 All right, well, welcome. This is the lecture, Eat Better, Not Less. And I hope to provide some basic nutrition insights into what we need and how we can simplify our diet for our health. A little bit of background about me. So like Lori said, my initial degree was in physiology. At that time, I was thinking about going into physical therapy. I had to take a class to apply to PT school that was on diet and exercise. And I was really intrigued more about the diet portion of the class than the exercise. So I acted quickly and sent out applications for master's programs and ended up at the Linus Pauling Institute at Oregon State. And while I love the science of nutrition, what I really wanted to do was get into medicine, which is what my original degree was preparing me for. So I completed a dietetic internship and passed my boards to become a registered dietitian. I called myself a jack-of-all-trades dietitian because I really held a lot of positions in the medical field that dietitians can hold. And that includes 15 years as an oncology dietitian and going on 17 years as a diabetes educator. Just in the last eight years, I've moved more towards critical care, which really kind of satisfies that data analysis side of my brain. But I really wanted to educate more. And that's how I ended up at a part-time teaching position at Diablo Valley College in Pleasant Hill. And it's been really a perfect balance between the science and the teaching of nutrition. And so for this lecture, eat better, not less. Where should we start? And I want to begin with label reading. Because as a consumer, you're hit with all kinds of labels, some that you can see here. Some are relevant and some are not. And many are really misleading. So for instance, up here at the top left, there's one that says natural. And that's not even a regulated term. What that means is that we don't have a legal food definition for natural. And for the consumer, that sounds really appealing, doesn't it? Natural sounds like something really untouched and unaltered, but since there's no definition for the term, natural can mean whatever the food manufacturer wants it to mean. Something else that can cause a lot of confusion is like sugar-free down here. Oops, by sugar-free, there's, it means that the product contains no more than 0.5 grams of sugar per serving. But it also must distinguish whether it's a low calorie product. Since most consumers believe that sugar-free means that it's good for weight control. And if the company doesn't fit that definition, they can also use another regulated term called low sugar. And that means the product contains 25% less sugar than the company's original product. But some food manufacturers will add their own label to this mix. And one of them is called low and added sugar. And did you catch that? Yes, food manufacturers can make their own labels. It's kind of a loophole that they have in these nutrient content claims to create their own definitions. And despite sounding similar to the regulated ones, they bear no consistency from one food manufacturer to the next. And in fact, low and added sugar honestly tells you nothing about the sugar content of the fruit product. I like using the example of jam here, like a jam that you put on your toast because it may say low and added sugar, which means they probably add something like Splenda to it. But you can't take the natural sugar out of the fruit that they use to make the jam. So it's not really low in sugar at all. And there are so many misleading examples about food labels, even the regulated ones. And so where does that lead the consumer? What are you supposed to do? Well, my advice is really to ignore all of these labels. Just ignore the front of the box and I wanna ask, do you know where you should look? And I think that is the nutrition facts panel. So this is your golden ticket to understanding what is really in the food you purchase. Now, the only downside here is that you need to have some guidance on what you need for your health goals. So on the nutrition facts panel at the very, very top, it is important to know how many servings are in that container and how big that serving is supposed to be. If you grab a bag of chips at the store and you take one of the small ones, not the super tiny ones, more like the two to three ounce ones, that bag has two to three servings on it. What that means is that if you eat the entire bag, you're eating two to three times the calories, the fat, the sodium, the carbs and everything listed here on this label. So this is always a good starting point to know how many servings you're getting in the package and how big that serving is. The label also now very clearly puts the calories bolded and then bigger type. This is consistent with FDA goals to help manage weight control in Americans. So they want you to know what you're getting when you eat. And underneath those, we have the macronutrients. That's gonna be your fat, your carbohydrates and your protein. It's also gonna list sodium as well as nutrients that if they're present, vitamin D and calcium and iron. And that's because most Americans are notoriously low in all of these. A potassium is listed on there too. But that's usually helpful if you have any kidney issues. And so how can you use this to help? Well, let's take sodium as an example. So most Americans eat too much sodium. And every day I'm sure you can see there's some new research coming out on how sodium restriction can improve heart health. So your doctor told you to cut back on salt. Salt is just sodium chloride. And so when your doctor says cut back on salt, they mean sodium. And your doctor or your dietician's recommendation might be to have less than 2,000 milligrams of sodium per day. This particular label says 160 milligrams. Can you see that there next to where it says sodium? Okay. And that's not too bad. I mean, if you're eating the recommended serving size, that should be able to fit into your diet pretty well. The actual definition of a low sodium food is if it contains less than 140 milligrams of sodium per serving. And if you choose all of your foods with less than 140 milligrams of sodium per serving, you're very likely to stay under that 2,000 milligram a day goal. The other things you're gonna notice on this food label are these percentages on the side. These are called the daily values. And I like to use them to help people stay within the dietary guidelines for Americans. So if you stay within less than 10% of saturated fat, you're gonna meet that goal. And the same for added sugars, which is less than 10%. We have trans fats listed on here still. And they were important to list on foods because we wanted to know which foods contain them. We know that trans fats are worse for us than saturated fats for heart health. And artificial trans fats, those are the partially hydrogenated lipids. They've advanced 2018, but you can still find them at small amounts if they have less than 0.5 grams per serving, or if