ELDER DIABETES PATIENTS



Know the Signs and Symptoms of Type 2 Diabetes in This Population to Improve Care
Jean, 78, has been experiencing urinary incontinence and showing signs of confusion. Her physician also notices she’s slightly dehydrated. When he suggests screening Jean for type 2 diabetes, she thinks this is a waste of time. After all, she isn’t experiencing frequent urination or excessive thirst, which she knows are telltale symptoms of the disease. But the truth is Jean’s symptoms are typical in elder patients newly diagnosed with type 2 diabetes.
Elder patients often present with different signs and symp­toms of diabetes, so it’s important for RDs to know what these are so they can help this patient population stabilize blood glu­cose levels with proper nutrition or refer them to a physician who specializes in geriatric diabetes care. 

ELDER DIABETES PATIENTS

Different Signs and Symptoms
More than one-quarter of the US population aged 65 and older has diabetes, including type 1 and 2, and approximately one-half of older adults have prediabetes. In this population, age-related insulin resistance and impaired pancreatic islet function increase the risk of developing the disease.

TEA’S GOOD FOR THE HEART



Studies Show a Few Cups a Day Keep Heart Disease at Bay
There’s nothing like having a hot cup of tea to jump-start your morning or a tall glass of iced tea to cool you off in the summertime.
For more than 5,000 years, various peoples and cultures across the globe have enjoyed drinking tea, making it the most consumed beverage second only to water. Fortunately, our tea-drinking ancestors had the wisdom to recognize its value and the foresight to continue the tradition of enjoying this elixir that we now know has powerful health benefits. One of the many known benefits uncovered by modern research: High tea consumption leads to a healthier heart. 

TEA’S GOOD FOR THE HEART



Upbeat Findings
According to data published in 2012 in Food & Function, black and green tea may reduce the risk of coronary heart disease and stroke by 10% to 20%.1 Two years before, one of the largest studies on the impact of tea drinking on heart health was pub­lished in Arteriosclerosis

CAN FOOD ALLERGIES BE PREVENTED?

Studies Show Introducing Risky Foods in Infancy Lowers Incidence
It’s estimated that approximately 4% of adults and teens, and about 5% of children under the age of 5 suffer from food allergies. And according to the Centers for Disease Control and Prevention, food allergies increased dramatically between 1997 and 2007.
Food allergies can vary in severity from mild, self-limiting reactions to severe, life-threatening ones. While eight foods—milk, eggs, peanuts, tree nuts, fish, crustacean shellfish, wheat, and soy—account for 90% of food allergic reactions in the United States, more than 160 foods have been documented to cause reactions.



CAN FOOD ALLERGIES BE PREVENTED?
Researchers and physicians haven’t been able to determine the exact etiology of food allergies and the reasons for the increase in allergic diseases. A variety of hypotheses have emerged, including the impact of changes in the environment or food system, vitamin D deficiencies, and the fact we’re no longer plagued by parasites and pathogens as our ancestors were due to better sanitation. To complicate matters, there appears to be a genetic component, since those with one or more first-degree relatives with allergic diseases are considered at higher risk. Children who have severe allergic disease, including asthma or atopic dermatitis, also are considered high risk.

ILLINOIS DEFEATS RD-ONLY LICENSURE BILL


ILLINOIS DEFEATS RD-ONLY LICENSURE BILL
The Vote Overturned One of the Most Restrictive Dietetics Laws in the Country
Legislation mandating that only licensed dietetics profes­sionals can provide nutrition counseling in the state of Illinois, the headquarters of the Academy of Nutrition and Dietetics (the Academy), was recently defeated.
The landslide victory in the House of Representatives in December 2012—following a unanimous Senate vote the week before—dismantled the 10-year dietetics law, which was con­sidered one of the most restrictive pieces of legislation in the country. The Senate bill would have extended the state of Illi­nois’ Dietitian and Nutrition Services law for another 10 years and increased the penalties for practicing without a license to $10,000 per offense.

With the renewal blocked, the new bill, signed by Gov Pat Quinn on December 28, 2012, ends the RD-only monopoly in

KOSHER GUIDELINES

Q:More and more of my clients are following a kosher diet. What do the dietary guidelines say about this particular eating pattern?
A: Dietitians should be familiar with various cultural and religious dietary guidelines to better serve their clients. I’ll discuss the basic guidelines for a kosher diet, but keep in mind that individuals can modify them based on their upbringing or personal views. It’s important to ask clients questions about their dietary preferences and beliefs during their initial visit to gain a better understanding of the foods they’re willing to eat.




