World Diabetes Day: Why and How YOU Should Eat More Easy, Real Food

Yes–I’m talking to you. All of you. Whether you have type 2 diabetes or not–on World Diabetes Day–I’m talking to everyone just the same, because I believe you all need to hear this: 70 percent of cases of type 2 diabetes could be prevented by the adoption of a healthy lifestyle (according to the International Diabetes Federation).

Many people watch the news or scour social media and are upset by what they see.  It’s part of our high-tech culture to be inundated with polarizing opinions on important topics.  Me? Right or wrong, I tend to avoid daily political news. Frankly, I love our country, but I don’t see how my rants could possibly help.

Instead, I channel my beefs elsewhere; I simply go to the grocery store and find myself fired up by what I see. It’s now part of our culture to be inundated with CONVENIENT JUNK, some of which masquerades as health food. And sorry (not sorry), I have no choice but to rant because I’m hoping it may possibly help you.

God Bless America…we have choices, we have innovation, we have advances in technology, we have more of everything. But it seems like everything that makes America great has made our food culture deplorable.  So, if you feel helpless when it comes to eating better to improve your health, my only goal is to help you figure out what to eat. I hope you choose to keep reading because it is my passion to help you eat easy, real food to prevent obesity and type 2 diabetes.

Although type 2 diabetes is affected by your genes, studies have shown its progression can be prevented and managed by healthy lifestyle interventions. But our food culture is not making this easy. Successfully managing, reversing or preventing diabetes requires a complete overhaul of our way of thinking, which means bucking our ubiquitous food culture.

It’s a daunting task, but I strongly believe in owning the responsibility for your own health. We can’t expect the government to tell us how or what to eat, or food companies to change their products for the better. The changes to our food culture have to come from within us–the consumers. And when we simply shift our focus from one processed food to a “healthier” processed food (gluten-free products, for example) or continually seek better “fast-food” options, we are completely off the mark and missing the point.

We have to slow down…and value ourselves, our family and our health enough to want to find the necessary time it takes to prepare and really savor real food in the company of our closest companions–our physical and mental health depends on it. And no governmental policy or commercial product can help us do that. 

But it doesn’t have to be terribly time-consuming or complicated. That’s why I am always talking about EASY, real food. You don’t have to do elaborate meal planning. You don’t have to plan a month of meals in advance. And you don’t have to cook all your meals for the week in one afternoon (unless, of course, you want to). But you do have to find ways to incorporate real food that work for you. I am sharing these suggestions that work for me and I hope they will help simplify the task of eating more easy, real food.

10 Ways To Eat More Easy, Real Food:

  1. You can eat eggs every day. I eat 2 eggs every day for breakfast. It takes less than 5 minutes. Sometimes I scramble several portions for a few days and store them in individual containers to reheat for 20 seconds. Sometimes I add sauteed veggies, or cheese, but most days just salt and pepper. At first, it was monotonous, I can’t lie. But somewhere along the way, it became a healthy habit and now it’s just “what I eat” and I don’t have to think much about it, which works for me and my busy mornings.
  2. Set real-food goals. Try having at least one fruit and vegetable at every meal. I do this for my kids’ packed lunches from home (because I can’t wait for school lunch to get healthier) and after we returned late Sunday from a weekend trip, I skipped the veggie on Monday because I hadn’t gone to the store and I got complaints about it! I love it when healthy habits become ingrained!
  3. Cook more. I usually cook dinner 4 to 5 times per week (often with leftovers). If you don’t cook much at all, start with one meal a week and increase as you can. And try to keep your meal planning (I use a white board) and your meals simple and full of real foods. Visit the recipe index for a sheet-pan meal, or a slow cooker meal, or an Instant Pot meal.
  4. Rebrand “leftovers” as “premade meals” and enjoy the extra free time. I know I talk a lot about leftovers, which don’t sound very appealing to many people. I used to be one of them! But as a busy mom, I now appreciate that they are time-giving, lifesavers! So, I recommend doing whatever you have to do to wrap your brain around using this meal prep strategy to your advantage. For lunch, B and I usually eat leftovers from the previous night’s dinner. Or I will make a quick simple salad with cucumber, tomatoes, and tuna or chicken for protein, toasted pecans or walnuts for crunch and flavor (with olive oil, vinegar and salt and pepper as dressing). Sometimes I double a meal to have leftovers for dinner the next night if I know it’ll be a busy one.
  5. Snack on some real foods if you want, or don’t snack; the choice is yours. But if you do snack, stick to lower sugar, easy, real food snacksAs a snack, I usually choose some nuts (walnuts and macadamias are my favorite), OR a piece of cheese OR a piece of fruit, such as an apple, pear, or clementine. About once a week I’ll have 4 oz. of my favorite Noosa pumpkin yogurt or even a convenient Kind Bar (Maple Glazed Pecan and Sea Salt or Madagascar Vanilla Almond), because it’s nut based and yummy, if not exactly real food.
  6. Buy fewer processed food products. I find it easier to avoid many products because there are scant good choices: such as cereal, crackers, and easy side-dish mixes. And keep in mind, even if you need to follow a gluten-free diet, gluten-free processed products are not better than their replacements for someone with diabetes. Instead focus on simple ingredients and ask yourself, “does this food come from nature?” For example, meats, fruits, vegetables, dairy, rice, quinoa, etc.  Some minimally processed canned foods I buy include canned tuna or salmon, chopped tomatoes, tomato puree, tomato paste, a variety of beans, pumpkin puree, coconut milk, and broth.
  7. Limit sugar. When you think you’ve decreased sugar in your diet in the obvious places (sugary beverages, limiting sweets, etc.), decrease it some more by reading the ingredient lists on food labels and avoiding products with sugar (and its various names). At first you may miss it, but you’ll likely notice your taste buds adjust and things taste sweeter without the sugar.
  8. Limit refined carbohydrates or preferably all carbohydrates.
    Highly processed carbohydrates such as white flour, corn flour or even gluten-free flours break down quickly into sugar in the bloodstream and research shows these refined carbohydrates are harmful to your health. A recent randomized controlled study conducted in Norway reveals that neither a very high-fat diet nor a very low-fat diet (both of which included “good” low-glycemic index carbohydrates) contribute to abdominal fat or metabolic syndrome—if they are free of refined carbohydrates. This is why for someone with diabetes, or anyone trying to prevent diabetes, it’s most important to limit refined carbohydrates, not saturated fat. Research also shows a lower carbohydrate (not just the refined type) diet is a very effective way to manage blood sugar for people with diabetes or for those wanting to prevent obesity. In particular, a diet low in carbohydrates is beneficial for reducing belly fat, which contributes to insulin resistance and diabetes. One randomized controlled study found that participants following a very low carbohydrate ketogenic diet lost more abdominal fat (trunk fat) than participants following a low-fat diet.
  9. Choose fats wisely. I use olive oil and butter mainly, with some coconut oil and sometimes even rendered bacon grease. Although these fats contain some saturated fat, research supports that saturated fat does not appear to be harmful to heart health.  Also, these fats are fairly naturally derived and minimally processed–unlike many vegetable oils such as corn, and soybean oil (which are in almost all processed foods) and even canola oil. I also recommend avoiding all trans fat, which is in margarine and other processed foods.
  10. Choose unsweetened, low-sugar beverages. I start my day with one (or two) unsweetened Italian “long” (diluted) espresso, to which I add a splash of whole milk.  I consider fresh-brewed coffee a real food, which is only minimally processed, when nothing else is added to it. Recent research suggests coffee may be protective against type 2 diabetes, heart disease, and some cancers. In fact, a recent study suggests 3 to 5 cups per day had the most protective effect on risk for heart disease. Another study suggests at least one cup daily is protective against type 2 diabetes. Then I drink seltzer (La Croix grapefruit is my favorite) and water the rest of the day. Sometimes I add a lemon or lime wedge for flavor. And I often have a glass of red wine with dinner.