they're naturally occurring in the food. And we're still researching the health effects of natural trans fats, but rest assured that it's the artificial trans fats that you need to be most concerned about. As far as fiber goes, how do you know if a food is a good source of fiber? I ask people to aim for something that has two or more grams per serving, okay? And then there's the ingredient list on the label, but how come I don't recommend looking at the ingredient list? Well, there are many people out there who say that if you shouldn't be eating the foods you can't pronounce. And I can't go a day without seeing an influencer on social media who's recommending that we count our chemicals in our foods. If you don't know what it is, then don't eat it. I think this pairs pretty well with that natural label we talked about earlier. People want foods that are unaltered and simple. They associate chemicals with cleaning supplies and science experiments. But this kind of chemophobia became really evident to a high school teacher by the name of James Kennedy in Millbourne, Australia. So he made up this ingredient panel for a fresh banana. And the ingredients he listed here have been validated by the USDA Food Database as well. So you can see here that many of these components on the banana sound just like chemicals. Ingredient labels list the components in order of weight with the one that weighs the most being listed first and then the next heaviest and so on and so forth. And they sound really intimidating but it's mostly because we're not used to those kinds of terms in everyday language. However, it doesn't mean they're harmful. In fact, bananas are really helpful for us. They're full of potassium and fiber and they balance out that sodium you're trying to cut back on. So I don't find this to be a very helpful tool at all. And just to kind of give a meme to this, to sum up the thoughts on this trend. Here's one that I found that says, too many people are counting chemicals and not enough people understand basic chemistry. And so they list three points here that I want to point out. Number one, everything is made of chemicals. It's not only a word for cleaning supplies, it's a word that tells us how things are made and how they behave. And number two, whether a chemical is man-made or natural will tell us absolutely nothing about how dangerous it is. There are numerous natural chemicals that you can definitely find out there that you don't want to consume, like arsenic and cyanide and lead and bleach. Yeah, they're natural, but I wouldn't want to have them and you shouldn't either. And finally, number three, whether or not you can pronounce a chemical is really irrelevant. We've all stumbled upon words in a book and that doesn't mean anything other than we haven't had any practice saying it. And so speaking of chemicals, we can classify them in two main ways that we're talking about nutrition. There's macronutrients, those are your proteins, your fats or lipids, carbohydrates which includes starches and sugars and water. And micronutrients are another category of nutrients that we need in smaller amounts on a daily basis and they include things like vitamins, minerals, phytochemicals, which are chemicals found in plants that provide some known health benefits and antioxidants. But I could talk about nutrition all day. They've limited me to an hour on this presentation. So let's focus on just these three for now, okay? And I want to start with everyone's favorite macronutrient and that's protein. Protein is kind of the unicorn of nutrition, right? I mean, it's everyone's golden child. And so what makes protein so special to so many? I think it's because most people associate protein with healing and with lean body tissue. And while it certainly is needed for healing, protein is no different than any other calorie taken in excess and then it can lead to body fat deposits. Where do we find protein? Well, we find protein in things like meats, fish, poultry, dairy, eggs, as well as vegetarian sources like beans, nuts and seeds. But almost all of these foods that we eat contain a little bit of protein. Just some of our better sources. And I'm thinking about a time when I was working up in Oregon, I had a patient who had something called an inborn error of metabolism. And patients who had this condition are at risk for building up dangerous levels of ammonia and their blood. And so we usually treat them with a very low protein diet. And I remember walking up to the floor after having this patient for a few days and I was greeted by the medical intern because you can tell he has a really short white coat on. And he was so excited to talk to me about our patient and he wanted to know how to restrict the protein because he had, quote, gone down to the kitchen to see what the options were and was shocked that even bread had protein in it. So I think it's a great learning experience for everyone to know that protein is widely available but has richer sources such as those are listed here. And after eating the foods with protein, our bodies are going to use enzymes to digest them, breaking them down into individual amino acids which are known as the building blocks that our bodies will use to make specific combination. There are nine essential amino acids out of the 20 available ones that we need for our bodies maintenance. Essential means that we cannot make it ourselves. So we have to obtain it from the diet. And those nine are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. There are some other amino acids that are conditionally essential. And what that means is that even though our body can make them under certain conditions, we can't make enough. So what we need to do in those types of scenarios is eat more dietary protein so that we can build up more of those particular amino acids. And of course, protein will provide our bodies with four calories per gram. Not all proteins provide us with all of the essential amino acids that we need. Those that do are called complete proteins. They contain all nine of the essential amino acids. The best sources of complete protein are animal proteins, things like meats, fish, poultry, but also eggs and dairy. And the quality of the meat matters too. If we use something called an egg standard, one ounce of chicken meat or fish will have about seven grams of protein in it. And let's compare that to a two ounce sausage which also has seven grams of protein. So why is that? Well, it's no secret that things like sausage and hot dogs are made from the byproducts of animals. And most of those proteins are fibrous and they're not easy to break down and digestion. Plus they're also higher in fat, usually saturated fat. So even though they provide more food by weight, they are not as dense in protein for that extra weight. There are two known sources of complete protein in the plant world. Both soy and quinoa have all nine amino acids that our body needs, but soy is clearly the winner here. Between the