Kosher Defined
The term “kosher” is derived from the Hebrew word that means to fit in. If a food isn’t appropriate (or doesn’t fit in) according to the Jewish laws, it’s described as treif. A rabbi doesn’t bless kosher food; instead a certified individual, called a mashgiach, ensures the food is prepared in accordance with the Jewish dietary laws.
Separating Meat and Milk
Foods are divided into three categories: meat, dairy, and neutral (or pareve). Neutral foods can be eaten individually, with meat, or with dairy foods. Meat and dairy foods, however, should never be eaten together because of an interpretation of a directive from the Old Testament that states “you shall not boil a young goat in its mother’s milk.” These categories include the following foods:
Meat: beef, lamb, venison, chicken, turkey, and duck;
Milk: milk, cheese, and yogurt (all dairy foods are derived from kosher animals); and
Neutral: fruits, vegetables, eggs, grains, nuts, seeds, and fish.
There’s a waiting period between eating a meal or snack containing dairy and one including meat (and visa versa). The time between eating meat and dairy foods tends to vary from three to six hours, depending on your client’s beliefs. There’s usually a shorter wait time between eating dairy foods then meat, sometimes as little as 15 to 30 minutes. Ask your client what specific timelines they follow.
Kosher Animals
For an animal to be considered kosher, it must have split hooves and chew its cud. Prohibited animals include pigs, birds of prey (eg, hawks, vultures, eagles), reptiles, rodents, amphib­ians, and insects. Jewish dietary law outlines the humane manner in which a certified individual known as a shochet should slaughter an animal. Even if an animal is kosher, not all the parts can be consumed. For example, filet mignon is not kosher since it’s located close to the sciatic nerve and may contain blood.
Kosher fish must have fins and scales. The scales must be permanent during every stage of life. Kosher fish include tuna, mahi mahi, salmon, and carp. Prohibited seafood include crus­taceans (eg, lobster, shrimp, crab), shellfish (eg, clams, oys­ters), swordfish, and sea mammals (eg, whale, walrus).
General Guidelines
Other kosher guidelines you may come across include the following foods:
Grapes: Since wine is used in religious rituals, any food derived from grapes (eg, jelly, wine, candy) must be overseen by a mashgeiach to be certified as kosher.
Cheese: Many cheese makers use rennet, an enzyme typi­cally derived from nonkosher animals, to harden cheese. Certified kosher cheeses don’t contain this enzyme.
Equipment: Dairy and meat plates, pots, and utensils must be washed and stored separately. Usually, clients will have two separate sets of dishes, cookware, dishwashers, sinks, and even refrigerators. If the meat and milk equipment come in contact with each other, it’s no longer considered kosher.
For more information on kosher guidelines, visit the Orthodox Union’s website at www.ou.org.
Recipe Modifications
If you provide healthful kosher recipes to clients, simply substitute oil or nonhydrogenated oil for butter. For thicken­ing soups and sauces, nondairy milks such as almond or soy can replace dairy milk or heavy cream. Vegetable stock also can replace shellfish, meat, or chicken stock in a dairy recipe. 

All Fitness __  KOSHER GUIDELINES
— Toby Amidor, MS, RD, CDN, is founder of Toby Amidor Nutrition

Helping Overweight Patients Face Their Gym Fears

Some clients who are overweight may embrace the idea of exercising at a gym but find it
Helping Overweight Patients Face Their Gym Fears
difficult to face the other people there, concerned about the stares, snickering, unwanted advice, and questions they generally associate with such a setting.
Allison Grupski, PhD, a psychiatrist at the Loyola Center for Metabolic Surgery & Bariatric Care in Chicago, helps patients who are overweight establish new behaviors in both eating and exercising. “I encourage patients to engage in reality testing,”
she says. “Some of the judgment you perceive might not actually be coming from others but rather is a thought you have to explain to your brain why you feel uncomfortable or self-conscious.”
Grupski says there are many ways to help clients improve their comfort level while exercising, including staying in one room of the gym until they become more familiar with the layout, exercising with a friend, having a trainer introduce them to the machines, going to the gym during off-peak hours, or staying toward the back of an exercise class until they have a better sense of the routine.
“It’s important to remind yourself that any new routine takes time to become comfortable with and that over time and with experience, you will notice a difference in how you feel,” she says.
Sometimes, overeager gym staff members are unwelcome. If employees push interactions, Grupski recommends telling clients to do the following:

All Fitness Step 9: Feet To Ceiling 2

 All Fitness Step 9: Feet To Ceiling 2 

All Fitness Step 9: Feet To Ceiling 2


FIRE UP THE BARBIE


A Basic Guide to Grilling Summer Vegetables I grew up in the southern part of the United States where grilling and barbecuing were distinctly different: The former was a weekday task, and the latter a weekend hobby.
Grilling is quick cooking over a relatively hot fire. It’s best suited for small cuts of meat (eg, steak, chicken breast, burgers), fruits and vegetables, and sometimes for more esoteric items such as pizza. Barbecuing involves slow roasting larger cuts of meat (eg, shoulders, legs, ribs, brisket, whole animals) over indirect heat, using hardwood or charcoal, and smoke


FIRE UP THE BARBIE

Now I live in the Northeast, where it’s cold much of the year, and grilling on gas grills is something people occasionally do, and real barbecuing is a myth. Still, I do what I can to cook outdoors as much as possible from early spring until that first unwelcome blast of winter. Even

Vegetable Mixed Grill

Vegetable Mixed Grill
Serves 6 as a side dish
Ingredients Vinaigrette
3 T fresh lemon juice
2 garlic cloves, minced
Vegetable Mixed Grill
2 tsp coarsely chopped fresh thyme
1 tsp Dijon mustard
1⁄2 tsp fine sea salt
1⁄2 tsp pepper