Bottom Line:

I hope these tips and recipes help you rethink your day-to-day eating to incorporate more easy, real food to prevent or manage diabetes.  By doing so we can harness the power we have to control diabetes better with real food, less processed food and a healthy lifestyle. As a diabetes expert, it is difficult to deliver restrictive advice, but on the bright side, it is the best evidence-based advice to prevent and manage diabetes.  And if it helps to know that I do follow my own advice, then rest assured I know it is difficult–but also possible and satisfying to eat this way longterm. As always, feel free to share your questions or comments! 

 

Sugar: What You Should Know

Sugar is always making it into the news—and into products on grocery store shelves.  It, apparently like sex, sells. As a result, we are bombarded with conflicting and even controversial information about sugar every day. We love it, and at the same time, we hate it. One minute dietitians (RDs) are telling us “everything in moderation.”  How can we not love that–permission to eat what tastes good? The next minute, we hear how Americans should banish sugar from our lives forever.  And oh, how we hate that! Sugar is the ultimate love-hate relationship! What gives? Sugar tastes so good. How could it be so bad?

Well, let’s discuss all things sugar. In this post, I will do the following:

We Are Simply Eating Too Much Sugar
American women eat an average of 15 teaspoons of sugar each day, while men eat 21 teaspoons (it likely differs because men eat more, in general).1 Children eat an even higher percentage of added sugar than adults each day, and surprisingly, the majority of sugar is coming from store-bought foods eaten at home.2 These numbers are likely significantly lower than actual intakes, because they are estimates from 24 hr recalls, which are notoriously unreliable. Yet, even these numbers far surpass any current recommended limits (see chart), which I believe could even be falsely high due to sugar industry lobbyists influencing them. After all, a 20-ounce soda alone provides a day’s worth of sugar (about 15 teaspoons of sugar) according to all these current guidelines. I’d say soda companies have a vested interest in the science and policies of sugar, wouldn’t you?

Most concerning is the fact that people haven’t always eaten sugar in these proportions. In fact, for the great majority of human history, before sugar and flour became easily refined and cheap during the industrial revolution, we ate far less sugar and carbohydrate.  Americans have increased our sugar intake more than 40-fold since the American Revolution!6

Not everyone agrees on the cause, but all researchers agree that people grow fatter and sicker after adopting the “Western” diet and/or lifestyle. This has occurred in many populations around the globe, and it seems to happen within only two generations. Many argue that we grow fatter and sicker because of increased total calories, which have no doubt increased over time. But even if refined sugar and flour aren’t specifically to blame  (although many experts, including me, would argue that they are), it’s hard to argue that these excess calories are coming from anything other than refined sugar and flour. Yes, some increased calories are coming from the fat in our ice cream and other processed foods, but we probably wouldn’t be eating these foods if they didn’t have the added sugar.

Since the beginning of the low-fat diet craze that started in the early 1980’s, added sugar, and carbohydrate intake in general, has dramatically increased (food companies had to replace the fat with something) and so have many diseases.32  It appears that many chronic diseases such as obesity, diabetes, metabolic syndrome, heart disease, Alzheimer’s, and cancer are negatively associated with sugar intake.6-31

Soda often takes the brunt of the blame for added sugar intake because 1) Americans drink a lot of it, and 2) there are very few foods that are pure sugar like soda is, which makes it easier to identify and study than the various types of sugar in other mixed-nutrient foods. 6-31   I’m not a soda fan, but soda does not appear to be any worse than any other source of added sugar. The problem is it all adds up. Sometimes certain sugars are described as “better” than others. Particularly, there has been a lot of misguided focus on high fructose corn syrup (HFCS) as the “worst” added sugar, and honey, agave or maple syrup are often described as “better.” The bottom line is this: existing research shows (and in my opinion future research will continue to show) excess sugar of any kind appears to be harmful to your health—which is the first compelling reason we should limit all types of sugar–and FYI, sugar has 50+ names.

  1.  Sugar is Linked to Many Diseases

This is my first point deliberately—it’s actually many related points. Just look at this long list of diseases associated with sugar. It’s shocking, and I promise I don’t mean to scare you as much as educate you. But frankly, I find it a little scary. The good news: eating less sugar may improve your health!

