Nutrition and Supplements

SHARONE ABRAMOWITZ MD
motivational interviewing trainer and healthy communications consultant
integrative psychiatry and addiction medicine private practice




Nutrition Patient Education
use "nutrition agenda setting/action plan" tool to help patients focus on what they want to work on (see attachment at bottom of this page)

one page patient handout explaining the mediterranean diet (see attachment at bottom of this page)

BASIC NUTRITION INFORMATION
ANTI-INFLAMMATORY DIET 
DIET ASSESSMENT & MANAGEMENT TOOLS
putting weight in perspective 
briefest advice: stop eating flour & sugar, and eat an abundance of fruits and vegetables
  • bmi calculator: provided by nih. bmi is not based on exact science. some sub-cultures feel critical of this tool.
    • bmi pdf
    • waist: height ratio of >0.5 is consistent with central adiposity, which is highly correlated with insulin resistance
  • weight loss calculator, can be done with patient in office, tells calories needed to maintain or lose weight.
  • body weight simulator, nih research tool for most accurate calculation of calorie needs relative to activity level.
  • dietary reference intake calculator, by iom, dri's tell nutrient needs
    • includes link for a useful phone app for clinicians
  • reap & wave, article with quick primary care nutrition assessment tools
food and activity awareness
good first step is a food diary either using paper or an on-line tool. this alone can lead to weight loss. best if also connects mood to daily eating habits.
  • 1-day recall or typical day, ask pt to recall yesterday's food, drinks, snacks, dessert intake
  • food & activity diary, from kaiser, includes mood & hunger ratings, print double sided, give 3 to track 3 days in a row (one should be weekend day)
  • 3 day food record, use an app that tracks calories and nutrition: 
Further Nutrition Information


Nutrition Support Groups
    • weight watchers, covered by alameda alliance, find a meeting 
      • Fax referrals to: 877-813-5151 Health Programs Dept.
      • E:mail: livehealthy@alamedaalliance.org
      • Phone: 510-747-4577 Health Programs Line
      • After attends first free meeting, will cover reg fee & will supply 5 coupons. 
      • After 4 wks, must supply them w/ a wt loss journal copy and then will get 5 more coupons. After that they will get 10 more coupons. Can be supported up to 1 year.
    • overeaters anonymous, o.a., donation based 12-step group
    • food addicts in recovery anonymous, stricter than OA, but useful for losing lots of weight, donation based 12-step group
    • topstake off pounds sensibly, low cost diet group, Castro Valley & San Leandro, a nominal annual fee
    • senior healthy living councils, sponsored by alameda county public health to promote healthy eating among senior peers, located in senior centers and recreational centers
    • mindful eating videos, free from center for mindful eating
    • highland's bite to balance, see this youtube, nutrition education and food access for underserved
      • thurs 9-4pm enroll highland patients in CalFresh (i.e. food stamps program): appointment or drop-in, women’s clinic front desk 

      • bite to balance eligibility: bmi>30, CalFresh recepient, get fresh creds (50% bonus for fruits & veges), support groups, learn healthy cooking  

Healthy Food Access
low-incomes create great risk for obesity and metabolic problems due to lack of nutritious food due to cost and neighborhood food deserts
  • don't assume healthier alternatives are always more expensive than disease promoting processed non-whole foods, examples include:
    • dried plums (prunes): super food with more anti-oxidants than blueberries and prevents constipation
    • oatmeal: high fiber, lowers cholesterol, prevents constipation, high in minerals
    • tap or bubbly water with lemon: alternative to high glycemic juices/sodas
    • green tea: anti-oxidant super-drink
    • whole fruit: nutrient loaded alternatives to high glycemic juices
    • sweet potatoes: nutrient loaded and lower glycemic than russet potatoes
  • low cost and healthy recipes
  • alameda county farmer markets guide, search by city 
  • buying organic can be expensive. here are alternatives:
    • grub box,csa (community supported agriculture) boxed fresh fruits and veggies from $10 for 7 lbs to $25 for 16 lb boxes
    • dig deep farms, alameda county csa that employs marginalized workers, inexpensive
    • imperfect produce, emeryville low-cost csa delivers cosmetically challenged produce
    • urban adamahfree organic food stand grown in berkeley
    • dirty dozen & clean 15, from the environmental working group
      • clean 15 foods, foods that don't have to be organic: Avocados, Sweet corn, Pineapples, Cabbage, Sweet peas(frozen), Onions, Asparagus, Mangoes, 
      • Papayas, Kiwi, Eggplant, Grapefruit, Cantaloupe (domestic), Cauliflower, Sweet potatoes
      • dirty dozen plus, should always be bought organic: Apples, Strawberries, Grapes, Celery, 
      • Peaches, Spinach, Sweet bell peppers, Nectarines (imported), Cucumbers, Cherry tomatoes, Snap peas (imported), Potatoes, Hot peppers, Blueberries (domestic)
    • find a food bank, on-line locator
Supplements and Herbs

EVIDENCE-BASED INFORMATION ON SUPPLEMENTS & HERBS
WHAT'S IN THE SUPPLEMENT YOUR PATIENT IS TAKING
some supplements don't have what the label says is included

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Sharone A,
Feb 4, 2016, 2:07 PM
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Sharone A,
Feb 24, 2016, 12:32 PM
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Sharone A,
Jan 30, 2017, 4:16 PM
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