two, it provides 18 grams of protein per serving compared to four and a half for the quinoa. So what do we call all of the other foods that provide protein but don't have all nine amino acids? Well, these are called incomplete proteins. They're defined as missing at least one essential amino acid and they're largely vegetarian sources like the beans, nuts, seeds and grains. If we combine a food that's missing one type of amino acid with another food that has that amino acid but is missing a different one, we call these complementary proteins. And a classic example would be beans and rice. Beans are missing methionine, are commonly served with grain products like rice, which have the methionine, but they're missing lysine. And similarly, beans have lysine. So together, they complement each other to form a complete protein. However, you don't need to consume these two foods at the same time, but in order for them to be considered complimentary, you should have one of each during the course of a 24 hour period. Now you know where you can get your protein. The next question you might be asking is how much protein do I need a day? And that answer really depends on many things, but the simple answer is that for a healthy adult, you only need about 0.8 grams of protein per kilogram of body weight. Older adults are going to need more anywhere from one to 1.3 grams of protein per kilogram. That's because after the age of 65, muscle masters decline. It puts the older person at risk for something called sarcopenia, which means muscle wasting. As we age, we tend to eat less overall. So our calories decline. And when our calories decline, so does our protein intake. And since our bodies need a certain amount of protein, they're gonna break down the muscles in the body that we have. By encouraging a higher percentage of protein in the diet, we can hopefully prevent this muscle loss. Vegetarians and vegans should also aim for greater amounts anywhere from 0.9 to one per kilogram. This is because most of the vegetarian sources are not complete proteins. So they would need to eat a greater amount to ensure they're getting enough of all of those essential amino acids. Some also believe that vegetarian sources are not as well digested due to the presence of fiber and components in the plants. If you had surgery or if you're recovering from an illness, you're gonna need more protein to repair the damage and prevent the muscle breakdown. If we took a look at how much protein we need as a percentage of our calorie intake, this is all going to amount to somewhere between 10 and 35% of our total calories. Now you're probably thinking that's a really wide range, but I think it just goes to show that we really do overemphasize protein intake in the US when most of us can get by with much less. And honestly, that comes down to being only about 50 to 75 grams of protein today is how much people can mostly do well with. Speaking of eating protein to prevent muscle loss, I can often hear people tell me that, oh, I need to eat more protein so I can gain muscle. Well, this isn't really the same thing. So preserving muscle mass and gaining muscle are not the same and eating more protein alone will not lead to muscle gain. So if you're trying to gain muscle, you do need to increase your protein intake, but I want you to think about it like building a house. You're going to need the materials, which is the protein. And you have to do the work, which is the resistance training. Okay, let's move on now to a lesser appreciated macronutrient. These are the devil of the 90s, these are fats. We also call them lipids, but we've learned so much more since the 1990s and we can better understand what kinds of fats are beneficial and those that are harmful. And I like to always point out too that nutrition is a very young science. It's actually even a younger science than genetics. Let's face it, humans are pretty unreliable subjects which makes getting consistent results really difficult. So we do get fats from food. These are called dietary fats. They're calorie dense. They provide about nine calories per gram of fat that we consume. They also contain essential fats that we need to obtain from our diet. Alpha-Linolyneic acid, which are the Omega-3 fats and Linoleic acid, which are the Omega-6 fats. Our body has digest dietary fats into fatty acids, which we will use to make hormones and the structural component of cell membranes. And here's an illustration I have of what a cell membrane looks like. And you can see that we use two layers of what's called a phospholipid to make up the membrane. You have the water-loving part of the phospholipid that faces outward toward the blood and the inside of yourselves. That's kind of little pink balls you see there. And the lipid layer here in the center is the fatty acid tail, okay? Something we also need fats for is to digest fat soluble vitamins. We need vitamins A, D, E and K. And honestly, I think a lot of people will take these supplements with their breakfast. And breakfast for many people is a cup of coffee or a glass of OJ. And might I suggest instead, you start taking your vitamin D supplement at nighttime with your dinner, because your dinner's gonna have a little more fat and that's gonna help absorb these nutrients a little bit better. We also have non-essential fats. We can use these fats in our diet to make whatever we need for our body. We also use fats as an energy source when we're resting and also during low intensity exercises. There are two main types of fats. One is called saturated fat, and I'm sure you're probably wondering what that really means. So if we look at the chemical structure of fatty acids, saturated fats have only one single bond on the fatty acid tail, meaning it's entirely saturated with hydrogen atoms. And here you can see a diagram of the chemical nature of a saturated fat compared to an unsaturated fat. The little red circles on the end here are the oxygen and they make up what's called a glycerol backbone. And this long chain of blue circles represents the carbon of the fatty acid tail. And you can see there are only one dash attached to the green hydrogen atoms. That's saturated with the hydrogen that we see there. Okay. Saturated fats are solid at room temperature. We often say that if the fat is hard at room temperature, then it's gonna be hard on your arteries. And the dietary guidelines for Americans recommends that we consume no more than 10% of our calories from saturated fats each day. Thinking back to that nutrition panel that I showed you earlier, you can look at those daily values on the side, on the right hand side of the label to see the percentages of saturated fats and aim for anything to be less than 10% and you're gonna be well underway in eating this goal. Saturated fats are often found in animal fats. So if you look at a steak and you're kind of admiring that marbling between the meats and fibers and so forth, those are the, that's the saturated fat. My husband