Hospitals battle “deep-fried hypocrisy”- Is change in our future?

Photo credit: www.foodcourtlunch.com
Photo credit: http://www.foodcourtlunch.com

I read an article yesterday from the Ottawa Citizen, titled Hospitals battle ‘deep-fried hypocrisy’, push junk food out the door. The gist of the article describes the changes that are (slowly) being made to reduce the presence of fast food restaurants (Tim Hortons®, Burger King® etc) in hospitals, or at least change the offerings of these restaurants to healthier options. While this is a great idea (in theory), there are a few points to consider:

The Tim Hortons® near my hospital really makes my job challenging. Many of my clients are hooked on caffeine and sugar, therefore they frequent Tim Hortons® daily, or multiple times per day. The article in the Ottawa Citizen states “Hospitals in central Nova Scotia introduced a similar program about five years ago and Tim Hortons® now serve muffins, tea biscuits and trail mix cookies, instead of doughnuts, at hospitals there”. Ok.. but look at the nutritionals for a Tim Horton’s chocolate-dipped doughnut compared to a chocolate chip muffin (found on Tim Hortons® website):

  • Doughnut: 190 calories, 6g fat, 10g sugar
  • Muffin: 420 calories, 16g fat, 35g sugar

Yes, the doughnut is deep-fried, but you tell me what the better choice is. I would down a 190 calorie doughnut over a 420 calorie fat bomb muffin any day! I commend the hospitals for trying to encourage healthier choices at a fast food outlet, but they are missing the point between foods that are actually healthy, versus foods that are “health washed” (aka muffins, cookies with healthy-sounding names etc).

Are they even good for hospital business? Maybe not. A 2012 article published in the Windsor Star reports the Tim Hortons® kiosk in the Windsor Regional Hospital sets the hospital back about $265,000 per year. How? Labour costs. The Tim Hortons® franchise workers at this particular hospital are unionized (CAW) and they are paid DOUBLE what franchise workers in the community are paid. This is not the case for every hospital (many hospitals actually make quite a profit from these franchises), however it all depends on the collective agreement the hospital has with their union(s) in relation to contracting out work. So if the franchise is causing the hospital to bleed money, why not get rid of it? Well, the Windsor Star article reports there would be an “uproar from patients, staff and families” who purchase from the kiosk every day. Clearly a Tim Hortons® in and/or near a hospital is good business regardless.

So it looks like these types of establishments aren’t going anywhere. But how can we actually make it work out in the best interests of 1) customers and 2) healthcare workers who want these franchises to have their products align with healthy eating messages? Here are my ideas:

  • Make the healthy choice the default choice. Marion Nestle said it best: “Plenty of research shows that although customers can request other options, most take the default. So the default is what counts”. So make some small changes here and there so customers almost always pick the healthier option (by default). For example: a “double double” is 2 creams, 2 sugars. By making the default “double double” 2 MILKS, 2 sugars, you automatically save 54 calories and 6g of fat with a medium coffee. For combo meals, make the default side a piece of fruit (instead of a cookie/doughnut), and the beverage a small.
  • Portions are more important than “healthy-sounding” alternatives. As evidenced by my doughnut to muffin comparison, customers are often duped into purchasing health-washed foods, thinking they are making a better choice. So instead of continuing to promote these foods as “healthy”, what about reducing the portion size of gigantic muffins and bagels (both which have the carbohydrate equivalent to 4 slices of bread)? What about eliminating the largest sizes of the sugar-sweetened Iced Cappuccinos, fruit smoothies and frozen lemonades? All of these ideas sound great to a health professional, however it probably would spark customer outrage, who often look at “value for money”. A girl can dream though 🙂

Happy Friday!!

Minimally-processed versus Ultra-processed: What is the Difference?

thanksgiving

Happy Canadian Thanksgiving everyone! I hope you all are enjoying the last day of the long weekend, doing exactly what our ancestors would have wanted: spending time with family and napping on the couch after a turkey coma.