  • Sugar provides excess calories and increases levels of the hormone insulin, which promotes fat storage and leads to obesity.
  • Chronically elevated levels of insulin are linked to insulin resistance, type 2 diabetes, and metabolic syndrome, all of which increase your risk for heart disease.
  • Sugar contributes to increases in blood levels of circulating fatty acids (dyslipidemia), which increases your risk for fatty liver disease and heart disease.
  • Sugar also contributes to hypertension, which may increase your risk of heart disease, stroke, and renal failure.
  • Chronically elevated levels of blood glucose and insulin levels are linked to cancer, including endometrial, esophageal, pancreatic, kidney, gallbladder, breast and colon cancer.
  • Chronically elevated levels of blood glucose and insulin levels are also linked to Alzheimer’s disease.

Further, there is research linking nearly all of these “Western” diseases with each other. Obese people are more likely to develop diabetes. People with diabetes are at higher risk for heart disease. Cancer occurs more frequently in people who have diabetes and obesity.  Alzheimer’s has been dubbed “type 3 diabetes” by many researchers.30  Is sugar part of the connection? It is not completely clear. It is very complicated and difficult to study to be sure what is causing the associations. And your genetics most certainly play a part. But let’s discuss what happens in your body when you eat sugar.

Of course, as you know, there are different types of sugar. But when they are metabolized, many break down into varying amounts of glucose and fructose in the body. The body handles both of of these differently.

Glucose enters the blood stream, increases your blood sugar, and your pancreas pumps out the hormone insulin to escort the glucose into the cells, where it can be used for energy. To be clear, insulin itself is not the problem. In fact, you can’t live without insulin; it is just the catalyst for increased fat storage in response to excess sugar intake.  Some glucose is used directly for energy, some  is stored as glycogen in the muscles and liver, and some is converted and stored as fat. So, a high sugar diet may lead to obesity, which then puts you at increased risk for metabolic syndrome, diabetes, heart disease and some cancers.

Many types of added sugar, including HFCS, white table sugar (sucrose), honey, maple syrup and agave also break down into about half fructose and half glucose. Fructose is the natural sugar found in fruits, and it should be noted it would be difficult to get too much by eating fruit alone.  But when you eat unnatural amounts of fructose from various sources of added sugar, fructose can be converted into fat directly in the liver, and this process also produces uric acid, which can lead to gout and possibly hypertension. So, a high sugar diet may also increase your risk of gout,  hypertension, and dyslipidemia, which further contributes to metabolic syndrome, obesity, diabetes, and fatty liver disease.

The metabolic pathways that occur when we eat various types of sugar are also thought to cause inflammation, especially when you have abdominal fat, which may be part of the process by which sugar is linked to certain diseases, especially cardiovascular disease.31 More research is needed, but the arrow is pointing in the right direction: cutting out all forms of added sugar and refined grains (which break down and are metabolized much like sugar) and eating mostly easy, real food can only help.

  1. Sugar Provides No Essential Nutrients

Excuse me for restating the obvious—but you do not need sugar, and it takes the place of more nutritious real foods.  This is the second reason I urge you to limit your sugar intake. It provides energy (that is, calories, usually in excess of what you need), but no other nutrients. That’s what we RDs mean by “empty calories.” Yes, we have been saying this for yeeeeears. But please don’t gloss over it—it’s what I like to call a “common sense verification of science.”  In other words, does the science make sense?  Well, yes, indeed, it does. There’s never been a research study or a dietary guideline that has suggested we need to eat any amount of refined sugar regularly. (I know, right? Duh. And it’s crazy to say “never” and “research” in the same sentence.)

If you want to get even more technical, carbohydrates from foods are not exactly necessary either. There are “essential amino acids” (protein) and “essential fatty acids” (fats) that our bodies cannot make, so we need to eat them from foods. But your body is technically able to make the carbohydrate it needs, specifically glucose from protein or even from glycerol, which is released in fatty acid metabolism.33 And your brain is able to function quite well on mostly ketones, which are produced when you burn fat for energy (hence, the popular “keto” diet.)  Of course, that’s another post…or several!  But I digress. For most people, this discussion is moot because our food supply provides more than enough carbohydrates for our bodies…even if you’re eating mostly real foods, which is the best way to get your carbohydrates because then you also get beneficial nutrients and phytochemicals that only whole foods provide.

Are you with me so far? We are eating too much sugar, it negatively affects your health, and it provides nothing your body needs. Still need another reason to lower your sugar intake?

  1. Sugar May Be Addictive

It is not my intent to minimize how hard it is to cut out sugar—it does take some getting used to. It even requires some will power.  But that might be putting it mildly, for some people. Although it’s controversial, some scientists suggest sugar may be addictive.34-36 Addiction or not, the jury is out, but sugar tends to lead to continued cravings for some people. If you’re one of them and you’ve ever tried cutting it out, you know the feeling. Sugar hovers in your forethought, almost haunting you, even after you’ve eaten a meal and should feel satiated. Maybe you need that piece of chocolate after your meal? You’re used to that feeling of satisfaction that serotonin triggers in your brain after you eat sugar.  We are learning more and more that our gut hormones are also intricately involved in appetite, satiety and sugar metabolism. Some people can have a little sugar and be fine. Some people can even have a lot. Some people find it easier to try to avoid sugar because even having a little leaves them wanting more and more. I suspect there’s something in that, beyond just will power.

However, as hard as it is to avoid sugar—both due to its prevalence in our food supply and the possibility it may be addictive—the cravings can be overcome with time, the right mindset—and by sticking with real foods. The body is able to adjust to lower sugar intake in a few weeks, and it gets easier, so don’t give up and give it enough time!

Sugar: Putting the Science into Real-Life Perspective

To summarize this evidence-based perspective and put it into practical terms, I will ask you the very questions I consider when deciding what to eat and feed my family:

  1. What if you have genes that are prone to obesity? Or diabetes? Or heart disease? Or cancer? Or Alzheimer’s? In other words, you may not know you have these genes, but what if these health problems run in your family, and therefore, you might also be more susceptible to them?

and

  1. What if our food supply is providing too much refined carbohydrate and sugar, often in hidden places, so that it’s nearly impossible to eat within the recommended guidelines (if you’re not purposely trying to avoid sugar and refined carbohydrates)? (Or worse still, what if the guidelines aren’t low enough for optimal health, even if you are eating within the recommendations?)

and

  1. What if sugar and/or refined carbohydrates may be addictive?

Add together these very real (evidence-based, although not all conclusive as of yet) possibilities and ask yourself this final question:

Do you want to be a slave to the high-sugar, highly-refined processed foods you eat, so that eating them makes you crave more and sabotages your health?