and I were eating at a restaurant up in Portland, Oregon many years ago. And my husband saw there was something called Kobe beef on the menu. And at the time he's like, I don't know what that is. So we asked the waiter, what's Kobe beef and what makes it so special? The waiter told us that the meat is really highly marbled. And when it's cooked, the fat melts away and becomes very lean and tender. After the waiter left, I told my husband that there's no way that's true, but he could still order it if he wanted to. USDA will define the lean cut of meat is to have no more than 10 grams of total fat and no more than four and a half grams of saturated fat in a three and a half ounce portion. By comparison, that Kobe beef has 28 grams of total fat and 11 grams of saturated fat. So it's pretty heavy up there. There are leaner cuts of beef, by the way. Some of it will cook away, but that portion that has most of the fat, this can be bound to something called fibrous fat, meaning that it doesn't really cook away with the heating process. And so you're going to consume that. There are some vegetarian sources or plant-based sources. And you might be thinking things like coconut oil is fine because it doesn't come from an animal source. So honestly, our bodies don't know the difference between saturated fats from animals or plants. And the research has shown that coconut and palm oils will raise the bad cholesterol. Moreover, we have plenty of research indicating the health benefits of fish and plant oils that have been demonstrated in reliable research. We don't have that with coconut oils. So even though we know that saturated fats are known to increase the bad or that LDL cholesterol, the exact link is debated, and many people will say it's clear as mud. The other type of fat is called an unsaturated fat. And unlike saturated fats, the fatty acid tail will have at least one double bond, so it'll have fewer hydrogens. When there's only one of those double bonds, it's called a mono-unsaturated fat. These fats are liquid at room temperature, and you can find them in plants like nuts, olive oil, avocado, and canola oil. These kinds of oils can help to lower the bad or the LDL cholesterol and raise the good or the HDL cholesterol. Now, if that unsaturated fat has more than one double bond, so even fewer hydrogens on it, we call it a polyunsaturated fat. And just like the mono-unsaturated fats, they are liquid at room temperature. Polyunsaturated fats contain the class of essential fats that we need to obtain from our diet to survive. There are two types of essential fats. Here's the alpha-lenolenic acid, or the omega-3, and the lenelaic acid, or omega-6. The omega-3 fats are anti-inflammatory, and you might see them listed as DHA or EPA, or a plant-based version called ALA. And our bodies can usually convert that ALA to both the EPA and DHA. But this process is really inefficient, and so vegetarians should really aim for a higher amounts of ALA, or think about consuming seaweed, which is a great source of EPA. Black seeds, chia seeds, nuts, and fish, as well as plant oils like canola, avocado, and olive are all good sources of omega-3 fats. These oils really should be stored in a dark container away from heat and light, so you can prevent them from going rancid. And similarly, you should avoid using these oils for frying since it degrades the omega-3 fats. Of all of these, the avocado oil has the highest smoke point that's followed by canola oil and then olive oil, and this is the temperature at which you can heat an oil before it starts to create smoke. So here's a diagram to kind of sum up the dietary fats for you. We touched a little bit on trans fats. These aren't the highly inflammatory fats that were banned from the U.S. food market in 2015. Companies hadn't had until about 2018 to comply, and they were used by taking liquid oils from plants and pumping them full of hydrogen to make them solid. And we know that these oils are more aphorogenic than saturated fats. On the ingredient label, you see them listed as partially hydrogenated fats, and it's not the same as fully hydrogenated fats. Fully hydrogenated fats are not as inflammatory as partially hydrogenated fats, but still they're not considered a healthy oil. Crisco is a good example of a fully hydrogenated oil, and you still find these oils in many processed foods that are high in added sugar and high in added salt. Saturated fats are the ones that are solid at room temperature, and they can be found in meats and full fat dairy products, as well as those tropical oils like coconut and palm. Unsaturated fats over here are the healthiest. We have the polyunsaturated fats that provide us with the essential fats we need to survive. You get them from fish, nuts, and plant oils. And then the monounsaturated fats are helpful to lower the LDL and raise the HDL cholesterol. And you can find them in plant sources like the nuts, feeds, and avocados. And so how do oils relate to heart health? Well, simplistically, there are two types of cholesterol. There's the LDL cholesterol. There's the bad cholesterol. And I want you to remember that L stands for lousy, and we want that number to be low. And the HDL is the good cholesterol. H will stand for healthy, and we want it higher. So LDL cholesterol is what our bodies will deposit in the arteries. The more LDL is deposited, the narrower the arteries become. And this creates higher blood pressure and eventually decreases the oxygen to the heart, causing a heart attack, or will decrease oxygen to the brain and cause a stroke. The HDL cholesterol will act like a garbage truck and pick up the cholesterol to deposit it back to the liver where it'll be excreted in bile. So here at the bottom, you can see a young healthy artery. And as it slowly becomes narrower and narrower with LDL cholesterol deposits. And when do we start seeing this kind of narrowing? Well, it's usually sooner than you think. They've done autopsies on children who's nearly six years old and have already demonstrated cholesterol plaque formation, usually coming from highly processed, highly saturated fat diets, namely fast foods. And sometimes I'll hear too, patients who have had a cardiac event in the hospital, and they'll tell me, had me eating healthy for the last two, five, 10 years, whatever it might be. But unfortunately, if your HDL cholesterol remains low, those plaques can remain stable and lead to these events. That's why your doctor will often place so much emphasis on improving that HDL cholesterol while still lowering the LDL. All right, so here's a pop quiz, okay? Which of these fats are heart healthy? And you can choose more than one. I've got canola oil, coconut oil, butter, margarine, olive oil, avocado, Crisco, what do you think? Well, if you said canola oil, then you're right, okay? There's a lot of myths about canola oil, but the truth is that it's really the best ratio of omega-6 to omega-3 fats out of any of the oils. However, you really should minimize