quizes. I think I was telling you Mathea that I’m really excited on when you talk about like where people are looking. They are looking for nutrition so they’re looking for health answers and guidance everywhere. And as a result, companies are all and people and everybody is talking everywhere I even use the term infobesity. We just we have too much information and it’s not even beneficial right? It actually can like stop us. Where people are looking, as a dietitian I would say so they’re looking everywhere so what you need to understand is it have them not just looked to you but invest in you and want to have a relationship with you. You have to be very clear about the fact that your training and your experience and what your brand is allows them to actually get the better health results that they’re seeking. And so that’s why I’ve made my tools available in a shared partnership for dietitians. I do a different program even for dieticians than I do for you know people who are not don’t have our license you know whether it’s a health coach or whether it’s a fitness professional or someone but you need to make sure that you can say to them I have a tool kit that’s going to help you get this better results and then what you also want to do is focus in on what are all the points in the day that somebody can talk to them. So one of the ones that most recently came to me I know everybody is on Facebook and Instagram and Twitter but I also realize that’s a place of massive infobesity. I mean, I actually as a dietitian get upset sometimes being on those platforms because I noticed myself I sort of think about what I had tea. I know what to do for myself right? and So I’m like “So, if this is the amount of information and what I’m looking at is even making me feel like I might have a problem or some thing I need to address. Imagine what it’s doing for the person who you know doesn’t have the training and does have a problem you address.” So I’ll look for places where people are not talking as much about it. And so one of the areas for me that’s recently opened up we’re talking about this is Alexa and it’s actually pointed out to me. I was not using Alexa. Alexa didn’t tell me this that the mind behind Alexa told me that there was not really anyone offering any nutrition tips there and that blew my mind. You know are you kidding me? People have Alexa around them all the time and are used to Alexa telling them what to do or what they need to know. So, that’s an area that I’ve gone into with my better nutrition skill. People can open that skill and ask a nutrition question. And I invite other professionals too if they have questions and answers and things they want to promote on to be a part of my better nutrition skills. You’re listening and acts of interest, please reach out to me. And I think that that’s a great way to do something that’s different than what exists out there and maybe where everybody is already talking about something about nutrition.

Mathea Ford: [00:18:30] That is a great explanation. And I think it’s a paradigm shift for dietitians because we really do think about things as nutrition and kind of the features or how it works. And you just made me think about like diabetics don’t want to count carbs but they want better blood sugar. So, if getting better blood sugar means better nutrition by counting carbs you’re not going to tell him “Hey! I’m going to help you learn to count carbs. I’m going to help you get better blood sugar.

Ashley Koff: [00:19:04] And I’m going to say that it’s delicious easy. Like that’s how you know I mean.

Mathea Ford: [00:19:08] Yeah yeah yeah yeah. That type of thing. So, with your Alexa’s skill is that something we just ask Alexa? “Hey Alexa! Hey, activate the better nutrition skill or?

Ashley Koff: [00:19:20] Exactly! There, you can open My Better Nutrition Skills you just say “Alexa, open My Better Nutrition Skill!” And the first time she’ll ask do you want Daily Tips, do you want to ask questions. You can say you want to do both. You can you know and you can set that up. And then we also have a cool function there where I will send you more information via a web link. And so if you at any point want more information because as we all know just like Twitter, 140 characters specially I am Ashley Koff RD. I am an overspeaker or an overshare so I’m not good, I can’t do it in this short amount of time. You know I made things very short for Alexa. So, I say in there “If you want more tips and resources than you can just provide your phone number the one time.” And then we’ll be able to send you stop by a web. As a practitioner if you have something that you want to submit to me as a question and I’m happy to promote you it does not need to be that it’s you know that it’s going back to it’s not about Ashley Koff on this part it’s about My Better Nutrition Skill in which should be a lot of people talking about better nutrition. And likewise The Better Nutrition Program so then people would just e-mail me through The Better Nutrition Program to submit any content that they’re… and to talk to me about submitting content for it.

Mathea Ford: [00:20:34] We’re thinking about guiding people to healthier choices and working with consumers. How do we guide them to get these better choices as dietitians either on a large platform like Facebook or Twitter or just individually one on one? Do you have any thoughts on that?

Ashley Koff: [00:20:55] Yes! And I actually have done a couple of webinars. They are available for free. And I have engaged other people who are better at things like online marketing. And for me the real game changer was I did not want. I was thinking about what I needed to do on Facebook what I needed to do on YouTube or even just bringing people to my Web site. I was not thinking about how do I actually helped someone get from me what they’re looking for and that’s embarrassing to admit but I’m comfortable in admitting it. And the reason I admit it is I was trained as a dietitian. I was not trained as a salesperson for products. Although that’s kind of like because I did the marketing stuff before. But you know when I became a dietitian right? And the second part about it is the only people who are getting really rich off of Facebook or Twitter are Facebook and Instagram which are now owned by Facebook and Twitter and Google you know that kind of a thing. And so giving them money started to say to me look so what’s the ROI? And for me it’s not just the return on investment from a dollar standpoint but we are businesses. It’s really Return on Impact. So I think as dietitians we got into this business because we want to impact the health of individuals and the health of the country. And so I need to know when I’m doing something but what I am doing is going to have impact. And so really big change for me was actually to learn about tools that could help me make my messaging more effective and then also could aggregate it in a way that I knew who I was talking to. And that’s very different today that we’re able to do that online or through social marketing or that case. So, I also have a free guide that connects you to any of the resources that I have through this and I use it through elite digits so people can text. And we’ll put this in the show notes but new trip is one two three the number 4 4 2 2 2 and I’ll remind that at the end but in order when doing that in there I’ll show you what was probably the biggest game changer for me. So, I mentioned I’ve been doing this for 20 years. I was doing it first in a little bit in New York and then out in LA. I’ve had a lot of exposure through meet the media whether it’s TV shows, magazines, online podcasts you know all these different pieces but I didn’t have a way to know who I was reaching. And then also how to connect them to specifically what they wanted to get from me and to my point in the last conversation, we have to make sure that we are always talking to them about what they can get for me. It’s not just like “oh it’s high value blah blah blah.” No no. It is what they need. Right? Because we are as dietitians we are return on impact. We want to have that impact. And so there I learned that way more important than putting my Facebook icon on something are way more important than even having the lower third of a TV show have my name spelled correctly or even my RD because we all know that part is like they always leave the RD off or call me a nutritionist. So even more important than any and even having my website up there is I have a tool and I use this digital tool and there are other versions of it etc. It’s not expensive and I use it to give people a guide that has more information they can text to get it where they can email me for it. And when they get that then they come in to me and I know that they got it from seeing me on that TV segment or from a specific Facebook post or you know that kind of a thing. So when I now connect with them I can say legitimately “hey Mathea! So great that you reached out for my magnesium evaluation. I’m excited to have you see where you’re getting magnesium and what’s already better. Yey! Keep doing that and what could be better. And what did you think about the segment? Like I showed you a couple of ideas for chocolate in there. Do someone likes chocolate and then suddenly we have an it’s just like you were in my office right and we can handle all of that through email and through my connection with you because I know where the ends meet. So I think it’s kind of it’s going to be essential for dietitians to not just do something like everybody says like “oh! I want to go on TV.” Not everybody people want to go on TV or someone wants to have a podcast or they want to you know “oh! I need to do a SEO or Google Ads or any of that stuff” but don’t do any of that! Those are great to generate leads. But if you don’t know where you’re taking someone on a journey and another part in this very humble lines are either list of about I think we’re at 45 thousand and roughly. And I have done nothing with my list. I just had this list. Ever had it for over a period of time. And when I started looking at the list I was like “Well, I don’t know where any of these people.” What do you know? I let go.

Ashley Koff: [00:25:38] I sent an e-mail to everybody and said “hey! I haven’t really. You know I’ve been sending my newsletter. Doing all these stuff but I don’t really know like.. So these are the things I offer. Are you looking for it? And if you’re not looking for it just let me know because who wants an inbox full like Ashley? like if it’s not useful. Right?” And so we had about 11,000 of that 45,000 go away. And if anyone like focuses on their business may think “Oh my gosh! She went from you know 45,000 to 34,000.” Well let me tell you the 34,000 that I have now are the engagement is 16 times more significant. I’ve looked at these numbers and getting fun things. Like people responding the stuff saying like “hey!” You know do you want Like exactly what I wanted from them like “hey! You asked me to tell you what’s better. Here’s what’s going on that’s better. Hey! I really wish you would create this. Hey! Is there a place that I could get you know such and such?” And so I think you have to be a little bit disruptive or to use your phrase appreciate that there is a paradigm shift and just doing marketing and learning to do marketing the way that all of these like coaches and courses and programs and all that stuff that is not going to cut it. You need to go back to what we do as dietitians that is totally unique from what other people do and that is we cultivate relationships with people to help them get healthier powered by improving their nutrition and that has to be what you do in wherever you choose to connect with it. So it’s a long very creechy answer but hopefully it explains what I’m doing and how I’m doing it a little bit differently.

Mathea Ford: [00:27:19] That was just Golden! I do exactly what you’re talking about and it’s so great when people reply to me and tell me “thank you for the encouragement. Thank you for the recipe. You know this is what I’ve done. This is what’s changed. This is what I need.” And you know that youre making a difference to them. Then, I love that. We kind of think sometimes that marketing is a quote unquote dirty word cause it seems like Dr. Oz and everything is all marketing. But what they’re doing if you look at what they’re doing, you can take that and do it in your own way. So, like you talked about in the beginning what is the outcome they want. They want better skin. Dr. Oz Says here’s a cream for that. You know your outcome is this. So…

Ashley Koff: [00:28:09] I love to discuss this. So, first of all, like I really admire him. I think I have a good relationship with him. So, he is not show like there is a whole show there’s a machine behind it but your point you can, we can all learn. And I also encourage anyone to rather than say like “hey! Like, Oh gosh he just does marketing or he just says ‘hey there’s a cream for that.'” First of all, if happened to be in a place where you’re engaged with a show in any capacity. You do not have to do what they say. So, I repeatedly… They always laugh like I’m so engaged with scripts. I will say you know what? “But I am not going to say that.” Like there was a time they were trying to get me to talk about wine as being like okay for an I can’t remember what it was you know just because it was like “oh! Let’s just tell people a little bit of wine” you know and they weren’t wrong but I felt that it was wrong to let you know it was a stretch to say on that premise. So I actually said to him I was like “if you want to say that, you can say that. But as a dietitian I would never say it.” He is like “I’m not going to say that!” And so he’s like he turned to people almost like “Why is the script?” So, just the same way that we have to stand up to doctors in the hospital make sure they hear us like we need to do that. You know that’s it. And then the other thing that they do that I think is a great thing for us to learn from it is they do teasers. And so we’re some of the most egregious information comes is actually not in the show but it’s you know where people can perceive like “oh! He’s just saying or he’s doing that.” No, no, no he is doing that to get somebody to tune in. And so I think what you want to be careful. What we as a dietitians want to be careful about is there is a marketing technique called clickbait where you can write any headline and get somebody to click on it but you better hold yourself accountable. If your name is going to be associated with the clickbait you better be okay with me thinking that about you. And I think like that whether it’s you know the food babe, whether it’s Dr. Oz, whether it’s on and I could look outside of our space you know into other area as in any type of advertising and marketing. You really need to make sure that you’re okay with those pieces because when you substantively read somebody’s book or you watch their show or you get their whole explanation, they’re not just recommending a cream for your skin. Right? But what you thought was they were recommending you cream for their skin because they’re clickbait or they’re teaser. So, one of the things about dietitians is I think we have to be we can do better and really help people and lead the way by having these. We have these ways to help people understand that we are going to get them results. And explain it’s going to be deliciously easy and we’re going to give you those tools or we’re gonna show you exactly how to do it but we’re not going to tell you something that actually isn’t true. And that’s a really good place we only can know that for ourselves what that barometer like what’s true or not is.

Mathea Ford: [00:30:57] Well, I appreciate you mentioning that because I love like Ryan Seacrest on American Idol you know the promo right before they go to commercial. We’re going to tell you who won after the commercial. So you know how are we going to… How can we put out things that are engaging our audience that they’re interested in that they’re seeing in the media? But you’re right we have to be true to ourselves so we’re not going to say 10 ways you’re going to lose 10 pounds this week but we might say 10 ways you can have a better body, a better health in a week and that is a true statement. You know you can switch what you’re eating or whatever but lovely, I love talking about marketing so. You have any more little tips on marketing or?

Ashley Koff: [00:31:48] Oh my gosh! I have like I have like four webinars, three quick guides like all of these.

Mathea Ford: [00:31:54] Just share a couple quick things that might help and then we’ll go on.

Ashley Koff: [00:31:59] One, two things about email communications. I spent a long time whether it’s newsletters or the e-mails I send to people you also remember. Now I know like “hey! If you downloaded my Magnesium Guide where they text Calm123 to 44222 they get the Magnesium Guide. I actually tell people when they get that you are going to get four e-mails from me. They are. Because I want to make sure that you actually use this guide right? And use it so that you get better results. So, if you don’t want those four e-mails, if it works for you to get the guide and you’re off and running then just make sure put me in your job like just like anything else from this e-mail and I actually say that up front first thing in my e-mail and then, I go through and I talk about in my e-mail just one thing. So, one of the things that we as dietitians are not good at and one of the things that we can be better and I will certainly say this “Ashley Koff RD is not good at is I like to tell people a lot of things that they can do. You just asked me you said ‘Com’on! Give us more tips!’ Right?” As if like the one tip for like just focusing on a health outcome as opposed to a nutrition one isn’t like I know that we just knew every one of your business epicly forward and so I shouldn’t even give you… I shouldn’t have been giving you another tip because what I learned is just one call the action. One tip and what should they do with it. However, to your point about we’re not going to tell somebody ten days and all that stuff. What I do at the end is I do tease them. So, I’ll say “So now, you learned about magnesium and my next e-mail. I’m going to give you three of my favorite ways to get magnesium in and so then I said “make sure you’re looking for that.” In another e-mail I might say “So, remember there is one thing that will no matter even if you’re getting the right amount of magnesium and there’s one thing that’s still going to keep your body from turning off the stress response. I promise you that it is the highest open rate that I have of any e-mail. Everybody wants to understand because part of what I presented to you is it’s actually not that you need to deal with your stress. Of course I want people dealing with their stress but I’ve shown you that if your body has what it needs to turn off the stress response you are going to do it better. Everybody wants to know both what can I do to turn off the stress response i.e. magnesium. And number two, what would keep me from having it be effective even if I get the magnesium right. So, I think that the other tip on this piece is there is a way of communicating with people. And you know if we go back to SOAP notes. SOAP notes we all learn that if you are like me I couldn’t wait to be done with them like SOAP notes are so stupid. They like I sit here and write all these things I write this beautiful note in because back in the day I was writing them because I am that old. Yeah! I write it in my… You know I had to learn, I had to get it approved by my internship director then I could even put it into the church. And by that point I’m like “really? Who’s even reading it? And blah blah…” And the way the doctors would even say to me “oh my gosh! I’m just looking at your pee. Right?” Like I’m just going breathe through this. However, we know that when we did SOAP notes and when we learned to do it our thought process and also what somebody who was reviewing that could get was an insight into our thought process and we took them along the way. And so there is a thought process for a more effective emails that can elevate your communication to a way that actually gets a call to action. And I had to learn this. So, things I think that’s really valuable from a marketing standpoint is to turn around and say and actually look at people who are doing companies that are doing the best marketing. What is making you actually purchase? What do you subscribe to? What are you looking forward to? What e-mails do you always open? And then think about. Now, I’m a dietitian. What like I want to understand what’s there SOAP note in there? What was their process? Like did they come to me from a pain point? Did they come to me? And when you look at that part you can start to say “Okay, now I put it in; I insert my information where I can follow the flow or the tip like so as I said one of them is just being where other people aren’t. I am totally tired of being where everybody is. But even within Facebook, I do more now in my groups and I interact with more of you in groups. That’s how we met then I do. I’m not just sitting there doing Facebook posts like that’s I’m like “Uhuh! I’m not going to spend my time on that part” or if I do do a Facebook post or even if I’m invited to you know these to do a sponsored post of course I’m going to note that that’s a sponsored post. But if I’m doing that, then I got to make sure there is a call to action in there and then I’m actually giving somebody something that can have for me return on impact.

Mathea Ford: [00:36:43] Well, I’ll just tell everybody I’ll remind them most people today probably haven’t heard about SOAP notes unless they’re 20 years old dietitians like us. So it’s subjective, objective. So subjective is like what you talk to the patient about and what they told you. And then objective is like your labs and all the stuff you can find in the chart and an assessment is what you think. So, it be your nutrition care plan or whatever nutrition. What is it called?

Ashley Koff: [00:37:12] Assessment. Right?