I, for one, don’t. So, I choose easy, real food. Every. Single. Day. And I personally find that once you limit sugar, it’s easier to eat for your health and most surprisingly, it’s equally satisfying. Do I deviate sometimes? Yes. I just got back from a week at Walt Disney World. I still tried to limit my carbohydrates to mostly real foods, but I had some dessert foods. You know how moderation makes me cringe, but that’s my kind of moderation–a very small portion of one or two of my favorites when I’m on vacation once or twice a year!

Real Food: a Work Around?

You know how I love simplicity. And real food. And most importantly–life itself (hence the extreme value I place on health.) So, while we are continually waiting for more conclusive research, I do not believe you need to count grams of sugar or carbohydrates. The simplest way to limit sugar is to choose real, unprocessed, whole foods.  Added sugars are not going away from our food supply. And public health policies or guidelines are not going to dramatically change anytime soon either. (Well, the Nutrition Facts Label is, but you can read what I think about that here.)  Rather, I see it as a “work around” to these fundamental problems if you choose to be mindful of your body and intentional with real-food fuel.  The quantity and the quality of the carbohydrates you eat will be vastly improved when you choose real, whole foods and you will drastically cut added sugars.

You might worry it will take lot of time looking for sugar in products, researching healthier options, and cooking from scratch. But I would argue lowering my sugar intake has even simplified my life. I share here How Slashing Sugar Can Simplify Life.

Final Thoughts

Slashing sugar (and refined carbohydrates) in your diet can be a big adjustment, I realize. We are surrounded by foods not fit for healthy lifestyles. But choosing better food doesn’t have to be complicated or a negative experience of deprivation. You are changing your health for the better, going back to the basics and simplifying your life, and enjoying foods as nature intended them. With the right mindset about food (which science shows you have control over, so think positively…more on that later), I believe it can be a very rewarding experience. Don’t aim for perfection, but aim for improvement with consistent healthy habits. You can retrain your brain and your body. You have nothing to lose–except possibly some excess weight and/or some health risk–giving it a try.

Start with these Tips for Slashing Sugar. I’d love to hear how it goes for you…please share your comments and tips if you’ve been trying to cut out sugar!

References

Preventing Diabetes (and Obesity): We Can Do Better with Real Food

I was at a diabetes conference last week and it was eye-opening, but maybe not in the way you are thinking. (Get ready to wander with me…) As a certified diabetes educator (CDE), I am all too familiar, as maybe you are too, with type 2 diabetes and its disease process, progression, and complications. And while I did learn several new and fascinating treatment options from the conference, the most important thing I took away is much more of a practical revelation.

These well-respected medical professionals were presenting valuable information on how to manage the “train wreck” that is full-blown diabetes, but we are still largely ignoring (thanks mostly to a lack of insurance coverage) the prevention of diabetes in the whopping 86 million Americans who have prediabetes.(1)  What struck me is that while I have not been working with patients as a CDE for more than 10 years, there have been many advances in medication and technology, but not much has changed in our efforts to prevent people from getting this terrible obesity-related disease.

There are 29 million people who already have diabetes, 8 million of whom are undiagnosed. (1) What if we could also help them reduce the number of medications they are taking (and paying for), prevent complications, and improve their quality of life? It’s not just prevention, but better management we could help people attain with practical lifestyle interventions–involving easy, real food, of course.

In general, would you agree that it’s easier to prevent problems than to deal with them after the fact? It’s better to have money in the bank before you shop. It’s better to have insurance before you need it. It’s better to have a will or trust before you die. Well, I strongly believe it’s better to delay or prevent diabetes than to treat it.

Research shows lifestyle interventions, which often result in weight loss, are able to drastically slow the progression of diabetes and prevent it in many people. In the landmark study, Diabetes Prevention Program, the lifestyle therapy resulted in a 58% lower incidence of diabetes than the control. (2) Other studies have shown similarly beneficial results from lifestyle interventions. (3) I feel excited to be in a profession in which I can help people prevent diabetes. But I’m frustrated because I have encountered health professionals (not necessarily at the conference!) who seem either unaware, complacent, disillusioned–or even self-righteous at times–when dealing with people already in the throes of diabetes. Then there are food bloggers (not necessarily RDs) in the Internet realm who may seem extremist, fanatical and maybe even on the fringes of nutrition. And there seems to be no platform in between to reach the 86 million Americans with prediabetes…or the two-thirds of Americans who are overweight or obese and may develop diabetes if they haven’t already.(4)

Further, it has never been more obvious to me that there is stark division between this RD’s idea of optimal nutrition and what most Americans are eating. But of course most RDs have to negotiate and compromise and teach whatever the patient is willing to learn. I get that there are stages of change and we need to be sensitive to a patient’s needs, but couldn’t we do better? We can and need to do better. I can say this because the number of people with diabetes is expected to double by 2050 (5) and this epidemic isn’t going to stop with advances in medications and technology alone. Indeed, they are vital for the management of diabetes, but they are like Band-aids on the symptoms (and metabolic dysfunctions) of diabetes, not solutions to the underlying problem.

I believe RDs could be a much bigger part of the solution to the problem of diabetes (and obesity). What if we were relentless in expressing our empathy and passion for helping our patients understand they have more control over their health than they may feel they do? What if the foods they are eating and their hormones are making it harder to stick with healthy changes? What if we gave them support to change how they are eating and stick with it along the way?  I believe that we all have the power to change our health habits and want to help people understand that. But I believe most health professionals working in health care institutions are limited by guidelines (and insurance policies) that are not serving their patients well.