its exposure to higher temperatures when cooking to preserve that omega-3 profile. And similarly to the canola oil, you've got olive oil and avocado oil, which I've moved through here. These oils have a higher ratio of omega-6 to omega-3 fats than the canola oil does, but they're still really good anti-inflammatory oils. As I said previously, the avocado oil has a higher smoke point and that allows you to cook with it at a higher temperature. What about margarine? Well, this one really depends on a lot of factors. Margarines in the US must be free of trans fats. So the healthiest ones are a blend of plant oils that are high in unsaturated fats. However, some margins will substitute palm oil or fully hydrogenated oils can make them more firm. So the answer here is to choose a very soft tub margarine and then check the ingredients for tropical oils and fully hydrogenated fats. And now, which ones didn't we choose? Well, we didn't choose coconut oil. And like I mentioned before, they're a saturated fat and they've been shown to raise the LDL cholesterol, even though they've also been shown to raise the HDL cholesterol too. Butter is another saturated fat that has negative consequences on the lipid profile. And then there's the Crisco that we talked about, which uses those fully hydrogenated fats and it doesn't really have any heart health benefits. All right, so let's move on to America's favorite micronutrient, but the one that has the most controversy behind it, carbohydrates. Carbs, as we call them, are starches, sugars and fiber that provide the body with glucose for energy. Glucose is the body's preferred form of energy and all of the cells in the body use glucose to function. Our brain is the only organ that we know that can run on ketones for energy as well as glucose. And so what else does our body use carbs for energy? Well, if you need a quick burst of energy, I can bet that that's going to be from glucose. And when you do cardio exercise where your heart rate gets up, your body will also use glucose for that activity as well. Carbohydrates will provide us with four calories per gram. It's something you may not know. Carbohydrates are actually considered conditionally essential. And that's because we can get our glucose from other sources in our diet rather than carbs. And it's not true for everyone in the population, but for the general population, this is true. Foods with carbohydrates do provide us, though, with some important nutrients like thiamine, riboflavin, niacin, folate, iron, zinc and magnesium, though we can get those to other food sources. But there's one thing that carbohydrates provide for us that we can't get anywhere else, and that's dietary fiber. And this has been shown to be hugely beneficial to our health. So there are two main classes of carbohydrates, okay? Simple carbohydrates are known as monosaccharides. Monosaccharides are glucose, fructose and galactose. There's also disaccharides, that means two sugars. It's a combination of any of the glucose, fructose and galactose to form sucrose, lactose and maltose, say that five times as fast. You'll know they're simple carbs because they're sweet in taste, which is why they are refined and they're used to make added sugars and sweeteners. But they can be found naturally in foods like honey, milk and maple syrup and fruits. Complex carbohydrates on the other hand are just long chains of monosaccharides. And because they're so long, they have more of a starchy taste to them. And we find them in foods like rice, wheat, potato, barley, oats, beans and lentils. The complex carbohydrates also contain non-digestible ones called fiber and fibers are not broken down and absorbed by our bodies at all. They can still provide some important improvements to our health. And you can find fibers in whole form of complex carbohydrates like whole wheat, brown rice and potatoes with their skins. Soluble fiber is the type of fiber that helps as the name suggests, it's soluble in water. It can slow down digestion. That helps to improve satiety, which that feeling of fullness after a meal. I want you to think of a marathon runner. Soluble fibers have a slow and steady pace that's still strong but moving along. They don't create a lot of bulk in the stool. In fact, this gel-like texture can bind the bile of our intestine during the digestive process and it'll excrete it in our stool. And our body needs to pull more cholesterol from the blood to make more bile. And this is how soluble fibers can help lower cholesterol levels. Soluble fibers can also hydrate hard stools to relieve constipation and absorb extra liquid in stools to help manage diarrhea. You can find them in things like oats, beans, psyllium, apple pectin and bananas. Then there's insoluble fiber. Okay, so this type of fiber does not dissolve in water and therefore creates a lot of bulk in the stool. When you think of insoluble fiber, I want you to think of a bodybuilder. So look down here at this picture of Arnold Schwarzenegger and Nick Corny and you can see they have quite a lot of bulk and that's kind of the same bulk that insoluble fibers are creating too. With this bulk, it causes those smooth muscles of the intestines to squeeze and it really acts like a workout and strengthens the wall of the intestine. This could help prevent constipation and also a condition called diverticulosis where these little pockets form in the large intestine that can become inflamed and cause problems in the large intestine. Insoluble fibers might also help in aiding and weight loss because they can make you feel full. You can find them in things like bran, nuts, the cellulose of vegetables and fruit skins. Some of you might be thinking, oh, we're talking about fiber. How does it relate to the glycemic index? What is the glycemic index? Well, this is a measurement of how much 50 grams of food raises the blood sugar two hours after consumption and this is done after a 12 hour fast. That sounds really complicated but what they're doing is they're demonstrating how quickly food is broken down in the digestive tract and absorbed into the bloodstream. So foods that are broken down more quickly enter the bloodstream faster. Those foods have a higher glycemic index than the foods that are slower digesting. And so foods with a high glycemic index would include things like potatoes, cornflakes, white rice, instant oatmeal. Foods that are more slower absorbing include ones like apples, bananas, oats, beans, spaghetti and bread. And some fall somewhere in the middle like brown rice, french fries, potato chips, sweet potatoes and wheat cereals. But the system is really problematic. Some foods just don't make sense. Chocolate and Snicker bars are really slow absorbing despite being the kinds of foods we encourage in moderation. And watermelon is a high glycemic food and as a fresh fruit, I would certainly want people to enjoy more often. And soda absorbs similarly to brown rice. So part of the reason for these differences comes