Last week I read a great Huffington Post article by RD Abby Langer (Hi Abby!) titled “Not all processed foods are created equal”. Seeing as I am doing my October unprocessed challenge, I thought this article was right up my alley. You can view the article here. I really enjoyed it because Abby shares many similar viewpoints to me around eating more unprocessed foods. In an ideal world, eating 100% unprocessed means making your own bouillon stock, buying pounds of almonds to make your own almond milk and never purchasing a bottled condiment again (yes, here is a recipe to make your own Sriracha!). However realistically, many of us do not have the time, budget or cooking/storage facilities to make all these unprocessed foods a reality. For example, Abby discusses how she simply does not have the freezer space to hold jars and jars of homemade chicken stock. And in my tiny Toronto apartment, I can barely fit an ice cube tray in my freezer!

So for those of us who still want to eat unprocessed foods, should we make ourselves feel bad for succumbing to so-called “convenience foods”? Of course not! Because you can break down “processed versus unprocessed” even further: “minimally-processed or ultra-processed”. I define them as follows:

Minimally-processed: Foods that have been processed to require less preparation time (e.g. vegetables that have been blanched and flash-frozen), yet still list minimal ingredients and/or contain ingredients that can be found in a common kitchen. Minimally-processed foods are still very healthy and I consider a healthy option within MY GOALS of the October unprocessed challenge. Here are my top minimally-processed foods:

  • Frozen vegetables and fruits: These foods are technically processed as they are blanched (vegetables) and flash-frozen. However they are a great way to enjoy out of season produce, and are so fast to prepare as they are already washed and chopped. I use frozen fruits in smoothies and baking. I use frozen vegetables in everything from soups to curries.
  • Yogurt: Yes, some people make their own yogurt (apparently it is a great cost-saver). But for me, time can be as important as money, so I buy my own yogurt rather than make it. But the key is buying yogurt with the LEAST amount of ingredients. And that means buying PLAIN yogurt, and sweetening/flavouring it yourself. The amount of added sugars and dyes in flavoured yogurt is staggering. Plain yogurt is a blank canvas, where the opportunities are limitless! Add frozen fruit, nuts, seeds, a dab of honey/maple syrup, flaxseed, etc etc.
  • Vegetable/chicken stock: As mentioned above, I don’t have the storage capacity for containers of stock in my apartment. Therefore I buy organic (I like Pacific brand or GoBio) vegetable or chicken stock. Since fall is soups and stews season, I go through A LOT of stock 🙂
  • Natural peanut/almond butter: I don’t think a day has gone by in the last year where I didn’t eat some sort of nut butter, on or in something. I LOVE nut butters. However the thought of grinding and pressing bags of peanuts/almonds just doesn’t appeal to me. Thankfully, there are a lot of options out there to purchase nut butters with one simple ingredient: NUTS. Be weary of nut butters that have other additives (e.g. Kraft® Smooth peanut butter) like icing sugar and soybean oil.

Ultra-processed: Foods that have been changed so drastically that they no longer resemble their natural form, and have many additives that are hard to pronounce and would never be found in a common kitchen pantry. Here are my top choices for ultra-processed offenders:

