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The Art of Enjoying Your Thanksgiving Meal

Monday, November 24, 2014

This is a re-post but one that definitely deserves repeating.  As you prepare to gather with loved ones and enjoy a beautiful meal, remember to enjoy it.  For those struggling with eating issues, this may seem like and insurmountable task.  Sometimes it helps to have a few helpful phrases on hand to repeat to yourself when critical thoughts arise.  One of my favorites comes from Ellyn Satter:  "When you give yourself permission to eat, you can give yourself permission to stop"

The Thanksgiving meal is known to be one of excess.  And it should be.  Occasional overeating can be an enjoyable part of a normal eating pattern.  As mentioned above, just make sure to enjoy it!  Also, know your limits and pace yourself.  What do you want most?  Make sure you have room for that.  Leave the table a little or a lot stuffed, just leave the remorse out of it. Instead of depriving yourself to build up to the big event, eat when you're hungry.  Let yourself enjoy the leftovers.  This way, you won't experience the discomfort (physical and emotional) of the "last supper" mentality.  This woman's story was in Ellyn's latest Family Meals Focus newsletter and I thought I'd share it Holiday Eating Success Story.

Talking to Your Kids about Eating Disorders & Body Image: 5 tips for Parents

Monday, November 10, 2014

When should you start exploring eating and body image issues with kids?  

Although it's never too early to start emphasizing the importance of good nutrition, middle school and junior high are when these issue tend to start.  Between ages 10 and 14, kids' bodies are rapidly changing as they become more aware of appearance and compare themselves to peers.  It can be hard to get kids to talk about anything at this age, let alone something so personal.  Here are some tips for parents on how to approach this touchy subject.

1.  Discuss the benefits of good nutrition.  Talk about how food helps fuel the body and how good you, yourself feel after a balanced meal.  Need help determining what a balanced meal looks like?  See this handout for some useful information - Balance Your Plate.

2.  Consider going to a registered dietitian.  Visiting a dietitian together will allow you to start the conversation and provide good, solid overview of the importance of nutrition during adolescence.  Plus, sometimes having someone else communicate the information has a greater impact.  If your child wants it, give her some time alone with the dietitian to discuss any issues that she may not want to talk with you about.  If it's important for you to know, the dietitian will make sure you do.

3.  Ask about friends.  It is much easier for kids to talk about what their friends are doing.  Starting a conversation this way can open up the door to self-disclosure.  Consider reviewing some of the items on this screening tool ChEAT.  Ask your son or daughter if they know anyone who struggles with some of these issues.  Or, find an article to read together.  

4.  Watch videos & media clips.  There are some great resources available to explore media's influence on body image.  Jean Kilbourne's Killing Me Softly is an excellent one.  Here's a short clip from the movie to give you a taste.  The Dove Campaign for Real Beauty is another one.  This clip, Dove legacy is great for mothers and daughters to watch together.  Take some time to process the information after watching.  Or, it may work better to have your child write a few things down that they relate to and have you read them.  

5.  Don't pressure!  The best thing you can do for your child is to leave the door open.  Let then know you are available and interested in talking about this.  If you suspect a real problem, definitely visit a licensed psychotherapist for further evaluation.  Otherwise, just present opportunities for discussion and self-exploration.  Help your child identify several other people she can talk to if she doesn't feel comfortable talking to you.

Body image concerns are a natural part of adolescence for males and females.  Offering yourself or someone else as a support during this period can help ease any anxiety it might be causing your pre-teen or teenager.

Chocolate's Hidden Bounty

Sunday, November 09, 2014

Is chocolate your friend or foe?  People often describe themselves as being “addicted to chocolate”.  Of all foods, chocolate is likely the most commonly craved, particularly for women.  The winter months seem to heighten these cravings.  Many people also express guilt over eating chocolate, assuming it has a negative impact on health. 

You may be surprised to learn, chocolate actually has significant health benefits.  Chocolate comes from the cocoa bean, originating from South America.  Mayans historically used it for medicinal purposes.  It’s ironic that something we often assume to be a an indulgence actually has more antioxidant power than most "super fruits" (acai, pomegranate,goji berries, etc).  

Cocoa improves mood.  It’s rich in agents that enhance the production of various feel-good chemicals in the brain, notably serotonin and dopamine. This means that cocoa possesses anti-depressant, mood-elevating properties.  

