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Thursday, January 22, 2015

Water.  It's so easy to forget it this time of year but SO important not to.  50-60% of the body is water and it's a critical ingredient for all metabolic processes.  We need about 1ml of water for every calorie we consume daily; this equates to 48-64oz for most - more if you are an athlete. 

So, how do you know if you're not getting enough?  Fatigue, dry skin and headaches are a clue.  More severe signs of dehydration include extreme thirst, irritability, restlessness, dry mouth, little or no urine output (or very dark colored urine). 

During the colder months, we're less likely to crave a cold beverage.  However, there are other ways to get your fluids in.  Try decaffeinated or herbal tea or hot water with lemon.  Even coffee and regular tea offer the benefits of water intake but also may increase your need for fluid due to the diuretic effect. 

A good way to ensure you're getting enough is to shoot for 16-20oz of fluid with or between each meal.  After breakfast or lunch, fill up a water bottle or travel mug and keep it with you.  Having a water bottle or mug handy makes it more likely you'll take opportunity to get fluids it.  Another option during cold weather is soup.  Have a 16oz bowl of soup with your lunch and you've just about met your fluid needs for that meal.  Here are some great soup recipes from one of my favorite sources, Eating Well Magazine.


Interesting Stats on Resolution Success

Monday, January 05, 2015

I'm sitting here in my office with a little extra time on my first day back from vacation.  While I started with a full schedule this morning, a number of (new) patients didn't show.  This is unusual and it got me thinking about the motivation to change leading up to New Years and after.  Did these individuals resolve to make some health changes in the new year but when it came time, commitment fell short?  Was it just simply the fact that it was a cold, post-holiday Monday?  So, of course, I googled it.  This video was my first find and is a great and llustration of research done by Dr. Mike Evans comparing success of behavior change following New Years' resolutions versus resolutions made at other times during the year.  It's short and worth the watch.  The fact that weight loss is the #1 goal was no suprise.  The other results, however, were rather fascinating.  

It seems you are 10 times more likely to succeed with you goal if you make it at New Years!  So, now's the time for change folks.  

What are the keys to success?  

1.  Small Goals and Gradual Change

2.  Set Up Your Environment for Success

3.  Play Offense Instead of Defense

4.  Plan Ahead

5.  Reflect and Recommit

I would add support.  Taking the time to meet with a dietitian or other health professional gives you the opportunity to recommit to yourself -- to your health.  Let us help you reach your goals this year!  Contact us at or 617-332-2282 to set up an appointment today and get started on a healthier you!

Pass the Cheese Please!

Thursday, December 04, 2014

Are you a cheese lover?  If so then you're in good company!  This time of year definitely puts me in the mood for some warm brie, a nice viney blue or our family favorite, Dubliner.  Which is why this article in Food & Wine about the best artisinal cheese got my mouth watering.  It features some local New England cheeses including one from Shy Brothers Farm in Westport, MA.  Luckily, we don't have to travel to Vermont, Connecticut or even Westport to enjoy these delicious artisinals.  If you visit the farm's websites, you can find out where their products are sold or possibly order online.  

Many people assume cheese isn't "healthy" due to it's high fat content.  Before I argue that point, let's just say, so what if it isn't healthy?  Must every morsel we put in our mouths be contributing to the greater good of our body?  Is enjoying food important?  Is it possible to balance nutrition with enjoyment?  What happens when you deprive yourself of foods you love?  Managing your relationship with food is a personal matter and these are good questions to ask yourself. 

More often than note, deprivation leads to over-indulgence.  Think about this throughout the holiday season.  Let go a little more and let your body cues guide the way.  Try to avoid 'all or nothing' mentality.  Instead think 'some'.  Many people give themselves unrestrained permission to eat throughout the holidays with the caveat "my diet starts in January".  This can be a set up since the message remains that it's really not ok to eat these foods and therefore, you better get it all in while you can!  I'm going to repeat my favorite quote from Ellyn Satter once again, "when you give yourself permission to eat, you can give yourself permission to stop."  

Now for the health benefits of cheese.  It is "healthy".  Cheese is an excellent source of protein (5g/oz) and of course, calcium (~300mg/oz).  It also has a good amount of fat to help with satiety .  Cheese satisfies the palate's craving for creamy, rich and savory food.  Finally, recently a lot of attention has been placed on the importance of our microbiome (see former post,  "Getting to Know Your Microbiome" for more on that).  While there is still a lot of research to be done, probiotics appear to help improve gut bacteria. One of the best sources of probiotics is raw milk.  That's right raw, as in not pasteurized

If interested in raw milk, you will want to find a local farm that sells it. The Raw Milk Network within the Massachusetts chapter of the Northeast Organic Farming Association (NOFA) is a great resource for finding local dairy farms.  You will also find more information here on local, organic foods.  Eastleigh Farm in Framingham offers raw as well as pasteurized dairy. 

So go on, enjoy your cheese; along with a variety of other foods this holiday season!  

Here are some of our favorite combos:

1.  Baked brie with fruit.  Try this one Baked brie with apples and cranberries .
2.  Fruit and cheese platter.  Here are some tips for creating it.
3.  Baked into things like in these cheese crisps.
4.  Sprinkled on salad.  Read about 5 great cheeses for salads.

Get Your Greens!

Tuesday, December 02, 2014

We featured the first smoothie listed below at our wellness table at Blue Cross Blue Shield in Quincy last week and received rave reviews!  Many people asked for the recipe so we thought we'd re-post it.  Try both of these great green smoothies, each with a different nutrient profile.  The Kale-Pear smoothie is packed with vitamin C, folate and other B vitamins, lutein and zeanthin while the Avocado-Melon smoothie provides a good amount of mono-unsaturated fat, vitamin E, calcium and protein.  Both smoothie offer the benefits of fiber and water.  

Use these energy boosters as part of your breakfast or lunch or between meals instead of coffee.  Loading up on greens is a great way to recharge without the caffeine!  

Kale-Pear Smoothie (makes 3-4 servings)

1 banana

2 cups kale, cut, large rib removed

1 pear

1 cup grapes

1/2 orange

1 scoop veggie protein powder*

1 cup water (trade a 1/4 c for apple juice if you'd like)

1 cup ice

Mix in blender and enjoy!  You've just had your day's worth of folate, potassium, vitamin C and oodles of other vitamins and minerals.  Plus it's got fiber and a protein to help fill you up and balance blood sugar.

*Optional if you want some extra fiber


Avocado-Melon Smoothie

1 ripe, fresh avocado

1 cup honeydew melon chunks

juice from 1/2 lime

1 cup fat free milk

1 cup fat-free or lowfat yogurt

1/2 cup apple juice or white grape juice

1 TBSP honey

This sweet, creamy smoothie is a great alternative to ice cream adding the benefits of potassium, B-6 and folate along with the calcium.





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

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