  • Cheez-Whiz® or processed cheese slices: Notice how Kraft® can’t even use the word “cheese” in their product? That’s because it contains very little actual cheese. In fact the official title is an “edible oil product”. Do you have any “modified milk ingredients” lying around your house? Didn’t think so.
  • Sugared cereals: Many sugared cereals have added processed sugar (corn syrup, modified corn starch) and dyes, especially those that are coloured (e.g Lucky Charms® has Yellow 5 & 6, Blue 1, Red 40 and “other natural and artificial colours”). Sadly these products are marketed to children. You are much better off getting cereals with 1-2 ingredients (e.g. Shredded Wheat® has one ingredient, wheat!) and using it as your blank canvas to add other healthy ingredients (fruit, nuts, seeds, flax, honey, maple syrup etc)
  • 100% fruit juice: Would you go and pick 15-20 apples off a tree, and eat them all at once? Of course not, that would take forever! So why would you drink a huge glass of apple juice? Juice is just the super-concentrated sugar from fruits, without the added benefits of fibre. Just eat a piece of fruit instead of the juice.
  • TV dinners: Reading the ingredients list of TV dinners reminds me of looking at my chemistry textbooks in highschool. A bunch of weird chemical names that somehow form a product that we all recognize. Don’t believe me? Take a look at this ingredients list I found on a “Hungry Man® TV entrée” (Saisbury steak with potatoes, green beans and brownie):

Ingredients:

Gravy (Water, Mushrooms, Onions, Modified Corn Starch, International Sherry Cooking Wine [Sherry Wine, Salt], Flavor [Salt, Beef Stock, Beef Fat, Maltodextrin, Potassium Chloride, Hydrolyzed Soy, Corn And Wheat Gluten Protein, Yeast Extract, Vegetable Stock (Carrot, Onion, Celery), Natural And Artificial Flavors, Potassium Lactate, Onion Powder, Dextrose, Sugar, Disodium Inosinate, Disodium Guanylate, Soy Sauce (Soybeans, Salt, Wheat), Modified Corn Starch, Tomato Powder And Citric Acid], Enriched Flour [Wheat Flour (Niacin, Reduced Iron, Thiamine Mononitrate, Riboflavin, Folic Acid)], Onion Powder, Sugar, Cream Powder Blend [Heavy Cream, Whey Protein Concentrate, Whey, Sodium Aluminosilicate], Caramel Color, Salt, Yeast Extract, Spice), Cooked Salisbury Steak Patty (Beef, Water, Pork, Textured Soy Protein Concentrate With Caramel Color, Bread Crumbs [Enriched Bleached Wheat Flour (Enriched With Niacin, Ferrous Sulfate, Thiamine Mononitrate, Riboflavin, Folic Acid), Dextrose. Contains 2% Or Less of Yeast, Partially Hydrogenated Vegetable Oil (Soybean And/Or Cottonseed), Salt], Soy Protein Concentrate, Seasoning Blend (Maltodextrin, Salt, Grill Flavor [Soybean And Cottonseed Oils], Modified Food Starch, Corn Syrup Solids, Smoke Flavoring, Salt, Dehydrated Onion, Caramel Color, Sodium Phosphate, Garlic Powder, Spice Extract, Eggs, Spice), Mashed Potatoes (Reconstituted Potatoes [Mono- And Diglycerides, Sodium Acid Pyrophosphate, Citric Acid], Margarine [Partially Hydrogenated Soybean Oil With Tbhq And Citric Acid As Preservatives, Water, Mono- And Diglycerides (BHT, Citric Acid),

Beta-Carotene For Color (Corn Oil, Tocopherol), Vitamin A Palmitate], Dried Dairy Blend [Whey, Calcium Caseinate], Salt, Water), Green Beans, Brownie (Sugar, Water, Enriched Flour [Wheat Flour (Niacin, Reduced Iron, Thiamine Mononitrate, Riboflavin, Folic Acid]), Partially Hydrogenated Soybean Oil With Tbhq And Citric Acid As Preservatives, Cocoa, Eggs, Margarine [Partially Hydrogenated Soybean Oil With Tbhq And Citric Acid As Preservatives, Water, Mono- And Diglycerides (BHT, Citric Acid), Beta Carotene For Color (Corn Oil, Tocopherol), Vitamin A Palmitate], Acacia And Xanthan Gums, Sodium Bicarbonate [Hydrogenated Vegetable Oil], Salt, Natural And Artificial Vanilla Flavor [Water, Propylene Glycol, Ethanol, Caramel Color, Vanilla Extractives]), Sauce (Water, Sugar, Margarine [Soybean Oil, Partially Hydrogenated Soybean Oil, Water, Salt, Whey, Soy Lecithin, Mono- And Diglycerides, Natural Flavor, Beta-Carotene (Color), Vitamin A Palmitate], Salt, Partially Hydrogenated Soybean Oil With Tbhq And Citric Acid As Preservatives). Contains 2% Or Less of: Margarine (Partially Hydrogenated Soybean Oil With Tbhq And Citric Acid As Preservatives, Water, Mono- And Diglycerides [BHT, Citric Acid], Beta-Carotene For Color [Corn Oil, Tocopherol], Vitamin A Palmitate). Contains Soy, Wheat, Eggs, Milk.