down to the fiber content of the food, the fat content of the food, as well as preparation methods and other things. It's also important to know that when these foods are tested, they're tested individually. But when we eat them at meal times, we eat them as a mixture of other foods like proteins, fats and vegetables that pretty much evens out the blood sugar absorption. Moreover, the amount of carbohydrate consumed seems to have a bigger impact on blood sugar levels than glycemic index. And that's why we tend to emphasize more carbohydrate counting for diabetics than using the glycemic index. So that leads you to question, which carbs are best? Well, I want you to focus on fiber first. Adult Americans should be getting anywhere from 22 to 34 grams of fiber a day with women being on the lower end and men on the higher end. And you can do this by eating more whole fruits. I do recommend selecting seasonal ones. You have some changes to your palate over the course of the year. Choose whole grain options when possible and make vegetables a priority too. But I know there's some instances where you just don't wanna make that substitution. And sometimes that's when other types of carbs are best. So if you go to New Orleans to get some authentic gumbo, they're gonna serve it over white rice, not brown rice, and that's okay. Or you're gonna go see your Nona and she has a spaghetti and meatball recipe that her family has passed down for 100 years. And I guarantee you, she's not using whole wheat pasta. That's okay too. And of course, you really should enjoy your birthday cake the way you want it. These are examples of moderation in your diet. But there are other times that you wanna try and reduce the added sugars in your diet. Remember, the Dietary Guidelines for Americans does recommend consuming less than 10% of our total calories from added sugar. And again, going back to that nutrient panel and looking at the daily values, just make sure that number on the right hand side is less than 10%. It would mean reducing sweeteners like table sugar, honey, agave syrup and similar things like that. If you're worried about your heart health, I really can't emphasize this enough. Fried starches and starches that are cooked in high temperature oils really should be avoided. Some other things that you may want to consider too, especially if you're worried about glucose spikes if you're diabetic. There's new and upcoming research on something called a resistant starch. And what resistant starches are, are starches like rice or potato or pasta that have been prepared and then refrigerated and then reheated. And in this process of refrigeration, the starches realign and they become more resistant to breaking down. So this lessens their effect of the blood sugar and helps to improve satiety. Okay, how are we gonna put this all together? This is a lot, I know. There's a few things I want you to aim for here. First and foremost, I want you to aim for moderation. And even though I really don't like this term because it doesn't really provide anything specific, what it's telling you is that it's okay to have some foods that not be the healthiest all the time, just small amounts. As an example, I eat breakfast at the hospital five days a week. And usually my breakfast consists of some hard boiled eggs, some fresh fruit, some yogurt. And sometimes they will offer up a sweet bread like a pancake or a French toast or a waffle. And so moderation would be me saying on Tuesday, no, I don't wanna have pancakes because I'd rather have the waffles on Friday. Moderation is not saying I'll have the pancakes today, the French toast tomorrow, I'll have the waffles on Friday. That's not moderation. Moderation is picking one in a course of a period of time that's going to allow you to fall off of that kind of healthier pattern that you're trying to fit into. And most of you should probably agree right now that these foods can fit. Like if you're trying to eat a cookie and then you can keep the rest of your added sugars below 10% of your calories, that cookie is gonna be just fine. Think about the course of a week, think about the course of a month. There's certain times of the month where you might say I'm gonna have it on this day or pick a day of the week that you're gonna have a sweet bread or something that might fall off to consider that to be war and moderation. There's also a trend on social media that's called eat what you need, add what you want. And those waffles that I mentioned earlier that I like on Fridays, I want them, but I still need to be sure I'm getting some protein and some fruit. So what I'll do is I'll take some plain Greek yogurt, super high in protein, I'll put them on top and I'll add some sliced strawberries. And this makes me happy because I can still have my waffle, but it suits my dietary needs with the protein and the yogurt and the fiber and the fruit. And then let's not forget my favorite goal of all which is eat better, not less. It's a fact that cutting calories is the only way to lose weight. And many diets out there will try and convince you that it's some special makeup, but really when we look at it, they just cut back on calories. But when people start to diet, they talk about how they're eating less. And I wanna stop them and say, no, no, no, you don't need to eat less. You go from having a hamburger and a french fries and a large Coke to a chicken breast and a carrot stick, but some water, you're gonna be really hungry. You're gonna reach for something later that you crave and you're gonna overdo it. So don't subtract, just make better choices. Have a chicken breast over a salad, put some quinoa and some steamed beans and beets and broccoli and carrots, add a vinaigrette, squeeze a lemon. That's gonna be a much healthier lunch. That's gonna be much more filling and you're gonna feel full afterward. There are some things I want you to try and avoid though. Really making sure that you have a good relationship with your food is paramount. So you want to avoid diet extremes. There are people who create some fear about foods or food groups and they're really unfounded. People don't generally stick with these types of extreme diets and they go back to bad habits and unconscious eating and that can lead to the same health problems that they had before. I see people then say, look, I was following that really strict diet and it was working and now I'm back to eating like usual, but I've regained weight. So that means the diet was probably right, but honestly, it's not. Another example would be like 15 years ago or so, everyone was going gluten-free, even if they didn't have celiac disease. But for the most, that just isn't sustainable and they go back to eating foods with gluten that they would have gained the weight with. The gluten rule was never the problem. It never was. It was the foods they were eating and avoiding at the time like crackers, muffins, cakes and chips that were high in calories. Then when they cut them