For example, at the conference the RD presented how the 2015 Dietary Guidelines for Americans (6) recommends a limit of 10% calories from added sugar (50 grams for a 2000 calorie diet, or about 13 teaspoons of sugar), and how the new Nutrition Facts label (7) will include added sugars. This is factual information the RD was probably asked to cover. But here are my concerns: all carbohydrates affect your blood sugar, natural or added. So, 1) that is too much added sugar and it’s taking the place of more nutritious sources of carbohydrate from real foods, and 2) having added sugar on the label is not at all helpful to someone with diabetes. It’s the total carbohydrate that matters when controlling their blood sugar or dosing insulin.

As hopeless as this may sound, we will never have completely conclusive research in nutrition. That’s the nature of the beast (nutrition science). You can’t always put people in randomized controlled trials to test what you want to test. And even when you can, you can’t expect the results to apply perfectly to everyday life. But to help people prevent diabetes (and obesity), we must do better than simply relying on guidelines (that of course are influenced by all sorts of bias) and not applying whatever new research we have as it becomes available. At the conference, for example, I was hoping to hear more about the newer, very relevant evidence supporting low-carb diets as not only a viable, safe option for someone with diabetes, but as an optimal treatment. (8,9) And I was hoping to hear less about dietary fat (and especially the very outdated concern about dietary cholesterol, which even the Dietary Guidelines downplays)(6), because the evidence is mounting that we need to be less concerned about fat and salt and much more concerned about sugar. (10-15)

In all honesty, I used to believe low-carb diets were potentially harmful and inadequate in nutrition, and that they were hard to stick with. But more and more research is showing low carb diets are not harmful, people can indeed function well on fewer than 130 grams of carbohydrate each day, and they can stick with this low-carb lifestyle and reap many benefits. So, who are we as health professionals to keep this evidence-based option from people if it may help them? Low carb diets may not help everyone, but in my opinion, they are worth a try with patients who are willing (and it’s worth trying to convince those who are not willing initially) because getting diabetes has the potential to be far more harmful than any effort to follow a relatively simple, low-cost, low-carb, real-food approach.

If you’re still with me…thank you!  Please share your comments or questions. Why are low carb diets so controversial? What’s your take or experience? And always feel free to share special requests for nutrition topics you’d like to explore!

References:
  1. American Diabetes Association. Statistics About Diabetes. Overall Numbers, Diabetes and Prediabetes. Accessed 3/25/2017.
  2. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Prevention Program. Accessed 3/25/2017.
  3. Chen L. et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015; 64(2): 338-347. 
  4. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics. Accessed 3/25/2017. 
  5. Matvienko OA. et al. A Lifestyle Intervention Study in Patients with Diabetes or Impaired Glucose Tolerance: Translation of a Research Intervention into Practice. J of Amer Board of Fam Med. 2009;22(5): 535-543.
  6. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans 2015-2020. Eighth Edition. Accessed 3/25/2017.
  7. US Food and Drug Administration. Changes to the Nutrition Facts Label. Accessed 3/25/2017.
  8. Feinman RD et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 31 (2015)1-13.
  9. Noakes TD, et al. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med. 2017;51:133-139.
  10. DiNicolantonio JJ, Lucan SC. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 2014;1:e000167.
  11. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, Gersch MS, Benner S, Sánchez-Lozada LG. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007 Oct;86(4):899-906.
  12. Te Morenga LA, Howatson AJ, Jones RM1, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014 Jul;100(1):65-79.
  13. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007 Mar 7;297(9):969-77.
  14. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Jul 17;359(3):229-41.
  15. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006;83:1025-1031.

 

 

 

 

30 Eating Habits of Healthy and Happy Families

Have you heard? March is National Nutrition Month!  Nothing is dearer to my heart than the topic of family nutrition, which I practice morning, noon and night on my four most important clients! So, I’d like to celebrate National Nutrition Month with you by offering this calendar of 30 eating habits of healthy and happy families.

I hope these practices help you incorporate more easy, real food into your lives. I use the word practice very deliberately; wander a little and embrace that you will not be able to achieve perfection. But when these practices become habits, I believe they can help you minimize time spent preparing healthy food, and maximize time spent making meaningful memories with your family. But that happens over time–and only if you start somewhere. What are you willing to start doing for your family’s health this month? As always, feel free to share your ideas as a comment to help others!

Click to download a printable calendar.

“Moderation” Makes Me Cringe

A while ago now, I read yet another nutrition-related news article that stated “moderation” was key–and I cringed. Then it hit me, I am a moderation-hating registered dietitian (RD). You will no longer hear me use the word “moderation” or worse, the phrase “everything in moderation.” You heard that right. Hear me out…

I used to preach “everything in moderation” as much as the next nutritionist. Especially when friends or acquaintances asked me on the fly for nutrition advice. Or when I addressed a group of people and couldn’t delve into individual specifics. I walked a line; I wanted to promote a balanced and sustainable way of eating, while not giving too much bad news. And I also towed the line with my fellow RDs; moderation was our mantra. However, recently I have become frustrated with the ambiguity and the political correctness of the “moderation” philosophy, which is geared toward the masses and therefore, grossly oversimplified.

I can see how this phrase came to be. Unfortunately, I think nutrition experts (like me), food industry, government, and consumers are all partly responsible for this ill-defined, mass-communicated, often ineffective approach to eating. But the fact that moderation has gotten out of hand as a philosophy is as much my fault as anyone else’s. As a nutrition expert, I now believe it is negligent telling people they can eat everything in “moderation” knowing it’s likely not specific enough to help them improve their health.

But in all honestly, one of the reasons I haven’t been posting (besides a busy life) is because I have been hesitant to say it. Afraid of turning people off immediately and not getting through to help them. Afraid of taking a stand when science may disprove me in the future. And I honestly think even our political climate lately has affected me so very personally, so that I have been generally afraid of voicing an opinion. Eeek. How meek of me…

Am I a middle-child peace keeper having a mild mid-life crisis? Maybe, but the bottom line is this: I’m over it. (Until the next one.) And recipe posts are not all I have to share (although it is my pleasure to offer this practical information since I’m doing it for my family anyway). That said, I can’t make any promises about posting a certain number of times a week, although more frequently than once every five months should be doable. Ha. Blogging on my own terms…ah.