It also contains theobromine and a small amount of caffeine which have a mild stimulant effect.  The combination of these chemicals provides the perfect neurological cocktail.  It’s no surprise that some people use chocolate to self- medicate.  And...ahem, no surprise that my children's chocolate has quickly disappeared from their Halloween stash (to no fault of their own). It makes sense that cravings seem to increase in the winter months when depressive symptoms are on the rise. 

Cocoa is also great for your heart.  The polyphenols in cocoa are cardio-protective in two ways.  They help to reduce the oxidation of low-density lipoproteins (LDL), or “bad cholesterol”.  Oxidation of LDL is considered a major factor in the promotion of coronary disease, most notably heart attack and stroke.  Additionally, polyphenols inhibit blood platelets from clumping together.


Cocoa is a great source of magnesium and zinc.  Magnesium is an important and often over-looked mineral.  It’s critical for activating muscles and nerves, creating energy in the body, helping with digestion and producing serotonin and other neurotransmitters involved in mood.  Magnesium is also critical for the heart which holds the largest amount of magnesium in the body.  Zinc also plays a role in in neurotransmitter function.  It is also critical for growth and plays a role in immune function, smell and taste perception.  

So, you can feel great about eating chocolate and serving up the hot cocoa to your kiddos this winter, right?  Yes, but.  Cocoa clearly has some impressive health benefits.  Though, as with most things, when processed and mixed with other ingredients, the nutritional value diminishes.  The chocolate in a Milky Way is off-set by its high sugar & fat content and artificial ingredients to give it a longer shelf life.  

Alternately, pure cacao bars and powder have 0g of fat,, 0g of sugar and 2g of fiber per tablespoon along with the previously mentioned nutrients.  It is the best way to fully obtain cocoa’s nutritional bounty.  Consider using it as a base for hot chocolate or mixing it into your favorite recipe.  Chili and mole sauces are great ways to add some cocoa into your food in a flavorful way.  When searching for a chocolate bar, look for one that has no more than 2-3 ingredients, at least 65% cacao and < 5g of sugar. 

Here's a homemade hot cocoa recipe that's kid-approved: 

Homemade Cocoa

For every serving use:
1 cup or mug of milk (1%, almond, soy)
1 to 2 teaspoons of Cacao
2 teaspoons water
2-3 teaspoons of sugar, agave or honey*
Gently heat the water, sugar, cocoa and vanilla over medium heat, stirring until dissolved.  Add milk, lower heat and stir.  Heat until desired temperature is reached.
Your hot cocoa can be spiced up by adding any of the following during the heating phase:
Cinnamon stick, Orange or Lime Zest, Chile Powder, Nutmeg, Vanilla.

*You can start with less and add to taste - this way you can minimize the sugar content, unlike with commercial mixes.

Body Fat is Good for Baby Making

Wednesday, October 29, 2014

Want a baby bump?  Consider bumping up the body fat!

As the winter months approach, many couples may start to think about baby making (wink, wink!).  It can be disappointing when despite best efforts, it doesn't work out.  Infertility has been linked to a number of genetic and environmental factors, many out of our control.  It's helpful to look at the variables that we may have some ability to influence.  For example, did you know that the amount of fat on a woman's body impacts fertility?  There's a lot of focus (no suprise here) on how overweight contributes to pregnancy outcome but there are significant (perhaps even greater) consequences to women not carrying enough body fat before and during pregnancy.

Menstruation won't occur unless a woman has a minimum of 17% body fat.  More importantly, ovulation ceases at at body fat of <  23%.  Most fully developed females have at least 26% body fat.  This is healthy and adaptive; we need it to reproduce.  Reproductive function shuts down when there is not enough energy present via food intake and/or body fat storage.

Many woman who lose a modest amount of weight (10-15%) as well as those with anorexia (less that 30% of ideal weight) develop either primary or secondary amenorrhea.  Primary amenorrhea is when a girl has not menstruated by age 16.  This often occurs in female athletes who, despite being at a healthy weight determined by BMI, do not carry enough fat on their bodies.  Muscle is heavier than fat since it holds a lot more water; 80% compared to 5-10% in adipose (fat) tissue.  A normal weight athletic girl who lacks enough body fat to menstruate can easily go under the radar.  In addition to reproductive function, a natural menses indicates there is adequate estrogen in the body for bone formation and growth, a very important factor for adolescent girls who are at the stage of peak bone growth.