Mathea Ford: [00:37:12] Yeah! You have like your nutrition diagnosis statement.

Ashley Koff: [00:37:15] Yes.

Mathea Ford: [00:37:17] And then your P is your plan. So, for those of you are like “What in the heck is the SOAP note? That is what it is. Yes. And it was how we thought about things and yeah it’s one of the most detailed notes in the chart. Yeah.

Ashley Koff: [00:37:31] It’s like you weren’t passing to get your RD if you didn’t do a good SOAP note in any capacity but you know I think it’s… So, anyway I think that you know for us from a marketing standpoint. First of all, what you are doing is so awesome because by bringing in people. So, people listening right now might be like “okay, I don’t even want to listen to a dietitian that was on Dr. Oz.” And you know what? If you think that I’m good with that. Just take from me what I said about the difference in the communication or somebody else might say she talks really fast. I don’t get what she’s talking about but then the next expert that you have on is going to be somebody that they can really relate to. Right? And so I think that there is one of the great things about today is there are a lot of different people for us to interact with. I learned so much. I learned from you today. I learned so much from how dietitians, different dietitians are doing their business that I just love that you’re putting it together all into a podcast that I can listen to and it gets me very excited. So thank you.

Mathea Ford: [00:38:29] Well, thank you. What do you think is next in like nutrition or kind of what we’ve been talking about marketing nutrition and marketing and how do you see that affecting health care? So, how does it affect what we’re doing in the next five 10 years?

Ashley Koff: [00:38:45] You know the infoobesity piece to me runs pretty like that concerns me a lot. And so unfortunately or fortunately what’s next is so much money and effort and attention to this space which is awesome. Like it was definitely not the case when you and I got started. But it’s also very concerning because on when everybody’s trying something and when brands it’s hard enough to deal with all the new food products and supplements that all have publicists. But now all these health care companies have publicists. So, I think that that’s a hard thing for us. One of the great things is we are and we’re not like this isn’t light off into the future we’re moments away from at home or in person testing so that you can know things right whether it’s with your mobile device or whether it’s with strips you know or testing you know even just the adventure of being able to prick your finger and see your blood sugar.

Ashley Koff: [00:39:42] But because we’re able to see these things in the moment. We can actually, we as dietitians can have a much more immediate impact with people because just even doing a virtual consult. So, I’m to a virtual practice when I was in L.A. Gosh! About probably even like about 10 years ago I’m starting at maybe like eight years ago. And one of the great things was I would open with “So, it’s fun that we’re both in Los Angeles and I want to tell you that you already if you take nothing else away from our consult today. You already are healthier.” And they would go. “What is she talking about? Is this her way of like charging a lot and like not doing anything?” And you go so “you did not have to get into your car and deal with stress of getting to my office. Traffic, Parking spending money. So I think about like I’ve already shown you how you could invest your time better. Now you’re in your kitchen. We can have a focused discussion about what you do in your kitchen or what’s in your kitchen or we can literally have you now with your phone. I literally will have people go over to their supplement cupboard or whatever and show me what it is that they actually have right? Or take a screenshot of it and show me. And so, we’re able to move things into a much more personalized immediate response. Because of that, what we also know is the role of the dietitian has never been more important because what if you understand this key piece? If you understand that you are not a source of information. I want to be really clear when I say that. You are not a source of information. You need to be a partner. A vehicle, is tool for somebody to use to get better results. So if you count yourself as a source of information they are going to compare you to all other sources of information. But if you are a tool an unexceptional tool and a better tool and one that’s worthy of investment and one that can be with them when they need you and one that has certain skills. You know any of these things. Wow!like that’s different. And it also allows you to be a tool for other practitioners. So, as a doctor you can turn. A doctor to turn around and say “oh! Literally I might not know certain things about nutrition but I do this for one doctor in particular. So, he actually knows that we have times where we have built into a calendar where we Skype in his office and go through certain patients. He has a series of patients he once asked me nutrition questions about and we go through all of those. And he pays me my hourly rates and sometimes it’s four hours because he has a lot of patients with nutrition questions. So if you mold yourself to being and focus on being where I know you actually are and you aren’t just “Hey! I am someone with information. So, if you tell me that cinnamon is a source of antioxidants then shame on you because it for thinking that you’re going to have a business that’s different than Google and Google gets to how people a lot of information and so you’re not going to compete with Google and you’re probably not going to compete with the person who has is selling cinnamon because they have a lot more invested in about that part. So, I think that’s you know where we’re going is this amazing space for us as dietitians if we position ourselves properly and we’re poised to shift our business model or are capable of shifting our business models to be ones that meet that you know today’s consumer and today’s practitioner where they are as well as tomorrows.

Mathea Ford: [00:43:15] That was great! I love it. I like the idea of thinking of yourself more as a filter or a focus instead of a source of information. Because you’re right they can get it from a lot of people and if you don’t have that know I can trust with them. They’re not necessarily going to believe you over Dr Google so.

Ashley Koff: [00:43:35] Exactly!

Mathea Ford: [00:43:37] Okay, Ashley, my fun question: What’s your favorite food?

Ashley Koff: [00:43:40] Yeah! I could chocolate but the thing is like I’m like so I love broccoli. It sauteed in olive oil with some garlic and a pinch of sea salt and I probably love it more than I love chocolate. But if you told me I could never have chocolate again I’d probably be more like rebellious than if you told me I could never have broccoli again. So there goes the issue of green vegetables. Yeah! Okay that’s what I’m going to say!

Mathea Ford: [00:44:07] Okay. Alright Ashley thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about not only your Better Nutrition products but just that paradigm shift that different thinking about nutrition and marketing. So, if listeners want to connect with you what’s the best way to do that?

Ashley Koff: [00:44:30] I invite you to… Depends on what you want to connect with me for. If you want to connect with me because you’ve got nutrition questions open My Better Nutrition skill on Alexa and go to town right? If you want to connect with me about being a Better Nutrition affiliate, a Better Nutrition provider, hop over over to the Better Nutrition Program and sign up to be an affiliate. It’s a 50/50 financial split and it gives you access to all of my tools for your…. For anyone that you’re working with and also for yourself. And then if you have questions for me you can find in the usual spots. But probably the easiest thing to do is to just send me an email directly. ImetAshleyKoffApproved@gmail.com. And you know just give thought to what you’re emailing me about so that hopefully we can connect and I can be helpful to you.

Mathea Ford: [00:45:16] Do you want to remind them about the lead digits?

Ashley Koff: [00:45:19] Yes. Thank you so much. So, if you are interested in some of the nutrition tools, the marketing tips that I was talking about for building your better nutrition business. You want to text NutraBiz123 to 44222. And next Nutra like nutrition’s so NUTRABIZ123 to 44222. If you want Calcium, if you want to know about your magnesium and then text Calm123 also to 44222 and you can do both. You’ll just get the e-mails from me.

Mathea Ford: [00:45:52] Okay, well guys this has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 19 Healthy Snacks, Back to School Keto Diets and Intermittent Fasting with Janet Brancato, RDN

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Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food start today right now with our next guest. It’s great to have Janet Brancato on the show today. Janet welcome to Nutrition Experts.

Janet Brancato: [00:00:44] Thank you so much. I’m so glad to be here. Again, my name is Janet Brancato. I’m a registered dietitian. I’ve been at a dietitian over 20 years and I started out with community health talks and I also do outreach and nutrition counseling. In the past five to eight years, I’ve started my own virtual practice called Nutopia which reaches more people online with a virtual practice. I love to help out adults and children with healthy eating especially weight management but all kinds of medical nutrition therapy. So I’m so happy to be here to talk about all of these fascinating topics with you.

Mathea Ford: [00:01:24] Yes so this week we’re doing a little bit different. We’re going to kind of call it the news edition. And Janet is going to join on a regular basis and we have some topics that we’ve done a little research on that we’ve seen in the news and we want to kind of go over it and talk through it as from a dietitians perspective and a couple different perspectives. So, this is just kind of going to be a mishmash of a few different topics so we really get started. We thought well, it’s back to school time. It’s September and what’s one thing you think about going to school college freshman, sophomores is you know that college freshman 15 whatever they call it. So what do you think Janet causes a lot of those gains?

Janet Brancato: [00:02:11] I believe that it’s there’s change of environment. You know so when you go off to school you know you have that newfound freedom and you know now you’re making decisions about food and you know your stress levels are changing. You know you’re in a new environment with a lot of variety of food whether it’s in a cafeteria or the surrounding town that you’re in you know and you’re out with new friends so there’s a lot of like social eating, I believe stress eating you know late night eating I feel like all these factors can definitely contribute. Maybe there is less activity going on in their lifestyle you know as previously they might have been involved in sports. And so now starting the school year in the library more you might be sitting in classes more. So I think that all of these factors sort of are part of being to that.

Mathea Ford: [00:03:07] Yeah I agree. I think you also have sleep changes like you talked about a little bit. You’re getting up either earlier or you’re staying up later and getting up later and that kind of throws off your schedule. So, in addition to that you’re all of a sudden responsible for your own food choices like maybe up until that point your parents or parent made a lot of those decisions. They went to the store they had the food in the house and they hopefully make good decisions so you always just have good choices. Whereas now you have maybe a roommate and you guys have to you know pick your food and you may have a lot of unhealthy food around or just quick prepared food. So, ramen noodles, mac and cheese. That type of stuff. And you may not even being paying attention to how much you know you’re eating or what’s changing. So, I was trying to think of some ways that you can kind of prepare for that. What are your thoughts on some ways you maybe could be prepared for that change or help your kids prepare for that?

Janet Brancato: [00:04:13] I have two college age kids that have kind of gone through this process. And I believe it’s just always good to start ahead of time even just obviously as a parent, we’re going to provide the right you know the right foods, you’re going to be looking for healthy foods at home but also have a conversation with them you know about you know making choices and like we said these environmental factors that are changing. Maybe having that conversation ahead of time before they are going away to school you know help them to come up with a list for healthy snacks or some kind of plan for activity. A lot of these campuses now have really elaborate gyms you know and in classes some of them even have dietitians. So, you might you could even tap into that a little bit. But I think you know it always starts with a conversation and you know maybe finding out about the cafeteria what kind of foods are served just getting them a little bit prepared ahead of time. You know obviously things you know change once they get to school, roommates and things like that. But I think if they have a little knowledge ahead of time when you have that conversation that will definitely help.

Mathea Ford: [00:05:23] Yeah I think you can help them make good grocery list, talk about good food to eat. Even when you’re there obviously a lot of times parents go and buy food put in the room at first and just kind of encouraging that. Of course you don’t have control always over on the roommate. What the roommate might bring in but yeah I think a lot of campuses there’s a lot of walking and it’s just a matter of making a point to do that.

Janet Brancato: [00:05:53] You could send them some healthy care packages with some little healthy snacks.

Mathea Ford: [00:05:57] Yeah! I figured out care packages. Yeah because a lot of times they have junk food in them so.

Janet Brancato: [00:06:01] Yeah! Why not send it for the roommate to you know because they maybe they never tried some of these healthy items and you might force something in to want to eat healthier.

Mathea Ford: [00:06:12] Yeah and a lot of times they’re in the cafeteria and hopefully they’ve got a good foundation of good foods to eat. I remember when I went to college that was when I first realized there was other side dishes besides corn and potatoes. Because when I grew up all we had was corn and potatoes though I was like “what is that?” I’m trying all these new foods. So, yeah have that generally encouraging environment and also just even talking to them like your kids like “what are you eating? What have you been eating? What do you have in the house to eat?” Because if they’re like “Oh! I just got ramen and whatever.” You can help with that at that point. Of course it’s not the worst thing in the world ever to gain three pounds or five pounds or whatever. A lot of times they’ll come home and get back into their regular environment and probably lose it.

Janet Brancato: [00:07:02] Right. Exactly! They want to have positive messages.

Mathea Ford: [00:07:06] Yeah. Healthy snack ideas. So, we wanted to move on from that and talk a little bit about kids and snacking and a lot of times you have certain restrictions for allergies or whatever. What ideas do you have for like snacks that might be maybe not free if kids need to have like a lot of classrooms, they’re not allowed to have nuts?

Janet Brancato: [00:07:28] Yeah I know that can be deadly challenging and stressful for parents. But you know there’s definitely more variety out there now and I try to help parents sort of go back to basics you know. Think of the healthy food groups when you’re thinking about snacks for your kids. You know obviously fruits and veggies are always good and you get that color in each meal. You can maybe side that with a little kind of healthy fun dip maybe like a little yogurt dip or now they have the little free portion hummus or the guacamole on that kids really love or find a favorite salad dressing that they might like to do some dipping with. So those are always good to do. And then you can do things like you know like a pop corn is always good and kids tend to like something crunchy like that or a wholegrain tortilla with some salsa. Maybe some kind of homemade smoothie if you’re at home and you want to do something like that. Could do like wholegrain crackers if you even try like a sun butter which is made more from sunflower seeds that shouldn’t be a problem. And you could put it on a celery stick or on a whole grain cracker or something like that. So you could definitely be more creative with some of the snacks. You know try to keep them wholesome and healthy. You know cheese sticks, cottage cheese. There’s all kinds of ways to get a healthy snack in and you want you know when you think about snacks you know snacking is meant to kind of bring you from one meal to the next. You know, it’s meant to curb your appetite, keep your energy up, keep your blood sugars level. So, we want to try to get some kind of a protein and maybe a fiber source in there so that would be sort of a good combination.

Mathea Ford: [00:09:09] Yeah I love your ideas because we have so many prepackaged snacks that a lot of times you forget “Oh yeah! I can cut an apple or I can put an orange in there or… And we have the little snack size bags and a lot of times what I’ll do is if my daughter wants to put some chips in her lunch for example I’ll grab the smaller size bag so the portion she puts in there is not the full court size but it’s more just the half you know snack size or put some you know nuts in there or whatever. Obviously we’re talking about nut free but those types of things just even thinking about. It’s the whole idea of a smaller play and a snack. You’re right it should be just to get you from one meal to the next. If you’re feeling a little bit hungry, you don’t want to get to where you’re super hungry and are you going to go eat everything in the kitchen but healthy from that snack point. So again, I mean they could even have a little piece of chocolate but it’s a portion control more thing.

Janet Brancato: [00:10:11] Yeah! I try to have kids look at the food label and see what the serving size is. It might say two cookies or five crackers you know. Get them in the habit of reading the label and checking the serving size because that’s good guide to know how much to have. Its when something comes in a bag or a box sometimes you know we just keep putting our hand in and we don’t realize how much you know we’re having. But if you follow that serving size and it says you know ten chips, alright takeout ten chips. Put it on a little napkin or like you said a little snack bag and now you have your snack size portion. It teaches them as well as they get older, they get an idea of “okay, if I follow those serving size you know that’s the right portion.” So that can be helpful too.

Mathea Ford: [00:10:58] Yeah! Getting kids involved in the kitchen type thing where they’re making their lunch for school or whatever. Making those choices. You can let them read the labels because that is a skill that will help them as an adult. And you mentioned you have something called a Rule of Fives. How do you do that with the label?

Janet Brancato: [00:11:17] Yes! So, I find that everyone can remember the number five. Right? So, if you’re looking at a label or you have your child with you in your grocery shopping and you’re looking at snacks. If you remember the number five. So, that means looking for at least five grams of fiber or more, 5 grams of protein or more and then five or less grams of sugar. So that is a good sort of balance of nutrients that kind of keeps the nice and full with the protein and the fiber. And we’re not overdoing the sugar. And like I said it’s an easy number to remember. You can just kind of look down that Facts panel and look to see that there’s at least five or more or five or less and it can help out healthy snacks. So, it’s kind of a low numbers game too when you have kids they like to look at numbers and things like that. So it’s kind of helpful.

Mathea Ford: [00:12:06] I think it’s also very educational to have them compare two things that they like. You know maybe it’s a jar of peanut butter and they’re looking at two different brands and to see the difference in the food label and just understand you know which of those has a better profile to be a healthier food. Because sometimes you have peanut butters maybe with extra added sugar or other things. What kind of things do you have them do or would you think parents could have them do to help prep and do the set up in the kitchen for meals?

Janet Brancato: [00:12:40] Yes! So, you know depending upon the age what really you can start young. I mean you can even start them out by looking through some cookbooks or even online. You know there’s so many recipes sites or Pinterest. So, you could kind of get them even just getting creative with looking for the recipe or something that you know a visual that kind of they you know they want to make something new. So, you can get them involved in just picking out a recipe and then maybe going shopping, maybe making a shopping list or into the grocery store. You know you really the whole process is important because then they’ll be more involved in the kitchen depending upon the age. If the real young maybe have them wash something in the sink or whipping up the lettuce you know if they’re real young. As they get older you would have been season things a little bit more. They could add some spice and flavor things you know and then obviously as they get even a little bit older more high school age they could do a little bit more, maybe cutting or you know prepping and little like cooking you know that type of thing. So and I really feel because I’ve seen it with my own kids. More involved that they are the more apt they are to taste it and the more apt they are to accept it something new and the more that they are to like it. You know they’re looking to be a little more independent. It’s sort of a way of giving them a little bit of that freedom to be independent and then like I said they’ll be more apt to want to try something new you know. So, you get them involved in the whole process from picking it out to prepping to making it and then like I said you know and again every kid matures differently. But for the most part it’s definitely will be a more successful way of getting them involved.