Back to my main point…in our defense, sometimes we nutrition experts have engaged in the moderation conversation when it’s not the right time or place (in a group or in public), when what we really need is more time together to make individualized changes that you can live with to improve your health. But I now think it’s more harmful than helpful to give a cursory spiel of moderation even in these situations.

The way I see it, suggesting moderation for the masses can actually hinder individual behavior change. For example, sometimes during an individual counseling session— just when I think we have made progress together, forming some specific behavior change goals—I hear my moderation philosophy echoed back to me. At this point, it is as clear as a door slamming in my face that the conversation is being shut down. (We all do that sometimes, don’t we? Sabotage ourselves before we begin when we are not ready to make changes.) But when this happens, I am only half as frustrated as the people who later realize that eating in moderation hasn’t helped them achieve their food-related goals. I can only imagine how devastated they must feel, blaming me or themselves, or both. And the viscous cycle of weight-loss efforts and failures continues…

Just look around to see how moderation fails us with weight loss. Some people eat moderately and are not overweight. Some people eat moderately and are overweight. Some people do not eat moderately, and are not overweight. And yes, some people do not eat moderately and are overweight. Clearly, “eating in moderation” isn’t effective for everyone. It’s not simply a matter of increasing physical activity. There are many overweight marathon runners. And I strongly believe achieving a healthy weight is not only a matter of will power either. Obese people have different genes that are making it harder to be thin than people who are not obese. Weight control for overweight or obese people is an uphill battle that is definitely an injustice, yet deserves no judgment—only useful tools. And “eating in moderation” is simply not specific enough to be one of them.

I think the moderation philosophy also came into being because we haven’t wanted to negatively talk about certain foods. We don’t want to take away your eating pleasure by stigmatizing “bad” foods. Eating should be enjoyable! But what you may not realize (I didn’t for a while) is that certain food industry lobbyists go to great lengths to make sure government directed guidelines don’t identify and/or quantify “bad” foods. You could say I’m cynical (BTW, I think that’s when you know you’re getting old, when everything is a conspiracy!) but this really happens. So, we nutrition experts have been left frequently hoping we all have a “sixth sense” that helps us figure out how to balance mostly healthy foods with a few treats now and then, because that seemed reasonable. But it’s not reasonable or helpful.

Much as I hate to be the bearer of bad news, I care enough to spend my priceless free time saying this (among other things): there are indeed “bad” foods. While we might disagree on some, most unbiased experts can’t deny sugar-containing foods are among the worst. So, we’ll start there. Foods containing the refined white stuff we know as sucrose, the syrups (corn syrup and high fructose corn syrup) and all of the 50+ other names for sugar (cane sugar, brown sugar, and even honey, maple syrup, agave, etc.) are not healthy when eaten in excessand they almost always are eaten in excess if you’re not purposefully avoiding them.

Sorry, but there’s no sugar-coating it. And even though it may make me a nutrition extremist, I have to take a strong stance against sugar (all types)—and even a high carbohydrate diet (more on that later)—because I feel you should know it’s a serious health hazard. And it’s not just in regards to people who are overweight or obese. Sugar is linked to many different diseases—which means you might want to read on whether your weight is in a healthy range or not.

To be clear, I am not trying to take away your eating pleasure. Anyone who knows me knows I believe eating should be truly enjoyable! But I also firmly believe eating whatever your body craves is not the only way to enjoy eating.  Changing your mindset, “resetting your body” with easy, real foods, and focusing on many positive and social eating behaviors (shopping at local farmers’ markets, cooking with friends, eating as a family, etc.) will allow you to enjoy foods in a simpler, more meaningful way. I passionately believe (and there is some evidence to support this belief) “there is something in” these social connections we make while eating. And living overseas, especially in Italy, made it even more apparent that we are often lacking those connections in our American culture.

Who doesn’t crave simplicity and meaningful social connections in this often crazy, fast-paced, disconnected lifestyle we live? I think it’s a great start to eat easy, real food at your next snack or meal. Stay tuned for more on all of these themes, starting with more thoughts and data on sugar.

 

From Our Kitchen: Lemon Marinated Chicken Thighs

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I’ve been MIA. Maybe you have been, too! When did summer become so HECTIC! Come May, I always cling to the R&R that summer promises: sun-filled vacation days, schedule and homework free. But with three kids, the work of the day continues 24/7, and there’s a schedule of a different sort all summer long. Not complaining, just keeping it real! I’m sure you can relate. But rest assured, I’ve been cooking easy, real food all the while. I just haven’t had time to blog about it! My goal is to share more substantive nutrition posts with you, but until then I’ll show you how we eat and hope it gives you ideas. You don’t need to rely on processed food, take-out, or even “meal delivery in a box” to keep meals simple and delicious.

This recipe is a family favorite. (And dear to my heart, as I modified it from my dear friend Michelle’s family recipe–thank you for letting me share it!) We usually have all the ingredients on hand. And once you pop it in the oven, you have enough time to roast some vegetables along with it, and then make a quick simple salad. It also tastes great over cauliflower rice or zucchini noodles (zoodles.) I hope you enjoy it as much as we do!

Lemon Marinated Chicken Thighs

  • Servings: 6
  • Difficulty: easy
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Ingredients

  • 1/2 cup olive oil
  • 1/4 cup white wine or chicken broth
  • the juice of 1 lemon
  • 2 T. minced onion
  • 2 garlic cloves
  • 1/4 t rosemary
  • 1/4 t. thyme
  •  1 t. sea salt
  •  1 t. black pepper
  • 2 pounds boneless chicken thighs

 

Directions

Mix all ingredients and marinate chicken at room temp for 30 minutes (or overnight) in the refrigerator. Bake in a baking dish along with the marinade at 375 for 1 hour.

From Our Kitchen: “Is It A Dessert Night?”

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Ahhh, summer is here! It’s Memorial Day weekend and right on cue, Mother Nature turned up the thermostat and rolled back the clouds.  And it’s Friday, so as some of you might know, this means, right on cue, we will be serving up dessert tonight in the Norwood household!