Oh hi! You finally made it to the end 🙂 As seen above, I would prefer to stick to something without almost 100 ingredients! Happy Monday everyone!! xo

Nutrition and Mental Health: The Times They Are a-Changin’

You said it Bobby D... Photo: © Sony
You said it Bobby D… Photo: © Sony

So for those of you who aren’t aware of my day job, my long-winded title is “Clinical Inpatient Dietitian in Complex Mental Illness at the Centre for Addiction and Mental Health (CAMH)”. I’ve been working at CAMH just shy of 3 years now. When I first started working at the hospital, my background in mental health was extremely limited. Working in downtown Toronto in community health gave me a bit of exposure, but I was far from an expert. And I will remind you all that I am STILL by no means an expert. Working in mental health is a continuing learning experience, and I learn something new every day on the job.

Recently I was extremely lucky to speak at a conference in Ottawa for the Family Health Team (FHT) Dietitian network. It was such a fantastic learning experience for me, and a great opportunity to share my knowledge with others and increase exposure to the exciting world of nutrition and mental health.

Photo credit: my wonderful friend Katie Hortobagyi
Photo credit: my wonderful friend Katie Hortobagyi

I explained during my presentation that when I was in school for Applied Human Nutrition (back in the day kids), I don’t recall learning ANYTHING about mental health. The only thing I can really think of is learning about the management of dementia/Alzheimer’s. But working in the field, it honestly shocks me how much there is to know, and how the role that nutrition plays is always changing. For example, nutrition-related interventions can pop up in many of the following scenarios (and this list is not exhaustive!):

-Managing metabolic side-effects with antipsychotic medications (weight gain, increased appetite, insulin resistance)

-Helping clients cope with food-related delusions, hallucinations and phobias

-Managing macro/micronutrient deficiencies after abstaining from substances or recovering from an acute psychotic episode (many of my clients come into hospital really malnourished because they do not eat or take care of themselves)

-Teaching basic life skills around shopping, storing and cooking food

-Helping clients on a budget make healthier choices within their budgets

-Helping clients manage other chronic diseases (diabetes, heart disease, high blood pressure, cancer, kidney disease) that they may have ON TOP OF their mental illness

-Education and research on how food affects mood, depression (such as the mind-gut connection)

-Keeping updated on current research and what is emerging around nutraceuticals (e.g. there is research going on right now looking at nutritional supplements as adjunct therapy to medications used to treat schizophrenia)

-Debunking myths around food fads and the evidence on what works/doesn’t (e.g. I have educated patients and families on the relationships between gluten and schizophrenia symptoms)

As you can see, there is a lot coming down the pipe! It makes me very excited to be involved in this area of healthcare. Recently I’ve been having some feelings of doubt related to my position at CAMH. Mostly these feelings are in my own head, after a particularly bad day where I wonder “am I really making a difference, am I actually helping anyone?” The answer I have to keep telling myself is YES, YES a million times YES. As you can see above, a Dietitian can play a HUGE part in mental health, and the part is just going to get better as more knowledge emerges. So rather than feeling bad and wondering whether my job makes any impact, I’m going to embrace my unique role and do as much as I can to learn, grow and help those with a mental illness thrive 🙂