Mathea Ford: [00:14:28] Something that we do that’s kind of fun is if we go out to dinner and the kids have a meal that they really like or something that they really want or enjoyed then we’ll come home and try to make that meal the next week or so so we cannot keep track of what was in it and kind of try to reproduce it but it gives them the opportunity to think about what spices were in there. How did they do the food in that way? My kids are older they’re 12 and 14 so choosing the recipes I’ve found to be a huge factor in helping them to want to eat that meal so they know “Okay I made this meal. I picked this meal so to speak you know. Then I chose and this is food I like.” So they’re more willing to help, they’re more willing to eat. And that’s always helpful as a parent.

Mathea Ford: [00:15:18] Well, yes! I see kids that gets so stressed and they feel like it’s all on them. They have to. They’re the chef. They have to pick everything out, they have to decide. And you know you really can get kids involved and they want to be involved. They do! And it really is a great life skill. It’s a great life skill to learn how to take care of yourself like cooking for yourself. That’s such a great long term skill. So, you know and all three of my kids they cook. I mean they’re older and they enjoy being in the kitchen, they’re comfortable in the kitchen. And that’s because at a young age I tried to really get them in helping in some way. So it really does help. And what you just mentioned is a great idea especially when you’re out to eat. That’s the best time to try something new. I always encourage my kid “why you try something new something that you’ve never had before?” You know it’s always a good way to maybe experiment a little bit with something even if it’s just one little side dish that’s new. But age just gets mature their tastebuds and exposed to some new flavors. So it’s always going to be positive.

Mathea Ford: [00:16:26] We were looking a little bit about back to school and thinking about how do you make your school lunch healthier? And some of the suggestions were to kind of look at my plate type look you know how do you balance those items within the meal. So, when you talk to parents or talk to anybody about how to make a healthier lunch with your kid or for your kid which personally for me my daughter she’ll say she loves it because her dad will make her lunch and he’ll drop over her little bag and make her cute little signs. And I’m like if you want your lunch you can make it. So, she always appreciates it when her dad makes her lunch but she makes her own lunch but we always have a discussion about what’s going in it. But any ideas how to help kids to pack healthier lunches?

Janet Brancato: [00:17:18] Yeah! Like It and getting them involved is always good. And the My Plate is a great visual to start with because it does give you the right balance that you need. So, it just kind of depends if you’re going to have a hot lunch or cold lunch. You know you might want to start having a conversation with them about that. And then depending upon what they choose you know you want to try to get some kind of a protein in there you know doesn’t necessarily have to always be a sandwich. You know there’s all different kinds of breads you could do like a wrap. You know there’s all different kinds of now whole grain wraps you do or some wholegrain crackers. You could do the bento box idea which is sort of like a box that has a different sections. Some kids like that where you put protein in one section maybe some broiled chicken or it could be like a tuna salad type thing maybe another section of the box can have some vegetables and fruit or some cheese. You know so that’s another kind of concept would be one move away from the sandwich idea is maybe do something like a bento box or kids could bring leftovers from them the night before. You know so it’s really kind of brainstorming with your kids to kind of like maybe follow the My Plate and say “okay, what are some of the proteins that you might want to vary? You know because variety is going to be key here. They make get bored having a turkey sandwich every day but you get a variety you know? You know so kind of like brainstorm with them some ideas. Like we said, you could get a little pushing cups of dips. Kids like that. And like you said be creative. You know maybe have them pick out like a special lunch box or put a little note in their lunchbox like “have a great day!” It may be small sweet treat but they will look forward to having. So, get them involved just like you would with shopping list. You know maybe just write down some ideas with them and then you can have them put it together you could do it together at the beginning of this school year just to kind of get the momentum going you know and then maybe eventually they’ll be doing on their own. You know like I said it’s getting them involved in the process. You know that’s going to be key.

Mathea Ford: [00:19:25] I always try to make sure they have a drink in there because like a water or they can buy milk at the cafeteria because you want them to be hydrated. But one of the things I do with my daughter she does not like school lunch. So, she likes to make her lunch. My son will eat anything they have at school lunch. So I’ll say to her when I’m getting ready to make the grocery list I’m like “What do you want for your meals this week? And that makes her sit there and think “Okay. So, I need bread, I need this, I need that.” And then she has other components that she can assemble her lunch very easily. So, as long as you know you have the stuff in the house then usually it’s not a hard thing. We tend to not put sweets in there because a lot of her teachers use sweets as treats like Starbursts or mini candy bars or whatever. And so I try to encourage them to just put a fruit in there or make it colorful you know. Do you want a little you know with your meal? Are you having a little bit a vegetable, a little bit of broccoli, carrots whatever and fruit and meat whatever? I love the bento box idea. The other reason I love bento box not just because it separates all the food but because like sandwiches can get soggy. So, if they take the peanut butter and jelly separate or even the meat in the lettuce and the cheese whatever and then they assemble it there at school. It’s not a soggy sandwich. So it’s really good in that way if you can separate or if you have a tortilla or whatever in there but it keeps it so it still taste pretty good when you’re eating it.

Janet Brancato: [00:21:04] Yes! It’s great idea. And most kids love them.

Mathea Ford: [00:21:08] On a completely different topic since we’ve been about healthy snacks, and eating lunch and gaining weight. A ketogenic diet is huge in the news. I mean it’s everywhere. I know a lot of people are like ketogenic diet. All those diets are terrible. And I want to take a minute and just think about in the shoes of the consumer, what are some pros and some cons related to the ketogenic diet? So a ketogenic diet is typically you know Atkins Low Carb diets, can be a lot of protein and a lot of fat and little bit of carb, Keto is specifically you know 70 or 75 percent fat and 20 percent 20 to 25 percent protein and then like 5 percent carb. And I think that’s really just because there’s residual carbohydrate in almost everything. So, they have no choice. So, it’s a very high fat diet and it does affect a lot of things. So, for me I was trying to go over what are some pros and some of the pros I thought of were you would eat more veggies because they definitely eat a lot of vegetables on there and less added sugar. Those are both really good things for your diet. Possibly more fiber with more veggies and it would help. It does seem to help stop or slow down cravings just because with more fiber with more volume you’re getting you know fuller and also the protein and the fat tend to make you feel full. Did you have any thoughts on the pros for keto diet?

Janet Brancato: [00:22:51] Yeah! I agree with you. Definitely it does help to clean up your diet because you’re removing maybe some of the processed foods, the sugary foods, can stop those cravings for sweet. You’re feeling nice and full and satisfied. So, I see with that is definitely you know is a bonus to this type of style eating. With all that fat, you’re definitely have been nice in full for a long time. It takes a long time to digest the fat. Though you are going to feel nice and full. So, definitely clean up your diet from what I was reading you know people do feel like they have more energy. You know they they feel like the fog kind of clears up in their mind. They kind of feel like they’re a little more can concentrate a little bit more so you know. So, they’ve definitely been pros. People losing weight and like I said I think the main thing is is that they’re tuned into like what they’re eating, they’re a lot more conscious of what they’re eating and they’re kind of cleaned up there, their diet.

Mathea Ford: [00:23:53] Yeah! Those cravings because I know that sugar craving is can be really strong. So, thinking through what are some of the cons of the ketogenic diet? What are some things that make it not the healthiest way to eat? I really feel like eliminating entire food groups is not necessarily healthy. So, typically Keto, you know you’re going to eliminate fruit altogether because fruit is got a lot of fructose carbohydrate in it and yet it also has fiber and lots of vitamins you know. So, it’s not necessarily healthy to just eliminate entire food groups. The long term compliance. I don’t know how. I don’t know what the typical cycle people have is but it seems to me like it would be difficult to do long term. Although once you maybe get a set of meals that you’re used to eating and you’re consistent you might be okay. You know except for maybe some quote unquote cheat days. So, did you have any thoughts on cons?

Janet Brancato: [00:25:00] Yeah! I mean I agree. You know eliminating food groups definitely kind of throws off the balance of things and by eliminating food group, you’re eliminating nutrients like you might not get all those B Vitamins that you get from the grains and you know that kind of thing. So, you know that balance of eating there could be like again that boredom of eating the same type of foods you know. And you know not getting that variety that you’re used to. So, it’s always that long term whenever you’re citing a bell you know making a change with your you’re eating. What is it? How’s it going to look long term? You know this is something you can do long term and then what about the social eating? And what about when you’re out with friends or family you know how has that affect it? You know so you can definitely. That can be a little hindrance as well. You know so those are definitely some cons. You know that I see as well just that on balanced eating and just the limited. So limited and restricted.

Mathea Ford: [00:25:58] Yeah! Also for diabetics you can’t just jump off the wagon or you know jump on the wagon or whatever you want to call it because you may be taking insulin, you may be taking metformin or other medications that are going to lower your blood sugar. And then all the sudden you’re not taken in any carb, you need to talk to your doctor for sure before you do that. And I don’t see a lot of people encouraging that for diabetics or people who even use different medications, you do need to talk to your physician because that sudden switch while it’s probably good in the long run if you’re diabetic you cut down on your carbohydrate and you have some weight loss. Those are beneficial things but definitely you don’t want it. A low blood sugar is a much more medically harmful situation and a risky situation than high blood sugar although you know there’s high blood sugar can be bad but a blood sugar of 200 is not as bad as a blood sugar 50. You know you’re. So you just have to manage that. And I think it’s important to understand that success is going to be a little different for everybody.

Janet Brancato: [00:27:14] Yes definitely! Yeah! Talk to your doctor first.

Mathea Ford: [00:27:18] And your doctor may not be on board with it but that doesn’t mean you shouldn’t have a discussion with them and say “I’m going to do this. Can you help me understand what I need to change or what’s going to do this or?” You know maybe at that point the doctor realizes “Okay, you’re serious about you know getting your diet in a better health. Let me give you a referral to a dietitian” then that might be a good thing. But having that conversation I was doing another podcast this morning and we were talking about medical marijuana and which were not plated on talking about today. But just the idea of talking to your doctor about it. And there’s going to be some pushback. Some doctors are not going to want to. They’re going to feel like it’s inappropriate to talk about or to encourage. And some doctors may be a little more open minded and say “Okay, you want to do Keto. This is whatever you’re going to change. These are the things you need to do. So I think that open conversation and not just changing is important.

Janet Brancato: [00:28:24] Definitely! I know that’s key with anything but I totally agree.

Mathea Ford: [00:28:29] So, another diet that does another life change is intermittent fasting. I’ve seen this on the Today’s show I’ve seen it on a lot of different things. Intermittent fasting can be a couple different things but it can be like a 10 hour an 8 hour window that you eat everyday. So maybe you eat from 10:00a.m. to 8:00p.m. and you don’t eat outside of those hours. You obviously drink water or black coffee. My understanding as well is okay but there’s some results that people have seen and there’s been research that shows that doing that daily intermittent fasting and then there’s also like every other day type of fasting where one day you would fast the whole day and the next day you would eat either healthy or whatever you wanted. But it said to affect your hormones like insulin, your adrenal hormones like cortisol, thyroid because once you start eating something I imagine that your body starts to worry about digestion and not about repairing and all those other things although it does that too but it stops its focus on those things and starts to focus on the gut. If you give it more time to work on relaxing or repairing or whatever then you see those results.

Janet Brancato: [00:29:51] It’s definitely interesting type of lifestyle you know and I didn’t realize until I started reading that there were so many different types of fasting. You know like you said they’re still alternate one and then there’s ones where you’re fasting for 14 hours or 16 hours you know. So there’s all different ones there’s one way of fasting 36 hours and then you have a cheap meal. So, there’s there’s really quite a few going on you know and again I know that they stressed in the article that you have to fight if you’re going to try something like this. It really has sort of be easy to do like it had to kind of be easy for your lifestyle. They also a lot of them said to start out gradually with the fast. Maybe you don’t follow the full amount of time but maybe start out with the fast for as long as you can and then maybe just eat something light. So, there is sort of little variations of it. I know they also stress that you know on the day that you are eating or the time period that you’re eating that you really try to eat healthy because obviously that’s the part where you’re nourishing your body and like you said you’re repairing and you’re you know so you don’t want to go from not eating having that fast to eating a lot of almost like a binge eating or a junk food eating. You know you really do want to make it a quality eating. Before finding good results. I mean again it’s another lifestyle change. You know I you know I question like you said the long term health what can you do something like this. But on the short term from things that we’re reading you know people are having positive results. You have to take all these things into consideration. If somebody does have an eating disorder or have a problem with food. You know this can make it worse so you do have to be careful obviously someone’s pregnant, they’re breast feeding this will not be you know any kind of lifestyle that you want to want to try out. But definitely you know it’s something that has become popular. Now we’ll have to wait and see.

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Nutrition Experts Podcast Episode 18 Work on Your Day to Day Habits with Esther Avant

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Esther is a personal trainer and nutrition coach who works primarily with compassionate women to help them lose weight and become happier, healthier, and more confident. She has a BS in Exercise Science from Boston University and a variety of certifications in nutrition and exercise but her best education has come from working one-on-one with hundreds of women to help them take back control of their health. You can find more about her, including her blog and services, at www.estheravant.com

Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way by using food starts today right now with our next guest. It’s great to have Esther Avant on the show today. Esther, welcome to Nutrition Experts.

Esther Avant: [00:00:45] Thank you so much. I’m really excited to be here.

Mathea Ford: [00:00:47] Esther I’m excited to talk to you today. Can you tell my listeners a little more about you and what you do?

Esther Avant: [00:00:53] I would love to. My name is Esther event and I am a nutrition coach and also a personal trainer. I specialize in women’s weight loss and my clients are typically what I refer to as kind of do gooders. They work in selfless fields like nursing, social work that kind of thing. Basically caregivers who just put everyone and everything before themselves. And we work a lot on breaking old patterns and habits and taking a multifaceted approach to not just losing weight but also become happier, healthier and more confident.

Mathea Ford: [00:01:26] So that’s a really interesting market because how do you get someone to stop putting everybody else ahead of them even though they know it’s detrimental to their health. Like you said they’re caregivers, they’re nurses, they’re other health care. They know that they need to exercise, lose weight, whatever. But how do you how do you start to get them to think differently?

Esther Avant: [00:01:51] A lot of it is in how you frame it that typically these women are so selfless that they don’t want to you know put themselves first. It feels like there’s so many other people I could be helping that’s not the best use of my time. But when you kind of reframe the thought into think about how much better able you’ll be able to help people or how many more people you’ll be able to help if you’re feeling your best, if you’re not tired, if you’re not missing work for medical appointments, if you’re just you know if you’re not feeling good overall how well can you really help other people? And I think putting it in that light helps women realize “Well, you know what? It’s not selfish to take care of myself. It’s actually doing the people who are relying on me a disservice if I don’t take care of myself because then I can’t help them as well.”

Mathea Ford: [00:02:40] So, what types of things do you usually start with when somebody is determining the best weight loss approach? You know how do you figure out what is the best way to help them with weight loss or if if that’s even not necessarily your first target so to speak?