out and they lost weight and then they add them back and they regained it. Roller coaster dieting is something that's really dangerous too because your body is going through severe restrictions and calories, usually with protein that causes muscle breakdown and then the pendulum will swing back to normal diet as high in calories and people gain more weight than before and this repeats again and again and it wreaks havoc on your metabolism. There's also something called orthorexia and you might see that little stuff fixed there, rexia and I'm sure you're gonna associate it with anorexia and you're right, this is an eating disorder. So orthorexia is the avoidance of all foods that are not considered healthy and it's an obsession with healthy eating and it often leads to social isolation and anxiety about eating food. Avoiding foods that are not considered healthy can lead to malnutrition and other nutrient deficiencies. So remember, we really do know that all foods can fit into a healthy diet. Yeah, Kylie, I know, but how do I make this work? Okay, all right, so the simple answer here is my go-to recommendation, I like the Mediterranean diet. These are the foods that are eaten around the countries of the Mediterranean Sea including Spain, Italy, Greece, Lebanon, Morocco, Southern France. The foods in this region will vary on culture but they are largely plant-based with whole grains, nuts, fresh fruits and vegetables, beans, low-fat dairy, seafood and lean poultry. Very little meat is consumed and olive oil is the preferred dietary fat. In fact, these diets were studied in the famous seven country study which found that the type of fat affects cardiovascular health more than total fat. And in fact, Mediterranean diets average about 40% fat but they're mostly unsaturated fats. They're also 40% carbohydrate and they're high in fiber with very few processed foods. They also contain only about 20% protein. And here's the reason I recommend this diet. It has been ranked the number one healthiest diet for seven years in a row by US News and World Report. They found that it's best for weight loss, heart health, diabetes, bone and joint health. It's the easiest to follow. It's good for family meals and it has more longevity potential than most other diets that are out there. And the research backs this up. If you turn on the news or you check the PubMed database, you can find endless studies that are strongly linking the Mediterranean diet to lower stroke risk, lower risk for type two diabetes, lower risk for certain cancers, heart attack, hypertension and the lower risk for Alzheimer's and Parkinson's, these two. So if you're interested, here's some guidelines on how to follow the Mediterranean diet. First, aim for plentiful portions of fruits and vegetables. I recommend replacing not adding. So if I say, I want you to have some hummus and you say, oh, I have hummus every day with pita chips. I would say that's great. I want you to replace the pita chips with fresh carrots and bell peppers. Also think about having half of your dinner plate full of vegetables, but it doesn't have to be the same vegetable. You can have one prepared and one raw, eat fruits for a snack with a handful of nuts, choose whole grains most of the time, but be aware, like I said earlier, even Italians have white flower posses, but they have them in smaller portions. So the portions matter too. Choose fish and poultry a few times a week and use lean poultry or beans and lentils in other days. Some more tips for success are to limit things like butter and lard. I think we heard how bad marjoram was a few years ago and with the trans fats. And I think a lot of Americans went back to using butter, but honestly having a selection of oils like olive oil, avocado oil, walnut oil, and using them for various purposes is much better. Reserves sweets and meats for once a week. And if you choose to drink, red wine is what is used in the Mediterranean diet, but you need to limit your portion to five ounces for women or 10 ounces for men. And the thing that I really like about the Mediterranean diet is that it's not owned by any one person or company and there's so many three excellent sources that are out there. I like the old ways website and I put the logo right here so you can see it. They have lots of free recipes and resources so you can go on there to look up the more information about this. Here's what an example of a Mediterranean menu would look like, I pulled it from health wine. They've got some breakfast here with an omelet and veggie and olive. They have a snack of some dried apricots and roasted almonds. For lunch, they're having a falafel bowl with some feta, onions, quinoa, lettuce, tomatoes, hummus, and brown rice. They'll have some fresh vegetables with hummus for a snack. And for dinner, they'll have some grilled chicken with vegetables, olives, tomatoes, and a glass of red wine. And for dessert, they have some Greek yogurt with fresh fruit and honey. My personal take on this is I like to take frozen berries and I thaw them out in the microwave and then put a dollop of low-fat Greek yogurt on top with some pepitas and cinnamon and so good, yummy. That's one of my addictions right now. So is that it? Well, no, there's one other diet that's out there. It's called the dash diet. And dash stands for dietary approaches to stop hypertension and was created by the National Institute of Health and it rakes number two as the healthiest diet by US News and World Report. You're gonna find a lot of similarities with the Mediterranean diet, but this one was promoted mostly for preventing hypertension. It has a focus on reducing dietary sodium to less than 2,300 milligrams per day, which is about one teaspoon. And as this diet has been studied and used other health benefits, such as cancer reduction, lowering type two diabetes risk, lowering metabolic syndrome, which is the trifecta of high blood pressure, high cholesterol and insulin resistance as a consequence of having some excessive distal fat and the abdomen. It's also been shown to decrease heart disease and stroke in men and also in women. This diet is also free and you can find recipes on the National Heart, Long and Blood Institute's website. So here's an example of a dash menu. As you can see, it's very similar to the Mediterranean diet, but geared more toward that American taste. I also have several photo suggestions down here. So one of the very far right is mine. I serve that to my kids. It's some Greek vanilla yogurt with some fresh berries and nuts and a split banana. Sometimes I'll put chocolate chips in there too, just to make it more fun. There's a bento box over here with some quinoa, tomatoes, cucumbers and blueberries, probably some nuts in there too. Here's some chicken lettuce wraps. Here you can see a piece of whole grape toast with some nut-received butter and fresh berries. And here's a grilled chicken breast on a salad of lettuce and tomatoes. And hopefully you're starting to see a pattern