Secondary amenorrhea is when a female begins menarche but then stops menstruating in response to hormonal shifts, often relating to body composition.  Primary or secondary anorexia is caused by hypothalamic dysfunction and can be set off by weight loss.  The hypothyalamus is the region of the brain responsible for body temperature regulation, growth, sleep regulation, emotions, child birth, weight and appetite.  Read more about hypothalamic dysfunction here.  Interestingly, many women start dieting when they think about getting pregnant because of the importance placed on being at your ideal body weight to conceive.  It's important to remember that "ideal" varies from one person to the next.

In our practice, we frequently see women who are at a healthy weight but not menstruating.  Recently, we purchased a piece of equipment, the InBody™ which measures all components of body composition in addition to weight; muscle and lean mass, body water and body fat.  By using this analysis, we have been able to determine more specifically, what a healthy weight is for each individual.  Body Mass Index (BMI) is misleading because it doesn't take into consideration how athletic an individual is and tends to be less accurate for those on the taller or shorter sides of the height spectrum.  

We offer complimentary InBody™ assessments to our patients when it is appropriate.  In many cases, clients will get retested every few months.  We also offer this service along with a 60 minute consult to explain the results to anyone who wants the assessment.  See our Wellness & Sport section to find out more.  Insurance often covers the consult portion.


NEW! Foods to Fight Cancer Workshop

Tuesday, October 28, 2014

Join oncology nutrition specialist, Leslie Judge for a workshop on nutrition for cancer prevention and survivorship.  There are a lot of nutrition myths and media hype relating to cancer; unfortunately, this serves as a source of shame for individuals who are already suffering.  Whether you are concerned about risk or reoccurance for yourself or a loved one, this workshop will help you separate fact from fiction regarding the food and cancer connection.  You can purchase tickets online here or contact Leslie for more information: 617-332-2282 or

Nutrition to Beat Breast Cancer

Wednesday, October 15, 2014

As women, we are constantly bombarded with messages about maintaining a healthy weight.  While it can be difficult to face, we know that carrying around excess weight isn’t good for many reasons.  Increased risk of heart disease, diabetes and stroke are just a few of the health risks that are connected with weight gain as we age.  Achieving and maintaining a weight can help protect you from these diseases but did you know that it may also protect you from breast cancer?

As an oncology dietitian I work with women who either have breast cancer or have a strong family history of the disease. Weight gain in adulthood puts many women at increased risk of hormone-related breast cancer due to higher amounts of estrogen present in their bodies, produced by fat tissue. Women who are overweight or obese have higher levels of estrogen than thinner women because they have more fat tissue to produce the hormone. When you lose weight, you decrease your stores of fat tissue and therefore lower the amounts of estrogen circulating in your body. This can be beneficial for lowering risk of hormone-related cancers.

Studies show that weight gain, particularly after menopause, is the most troublesome for increased risk of hormone-related breast cancer however many women are unaware of this connection. The good news is that you don’t have to feel powerless. Researchers point out that even small weight loss can make a big impact on reductions in risk. You don’t have to lose 40 or 50 pounds to see a benefit. If you are overweight, reducing your body weight by just 10% will lower your risks.

Where to start? When I meet individually with patients, we start first by talking about healthful choices. From a cancer-prevention and weight loss perspective, my first priority is always to work with my clients on increasing their intake of plant-based foods and then we proceed from there. My baseline nutrition recommendations are listed below:

1.  Start with for 5 servings of fruits/veggies daily (at least!). We all can benefit from eating more fruits and vegetables. Period. From a weight-loss point of view, it is important to watch portions of starchy vegetables like potato, winter squash and corn and think of these foods more like bread or pasta on your plate. Although they are healthful options, calories in starchy vegetables can add up more quickly than with their less starchy counterparts. On the flip side, it is really hard to overeat carrots, greens, tomatoes, peppers, asparagus, summer squash, broccoli, Brussel sprouts, etc. so have heaping servings of these whenever you can. Brightly colored fruits and veggies are packed with beneficial nutrients so aim to have lots of different colors represented on your plate. 