Esther Avant: [00:03:00] So I think the most important thing in a lot of a lot of things but is is communicating. You know when I do an initial call with a new client I want to know, we know what their goals are and not just the surface value of all “I want to lose weight” but you know really why. What is the emotional root of your goal. Is it because you’re scared that you’re dependent on these prescription medications and you want to get off them to live a long healthy happy life? Is it that year that you feel like your weight is holding you back in your career and that if you took better care of yourself and lost some weight and were healthier you’d be able to advance? Things like that that a lot of times it’s not just about the weight, it’s about something deeper and more emotional. So, uncovering that is really important to start off and then I’m really big on not trying to squeeze a square peg into a round hole. And I think that’s an issue with a lot of the weight loss industry is that some coaches and some businesses can be really dogmatic in their philosophy that if you’re not following this type of diet you’re wrong. That kind of thing and it just ends up confusing people and ultimately paralyzing them into doing nothing. And really there isn’t just one way that works. Lots of things work. And it’s about figuring out what works for a certain person and more specifically what works for that person at this time in their lives. And if I were to marry to a certain idea or assumes certain philosophy and I would be doing my client a disservice. So, I think the most important thing at first is being open minded and recognizing that there is no one way that’s going to work best for everybody. And we both need to recognize that. That you know in the short term kind of something more cookie cutter approaches often do work but when you start thinking long term or about how to not gain the weight back that’s when it becomes a different story. And it’s a matter of being able to stick with something long enough that you reap the benefits. So in my coaching calls with clients or in our initial meetings or even just in a lot of blog posts and content that I put out, I encourage women to think about a number of different things but you know one being are you someone who does well with moderation or do you feel like if you give yourself an inch you take a mile? Balance and moderation are like really involved but they’re not necessarily the best idea for everyone. And there was actually a Gretchen Rubin book that talked about these different personality types and how some people just operate better when they give themselves more black and white guidelines. So, just as an example like there’s nothing inherently wrong about eating at night. Calories are still calories it doesn’t matter what time of day. So, there is no like scientific reason necessarily to stop eating at a certain time. But some people actually find it easier to house just a personal rule of “I don’t eat after 8.” And it’s not because those calories will immediately show up on their thighs or anything like that. It’s just because it’s easier than bargaining with themselves night after night about whether they should have dessert or have a snack. So, the same thing goes for weight loss approaches that eliminate or restrict certain foods, certain times of eating. Maybe the whole thing just feels easier if you don’t have to think so much about it and you just follow the “rules.” So that’s one thing to consider is do you like having rules or do they just buy their existence does it make you want to rebel against them. So that’s a factor that can play into what kind of approach you take. Another thing is are you drawn to a more introspective kind of touchy feely approach or are you somebody who likes numbers who likes hard data because intuitive or mindful eating is an approach where you pay close attention to your body? What it’s telling you it needs, how you’re feeling if you’re eating for reasons other than through hunger? How different foods make you feel things like that. And working on becoming a more intuitive eater is a skill that really would benefit all of us. But for some it comes easier than others. So, someone very in tune with her body and her emotions might really thrive in that kind of intuitive based approach. Whereas, if you have somebody who really likes numbers likes having data and target them being really specific then someone with that kind of drive might go absolutely crazy trying to be more intuitive right off the bat. It might feel really intangible and out there and they would do better focusing on something numerical. Whether it’s calories or macronutrients while learning about the energy content of foods and things of that nature. So that’s another consideration is do you prefer to introspect and rely on your intuition to guide your food choices or would you rather take more numbers based approach?

Mathea Ford: [00:08:04] You reframe a little bit and you talk about how it’s going to be better to be healthier and lose weight and they agree. But how do you really get that commitment because I think we all know it’s better and of course if knowing was the way to lose weight we would all be thin. But how do you get to that agreement or commitment to do the things that they need to do whatever they are? Mindful calorie restriction, not eating certain times. How do you get to that?

Esther Avant: [00:08:37] That’s something that in earlier in my coaching career I struggled a lot with the like “I know what these people need why won’t they just listen to me and like do what I say?” And through the course of various certifications and continue education, I was introduced to this a theory or a practice called motivational interviewing which helps someone like me help a client make their own choices and decisions that just by human nature if you go to the doctor and he says “you need to start eating better because you have high blood pressure.” You’re going to smile and nod and you’re probably going to continue doing what you always do. And that’s because you know that’s kind of being dictated to you is like “you have to do this!” Well, “I don’t want to I don’t want you to tell me what to do.” And the same thing goes with working with clients in my field as well that if I were to just tell you you have to do this because it’s good for you you don’t have the buy in. Really. And the buy in comes from I think to two things. One, is uncovering that emotional reason for their goal that you know you’re not just doing this because you want to lose weight. You’re doing this because you want to live a long life to see your grandkids grow up.

Esther Avant: [00:09:58] That kind of gives you some some perspective into an emotional root of “why we’re doing this again? Oh yeah. It’s actually really important to me because of this reason.” And the other thing is to work with the client to have them figure out what they want their next step to be is “I’m not going to tell you this is what you have to do. We’re going to figure out together what do you want to do.” And even if it might not necessarily be what I think is the best first step. I will kind of gently say “here’s my suggestions. What do you think about this or you know where would you like?” I can lead the conversation but ultimately at the end of the day if the client’s decision just say “here’s where I want to start. This is what I want to focus on.” And better to be consistently doing something in the right direction then having all of these starts and stops where you don’t really make any progress. So, even if I think okay this person has you know a major they’re drinking so many liquid calories it would make a huge difference if they just you know quit the capuccinos and put the soda. You know if I present that as a as a possibility and they absolutely shoot it down. Okay, then we’re not going to start there. Where feels comfortable to you? What are you willing to work on right now and let’s just take it from there and that way you’re in charge. You were the catalyst behind the change. I’m just kind of guiding you along the way.

Mathea Ford: [00:11:28] So how do you talk to people who really want this tomorrow? Like they want. So, you know there is on one hand there’s people who are willing to take small steps and understand that it’s them to use often used phrase “it’s a marathon not a sprint.” What about those people that are like “oh, I want to do I’m going to do my start exercising 60 minutes a day and I’m going to get up and meditate for a half an hour and I’m only going to eat 1200 calories. And they’re going to do everything right now. How do you manage that? Or maybe you don’t ever experience that?

Esther Avant: [00:12:04] The vast majority of clients do exactly that and I’m guilty of it myself in other areas where you just like “I want this! I want it now! And now motivated, I’m going to change everything and it’s going to be great. And today my life changes” and you know we all from experience that is rarely how it pans out. So, I think you’ve identified two really important things here. One, is having unrealistic expectations. And two, is trying to do too much at once. So, on the realism front, we have a conversation about you know with regards to weight loss. Specifically with you know what is healthy realistic weight loss. Reality shows like on The Biggest Loser was in its prime. It was really skewing people’s expectations because you’d see somebody losing you know 24 pounds a week and you’d think “Okay, well I’m not on the show. You know I have my life going on maybe I’ll only lose half that. Maybe I will lose twelve pounds a week.” And then when you lose two pounds which is actually you know within a very healthy and safe range, you feel like an absolute failure.

Esther Avant: [00:13:11] You’re like “I lost two pounds out of my 12 pound goal. What am I doing wrong or get this?” So part of it is just education on what even is realistic. And the second part of addressing doing too much at once. One of the most successful approaches that I’ve ever taken and I use it on myself all the time is somebody says you’re like you’re saying “I’m going to wake up at 6 AM and I’m going to meditate, I’m going to exercise everyday and I’m going to eat all these vegetables and I’m going to do everything perfectly” is you know all this I’ll smile and nod and I’ll say “Okay. On a scale of 1 to 10, how confident are you that you can do that this week? Whatever that goal might be?” And typically when you I don’t know if it’s the sliding scale or what but typically when you ask somebody to assign a number to it they actually take a step back and they’re like “oh. You know what?” I’ve had clients say before like “I think I’m like a 4” like “Okay that’s fine. But what if we scaled the goal back to something that you’re more confident you could do? Do You think it would feel better and might be more motivating if you set a smaller goal that you just knocked out of the park? As opposed to set this like really ambitious goal and then fell short? Because what I see time and time again is you missed a day you said you going to do everyday. You miss a day. You feel like a failure. You skipped the next day and then you end up like in that cycle where you know every Monday you’re starting over again. So, what’s more realistic? What do you 90 percent confidently you could do? What’s a nine out of a 10? And I mean scaling it way back. It might mean I think I can do one day this week. “Okay, great! Then do that one day. Give yourself a pat on the back. That’s your accomplishment. Feel good about it. And then when you feel ready this upcoming week what’s your next goal? Make it a little bit bigger. Do you think you can do a second day? Do you think you know whatever it is” and not just you know setting those more realistic goals but also addressing preemptively what obstacles you might foresee. So, you know say you’re only going to do one morning to work out next week. What happens if you don’t? What if you set that morning and you sleep through your alarm? What’s your plan B? So, it really comes down to having that realistic plan of attack, anticipating the obstacles that might occur and then being prepared to handle them when or if they do happen. And you’re literally what it boils down to is set goals that are action based. Make them so small that they’re almost Fail-Safe, meet or exceed your own expectations and then set the bar a little higher the following week. And it can be challenging at first to wrap your head around like you want me to do less like “This is never going to work. I need to do more.” But typically it only takes a few weeks of that consistent behavior to be like “wow! You know what I’m really experiencing a snowball here! That just the fact that I’m accomplishing my goals is motivating me to be more health conscious when I’m eating to walk more to all sorts of things and just kind of snowball” and it just stems from getting that early win and building some confidence yourself.

Mathea Ford: [00:16:20] When you’re talking to your client, how do you help them to really figure out what is going to work? Because I guess in a way like we all know kind of the things to do exercise, eat right. But how do they figure out what’s working for them and then how do they measure that? Like do you help them to be able to see the difference between like you started with once a week exercising, now, you’re at 5 or how do they figure out what’s going to work to help them to achieve that goal whatever it is?

Esther Avant: [00:16:51] The starting point is having a conversation about what has or hasn’t worked in the past is just as example you know a client will come and say “I’ve lost 40 pounds of weight watchers three times.” And so you have to keep losing the same weight over and over again. Has it really worked? Like you don’t want to be beating your head against the wall during the same thing over and over and wondering why it’s not working. You want to learn from your past and use that as your guide to guide your future decisions. As for how to determine what’s working, I’m a big advocate of data collection and using a variety of Progress Indicators. A lot of times women are very caught up in the scale which is totally normal but you know a lot of us know that we don’t necessarily have the healthiest relationship with the scale. That it can make or break your day. It can make you feel like either a success or a failure but everything is kind of riding on that number. So, with some clients who have a history of disordered behavior with a scale all incurred to not even use it at all. But even when we do use the scale it’s in conjunction with a variety of other indicators so I really like using circumference measurements because those are a really good way to see changes in your body that you might not pick up on otherwise and kind of see that recomposition where maybe the scale isn’t moving much but it’s because you are dropping Fat and putting on muscle and the shape of your body is changing. Even though mass isn’t necessarily.

Esther Avant: [00:18:29] I’m also really a big fan of progress photos which oftentimes clients are reluctant to do either initially or always but I have never had a single person tell me that they regret having the pictures and as hard as they might be to take in the beginning they can be so telling that when you hit you know inevitably you’re not going to be motivated all the time. Never they are going to have these times where you just kind of grinding along and you’re like “Oh! I’m Still doing this and I feel like I’m not seeing any changes.” When you have those pictures to compare, it can be undeniable. Similarly, how clothing fits. They’ve had a lot of clients, not even doing that really intentionally but you know they’ll put on a workout shirt that they wear all the time and they’re like “Huh! This has to be way tighter. This is sitting differently now” or belt loops or things like that. So those are kind of the the number base means of gauging progress. And then I think it’s really important to also focus on other stuff too. Like you mentioned energy levels. Are you hitting that 3:00 PM slump or are you feeling like you can power through the day? Are you sleeping better or longer or falling asleep more easily? The gym is a great way to gauge progress is a lot of my clients start off having pretty minimal recent work out experience and no go from either being unable to do certain things or from using a very light weight and they can just see over time. I used to do five pounds on this and now I’m doing 20 or I used to have to walk after three minutes jogging and now I can jog a whole mile. There are just so many things besides the scale that can help us determine whether we’re on the right track. And I work with clients to figure out what’s important to you. How will you know if you’re being successful? And yes if you want this girl to be a factor at but what else? Even if you know if you’re goal weight, if your dream body was 10 pounds heavier than the number you thought it would be. How would you know that you were successful? What would that look like? What would that feel like? What would your life be like? And then those are the things we look at week after week to say “okay we’re trending in the right direction or you know what? We’re not seeing the results that we want. How can we shift gears to be more successful?”

Mathea Ford: [00:20:52] What are some of the consistent changes that you’ve seen people make? You that you’ve been doing this for 12 years at least and the changes people make that seem to work best in the long term. I know that individuals have different things that happen but just a pattern, have you seen a pattern or anything that consistently works over the long term?

Esther Avant: [00:21:14] One of the things I think is really important in the long term is knowledge about the energy content of food and I’m not an advocate of counting calories or tracking macros indefinitely. But I think as a tool it can be really useful because a lot of people you know if I say if I even say the word calorie or macronutriet, they don’t know what that means. They don’t know what appropriate portions are. They don’t know how their lifestyle, their activity level, their job, their age their sex, their gender. They don’t know how that plays a role in how much food their body needs. So, I think the clients who are willing to be educated on just kind of the nutrition basics do really really well in the long term because those are tools, those are skills that serve them long after they’re tracking where they’re weighing or measuring. I think within that specifically learning about appropriate portion sizes is really important and that can be as numbers based as using a food skill or it can be a little bit more practical in the day to day sense in that you use your hand as a guide. “Okay, I want my protein to be about the size of my palm. I want the serving of fat to be about the size of my thumb” but just gaining that awareness. I guess that’s if I had a pick with an overarching theme it would be awareness. That clients who are willing to pay attention and be mindful and increase their awareness on health related things do best in the long term and the ones who are willing and able to make the connections between “oh I started doing this and as a result I’m feeling this. Therefore, I should keep doing it” using that kind of you know logical deduction makes a big difference. And then I guess I have to be more specific. Clients who prioritize having a lean protein source at most if not every meal do well in the long term. Clients who prioritize eating a lot of vegetables do well in the long term. Clients who make an effort to slow down when they’re eating actually chew their food, actually taste it, allow the digestive process to do its thing and pay attention to “am I stuffed or can I cut the brakes a little bit sooner so that I’m not feeling like I need a nap after a meal.” That’s a really important thing and obviously an exercise habit is something I feel pretty strongly about but even outside of that clients who are successful long term often embrace just kind of the active lifestyle overall. And I don’t mean like you go for century bike rides in your downtime. I just mean you’re inclined to “hey!I have to go from one end of the mall to the other, I’m going to walk instead of repass my car or I’m only going up two floors, I’ll take the stairs its probably faster anyway.” The people who are willing to just kind of embrace you know “Yeah! Give them a little bit of activity whenever I can.” That typically makes them successful in the long term as well.

Mathea Ford: [00:24:35] I think those are great examples. And it’s interesting because it’s truly what we’ve known for a while but once you kind of embrace it and understand that the calorie portion thing can be huge because you don’t pay attention to how much is in something usually.

Esther Avant: [00:24:55] Right! And We have all these processed foods now that you know if you’re talking only about whole foods, your body is able to self regulate pretty well. You know those foods are relatively high volume you start to feel full or satisfied around you know what your body needs for portions. And then we get into these like super processed foods that you’re not going to feel full after a serving of chips. You’re right is not going to be like “Oh I think that’s enough.” It is going to keep eating until you reach the bottom or you run out of time or something happens. So, you know just kind of our internal checks and balances aren’t able to work as well with foods that are made in labs with who knows what.

Mathea Ford: [00:25:36] Many people probably come to you and they’ve been cyclical dieters. So, they’ll diet like you said they lose the fame 40 pounds on Weight Watchers and Weight Watchers is neither good nor bad it’s just how you manage it. But what do you think seems to keep people from continuing that healthy eating and exercise plan once they’ve seen some success like why did they fall off the wagon?

Esther Avant: [00:26:03] I think one part of it is I guess probably subconscious like self sabotage. That if you’ve been wanting to lose weight for a long time and you kind of convinced yourselves that “once I am this weight you know everything is going to be better. I’m going to find love and I’m going to get promoted. I’m going to you know whatever it is” that we kind of in the back her mind somewhere are scared of reaching that goal because what if you reach that goal and it doesn’t change everything? So, sometimes it can be easier to not reach it and not have to be confronted with that possibility than it is to go full force ahead. And then get there and potentially be like oh “I’m thinner but not much else has changed.”

Esther Avant: [00:26:47] That’s one part of it I think. Another is that I used to be very opposed to any kind of short term diet or goal or anything like that and I’ve changed my thinking on it some because I get the appeal of seeing early wins, seeing results kind of proving to yourself that you can do something that you can do this. So, I understand wanting to undertake you know a challenge for 21 days or for a month or something like that or to sign up for you know a diet or a weight loss program that you just kind of do as you’re told. I think the main issue that causes people to fall on and off the wagon and just be in that cycle of “lose it,stop doing anything, gain it back, repeat” is that there’s not really a transition plan from what you’re doing to lose the way to how you’re going to keep it off. I think that’s really the missing piece for a lot of people is you know it’s okay if the way you’ve lost it is in maybe sustainable for the rest of your life but you need to have that plan in place to help you get to something that is sustainable in the long term.

Esther Avant: [00:28:05] So, if you do Weight Watchers and again I’m not necessarily opposed to Weight Watchers either it’s just easy example. But you know if you if you lose the weight with Weight Watchers and then you’re like “Okay, I’m at my goal now I don’t need this anymore.” You need to do something to stop you from just reverting back to what you did before you lost the weight. And that’s I think where the importance of working on your day to day habits in conjunction with whatever else you’re doing is really important that hopefully, however you’ve lost weight has also been teaching you things like we were just talking about portion control and macronutrients and listening to hunger and fullness cues and things like that being more active in your day to day life. So that by the time you are at a healthy and happy weight you are also equipped with all the skills that you need to maintain that weight loss just by kind of continuing to do what has become second nature.