here of what to expect when you're following a dash diet. There's an abundant amount of produce that helps to reduce the salt in the diet and the fiber and the meats improve the body's inflammation. And the last thoughts. Okay, please enjoy eating. Just really work on having a good relationship with your food. You can usually feel better about yourself by making some sensible choices. And I like to preach that 80-20 rule where you follow what you need 80% of the day and I'll allow 20% to stray from it. You wanna choose habits that are gonna stick with you for the long term. So it's not a diet, it's a lifestyle. And lifestyle habits take longer to see the benefits, but they are the ones that are proven to help you for your future health. And if you do make a bad choice, don't let it ruin your day. So if you get a flat tire, do you let the air out of the other three? No, you just change the tire and move on. And that's what I've got. Thank you so much for listening. It's been my pleasure to spend the evening with you. Thank you so much, Kelly. Does anyone have questions? Feel free to either put them in the chat or unmute yourself. Yeah, now you can unmute yourself and ask your question. Or you're free to put them in the chat. Okay, question. Any tricks for getting kids to eat raw bell peppers? Kids could be really picky and it depends on their age. Usually one of my favorite tips is that if you're going to introduce a new food, have a food that they're comfortable with on the same plate. So my kids usually love fresh fruit like strawberries. And if I was gonna put anything new on there, putting something that's really familiar that they enjoy on the plate at the same time, and then not pressuring them to eat it all. And honestly, you are going to be the poster child for what your kids want to do. So if you're eating the bell peppers, you're showing your children that they're delicious, that you enjoy them, and they're more likely to put it to their mouth. But sometimes maybe what you gotta do honestly is give them something to enjoy it with. This is where giving them something like a little bit of ranch dressing or something just until they can get used to having it. And that's perfectly fine. Sometimes that's what they need and then they enjoy it. And as they get older, they're not gonna want it with ranch and they're gonna want it with something else or even plain. Thank you, Kelly. Let's see, thank you from Shay. Oh, question. Okay, let's see. My tenure hates my cooking and I hate cooking. He suggested I take a cooking class or that he would teach me any recommendations for this situation. Maybe I experiment with dash and Mediterranean diets and try to enjoy it more. Incorporate your child into the cooking process with you. Usually if they are there and they're seeing how everything is gone into the cooking, they're committed to it and they're more likely to try the food. Not only that, but I think these are skills that children are eager to learn. They want to know how to prepare food. And a cooking class with your 10 year old sounds like a really fun activity for the two of you to do together. But I think engaging children in cooking and getting them to become more comfortable with the cooking process is going to allow them to see all the opportunities for healthy eating that are out there. Thank you, Kelly. Question. What are the foods that reduces the blood pressure? Most of the research is done on reducing sodium intake. And honestly, there was something that had just come out after I admit all these slides, which shows that a high potassium diet is actually the most beneficial for reducing hypertension. And we get potassium from fruits and vegetables. And that just aligns with both the Mediterranean and the dash diet. Both of those are high produce diets. We're talking about anywhere from nine to 12 servings fruits and vegetables a day. And when you're eating that many fruits and vegetables, you're not leaving a lot of room for processed foods and processed foods have a lot of sodium in them. So it goes hand in hand. Cut back on the processed foods, reduce sodium in your cooking by using other methods like marinating in juices or using lemon. Lemon rind actually is a really great way to add flavor without having to add salt. And then incorporating more of the fresh produce into the diet is going to help to reduce the hypertension. Thank you, Kelly. Question. Is there a brand you recommend for a vegan multivitamin? Oh, that's such a great question. You know, I'm gonna have to get back to you on that one. I can't say off the top of my head. And I'm not sponsored by anybody. So I don't want anyone to think that I'm selling a product but I can get back to you, Lori, with some recommendations. Okay, sure. I remember Jenny asked that question. I'll email it to her when I receive the information from you. So that's the last question I see in the chat. If you guys have any more questions, please feel free again to unmute yourself and ask or put it in the chat. Do you recommend Omega-3 fatty acids to everyone? I don't think that they're a bad idea. I'm, as a dietitian, I really believe in the power of food. And I want people to make healthier food choices. And when I was doing my master's research, I was on vitamin E. My major professor is known as the goddess of vitamin E and she was amazing. And she had this really fun cartoon that she would always show whenever she talked about vitamin E and it's the fast food counter. And there was a other portly gentleman ordering a double with a biggy fry and an extra large Coke and oh, throw in a vitamin E pill. Gotta watch the old ticker. That really sunk in when I was studying this that I thought, gosh, we shouldn't be bandating our diet by taking supplements. And he'd be so much better off if you were to have a handful of nuts to replace some of those french fries. And ultimately that's kind of what this conversation is about, eat better, not less and choosing foods that are going to be providing you with those nutrients. But if you are somebody who is a vegan or a vegetarian, I know that getting your Omega-3s are very difficult. And in those cases, or if you feel like you have a vitamin deficiency for a medical reason, then yeah, taking the supplement is absolutely advisable. But take it with a fatty food so it absorbs. Thank you, Kelly. That's the last question. Now it's 7.02, I wanna respect everybody's time and it's dinner time. Kelly hasn't had her dinner yet and she might be hungry. So thank you so much, Kelly. We really appreciate you taking the time to share with us the essentials of nutrition and how to eat better, not less. I also wanna thank everyone for joining the program. I hope you all find the information helpful to you. I will send out an evaluation survey together with the recording link and Kelly's presentation slides. Please give us your feedback so we can continue to improve. Again, thank you, everyone. Have a wonderful rest of your evening. Bye-bye now.