One of the easiest ways we started to slash sugar was by cutting out dessert during most days of the week. Early on while the kids were toddlers, B and I instituted a weekend-only dessert policy. (Funny fact about memories: My oldest “remembers” it as her good idea. I can live with letting her take the credit.) We felt it was important to restore dessert to its former role as an infrequent treat.

While helping us all eat better, it also cut out whining, begging and bargaining at dinnertime during the week. Bonus: I also learned to introduce new meals on weekends. With a “no dinner, no dessert” rule, the kids are more likely to try and eat new foods. One of my more brilliant parenting strategies, if I say so myself…

My kids love ice cream. What kid doesn’t? That’s their dessert of choice. We usually stick with the real deal: full fat, with the fewest ingredients possible, and a small portion.

But Brian and I are fond of fresh fruit with fresh whipped cream. You can make it however you like, but it takes only 10 seconds in a high powered blender (I use a Vitamix)!

Pour about a cup of whipping cream into the Vitamix, add about 1/2 teaspoon vanilla, and a teaspoon of maple syrup, if desired. Turn on LOW and quickly increase the speed to about 7. Watch carefully, and you will SEE when it stops sloshing around as a liquid at the same time you HEAR the change in the noise the blender is making. After only about 10 seconds, it’s done! Stop then, or you’ll have butter. Spoon it onto your fruit (red, white and blue in this case, of course) and indulge!

Have a wonderful long weekend, remember our fallen service members, and enjoy time with friends and family. God Bless America!

New “Nutrition Facts” Label, New You?

I read this New York Times article yesterday (March 20, 2016) about the newly approved Nutrition Facts Label, which will be required on most products by July 2018. Here’s the gist (and a picture, below) from the article:

  • the new labels will show updated serving sizes, to reflect more accurately the portions Americans are actually eating,
  • the calories will be listed in big print, and
  • there will be an “added sugars” line listed under carbohydrates.

new nutrition facts label 2016Hmmm…how do I feel about this? Well, I agree we eat bigger portions, and too many calories. We definitely eat way too much sugar. And I believe looking for added sugars is a big step in the right direction. But I think there’s a better, easier way to eat less and avoid sugar. Avoid most foods with labels whenever possible! Eat real, whole foods and eat more simply. I know it’s not always that simple for many people. But changing the Nutrition Facts label does nothing to make it easier, in my opinion.

I can see why they are increasing the serving sizes on labels, but I’m just not sure it will help anything. Americans eat bigger portions than the serving sizes currently reflect, so as it stands on the current Nutrition Facts label, we have to do math to figure out calories and all the other nutrients for the amount we eat. But are we going to eat less if the only thing that’s changed is we don’t have to do the math? (Actually, isn’t it possible if we don’t have to spend time on the math, we might spend the time we saved eating more?) Yes, we can see how much we are eating at a glance, but even without the math, the numbers are meaningless or easy to avoid for most people, aren’t they? I mean, who wants to worry about the math and the numbers anyway??? Sometimes I eat a handful of pita chips (one of my weaknesses) and I never even look at the label. Gasp. And I call myself a dietitian. If the numbers won’t stop me, who will they stop?

I actually found myself sympathizing with the soda industry camp when they said the rule to add the “added sugar” line lacks scientific evidence. Now, hear me out…there is plenty of evidence that sugar sweetened beverages are associated with obesity. I’m not saying you should drink soda by any means. (And BTW, who doesn’t know soda has a ton of sugar in it??? How is this label going to make a difference when people already know that and drink it anyway?) The main problem I see is that replacing products containing “added sugars” with products containing other forms of carbohydrate could be just as unhealthy as the foods containing added sugars. That is, the soda industry representatives are right in that the science does not support the idea that an excess of other sugars (or any carbohydrates for that matter) are any better for you than soda. For example, choosing a product full of “natural sugars” like 100% fruit juice and drinking too much of it is not a healthy choice. Choosing a highly refined white flour product, like bread or pasta, that has “no added sugars” is definitely not a healthy choice. And what about honey, maple syrup, and agave? The science doesn’t support choosing them more frequently than any other form of sugar. Focusing on “added sugars” completely misses the mark and doesn’t tell the complete story: that excess carbohydrates of any kind are likely to be bad for your health.

Well, the Nutrition Facts label is merely a tool, not an education in nutrition. If you have a drill, you won’t necessarily know how to hang a picture. If you have a better Nutrition Facts label, you won’t necessarily know how to eat well for better health. So, I hope to help your understanding of nutrition more than a Nutrition Facts label alone ever could. Yes, there are times when you can’t or don’t want to eat whole, easy real foods. I get that. But I also get–and I’m sure you do, too–that changing the Nutrition Facts label is not enough to change the health of Americans.

The good news is we have all the information we need on the Nutrition Facts label as it stands. When I do buy products with labels, I skip over the calories on the label. Because if you are choosing the right foods (real, whole foods and fewer refined carbohydrates and sugar), you will automatically lower your calorie intake and feel satiated, without counting calories. I do linger at total carbohydrates, and fiber and sugars for a minute to assess the quantity and quality of carbohydrates, but I would argue the ingredient list is the most useful part of the whole label.

  • If a product has many ingredients (say more than about five, according to Mark Bittman in Food Matters: A Guide to Conscious Eating), I avoid it.
  • If it has products that I feel are harmful, I avoid it. For example, any sources of trans fat.
  • If a product has ingredients I feel are unnecessary like food coloring or preservatives (especially if I can’t pronounce them) or if there’s an alternate fresh version that eliminates those ingredients, I avoid the product and choose the fresh version. For example, I never buy bottled lemon or lime juice; it takes only a minute to squeeze a lemon or lime with my handy citrus squeezer gadget, and it tastes better.
  • If a product has any of the 50+ names sugar goes by, I generally avoid it or when necessary only eat it once a month (or even less frequently). For example, my kids love baked beans, so if I don’t have time to make them from scratch, I buy one can and add a can of drained and rinsed pinto beans to them to make it go further. But again, it’s very seldom that we have baked beans. Ketchup and mayo are the condiment exceptions, I could try making my own, but until then, we don’t use enough ketchup or mayo to worry too much about the sugar they contain.