Mathea Ford: [00:29:07] Well I know I know about Weight Watchers, they do have a transition program and you’re able to stay and come to meetings and over a period of time to help you sustain that but it does seem to be that you need to change some on the inside as well. The stress and the anxiety and whatever factors it was that caused you to over eat after change either your reaction to them or you have to change what’s going on. Those are the things that we don’t necessarily associate with why we’re overweight but they’re definitely associated with why we’re overweight.

Esther Avant: [00:29:45] Absolutely! 100 percent. You need to confront the root issue at some point. And I think you know one of the main issues with a short term approach is that it can just be a bandaid that you know you can kind of push yourself through anything for a few weeks. You can tell yourself you know “I committed to this program. I’ve paid a lot of money for it. I’m going to make the most of it.” You can do that temporarily but if then afterwards you revert back to snacking in front of the TV every evening then those results are going to be short lived. So, you’re absolutely right that at some point you need to be confronting “How did I end up here?” What’s really at play? You know I am an emotional eater? And if so how am I going to walk through those emotions in the future in a way that will not leave me putting the pounds back on? And that’s where you know hopefully you’re working with someone qualified to help you do those things kind of concurrently that you know. “Yes! We want you to start seeing the weight come off. We want you to see that what you’re doing is working.” Of course we want you to be motivated to keep putting in the work. But at the same time, we also do need to be turning in a little bit and figuring out you know “Okay, what pattern’s are there? What habits do I need to break? What do I need to work on changing within myself that is going to give me a different result long term?” Because if you look at a lot of research there there’s no shortage of ways to lose weight. The main issue is maintaining that. So, you need to have that longer term outlook. It’s you know it’s not going to be fun, it’s not glamorous to assess why do I eat when I’m sad. And that’s why we don’t want to do it because it’s hard and it can be emotional and there’s no easy answer. Nobody can just tell me “here’s what you do” but if you really want those changes to stick then you do have to get a little bit introspective and figure out “okay, what’s going to be different? How am I going to change literally from the inside out to make it so I am a person who doesn’t have to struggle everyday to keep the weight off?”

Mathea Ford: [00:31:58] When you think about that as far as having like a healthy life and weight loss, how do you help people measure that? Like we talked a little bit before about what are their goals, what do they want to do, motivational interviewing, what are they willing to commit to. But how do you how do you measure that you’re now healthy so to speak?

Esther Avant: [00:32:18] There’s an obesity doctor in Canada almost positive name is Gianni Freedhoff who wrote a book I read years ago about weight loss and obesity. And in it he talks about how the goal for all of his patients is for them to live the healthiest life that they enjoy and that has stuck with me for years and I’ve used it over and over again because I think that’s what it boils down to is you know everybody’s healthy life is going to look a little bit different that you know to a lot of people they would kind of look at my life, my activity level, my diet and be like “Wow! She is like super into that stuff.” And you know there are certain other circles that would be like “Oh! She’s never done a marathon, she’s never done an iron man, she doesn’t eat by a certain way, you know she’s just a recreational healthy person.” So there’s just such a spectrum of you know whatever your norm is. And I think it’s just about taking someone from their current norm which is you know by their own admission, less healthy than they would like it to be. And figuring out how much can we cripple up that spectrum until you reach a point where you like “you know what? If I keep changing more, I’m going to totally hate my life.” And that’s the conversation that I have had often with clients and especially with a relatively thin women who say or you know wanting to lose the last two three or five pounds or get down to a certain body fat percentage is you know that’s possible. “It certainly is doable. I know you’re willing to work hard. You are physiologically capable of doing that. But is it worth it to you? If going from where you are now to that last little bit means sacrificing so much more of your happiness then is it really worth it?” So, sometimes it’s about figuring out “you know what? I’m doing pretty well most of the time and that’s good enough for me that you know I have an occasional drink, I have an occasional dessert. I don’t feel bad about it but overall my habits are pretty healthy then great. Then that is a healthy life and a healthy weight for you. I think the issue is when clients are too far one way or the other. Either they’re obsessively exercising and counting every morsel that goes into their bodies or they just seem like they don’t care at all about their health and it’s just about kind of working towards the middle until you strike your personal balance where you’re like “you know what? I’m doing pretty well. I’m pretty healthy. You know I don’t have any major health concerns and I’m doing the best I can and I’m also enjoying this kind of living and being social with people that I love and care about. And you know and that makes me happy.” And that’s where balance is.

Mathea Ford: [00:35:15] Yeah I was going to ask you kind of how do you help them figure out what is out of balance and what is good balance point?

Esther Avant: [00:35:23] That depends not just on the personal also like where they are in their lives that you know it’s okay to be off balance sometimes. And if you can read a lot of places that there’s no such thing as balance that something is constantly getting more of your attention. So, it’s instead of like a seesaw perfectly balanced it’s like you’re kind of going between one side is higher and the other side is higher. And as long as you’re sort of rotating between priorities then you know there’s no such thing as perfect balance. So there’s that too. Like for example if your daughter is getting married and you’re like I want to look like the hottest mother of the bride that you know this family has ever seen. Then, you know maybe that’s a time that you are going to be a little bit more or even a lot more concerned and you know caring about what you’re eating, how much you’re exercising and maybe it’s not sustainable long term. But you find a dress that you love. You look awesome in it. You look amazing in the pictures, you get tons of compliments and you feel great. Then, you know then that was balance for right then and then as long as you’re able to transition back to something that will help be healthier in the long term. Where you like “Okay, I’m going to ease up now and I sacrificed a lot of time at work or with my family because I was at the gym so much. So, now I’m going to devote more time to my job or to my family and kind of let that take a backseat like I’m not going to not a turn a dial all the way off. I’m going to stop from going, I’m just going to rebalance, we’ll recalibrate a little bit. That’s big. Its just figuring out like “okay, right now what do you feel like you can do?” Something a use often with clients is the idea of bare ass minimums or we call them BAMs and figure out like there are going to be times that you know you are slammed at work. If you’re accountant and you’re an accountant and it’s tax season and you are working 16 hour days. What’s the minimum effort you can put to your health that you can still feel good about at the end of the day? Maybe it’s making sure you eat a vegetable at dinner. Maybe it’s making sure you walk for 30 minutes at lunch. There’s always going to be kind of those ebbs and flows in what gets more of your attention. And I think as long as you’re able to move from you know flow from one to the other without shutting anything completely off then you’re in a pretty good place.

Mathea Ford: [00:37:50] What are some ways you think that our listeners could use the information we’ve talked about today in their day to day life? Whether they’re seeing clients, seeing patients or just for them personally? Do you have any kind of overarching ideas about how they could use it?

Esther Avant: [00:38:06] Yeah I have a few. First one being to learn from your past instead of repeating the same mistakes. If something doesn’t sit right with you, you don’t have to do it even if you know half your neighborhood has success with it. There are plenty of ways to skin a cat. Be open to destroying a bunch of things and see what’s going to work for you. And that goes right into the second one which is to keep an open mind. If you’re curious about something and you’ve done enough research to know that it is safe, give it a shot. Treat it like an experiment. You don’t need to be married to a certain approach and be willing to admit when or if it’s not working for you. Its just kind of there’s nothing to say that you can’t try something and give it your best effort for a month and say “you know what? That wasn’t for me. I did my best and I just don’t see it. I don’t see a penny out. I’m going do something else.” There’s nothing wrong with that. Keep an open mind about you know you might have certain thoughts about how you have to do this or this is the only thing that’ll work. And you know this kind of be open to having your mind changed.

Esther Avant: [00:39:13] And then I think the last thing is something that we’ve talked about but is so important that it bears repeating is that at the end of the day, no matter how you approach your weight loss the most important thing is that you’re simultaneously working on building the habits that will allow you to keep the weight off when you stop dieting. So, that means finding ways to incorporate regular movement and healthy foods into your day to day life in such a way that they don’t feel like a chore or something that you’re being forced to do. They just become what you do.

Mathea Ford: [00:39:44] I think those are great ways and we sometimes as a dietitian personally I get very focused on what does the research say, what is kind of the medical approved way or whatever. But if I pay attention to the other things outside of that, I can learn things from there, I can improve things and that’s also what my clients are listening to so I need to know a little bit more about them. Maybe even you know think about how it would work in real life just so that I can empathize and understand what might be thinking about too so.

Esther Avant: [00:40:28] Yeah, I think those of us with you know the degree, you know the science degree and the background and you know the better kind of scientifically minded and like are interested in the research. It can be hard to kind of shelf that and think about it from like practical points also is that like “Okay, you know just because research indicates something doesn’t mean that there is no validity in you know what this client is saying or what I keep jeering. And you need to kind of figure out where you know where you mesh the anecdotal and the scientific to you know to not forget that you’re working with an actual person not you know a lab rat.

Mathea Ford: [00:41:12] Yeah absolutely. So, Esther I always try to ask my guests what is your favorite food?

Esther Avant: [00:41:20] Well so I’m pregnant right now. And I think that all my favorite foods are just the ones that I can’t have. So I want a rare steak. I want some sushi, I want some Poke which is huge here in Hawaii. So, those are big right now just because you always want we can’t have. In general though I’d say my favorites would be kind of run the gamut here. So, potatoes, eggplant farm, pork nachos and sour gummy candies.

Mathea Ford: [00:41:48] Those are some really good. What’s pork nachos? Just nachos with some pulled pork on them?

Esther Avant: [00:41:54] Yeah.

Mathea Ford: [00:41:54] Okay. And I personally don’t know what Poké is. So, what is it?

Esther Avant: [00:41:59] So, it’s raw fish like cubed raw fish. Typically Ahi but you see salmon sometimes and octopus sometimes. What is that like with sesame oil and like chive or green onion. Sometimes there’s a spicy kind that’s like with some kind of Mayo. It’s kind of it’s similar to like a like sashimi just chopped up with some stuff. Yeah but it’s so good.

Mathea Ford: [00:42:24] That explains why I don’t know what it is because I do not eat fish in general but I don’t eat raw fish for sure.

Esther Avant: [00:42:33] Probably, not for you then.

Mathea Ford: [00:42:35] No, probably not. But I always find it interesting what is kind of trending and people have started doing kind of these smoothie bowls and just everything bowls putting together stuff. So, I think that that’s a great. That’s awesome it used to be wraps you know. It used to be anything so. It’s great! As long as if you want to try new things and you can make it healthy that’s great! So Esther. Thank you so much for being on the podcast today. It was a pleasure to have you on the show.

Mathea Ford: [00:43:10] I know my listeners have learned a lot about just thinking differently when it comes to even just changing habits not necessarily weight loss but changing habits for the long term, thinking about thinking differently about how that works long term. So if listeners want to connect with you what is the best way to do that?

Esther Avant: [00:43:29] The best way would be my Web site which is EstherAvant.com. I’m also on Facebook my business page is Facebook.com/EstherAvantWellnessCoaching. And I’m on Instagram where I do a lot of those infographic content and my handle there is @Esther.Avant.

Mathea Ford: [00:43:53] Great! Thank you so much!

Esther Avant: [00:43:55] Thank you. It was a pleasure to be here.

Mathea Ford: [00:43:57] Well guys this has been another great episode of the Nutrition Experts Podcast. The podcast that is about learning more so you can do more with nutrition in your life.

 

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Nutrition Experts Podcast Episode 17 Cook With Me TV with Ashley Thomas, RDN

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Ashley is a Registered Dietitian in Charleston, SC with a passion for cooking and helping people become more connected to their food. She is the founder of Cook With Me TV, a live stream cooking show run by Registered Dietitians where people cook alongside the RD in their kitchens.  Ashley also has a private practice called The Fresh Beet Nutrition where she specializes in helping people post-kidney transplant ease back into a balanced way of eating and better manage the cravings and weight gain that come with post-transplant medications. Her social media networks are dedicated to helping clear up the misinformation surrounding nutrition and reduce the anxiety people have about food. She believes that a truly nourishing diet is one where both kale salads and glazed doughnuts have a place.

Mathea Ford: [00:00:27] Hi there. It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Ashley Thomas on the show today. Ashley welcome to Nutrition Experts. I’m excited to have you on the show and share your expertise with my tribe.

Ashley Thomas: [00:00:48] Thank you. I’m so happy to be here.

Mathea Ford: [00:00:51] Ashley we’ve been talking for a few minutes and I love what you’re doing with all the things that are related to Facebook and teaching people to cook but we’re going to get into all that. But I would be excited for you to tell my listeners a little more about you and what you do.

Ashley Thomas: [00:01:07] Sure. I am a Florida I’m a Floridian born and raised in Florida. Done a little bit of traveling and have been transplanted here in Charleston, South Carolina where I have a private practice and I specialize mostly in seeing a post transplant patients post kidney transplant. And I also hope people prevent or reverse lifestyle conditions like heart disease and diabetes by helping them follow a sustainable plant based diet as well as a couple of other things like helping them better manage their stress levels and having them practice some intuitive eating techniques because as you know and a lot of other health professionals out there simply having someone a black and white meal plan doesn’t always get the results that we want. So, I know that behavior change is crucial and we can only really change diet when we dig deep into stress management and all the other issues surrounding what we eat, how we eat and why we eat and so on that behavior change train. As part of my practice, I also help people put their meal plans into action. And I do that with a lifestream cooking show that I just started in January, its called Cook With Me TV which is essentially like taking a cooking class but in the comfort of your own kitchen so people can grab the recipes ahead of time. Tune in to our Facebook page and actually cook along with us and the benefit of doing it live is that they can ask the dietitian questions in real time and get the answers. We’ve also got a lot of other people tuning in. So there’s a community aspect there. There might be someone who’s going through the same thing you’re going through and you can talk to them about it. It’s a really neat resource that I’m so excited to share with people and we’re just really trying to get it out there and get more people using it.

Mathea Ford: [00:02:57] I think that’s great because a lot of times people are on Facebook and you’re still looking for interesting things and communities and so can you talk a little bit about how that works? What you guys do to make the Cook With Me? You know you said you post your meal plans then and then you cook, how does? Do you do certain days or what?

Ashley Thomas: [00:03:17] Yeah. So every Friday we post recipes on our website which is at cookwithme.tv and you can head to that recipe page of what we’re cooking the next week and you can click on the recipes that you would like to plan to cook the following week and then at the top of the page you’ll click My Shopping List which will auto generate a grocery list for you based on the recipes that you’ve chosen. So it also makes your grocery trip a lot less stressful. You can either print out that grocery list or you can just use your mobile device in the grocery store and just kind of click off the ingredients as you get. And then you know the following week when it comes time to actually cook your meals you will see on her recipe the date and the time when we’re cooking so you know when to tune into Facebook and join that live show. We’ve dietitians. We have a total of five dietitians on the show cooking right now and we have shows Monday through Thursday. We have two shows on Monday, Tuesday and Thursday and then one show on Wednesday and we are continuing to grow so we’ll have a few more slots open there.

Mathea Ford: [00:04:24] So what inspired you to start that?

Ashley Thomas: [00:04:27] So I really wanted a brick and mortar style teaching kitchen is really where this all started. And my husband is sort of in this with me. So we’re driving around Charleston trying to look for a place to actually open up a teaching kitchen you know making sure that it’s got everything you would need for that. It was pretty difficult to find something and things that we did find were very expensive. And as we thought more about that business venture, we realized that it would likely be very costly and we wouldn’t really reach as many people that we wanted to reach. And so that’s why we thought that doing it virtually would let us reach a lot more people for reduced cost. So we decided to turn it into a virtual teaching kitchen and that’s kind of how Cook With Me was born.

Mathea Ford: [00:05:12] Are they made for special diets these recipes or they kind of general recipes?

Ashley Thomas: [00:05:17] They started out pretty general and right now they are still pretty general sort of you know balanced eating. We don’t really promote all of those fad diets that you see today like the Keto diet, the Paleo diet, Whole 30 or you know low carb, low fat any of that stuff. But we do you know the dietitians that are on the show have their own specialties. So for example, one of our dietitians specialises in gut health. She’s actually a food sensitivity dietitian so she talks a lot about food sensitivities on the show and what you can do to improve your gut health. Another dietitian we have is specializing in prenatal nutrition. And so she talks a lot about you know what nutrients are crucial in that phase of life. We do have dietitians that are specializing in we’re going into the direction of making that more apparent so that we can capture the appropriate audience that would benefit from the service.

Mathea Ford: [00:06:12] You talked a little bit at the beginning about helping people get a more plant based diet and can you talk about how that’s different maybe than a vegan or a vegetarian diet because I hear plant based diet a lot but I don’t know that people necessarily understand what the difference is. What is it?