2.  Choose whole grains as often as possible. Think brown rice, whole grain breads, oatmeal, whole wheat pasta, etc. Whole grains have more fiber and nutrients than refined versions. The additional fiber will help you feel fuller and more satisfied when eating, in addition to keeping your GI tract healthy.
3.  Cut back on packaged foods. Aim to eat more whole foods to reduce your intake of sodium and preservatives. When choosing packaged goods, look for those with the fewest ingredients listed and pick those with recognizable ingredients.

4.  Limit sugary drinks. Choose beverages that are naturally calorie-free.

5.  If you eat meat, choose lean poultry or beef. Organic options will further reduce your exposure to hormones which may be beneficial. Include fish often. Portion size should be 1/3 of your plate or less. Emphasis should be on the plant foods on your plate, not the animal protein. Aim to have at least one vegetarian meal each week and include things like beans and tofu.

6.  Limit alcohol. For women, reducing intake to 1 drink per day or less is associated with the lowest risk of cancer and other diseases. 1 drink = 5 ounces of wine, 12 ounces of beer or 1.5 ounces of liquor. 

Of course, it's always important to individualize nutrition and lifestyle goals and determine what a healthy weight is for you -- this is not a "one size fits all" scenario.  Behavior change is difficult and takes time.  Small, gradual changes work best.  A registered dietitian (RD) can help you through this process.  If you have survived breast cancer or have a strong genetic risk for it, consider reaching out to an RD to get some support around healthy changes you can make.  Be proactive and take charge of your health!

All information is in keeping with current recommendations from the American Cancer Society and American Institute for Cancer Research. To see more information from these groups, visit or

Blog written by Leslie Judge, MS, RD, COD

Pregnant & Feeling the Burn? Helpful Tips for Heartburn.

Wednesday, September 17, 2014

Every pregnant woman has her share of discomforts but I would argue that none are quite as annoying or uncomfortable as heartburn. I say this because many other things that plague pregnant women (morning sickness, back pain, swollen feet, sleepless nights) usually don’t last the entire pregnancy. Heartburn, on the other hand, can often start at the beginning and last right on through until your little one is born. There are a host of factors that contribute to heartburn in pregnancy. Hormones and the pressure your growing baby puts on your stomach are the biggest causes. Clearly, there is not much pregnant mommas can do to avoid these things. If you are blessed enough to be heartburn-free during your pregnancy, thank your lucky stars. You have no idea how much fun you are missing. If you are experiencing heartburn, be sure to speak to your doctor about taking some over the counter antacid medications. Most doctors readily give you the green light on things like Rolaids, Tums and even Zantac – but check in just the same before taking these. Here are some additional tips to help manage your heartburn:

  • Slow it down: Eat slowly and chew foods well. When you eat quickly you end up gulping more air which only increases heartburn and gas.
  • Size matters: Have smaller meals more frequently throughout the day. Five or six mini-meals will be easier on your system than the traditional three. Avoid sitting down to large meals which can stay longer in your stomach (and make heartburn worse).
  • Avoid the main offenders: Spicy, fatty and/or greasy foods, chocolate, peppermint, carbonated drinks, citrus fruits/juices (orange, lemon, grapefruit) and tomato-based sauces/juices.
  • Keep liquids and foods separate: Drink liquids separately from your meals to avoid overfilling your belly. Small sips with meals are fine but avoid downing large amounts when eating.
  • Loosey Goosey: Choose clothes that aren’t too tight on your belly. Extra pressure in this area does nothing to help lessen heartburn.
  • Keep it up(right): Don’t lie down too soon after eating. Remain in an upright position (sitting or propped up with pillows) for at least two hours after eating. Sleeping with your head elevated may also help you avoid heartburn.

Leslie Judge MS, RD, CSO, LDN

Is it normal fatigue or pregnancy anemia?