So, the bottom line is this: I wouldn’t wait with bated breath until July 2018; you can start now choosing whole, real foods and using the ingredient list to make better choices in the grocery store.

From Our Kitchen: Chicken Parmesan

chicken parmesan

Thanks to my day of rest on Mother’s day, I’m starting the week off way behind on my meal planning. Anyone else have that problem? A day of rest means double time the rest of the week. Whether it’s meal planning, work, laundry, errands…I’m sure I’m not the only one. Oh well, the break was nice while it lasted!

But who am I kidding??? I often let Monday slide by before I get my act together. Especially if it’s yet another rainy dreary day. Then I rally as only a good procrastinator can. Yet, despite the sophisticated flavors I try to serve up daily, even on weekdays, my meal planning is hardly elaborate or time consuming. You might be surprised to learn you don’t even need an app for it! But make no mistake, I believe planning ahead–any way you feel comfortable–is the key to serving easy, delicious real food. And your method of planning doesn’t have to take too much of your time, if you have a variety of go-to meal options up your sleeve. (Note the new, ever-expanding recipe index tab at the top of the blog!)

So, for me, meal planning is low-tech and old school. (I may know what you’re thinking. Just stop–I do at least keep all my recipes in Evernote, which I highly recommend. It comes in handy to check a recipe for ingredients while grocery shopping, particularly if you’re winging it, which I don’t recommend…) In fact, my meal planning generally consists of a dry-erase board on the fridge with usually no more than four meals planned at a time and scrawled in a hurry. Why four? I try to plan for slow cooker meals or leftovers at least twice a week, on our busiest weeknights. And I leave one meal open for one of these options: letting my mood decide, eating out, or–my personal favorite–letting B cook when time allows and the mood strikes.

However, tonight we have gymnastics, B works late as usual, and I didn’t plan on a slow cooker meal or leftovers…so whatever we are going to have has got to be easy! Naturally, I thought of this simply delicious baked chicken parmesan. I hope it can come to your rescue, too.

Chicken Parmesan

  • Servings: 4 to 6
  • Difficulty: easy
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Ingredients

  • 4 to 6 chicken breasts
  • about 1 cup of blanched almond flour
  • olive oil, spray
  • 1 jar of Rao’s marinara sauce (this is amazing sauce, from Italy, with an all natural short ingredient list, but you could use another favorite of your own that doesn’t contain sugar)
  • about 1/2 cup of parmesan cheese, freshly grated

 

Directions

  1. Slice each chicken breast in half lengthwise, to form two thinner breast pieces. (You can pound it with a meat tenderizer, but I skip this for simplicity.) Or you can buy your chicken already sliced thin.
  2. Dredge each chicken breast in almond flour. Place in a baking pan. Spray lightly with olive oil (I use a Misto spray bottle) or use a pastry brush and dab olive oil onto chicken breasts.
  3. Top with about 2 tablespoons of tomato sauce. Bake for about 20 minutes.
  4. Sprinkle with freshly grated parmesan cheese (the real, aged, good stuff from Italy). Bake 10 minutes more or until chicken is done. We like to
  5.  


Serve with a roasted green vegetable like broccoli and a simple side salad.

 

From Our Kitchen: Slow Cooker Chicken Burrito Bowls

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Cinco de Mayo is on Thursday! I highly recommend this easy recipe for your weeknight celebration. Then you can spend your meal-prep time making B’s homemade guacamole. He is well-known for his guacamole recipe–please comment if you’ve been lucky enough to have had him make you some! Everybody else, Thursday is your chance…or you can try making it at home, but I guarantee it won’t be quite the same.

A few comments about this recipe:

  • This recipe is higher carb than we usually eat at a typical meal, but beans and brown rice are whole foods with better quality carbohydrates and fiber along with important nutrients, so we eat them sometimes. Plus this recipe makes a lot more than one meal for our family of 5 (at least 2 dinners and several lunch portions), so when also served on top of a cup or two of lettuce, the smaller portion keeps the carbohydrates in check.
  • You can skip the cheese and/or sour cream if you avoid dairy, but if you like them, use the full fat version. Whole-fat dairy tastes good and is less processed. A recent study suggests whole-fat dairy is associated with a lower risk of metabolic syndrome, a carbohydrate metabolism problem linked with obesity, diabetes and heart disease.1 Other recent research suggests people who use whole-fat dairy products are less likely to be obese.2
  • I don’t, however, recommend skipping the guacamole! Making it is easy if you have a food processor or blender, but buy it if you have to (or used sliced avocado to keep it simple). Guacamole is authentic to Mexican cuisine, but even plain avocado provides a smooth texture, is delicious and serves up some satisfying “good” monounsaturated fat.

Slow Cooker Chicken Burrito Bowls

  • Servings: 8 to 10
  • Difficulty: easy
  • Print

Ingredients

4 split chicken breasts, or about 2 pounds chicken breastsIMG_4857
1 (26.46 oz) box of chopped tomatoes (I like Pomi because they taste great/are Italian, and there is one ingredient: tomatoes!) 
1 tablespoon chili powder
1 1/2 teaspoon cumin
2 teaspoons salt
1 (15 oz) can black beans, drained and rinsed (I prefer organic beans)IMG_4859
1 cup brown rice
Optional: shredded lettuce, chopped tomatoes, shredded cheese, sour cream, guacamole, salsa

 

 

 

 

Directions

  1. Place chicken breasts into large (6 quart) slow cooker. (Split chicken breasts provide more flavor and liquid than boneless; you may need to add a small amount of chicken broth if you use boneless.) Pour tomatoes, spices and beans over chicken. Cook on low 3 to 4 hours.
  2.  Add brown rice, stir and cook another 3 hours on low, or until chicken and rice is done. (If you won’t be home until mealtime, cook rice separately and then add to chicken mixture before serving.)
  3. Remove chicken from slow cooker and remove meat; discard bones. Return meat to slow cooker and stir.

Serve meat mixture in a bowl over shredded lettuce and add desired optional toppings, including B’s homemade guacamole. These burrito bowls are great as leftovers, and freeze well.