Ashley Thomas: [00:06:31] Yes! I’m so glad you asked this question because I hear this and I see this all the time and people do believe that plant based eating means vegan and it does not mean vegan. I think that there are many websites that are vegan but also call themselves plant based which is perhaps where this has come from the confusion surrounding what plant based eating is. But for me and for most of the dietitians that I know, plant based just means that your diet as a whole is heavily based on plant foods not that you don’t ever eat any animal products. The majority of your plate at meal time is filled up with plant foods and then maybe you have some more products like meat or cheese or seafood kind of sprinkled in there to ensure adequate protein and to sort of enhance the meal. So, instead of our standard American diet that we see today where meat is you know the star of the show. The plant based eating it switches it and really the plants are the star of the show and the meat is there to flavor. And as we know as dietitians know rather plant foods are so nutritious for us. They help with a slew of chronic conditions that we’re seeing today and so if we can somehow help people shift their mindset into seeing their plate as you know more plant based and less animal based than I think we can do a lot in reducing the chronic diseases that we’re seeing today.

Mathea Ford: [00:08:04] What are some of the changes that people can make if they want to eat a lot more plant based? And what types of conditions might that be best if you’re thinking along those lines? What conditions would be most helped by a plant based diet?

Ashley Thomas: [00:08:20] Yeah! I think that’s one of the things people can do to transition into eating a more plant based diet is to first assess you know how much animal products are you eating for one. So, how large is that meat portion that’s on your plate? Are you eating a 12 ounces steak pretty frequently or are you eating even like eight ounces of chicken. The chicken breast today at the grocery store are huge. And a lot of times you get you know 8-10 ounces in a chicken breast when really your body only needs about four ounces at a time. You know it packs almost 30 grams of protein and just four ounces of chicken so it’s plenty of protein. So honing in on the size of your meat is one place to start. And then I’m sure people are thinking and actually people have told me this after I’ve given this recommendation they’re like “well, I’m going to be hungry after that. You know what else do I eat?” And so that’s where the plants come in. So then fill in the gaps with starchy vegetables, non starchy vegetables, whole grains, beans. Scale back a little on the meat and then fill out the plant portions. And for the types of people that would benefit from plant based diet, honestly, I think most people can benefit from a plant based diet. But the literature does show that people who have high cholesterol or Hyperglycemia or elevated blood sugars can greatly benefit from a plant based diet because they’re giving us a lot more fiber specifically soluble fiber which we know helps to actually lower cholesterol levels in the body. We know that fiber helps to better regulate blood sugars. So you know high cholesterol, diabetes and really honestly anyone especially if you’re trying to prevent disease.

Mathea Ford: [00:10:02] Well, I totally agree with you that everybody could benefit from just even adding a little more. So what are maybe some ways people could be a little more plant based if they’re interested in it but they’re not sure they want to jump off that cliff? I guess it’s not cliff but you know what.

Ashley Thomas: [00:10:19] Yeah! I always start with breakfast. I feel like breakfast is the perfect way to start eating more plants because it’s oftentimes easier than a lot of the other meals. Personally, my go to is oatmeal and you can really can really do it up with me also you know starting with about half of a cup of oats cooked in milk. But it’s really what you top your oatmeal with that makes or breaks it if just a plain old oatmeal that’s technically plant based but you’re not really getting a lot of nutrition in that. You need a little bit more than that and it’s best for round that plate out with some other food groups to help sustain your energy levels throughout the morning and all that good stuff. So, adding some fruit and some nuts on top can help you better balance that. You know it’s tasty, you can add a little bit of honey on top too if you want to make it a little sweet but I find that that’s a really good place to start with people even if it is including even if it’s just fruit you know maybe you’d start adding little bit more fruit into your diet. And breakfast is absolutely one great way to do that.

Mathea Ford: [00:11:19] Some of it is also reducing the amounts of other things that we’re getting in our diet like you mentioned adding fruit or eating oatmeal. But we’re so used to either eating that predone packs where you just put it in there and it’s loaded with sugar and so you have to kind of dial back that sugar a little bit and get your taste buds re-acclimated to how food tastes really good without all the added added ingredients.

Ashley Thomas: [00:11:47] Something that’s very difficult for a lot of people and I get it. Because when I think back when I was in college I did not have the best day ever and I had a very large sweet tooth. And I knew that I needed to cut back on my sugar and it was hard because I was just so used to eating high sugar foods that fruit really didn’t even taste that sweet to me anymore. So it took some time to wash out all of the sugar laden foods. Give myself some time to acclimate to a lower level of sweetness to where I could start to enjoy fruit even more.

Mathea Ford: [00:12:23] Yeah I feel the same way about like salt. Like we eat when we eat bacon I buy low sodium bacon. And so when we go out maybe where we travel a lot this summer. And when you go to the buffet at the hotel I couldn’t even hardly stand to eat the bacon because I’m like “oh my gosh this is so salty.” So yes! But maybe you don’t even really see how sweet sugar is or like Cokes or whatever until you’ve dialed that back down and went oh this is recalibrated. So, so when you’re working with your clients you mentioned that you do some things were you know thought pattern’s, mental health, also eating. So, what sorts of things do you do with your clients that help them to have a healthier diet to make it more well-rounded?

Ashley Thomas: [00:13:11] Yeah you mean on the topic of like stress reduction?

Mathea Ford: [00:13:15] Yeah you did mentioned that if we getting so I wanted to make sure we talked about that.

Ashley Thomas: [00:13:19] Yeah! I think stress reduction is super important. And I know as dietitians, it’s not technically our area of practice but I feel like it is extremely essential and I have seen it benefit a lot of my patients. So and even if it’s something as simple as and I think we talk about this quite a bit as dietitians you know finding, finding an outlet for stress and helping people going through different scenarios of what they can realistically do. I always throw out meditation or deep breathing exercises whatever you want to call it. And it seems to stick quite a bit. I think people are pretty resistant to it upfront. But it is something that I’m seeing is benefiting a lot of people even if it’s just taking five to 10 minutes to close your eyes, do some deep breathing and try to clear your mind of whatever it is that’s happening at the moment that’s stressing you out or making you angry or sad or whatever it is. Especially in those moments where you’re craving something because that’s usually where I find people are eating the things that they’re trying not to eat as much of. Sugar for example, I think sweet and salty things are the vice of many people. And stress is oftentimes tied to that a lot of times its work stress. So whenever they’re in that stressful moment where they want to reach for that sweet or salty snack to selfsooth. You know I asked them to first become aware that they’re even doing it. So, I think a lot of us aren’t even really aware that that’s the case. The first step is just become aware. And even if you don’t stop it that’s okay because you’ve got to take baby steps to get to where you’re trying to go. And so that is the first step is becoming aware that your brain is saying “give me something salty, give me something sweet so I can feel better.” And so when you can get past that then you can start to break action and the next time you are aware that you’re doing it, find something else to do to deal with that stress. You know maybe it’s going outside for a five minute walk, maybe it’s doing 50 jumping jacks or going for a run or doing some kind of exercise if that fits in your day. Maybe its walking into the water fountain and filling up your water bottle and then just walking outside know a couple deep breaths. Maybe you do have the ability to turn the lights off on your office, sit quietly and do some deep breathing for five to ten minutes. But the point is you just find something to take your mind off of that stress so that you can learn how to deal with stress in another way other than with food.

Mathea Ford: [00:15:48] So how does stress affect your health and your diet? I know this is a dietitian but we have a lot of different people listening to the podcast so they may understand kind of. So can you talk a little bit about the connection that stress makes to the diet and how managing that can improve just even a diet because they don’t necessarily automatically seem related?

Ashley Thomas: [00:16:13] Physiologically speaking when we are in a state of stress our body produces a hormone called cortisol. And what this does is it elicits that fight or flight reaction. And so it can also increase your blood sugars as well which we know is not healthy for us. So, finding a way to distress and prevent that hyperglycemia so frequently throughout the day can help you better regulate your mood which mood is strongly tied to what you choose to eat as we just talked about. We know that elevated blood sugars over an extended period of time can create or cause diabetes. And we also know that elevated blood sugar over time also helps us to gain weight. It actually helps us to store fat in the body. You know when people are highly stressed they may notice that they’re gaining some weight and that could be one reason for it but I think the strongest connection that stress has with diet is is our mood and the fact that we do search out foods specifically carbohydrates in order to soothe whatever is going on in our life. And whenever we do eat carbohydrates that are either sweet or starchy it floods the brain the serotonin the happy hormone it makes us feel better and so we are more likely to keep turning to that because it feels good.

Mathea Ford: [00:17:39] What are some like universal things that you see consistently with people when you work with them that they need to change to make their diet a little healthier?

Ashley Thomas: [00:17:48] Yeah I think a big one is meal skipping. I think that people are. A lot of people are very used to skipping meals and whether that’s usually breakfast for people who I see and a lot of times it can be it can be lunch as well. So, maybe sign eats a big breakfast and then they go all day and don’t eat anything until dinner. But you know when we do that we miss out on an opportunity to nourish our body and help meet all of those central vitamin and mineral needs that we need on a daily basis. And I also find that you know when people start to regulate their eating pattern, their moods are more stable, they do feel better. They may start to lose a little bit of weight because they’re kind of getting their body on this natural rhythm and a structured way of eating that helps to deliver good nutrition at regular times throughout the day. I think another one is not drinking enough water as well. And instead maybe drinking coffee all day or even drinking some sweetened beverages whether it’s Gatorade or soda. And simply just cutting that out and replacing that with water or finding maybe a fizzy water to kind of take the place of a soda for a short period of time to acclimate them back down to water. That’s another. Another common one.

Mathea Ford: [00:19:08] Can you talk a little bit about your work that you do with kidney patients, post transplant? What kind of things do you work with them on and I mean I would think that once their post transplant, do they not just go back to having a normal diet?

Ashley Thomas: [00:19:25] Yes. And that’s a great question. So, for post transplant they can go back to having a normal diet which is one of the reasons why they tend to gain a lot of weight is because they’re now free to eat whatever they want and they’re no longer tied to the phosphorous and potassium and sodium and protein and fluid restrictions that they were once tied to before they got their transplant. Getting back to eating is normal things are fun, it feels good and they’re so happy that they can do that. Another issue though is the medications that they’re taking. So, the immunosuppressant drugs and then the low dose prednisone steroids they’re on for life increases blood sugars. It does increase hunger and so they do eat a little bit more. So, managing blood sugars is a large part of the post transplant world. So bringing it back to that plant based eating so that we can get enough fiber in them and they can better regulate their blood sugars is very very important. And then again the intuitive eating techniques that go along with really anyone in figuring out how, what and why you eat is very important to you for weight control. You know a lot of the physicians that work with the post transplant patients are always very concerned about what we gain and so that’s usually what I hear about more and so they tell their patients that they need to lose X amount of weight and then don’t really give them any resources on how to do that. So that’s where we come in in. Yes, food and nutrition helps people lose weight. But there are other things too like stress and all of those Intuitive Eating techniques that can help better connect people with their food and help them make healthier choices.

Mathea Ford: [00:21:13] All of this comes back to eating right, eating more plant based cooking. So, what brought you full circle with this cooking and health care thing because I noticed that you said you know you want people to do more cooking at home that it’s harder to eat a healthier diet necessarily on when we’re more eating out alot. So how do you see that as part of a healthy diet? The cooking piece?

Ashley Thomas: [00:21:41] I strongly believe that cooking is at the heart of health. And I say that all the time and it’s plastered all over my social media. So I’m sure people that I know are listening to this, they’re like “Uhh! She’s saying that line again!” But I really believe it. You know I feel like cooking is so essential to our health on so many different levels. Yes, of course you’re able to control you know what you’re putting in your food and you’re able to choose healthy ingredients to create a meal out of. But there’s also something about touching food and manipulating it and turning individual ingredients into something new that helps people feel more connected and grounded. It also gets them thinking about where did this come from? How is this food grown? It cascades into a bigger picture of the food world in general. And I think that really helps to just ground people and instead get them to start asking questions, get them to start saying “why is this nutritious for me? Or how does this help me?” It’s no longer be the black and white you have to do this to get X Y and Z. It’s more engaging and interactive and it leads to people thinking a little bit deeper about food.

Mathea Ford: [00:22:55] Yeah I think you can be more engaged with your family too and have better habits. When I grew up my family we cooked a lot but a lot of what I’ve seen when I was teaching at the college and stuff is that a lot of people have not grown up with necessarily a lot of home cooking and understanding how to do that. And that’s actually a life skill. You know that is so important. So, I can see you know how people could find it difficult and needs some help and just even to see it happening on the screen like you do with your Cook With Me. Just builds confidence and then also maybe some older people who for example, a husband and his wife has passed or maybe she’s got Alzheimer’s or something but she was responsible for the cooking and so he needs to do a little bit more about cooking and learning. And you know that can happen at any age. So.

Ashley Thomas: [00:23:52] Right. So yeah I agree.

Mathea Ford: [00:23:54] Go ahead. Go ahead.

Ashley Thomas: [00:23:56] I was just an say and I say I agree and expand on the idea that not everybody did grow up with a home cooked meal with everyone sitting around the table and the fact that in school in elementary school even in high school I did not receive any nutrition education. And I know that a lot of those classes have been cut from the education system and so we’re not growing up understanding food anymore. And so whenever we get out into the real world or when kids go off to college they don’t really know what to do. They buy lot of convenience foods. They go out to eat. They get a lot of fast food. I know when I was in college. I mean I grew up with a home cooked meal. I was lucky enough to grow up in a family where mom made dinner every night, we sat around the table, we talked about our day and that was awesome. But I didn’t really cook myself or learn how to do that. So when I went to college I was eating just lots of bagels for breakfast and getting fast food all the time and drinking soda and looking back on what I know now I was experiencing IBS symptoms that were caused by typical college diet, those high in fat and sugar processed carbohydrates and low and the vegetables and whole grains and all those nutritious foods that we know today can help heal our bodies. So, I understand that you know we really just don’t receive education on how to eat well and so we can see what it’s doing to our country.

Mathea Ford: [00:25:27] A lot of the people I talked to on this podcast we talk about plant based eating. We talk about vegetarian, we talk about mindset, meditation, mindful eating. So how do you see this trend of change? I would hope it’s change affecting health care?

Ashley Thomas: [00:25:45] One thing I will say that I’m noticing though a lot of younger dietitians are choosing to open up a private practice. And a lot of those dietitians use a lot of intuitive eating techniques, talk a lot about cooking but the thing is that insurance will not reimburse for a service like that. And so we’re missing out on a large group of people who can’t afford this kind of thing. And we know that not all insurance companies or most insurance companies won’t cover for preventative services they’ll only cover for a disease day like diabetes or kidney disease. But I think you know we as RDs we have a strong presence in public policy and I do see a future where insurance will eventually cover preventative services by dietitians so that we’re not just able to manage a disease and were able to help people prevent it. At least that’s my hope.

Mathea Ford: [00:26:37] It’s my hope too or at least just even have more resources like as much as we can as dietitians out in social media encouraging, teaching people get success with these short term fixes like Keto or Whole 30 or whatever. But how sustainable is that versus you know making these changes over time is the question. So, what are some of ways that the listeners can use this information we’ve talk about? Whether it’s cooking or eating more plant based or stress reduction in their daily life? Whether it’s with patients or it’s just personal changes? What are some things you think that they could you know some key takeaways they might have?

Ashley Thomas: [00:27:23] Okay sure. I think behavior change is really the hardest part when it comes to eating well consistently and making sure that you’re eating nourishing meals. I think that what can be helpful is to take a baby step and just choose one realistic thing to work on at a time and be able to do that consistently until you feel that it’s now part of you and your lifestyle. I know that we’ve talked about a lot of different things on the podcast and it could be overwhelming for a lot of people sort of like “oh there’s so much information and I don’t even know where to begin but it’s really a finding just one thing that you can work on for a few weeks and try that out until it feel like it’s a part of your lifestyle. So, for example, maybe if you’re somebody who doesn’t really cook a whole lot, give yourself the goal of cooking a balanced dinner maybe twice a week or whatever the realistic number is for you. Maybe twice a week is too much and maybe once a week would be better or maybe you’re already doing once a week and you would want to do three times a week. So pick them you know how many times a week you think is realistic for you to actually start cooking and really hone in on that and make it a priority for yourself. So what that means is on the weekend maybe Saturday or Sunday you make a plan for yourself. Go online, look up some recipes. I’ll do a shameless plug here. Go to cookwithme.tv and grab a couple recipes that you want to cook during the week. Make your grocery list, go to the grocery store, get everything that you need to make those two meals and then you know schedule that on your calendar or put a sticky note on your refrigerator so that you know which days you’re going to be cooking those meals and do that for a few weeks and you can get the hang of it and you can actually work it into your lifestyle so that it no longer feels like work and that it no longer feels like you’re forcing something. And I want you to jot that down then maybe mosey on over to the next goal that you’re trying to work on. Trying to do too many things at one time is going to set you up for failure. I know that with myself and I see that in the people that I work with. So, focusing on one thing is really going to help you help us succeed. We know that Rome was not built in a day and neither are healthy diet so I just take it one step at a time.