Wednesday, September 10, 2014

Many women struggle with anemia during pregnancy. Although it’s a common thing for expectant moms to have low iron levels, it will be something that your doctor wants to address. In most cases, even given your best efforts, a pregnant woman couldn’t eat enough high-iron foods to take care of the problem without taking a supplement. Your doctor will likely prescribe some sort of supplemental iron regimen (and a note here, you should never take additional iron unless a doctor or medical professional tells you to – toxicity could be very dangerous).In addition to taking an iron pill, eating a high-iron diet is also very important and will have the added benefit of increasing your body’s absorption of the supplemental iron. Here’s what you need to know:

Iron-containing foods:


Iron content

Foods to try


* beef heart                                    * leeks

* clams                                           * liver

* chicken/turkey giblet                   * oysters

* fortified cereals

* lean pork, ham or beef


* beet greens                                  * salmon

* dandelion greens                          * sardines

* eggs                                              * spinach

* enriched breads/cereals               * swiss chard

* kale                                               * whole grains

* mustard greens                            








* asparagus                                    * molasses

* blueberries                                   * nuts

* broccoli                                         * peaches

* Brussels sprouts                           * peanut butter

* collard greens                               * potato

* dark green lettuce                         * raspberries

* dried fruits (apricots, dates, raisins, prunes)

* escarole                                        * sweet potato

* green beans and peas                  * wheat germ


Tips to increase iron absorption:

  1. Your body will absorb iron from meats more easily than from plant sources.  Eat iron-containing plant foods (in the ‘high’ and ‘good’ columns above) with meats (in the ‘highest’ column) to maximize absorption.
  2. Foods high in Vitamin C will help your body better absorb the iron in foods. Eat any of the following foods with any of the iron foods listed above for better absorption.
    • Oranges and orange juice
    • Leafy green vegetables
    • Berries
    • Potatoes
    • Turnips
    • Tomatoes
    • Bell peppers
    • Broccoli
    • Cauliflower
  3. When drinking tea or coffee, drink it at least 1 hour before or 2 hours after your iron-containing foods. Coffee and tea contain substances that interfere with the way iron is absorbed in the body.
  4. Cook foods in cast iron pans and skillets.
  5. Only take iron supplements if instructed to do so by your health care team. Too much iron in the form of supplements can be harmful.
  6. If you do take iron supplements, take them with foods high in Vitamin C (see list above) and separate them from your prenatal vitamin and any calcium supplement you may be taking by 2 hours or more.

Leslie Judge MS, RD, CSO, LDN

NEW! 'Yoga of Eating' Session Starting Soon.

Friday, September 05, 2014

Don't wait, this class will fill up!  We got such rave reviews when we held this group in June that we've decided to run it again.  This time, based on demand, we're doing 6 weeks instead of 4.  Join us in our new, larger office space in Newton Centre and learn how to truly make peace with food.  Develop awareness of internal appetite regulation while learning ways to incorporate mindfulness into your everyday life.  The class starts with a relaxation exercise including breathing and yoga followed by a mindful meal and finishing with a topic for discussion.  There will be plenty of time to share and reflect along the way -- most participants find the insight and support from others in the group equally as valuable as the class itself.  Please register here or contact Liz Fayram at 617-332-2282x2 for more information.

We had a waiting list for the last session and since we are limited to six participants, so again, definitely sign up soon if you're interested. 


Remaking Your Fall Baking

Wednesday, September 03, 2014

It just isn’t fall without apple pie, warm apple cider donuts and pumpkin bread.  Let’s face it, the cooler whether puts us in the mood for good, old-fashioned comfort food.  While it may be tempting to grab some off the bakery shelf in the grocery store, it’s more nourishing for the body and the soul to bake them in your own kitchen.  Plus, you can add an extra nutrition boost that you won't find in that Entemann's box (although there's a place for that too!).  There are many creative ways to shape up your recipes.  Following are some tips for common ingredients.

Sugar Alternatives: 

Sugar is getting a lot of bad press these days.  And while I agree, it is something we need to eat in moderation, it's not quite the villain it's made out to be.  That sweet taste provides us with one of life's greatest pleasures.  However, if you have a health condition like diabetes that precludes you from eating sugar or you find your body feels better with less, here are some great ways to ease up on it in recipes without sacrificing flavor.

  • Agave nectar:  It’s debatable whether this is actually a “better” alternative.  While it has a lower glycemic index and you can use less of it for the same sweetness, it does contain a high concentration of fructose.  A recent brain study showed fructose increases appetite more than glucose.  However there is no evidence that fructose is worse than sucrose found in sugar -- basically, we should try to limit both.  That being said, if you want to shave off some of the calories from sugar with the same amount of sweetness, use this conversion:  for every 1 cup of sugar in a recipe, use 2/3 cup of agave nectar and reduce the liquid by 1/4 to 1/3 cup.  You can also use agave crystals if liquid is not desired.
  • Stevia:  Stevia is an extremely sweet, non-caloric herb, native to Paraguay.  It has been used for centuries as sweetener and flavor enhancer but only recently in the U.S.  Here is a stevia conversion chart.