Mathea Ford: [00:29:39] Yeah, I think people underestimate what the thing people overestimate what they can do in a year and underestimate what they can do in 10 years. So, it’s kind of that we always want to hurry up and get a lot of stuff done but that consistent process is important. So, something I always ask my podcast guests is what’s your favorite food.

Mathea Ford: [00:30:01] A nice thick slice of freshly baked bread dipped in Olive oil. Toasted and dipped in Olive oil is absolutely my favorite food I think.

Mathea Ford: [00:30:12] Well, Ashley thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about all the different topics we talked about – plant eating, you know kidney disease, all that stuff. So, if listeners want to connect with you what’s the best way to do that?

Ashley Thomas: [00:30:30] Sure! The best way would be is to find me on our Facebook page at Cook With Me TV. If you don’t have Facebook though, you can always head to our website cookwithme.tv or send me an e-mail at ashley@cookwithme.tv

Mathea Ford: [00:30:49] Great! So well guys. This has been another great episode of the Nutrition Expert Podcast. The podcast is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 16 Real Food For Pregnancy with Lily Nichols

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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Drawing from the current scientific literature and the wisdom of traditional cultures, her work is known for being research-focused, thorough, and sensible. Her bestselling book, Real Food for Gestational Diabetes (and online course of the same name), presents a revolutionary nutrient-dense, lower carb diet for managing gestational diabetes. Her unique approach has not only helped tens of thousands of women manage their gestational diabetes (most without the need for blood sugar-lowering medication), but has also influenced nutrition policies internationally.

Lily’s second book, Real Food for Pregnancy, is an evidence-based look at the gap between conventional prenatal nutrition guidelines and what’s optimal for mother and baby. With over 930 citations, this is the most comprehensive text on prenatal nutrition to date.

Lily is also creator of the popular blog, www.LilyNicholsRDN.com, which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition.

Mathea Ford: [00:00:26] Hi there it’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today, right now with our next guest. It’s great to have Lily Nichols on the show today. Lily, welcome to Nutrition Experts. I’m excited to have you on the show and share your expertise with my tribe.

Lily Nichols: [00:00:49] Hey thank you for having me appreciate the invite.

Mathea Ford: [00:00:52] Great! So, you’re on this show to talk about Pregnancy Nutrition and that’s such a valuable important topic because it’s you know taking care of two or three maybe sometimes but so can you tell our listeners a little more about you and what you do?

Lily Nichols: [00:01:09] Sure thing! Yeah. I have specialized in prenatal nutrition for most of my career as a dietitian and diabetes educator. A lot of my work actually focuses on gestational diabetes as well. I first got interested in it quite a long time ago but didn’t come to professionally start working in the area until after I was a dietitian and working for the California Diabetes in Pregnancy Program which is known more commonly a Sweet Success. And it was there that I was able to see you know how we set our nutrition guidelines, how they work. I also worked clinically for a perinatalogist and our practice was almost entirely focused on gestational diabetes. So having seen the prenatal nutrition world and gestational diabetes world from different vantage points, the public policy level, the clinical level, I also do a lot of speaking and teaching for other professionals and really opened my eyes to the areas of improvement that we could look at for prenatal nutrition and have kind of led me to where I am today with you know two books on the topic.

Mathea Ford: [00:02:14] Can you talk about how a mother’s eating habits during pregnancy affects her baby?

Lily Nichols: [00:02:20] Absolutely! So, there is a whole field of study called epigenetics which is how our environment affects our genes. A lot of people think that your health or risk of disease is entirely inherited and it’s partly inherited and partly the environment that you’re exposed to. Meaning what you eat and drink, how you sleep, your exercise, your stress levels and all of those things. And we now know there is a whole subset of epigenetics that surrounds a woman’s health during pregnancy called fetal programming or intrauterine programming. There is a bunch of other different names that researchers will use for it but essentially the environment that a baby is exposed to from their mother can affect their lifelong risk of disease. So, for example when it comes to gestational diabetes we know that babies who are exposed to high blood sugar levels during pregnancy meaning not well controlled gestational diabetes they face a sixfold higher risk of obesity or type 2 diabetes by the time they turn 13 which is crazy. Right?

Lily Nichols: [00:03:27] So it really gets you thinking about you know we see all these disparities in children’s health these days with obesity on the rise and type 2 diabetes being diagnosed and even in toddlerhood sometimes. And we’re now seeing that it’s not just what these kids are exposed to now it actually could even go all the way back to their in-utero environment. So what a mom eats like the quality of her diet meaning the level of micronutrients which are vitamins and minerals, antioxidants, other compounds and food can really affect development. We could go into details but that’s sort of like the overarching theme is that it does matter the amount of nutrition you’re getting during pregnancy, your exercise levels during pregnancy, your stress management, your toxin exposure. All that stuff can play a role in your baby’s development. So, I’m really about trying to help women make the most proactive choices possible based on the latest scientific evidence that we have.

Mathea Ford: [00:04:28] Obviously, when you’re pregnant anything that you do is concerning. So, how do you kind of balance what they should do with not being you know emotionally stressed or concerned or trying to eat perfect?

Lily Nichols: [00:04:44] Well, I’m big on mindful eating which is listen to your body as you know hunger and fullness cues, your feelings about food like what you’re in the mood to eat or not in the mood to eat, the signals your body sends you around food outside of hunger and fullness like this upsets my stomach. This gives me good energy. This didn’t keep me energized for very long at all and I’m starving again. Like all of those cues are helpful and I think that’s primarily like the most important thing to focus on. First and foremost is mindful eating then aside from that you have to kind of make the decision that you’re going to do the best that you can during pregnancy given whatever knowledge you have that time or whatever your body he is allowing you to eat at the time for example if you have nausea or food aversions. Sometimes that makes it really tough to make healthy choices. So, I think it’s kind of a combination of being informed but also giving yourself some grace certainly I don’t expect anyone to eat 100 percent perfectly. So like in the meal plans section of my book Real Food for Pregnancy I talk about it very straight up you know it’s not about being 100 percent perfect it’s just trying to maximize the nutrient density of your diet as best you can given whatever circumstances you’re under at the time. But you certainly don’t want food to become an additional stressor. I think it can be depending on the quality of your diet previously. I mean if you’ve been eating a pretty good diet for years and years and years then coming into pregnancy it really won’t be that much of a shift but if you’re coming from not a very good quality diet and suddenly trying to make your eating habits a little healthier it can be a big shift because you may be mourning the loss of some of your favorite foods or not eating as much of those foods. So, it’s really about gradual changes, mindful eating and just doing the best you can given whatever circumstances you’re in.

Mathea Ford: [00:06:43] What are some ways moms can eat better during pregnancy? And is there a anything specific related to trimesters or is one trimester more important than others?

Lily Nichols: [00:06:57] You would think that that is super well studied and it’s totally not. Anyone that’s telling you that there is like a specific food that you have to eat at this point in pregnancy, they’re kind of making it up. I will say there are certain nutrients that we know are really important at certain points in pregnancy. So, for example in early pregnancy all the organs are being formed. That all happens before week 8 of pregnancy. So, this kind of overlaps with preconception nutrition but we know that nutrients like Choline, Folate, Inositol – all these things are involved in the closure of the neural tube. And since that’s all being formed really early on then we want to make sure we’re having enough of those foods. So, we’re getting it or getting enough of those nutrients through the foods in our diet or possibly through supplements as well to make sure that we don’t have a neural tube defect or Spina Bifida or something like that. We also know especially in early pregnancy that blood sugar levels that are too high can also impact the rates of certain birth defects including neuro defects and also congenital heart defects. And those have been linked to elevated blood sugar even below the diagnostic threshold of gestational diabetes so I think everyone taking a common sense approach to eating for better blood sugar is a good idea. Which means like less sugar, less refined carbohydrates first and foremost and making sure your diet has adequate amounts of fat and protein both of which don’t cause the blood sugar to go up. And then in later pregnancy and this is not to say all this stuff I just said doesn’t apply to later pregnancy but I will say this. In later pregnancy we know that the fetal brain starts cumulating omega 3 fats such as DHA really rapid pace like we think it’s around 67 milligrams per day. So, we want to make sure we’re getting enough DHA from the diet especially in the latter part of pregnancy. So fatty fish and seafood, fish oil or algae oils supplements would be great. And then you get a little bit like pasteurized eggs, grass-fed meat. Those are a couple examples.

Mathea Ford: [00:09:09] So just thinking though overall for pregnancy, are there any things that mom should really focus on eating?

Lily Nichols: [00:09:16] One of the big things that I think is important for everyone to pay attention to pregnant or not but especially during pregnancy is to look at the quality of carbohydrates you’re consuming. Carbohydrates are in many many different categories of food and they tend to be really convenient easy and delicious. And there is some research looking at micronutrient intake among pregnant women and women who consume a higher level of refined carbohydrates or high glycaemic carbohydrates meaning like refined grains and white flour and white rice and stuff like that they actually have lower micronutrient intake than women who are eating more low glycemic carbohydrates such as non starchy vegetables, nuts and seeds, fruit and its whole form that hasn’t been juiced. So, I think it’s important for women to look at the quality of carbs they’re eating and making sure they’re choosing real food less refined sources which tend to have less of an impact on your blood sugar levels. They tend to be a little more satiating and they’re packed with more nutrition. I would also say, protein wise we have some new research as of 2015. It’s kind of amazing how behind the times prenatal nutrition is as a field as a whole because this 2015 study was the first ever to directly measure protein needs during pregnancy and they found that protein needs were significantly higher in both early and late pregnancy as there were 37 percent higher in early pregnancy 73 percent higher in late pregnancy compared to our current recommendations. So, this actually puts you know optimal protein intake at the latter half of pregnancy above 100 grams a day and our current recommendations are only like they are less than that. So that’s important for women to know just to make sure you’re consuming an adequate amount of protein, doesn’t need to be like a massive quantity just enough. And it might be more than you were eating before. I also think women don’t need to be fearful of fat. Fat is very satiating. It comes with a lot of different nutrients if you start cutting way way back on fat. You also put yourself at risk for a number of nutrient deficiencies such as choline or vitamin A, vitamin E, vitamin K. So if you start looking from sort of a real food perspective on fat when you start omitting it you actually start omitting whole categories or types of foods that are also have other nutrients that you need. Some of it is quality of fat as well. We can’t just be like eat all the fat you want but it’s like a low quality vegetable oils or shortening or margarine it needs to be really high quality fats as well because that can actually influence your baby’s development also. So, like for example, I can’t give information without going into details. Women who consume a lot of vegetable oils consume a large amount of omega 6 fats and they’ve shown that that can actually influence the amount of DHA that’s incorporated into the fetal brain and has also been linked to developmental and motor delays in babies has also been linked to a higher risk of developing preeclampsia. So, I think we need to be really smart about the types of fat we’re recommending to pregnant women.

Mathea Ford: [00:12:38] When you’re talking about those recommendations you’re talking about just a single birth, right? So, does anything change with multiples or how does the recommendation change when you may be pregnant with twins or triplets or more?

Lily Nichols: [00:12:54] You know it’s interesting with that is it’s not super well studied. So what we do recognize is that calorie needs likely go up, protein needs likely go up and then virtually everything else we don’t know for sure how much it goes up. There’s not a ton of studies on twin pregnancy. You think about how hard it is to do even nutrient studies on singleton pregnancy or women pregnant with one baby. But you start trying to do interventions on women pregnant with two babies? It’s like you just don’t have a large pool of people to choose from and you wouldn’t even get statistical significance. So, it’s kind of a guessing game beyond knowing you need more calories, you need more protein. It’s pretty much a matter of just eating a larger quantity of whatever nutrient dense foods you recommend for a singleton pregnant women and then I would just recommend that the woman eats to satiety. So, following those mindful eating, hunger fullness cues and that’s the best you can do.

Mathea Ford: [00:13:58] So when you’re thinking about mindfulness, eating till your full eating when you’re getting hungry and the real food concept which maybe you can talk a little bit more about what you mean by real food for pregnancy your book. But how do you mesh those together? Because I mean how do you build them mindful eating to also incorporate more of the real foods? So talk a little bit about what you mean by real food and then talk about how mindfulness and real food go together?

Lily Nichols: [00:14:28] Real food is something that a lot of people have different definitions for but for my purposes, real food is made with simple ingredients that are as close to nature as possible and not processed in a way that removes nutrients. So, for example, for time match vegetables like vegetables will be more packed with nutrition if they’re in season, if they’re eaten soon after harvest and then also grown without the use of pesticides and those would be more nutritious than something eaten out out of season or eaten in like a canned or processed form. Another example would be like dairy products. So, what are cows naturally meant to eat? They naturally are meant to graze on grass, their milk naturally contains fat. So, from a real food perspective I would want full fat dairy from grass fed cows versus low fatter non-fat dairy from cows that never ate grass in their life and are just inside of a confined barn eating feed but feed of soy and corn. So it’s a bit of a nebulous term but I’m always looking at what is the least processed version and closest nature version of a particular food. So, for me like well-balanced real food diet would include vegetables, fruit, meat, poultry, fish, seafood, nuts, seeds, legumes, healthy fats and then depending on how a woman does digestive wise nutritionally for all the food sensitivities, allergies all that would also maybe include whole fat dairy products and maybe some whole grains for blood sugar can handle the grains. So it’s kind of that’s it in a nutshell. Hopefully that wasn’t too confusing as far as the Mindful Eating part goes I feel like real food and mindful eating go hand in hand. Because when you’re eating food that’s full of nutrients and especially when you’re not overloading yourself on refined carbs and sugars that leave your blood sugar and hormone regulation all over the map.

Lily Nichols: [00:16:38] You naturally tune in to your hunger and satiety cues really well. So I think the two of them go together really well. I think a lot of people the argument that I hear against mindful eating is that you sort of don’t need to pay attention to general nutrition advice because your body’s just going to tell you what to eat and how much and it’s fine. Or maybe you get sometimes mindful eaters will just like give a pass on not healthy food because as long as you eat it mindfully it’s fine. And I just feel like there’s a little more nuance to the topic and I think it’s easier to be a mindful eating when your diet is composed of less processed foods. So I think there’s sort of a balance between the two not getting so wrapped up in nutrition that you have to calculate every single thing or super measure your portion sizes. I mean unless it’s medically necessary versus I mean a mindful it with this sort of free for all attitude about food and not worry about nutrition. You know there’s somewhere in between.

Mathea Ford: [00:17:41] Can you talk about optimizing your diet when you’re pregnant for health or the baby’s health? Kind of what you would use food to help optimize that pregnancy?

Lily Nichols: [00:17:54] I’m going to talk in food terms. I like talking in food terms then breaking it down into nutrients because I think that just makes sense for more people outside of dietitians. So one of the most important foods to consider is eggs. And the reason for this is while it’s many many fold but what are the nutrients I want to focus on with eggs is that they are the number one source of choline in the diet. Aside from liver however not many people consume much liver. So really eggs are eggs are it. People who consume eggs consume about double the amount of choline as people who don’t consume eggs. And when it comes to pregnant women specifically 94 percent of pregnant women don’t meet the recommended amount for choline intake. So if you take eggs out of the diet or don’t consume them very often it’s pretty likely you’ll be deficient in choline. Why does this matter? We have a huge body of data on how choline impacts pregnancy outcomes and a mother’s health during pregnancy. We know that adequate amounts of choline can reduce the risk of developing preeclampsia, seems to play a role in nutrient delivery across the placenta. We also know that brain development is impacted by choline intake and we have both rat studies and also human studies that have shown this to be the case. And there was one fairly recent study, that was a randomized controlled trial on pregnant women supplemented with choline and they split them into two groups where they had one that consumed a little over the current recommended amount. So they had 480 milligrams per day versus the recommendation is 450 milligrams per day. And this second group had 930 milligrams per day more than double the current recommendation. They couldn’t have a group that they gave them no choline because that would be unethical. That didn’t pass the IRB. So they looked at how the infants fared after being exposed to these differing amounts of Choline and they specifically looked at reaction time in infants and some other intellectual tests at different time points in infancy. And they found that of the infants who were from mothers who had the high choline intake the 930 milligrams per day they scored better across all of the tests significantly better on reaction time. So, we know it plays a really important role in brain development and we know it’s a big nutrient of concern in pregnancy and unfortunately it’s something that isn’t on many clinicians radars. And it’s also not in many prenatal vitamins. So, it’s something you do want to look at from your diet and if your diet doesn’t have enough or you can’t consume eggs maybe for an allergy reason or food intolerance or food preferences it actually seems like a choline supplement might be might be warranted. So that’s important food source and also nutrient to take into consideration. As I mentioned earlier when it comes to early pregnancy we also know that choline plays a role in the closure of the neural tube so prevention of neural tube defects so it’s important across the entirety of pregnancy not just at the end. Another food that I want to point out is salmon, fatty fish and other seafood. I could go on to a bunch of different foods but I know we’re so short on time so I don’t want to waste too much of it right now. But when it comes to seafood this is going to be the number one dietary source of DHA that really important Omega 3 that’s also involved in brain development. It’s also going to be a major source of iodine, that’s a nutrient that is known to be the leading cause of preventable intellectual disability across the globe. And that quote comes straight from the American Medical Association. So it’s something that is recognized as a really vital nutrient. Pretty much across the board iodine needs go up by about 50 percent in pregnancy. And it’s something that a lot of us don’t really have on our radar as well. And new prenatal vitamin may or may not contain it. Some other things that are found in fish include vitamin D, selenium, zinc, of course it’s a good source of protein. Certain types of seafood can be a really good source of iron and B12. So oysters for example are extremely high in both iron and B12. I do recommend them cooked just because they’re the cause of a lot of foodborne illness outbreaks. So I think it’s a wise idea to do them cooked. You could do like canned oysters or something like that but they’re really really valuable source of nutrition.