Note:  There is really no difference between sugar, high fructose corn syrup, maple syrup, coconut crystals or even honey (although honey has other immuno-preventative properties) in terms of sucrose & fructose contribution to the diet. 

Baking soda:  Did you know that most baking soda contains aluminum?  Aluminum is a common additive in most processed foods and many personal hygiene products like deodorant.  So, it must be safe, right?  Yes, in certain amounts but it’s a heavy metal that can accumulate in our bodies over time.  Aluminum has been linked to neurological disorders including Alzheimer’s.  Make sure to read the label and look for “aluminum-free” varieties.  Choosing organic baking soda ensures there is purely bicarbonate of soda, what baking soda is intended to be.

Flour:  Many recipes call for All Purpose Flour (APF).  For a gluten-free (GF) APF, mix a ratio of 2:1:1 rice flour: tapioca starch: potato starch or look for a premixed version at the grocery store.  For extra fiber, consider substituting whole wheat flour but make sure to add an additional 2TBS-1/4c of liquid ingredient.  Almond, coconut and bean flours have great nutritional properties like additional protein and can provide nice flavor and texture to baked goods.  With the popularity of gluten-free eating and paleo diet, you can find oodles of recipes with these flours on the web.  One more tip here; chia flour can add some extra structure or “glue” to gluten-free recipes and also pack in some extra protein and fiber.  Try substituting 1/4 of the main flour (i.e. rice in the case of GF) with chia powder for a recipe you’ve already tried and see what you think.

Shortening:  Shortening is vegetable oil (soy or corn) that is chemically processed to remain somewhat solid at room temperature.  It contains a large amount of trans-fat which we now know is worse than saturated fat for heart health. Companies including Crisco, removed (most) trans-fat from their recipes in 2006 when FDA required it be shown on label and last year, categorized it as an “illegal food additive”.  Unsalted butter is a better alternative to shortening.  An even healthier option is Spectrum® organic palm oil.  Palm oil is one of few vegetable oils that is highly saturated and semi-solid at room temperature and maintains the properties of shortening.  You may also consider coconut oil which has revealed a number of health benefits recently.  It works wonderfully in frosting recipes too.  Just be for-warned, your food will have a slight coconut taste.

Eggs:  Choose organic, free range eggs that also have omega-3 fatty acids.  Free-range means the chicken was able to roam outside eating grass and getting plenty of exposure to sunlight (hint: vitamin D).  The omega-3 comes from the feed, often containing flax meal.  Organic eggs do not contain any hormones and receive organic feed.  Don’t assume that if an egg is free-range and/or contains omega-3 that it is automatically organic.  Read the label carefully.

Milk:  Choose 1% or skim milk in recipes.  If you want to ensure some of the properties the full fat milk provides, replace the milk equivalent with ½ skim milk and ½ yogurt (see the next section).  You may also want to experiment with almond or coconut milk which have fewer calories but contain some unsaturated “healthy” fat as well.

Replace Mayonnaise, Buttermilk or Heavy Cream with Nonfat Yogurt:  Mayonnaise, buttermilk and cream offer wonderful properties to baked goods.  They offer fat to create the moist texture we love.  Buttermilk contains acid which activates baking powder and baking soda.  The bad news is they also contain a lot of saturated fat which is linked to heart disease.  The good news is you can cut down or eliminate this fat but replacing some or all of the ingredient with yogurt.  It’s simple, 1 cup yogurt = 1 cup sour cream, buttermilk, heavy cream or mayo.   See Stoneyfield’s website for some great recipes using yogurt .

Check out the blog healthy seasonal recipes  for even more great fall recipe ideas and healthy baking tips.

And last, but most certainly not least, here's Eating Well's yummy, healthy version of the all-time fall favorite, apple pie!  And if you're a stickler for your mom's version, that's fine too.  So am I!  Whatever treat you choose, make sure to enjoy it.

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