Lily Nichols: [00:22:51] All different types of seafood not just the animal ones even the algae is going to be a rich source of a lot of minerals and iodine as well.

Mathea Ford: [00:22:58] Isn’t just taking the prenatal vitamin I’m going to make up for any deficiencies that I have with my eating while I’m pregnant?

Lily Nichols: [00:23:07] I wish it would. And there’s some better quality prenatal vitamins in the market that can probably do more of that than some other ones. But there is a lot in food that we need. I mean that’s kind of its not the whole point. It’s part of the point of me writing the book real food for pregnancy is that we need to be looking at food sources. We have so much developing in the field of prenatal nutrition. I know we were chatting earlier before we started the call about like well how much has changed in the field since you started? And just in the prenatal nutrition research I mean the fact that as of three years ago we identified that we got protein needs wrong. We’re looking at choline and maybe the amount needed for pregnancy is double the amount that we previously thought. I mean when they first set the recommendations on choline that was actually really recently that was 1998. They didn’t even have a recommendation before that and they set those levels based on the amount needed to prevent fatty liver disease in adult men. So they tried to factor in pregnancy but they didn’t know for sure how much to set to that. We even have another study on vitamin B12 where they recently shown that the amount of vitamin B12 needed to maintain adequate blood levels is triple the current RDA. So I think prenatal vitamins are a good idea. It is an insurance policy. I don’t think we can fully trust that all the recommendations are perfect because we just don’t have enough research to vet every single one. A lot of times they are best guesses. They are not bad. They are a good starting point. But if you can make sure you’re getting a really nutrient dense diet on top of your prenatal then you have much more of an insurance policy that you’re covering your bases.

Mathea Ford: [00:25:03] Do you think that there are foods we’ve talked about foods mom should include or nutrients. Are there foods moms should avoid during pregnancy?

Lily Nichols: [00:25:11] There’s you know alcohol is something that you should avoid or if you’re going to consume it consume it in very small quantities. It’s something that I go into all the research and controversy about in the book. Same goes of caffeine seems wise to keep caffeine under 200 milligrams per day. There are studies that look at both sides of the coin on that one just like on alcohol so it’s something to look into if you’re if you’re interested in all the nuance. But as a general rule, best people to those low. Refined carbohydrates and sugars are another thing that is beneficial to keep extremely low in your diet as well. And that’s because they a. Don’t contain much nutrition and b. They cause their blood sugar to go up. The latest data shows that about 50 percent of Americans have some form of diabetes whether diagnosed or undiagnosed. Full blown diabetes or prediabetes and depending on how we diagnose for gestational diabetes were looking at around 18 percent of pregnant women facing high blood sugar and pregnancy if we’re talking about a. Foods that are going to maintain healthy blood sugar levels which is important forever on regardless of a diabetes diagnosis or not and b. Provide the maximum amount of nutrition for baby meaning like micronutrients, vitamins, minerals those sorts of things. Refined carbohydrates and sugars don’t do that. They just leave our blood sugar high and don’t give us much nutrition. So that’s why I talked about you know quality of carbohydrates early on. I don’t think anything needs to. These things need to be entirely avoided. I just don’t think they should make up a very large part of the diet. I mean I know I certainly consumed a little bit of sugar during pregnancy but I was trying to keep it low so it’s like you know you have this super dark chocolate that doesn’t have that much sugar. You know just being smart about it is important. We know that with sugar in particular we see higher rates of gestational weight gain, higher blood sugar levels, higher rates of preeclampsia among women who consume a lot of sugars. So, not that great for you. There are plenty of other real food, lower sugar alternatives that you can go to. I also don’t think artificial sweeteners have much place in pregnancy. I have a whole big section on this in the book that goes through all the research. First of all artificial sweeteners make you crave more sweet foods. This has been documented in rat studies and also human studies. And then they’ve also shown that among women who consume artificial sweeteners on a daily basis in pregnancy their children are actually more likely to be born large even if the other group was consuming sugar sweetened beverages. There’s something about artificial sweeteners that seemed to change our insulin or change something epigenetically with baby. And so I think it’s something that we should not consume a massive quantity of. Probably the last most important one would just be related to quality of fat. So, I think I already mentioned the omega 6 and vegetable oil issue. Omega 6 fats are not great to consume in large quantities for a variety of reasons and the number one source we’re going to find them in our diet is vegetable oils and so those are things that are usually used in salad dressings, they’re used for frying oils at fast food restaurants. They’re often used in making like chips and crackers and other things like that which usually have the double whammy of being a refined carbohydrate that’s fried in that food and fried in that oil. So those are not great. And then probably the worst of the worst would be trans fats which are when they take a liquid vegetable oil and turn it into a solid via a process called partial hydrogenation and that’s what they used to make a lot of different spreads, shortenings. Those are sometimes used in frying oil although it’s being phased out in a lot of the food industry and processed foods. But we know that those can impair nutrient transport across the placenta. They can up rates of preeclampsia and they also tend to mess up insulin sensitivity which can be an issue for anyone whose blood sugar is already just regulated such as in the case of gestational diabetes. So trans fats. No way no.

Mathea Ford: [00:29:43] Can you talk about the fourth trimester that you referred to in your book what it is and how it affects mom and baby?

Lily Nichols: [00:29:50] Oh of course. I love this topic actually. I don’t know how you felt after having your kiddo kiddos. But the healing time the recovery time it takes is just incredible. Your body goes through just massive transformations in every possible way physically, mentally, emotionally. There’s so much that shifts and our bodies really require a lot of time to heal. And this is something that is not there’s not enough like reverence for it maybe in Western culture but if you look across the globe between a month and six weeks or around 40 days is very common of having a special recovery time for mothers where they are they are mothered by others. They are taking care of their food is made for them. Your entire job is to rest and recover and feed your baby. And in Western culture it’s just like “all right you had your baby. Okay. That entire pre pregnancy genes like drop your kid off at daycare, somehow figure out how to breastfeed while going back to work.” Like super early and it’s just really challenging and really stressful for mothers. So the fourth trimester refers to there’s different definitions but it usually refers to the first three or so months postpartum that really early recovery time. Some people will let it extend into the entire first year or even even beyond maybe you could call it trimester 5 and 6 or something. Essentially it’s allowing yourself some time to heal. So there is traditionally, there are specific foods that are beneficial for healing. Incidentally, a lot of them overlap with the foods that are beneficial during pregnancy. There are certain things that you can do to take care of your mental, emotional health, a lot of self care practices, allowing help from other people resting not jumping in to exercise right away. And when you do return to activity levels being really cognizant of your form, your alignment, the sensations in your public floor just being really gentle with yourself during this whole time period. I can go into detail on any of it but that’s that’s sort of in a nutshell.

Mathea Ford: [00:32:16] Yeah I think that’s very interesting. I had a couple c section so I was kind of forced to have that downtime for a period of time because you can’t do a lot with that but I can understand other moms it seems like it’s just like you said just get right back into it. Can you mention a few of the healing foods that you think are important in that fourth trimester?

Lily Nichols: [00:32:39] Yeah absolutely. So a lot of these foods I’ll say are things that contain nutrients that are beneficial for healing tissues. So things have been stretched, torn or maybe like surgically cut. These things require a lot of protein, a lot of specific amino acids that are important for your body to make collagen that’s important for your skin and tissue and joint integrity. And those are the amino acids glycine and proline. There’s also specific foods that can be more beneficial for like electrolytes and fluids that could have been lost during labor. And then also if you lost blood during labor and most of us do. And also you continue bleeding postpartum for several weeks maybe so could be up to six weeks or even more than that. Things that help build up your blood again. So like Iron and vitamin B12 rich foods and then especially if you’re nursing but even if you’re not nursing foods that are going to replenish nutrients that have been transferred rapidly to your baby during pregnancy. So like I mentioned DHA for example like when they look at rat brains they haven’t looked at human brains because they’re not going to sacrifice a new mom right? Rat brains post pregnancy, they’re actually depleted of vitamin sorry DHA. So that rapid transfer of of Omega 3 is to the baby could leave you depleted like your body will sacrifice its nutrient stores for the baby. It’s sort of just built into our design so being really intentional about replenishing those things. So some of the foods that will fit the bill for all those things I just mentioned for the building up of your you know your collagen and your skin integrity that source of the amino acid glycine we’re looking at stews, slow cooked meats especially in glycine as found in highest concentrations in the bones, skin and connective tissue of animal foods. And what’s interesting is when you look at traditional cultures the recommendations on postpartum foods are often soups and stews and curries which have a lot of this nutrient in it. They’re also very warming from like a temperature perspective which before the advent of like you know modern housing and shelter and heat and cool control like having a heater in the house like that was really important to maternal survival is like keeping you and baby warm. So those foods would also fit that bill. High iron foods would be things like the meats I already mentioned a lot of traditional cultures actually focus on organ meats like liver kidney and heart. I mentioned oysters already extremely high in iron. All those above foods are also high in B12. You could look at plant foods as well. The Iron is just not as as absorbable of a form that you could look at things like black beans and spinach and stuff like that as well. Higher fat foods can be really helpful because your energy needs go up postpartum. Actually across the board your nutrient needs go up postpartum even more so than pregnancy. So you’re choline needs are higher like your energy needs are higher, your protein needs are higher. All these things ramp up in this recovery period particularly for breastfeeding women your calorie needs are about 500 calories more than when your pre-pregnancy. Enough food period is helpful. But making sure you’re getting enough calories in one of the easiest ways to boost up your calories without getting super overstuffed is with higher fat foods. Some of those will also be really high and vitamin A that’s very important for breast milk. You pass by a minute through your breast milk along with many other nutrients and then I could go on forever but I’ll choose a couple others. Iodine rich foods would be really important. So traditionally in Korea they do like a seaweed infused broth and that is going to be superhigh in iodine. That’s usually also meeting the needs for the glycine if they’ve made it with some sort of an animal animal bones. But that iodine is really important for post-partum thyroid health and also for passing iodine through your breast milk. Your breasts actually are more reliant on iodine than even your thyroid gland and going through all the crazy changes that happen to your breasts when you’re breast feeding, iodine demands are much higher. So, that’s a really important thing as well. I don’t want to leave out anything but there are more foods. I’m just sort of highlighting the ones that are that are frequently left off. I feel like some of the other ones are kind of obvious so.

Mathea Ford: [00:37:27] Well. So knowing that the audience is dietitians, doctors, nurses, medical people or people that are specifically interested in this topic but usually people that are working at different medical things. What are ways that you think the listeners could use the information we’ve talked about today to improve their practice or information in their daily life?

Lily Nichols: [00:37:49] Well I think sort of understanding that there is a benefit in looking to meet your nutrient needs from food and not just sole reliance on a supplement. I think that is important to recognize. I think it’s important to recognize the signals that your body sends you around foods so see how you feel after eating certain things and don’t eat the things that leave you feeling like garbage. That’s fairly obvious that that goes on the Mindful Eating side of things. How do you feel after you have a soda? Like how long do you feel energized? How long, how soon until you crash? What kinds of foods you crave when you’re hungry again? That sort of introspection kind of leads you to really valuable answers surrounding food. I would also say you know your care of your body during pregnancy extends into the postpartum period. I think a lot of people sort of assume like the hard work is done with pregnancy. I mean I’ve worked with hundreds and hundreds of pregnant women. So I see this shift where it’s like you know you want to do everything you can to have the healthiest pregnancy possible and then of a postpartum like “Alright now I get a break now I don’t need to eat as well because you know baby’s out. I’ve already done my job.” And actually your nutrients are higher during that time and it’s not a matter of stressing yourself out or doing it perfectly or anything but it’s a it’s a matter of self care and recovery. I’ve observed in practice a significant difference in women’s recovery postpartum based on the quality of their diet. So just recognizing that care of yourself extends beyond pregnancy and that your nutrition matters a lot beyond pregnancy. I think it’s really important and I think sort of address a lot of the issues we see women have with postpartum recovery can be rough and a lot of different ways. And so that extra health care and help from others really pays off.

Mathea Ford: [00:39:55] So you can see where it’s just important term minor patients and our people we work with that. It doesn’t stop just because you had gave birth. That is the whole healing process days later, year, months later. My question I try to ask everybody is what’s your favorite food?

Lily Nichols: [00:40:15] Also a couple because I can’t choose just one. I really like eggs. They’re just one of the best breakfasts for me. So really good reality eggs. I love berries. I love avocados. I love dark chocolate. I’ll stop there. I like a lot of different foods.

Mathea Ford: [00:40:34] Can you talk for just a couple minutes that we have left about the process of writing the book? It’s an extensive book and has extensive references in the back. Can you talk about the process?

Lily Nichols: [00:40:45] I mean this is my second book so it was a bit maybe easier this time around because I had done it before. However, it was a lot harder because this time I had a child. So I started writing this book when my son was about 10 months old. So I was still in the first year postpartum but I had been really wanting to write this book for a while so once I got my my brain power back. Talk about fourth trimester takes a long time for your brain power and energy levels to come back enough to take on big projects. I started writing this. I think the most important thing for me was having a really clear outline of where it’s going. What I was going to cover and which chapter. I already have my own method for keeping track of citations and whatnot. But how it looked on a day to day basis was usually while my son was nursing I’d be looking up research on my phone and would find some really interesting studies. Write a little blurb about it and then later when I actually had time when he was napping preferably not on me then I’d spend some time at my computer putting that into context. And again just having a really clear outline helped me put things in the right place so that later when I was in editing and reediting and reediting mode it was easier to know what I had covered and what places and having a system for citations and all that stuff. I mean there’s like 934 references so you have to stay really organized when you’re doing it. It was extremely piecemeal. I mean I was written in like 10 to 15 minute increments across 15 months. So it was a very slow process compared to my first book which I from start to finish the first word on the page to publishing was six months. So that’s the reality of being a mom with very little child care and trying to take on a massive project. But yeah I would say if anyone’s interested in writing a book just get really organized, figure out how you’re gonna do your citations, have a really clear outline and then you just have to keep writing and then understand that the editing process if you want it to be well edited which I do that takes a really long time and a lot of different sets of aides. So there’s just you have to build a lot of time in your timeline for editing, formatting, re-editing, reformatting all of that stuff.

Mathea Ford: [00:43:12] So Lily, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about pregnancy nutrition and the whole gamut of ways we can improve that. And so if listeners want to connect with you what’s the best way to do that?

Lily Nichols: [00:43:30] Yes you can. My main web site is LilyNicholsRDN.com that has my blog and bunch other stuff. If you want to learn specifically about real food for pregnancy you can go to realfoodforpregnancy.Com. I do give away the first chapter for free if you just want to take a peek specifically for nutrition professionals in that chapter I go through a comparison between a conventional prenatal nutrition diet as in like the AND sample diet in their in their guidelines and a real food one and look at the nutrient density between the two. So you could see what’s the whole Why behind this is nutrient density. And I also just got word from CVR that the book has been approved for CEUs and so we’ll be working over the course of the rest of the summer really to try to get those up and ready for people to purchase. So it’s approved for 32 CEUs which is almost half of your five year recertification cycle which is awesome. And I’m also going to be working on continuing education webinars for nutrition professionals as well. So I have my little this recording will be up after my first one is released but we’ll be doing those ongoing webinars and we’re getting all of those approved by CDR as well. So if you’re interested in continuing on prenatal nutrition I really want to fill that gap for you.

Mathea Ford: [00:44:58] Great! So guys, thanks. This has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

 

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