March Newsletter

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Welcome to the great resignation. You thought that maybe it was over in 2021! Welcome to 2022!! Maybe this is the year for LTC to stand proud and employ proud, this is your opportunity to embrace people and place scaffolding to support employees in the right direction.

I was at Aqui, a very reputable restaurant, not high end by any means, but excellent customer service! Good food, not too much money. My point is someone took the time to make sure the employees are paid well and trained well. They were set up for success and supported! When was the last time we paid attention and took the time to visit and support the Nutrition Department? I guess when something went wrong? Have you looked at the equipment? Have you sat with the team that produces 3 meals a day 7 days a week? Most of the staff leave because it is a hard job! And most other fast-food restaurants are paying 4 to 5 dollars an hour more. I took a snapshot of the offering of salary for employ- ees, and there is no match. 420,000 people resigned from LTCC last year. HMMMM!? We live in the most abundant state, I have to ask who is responsible? Is it us that do not take the time to build a confident team?

The saddest conversations I have is when an RDN Team Member says to me they are frustrated and feel disrespected be- cause they see so no support or partnering to move forward. When our RDNs feel that way they usually resign because they signed up to make a difference and work with the team.

 

Spice of the Month: Peppercorns

by Jean Swailes, MS, RD, CSG

History of peppercorns

The history of peppercorns is rich and long. Originating in In- dia, use of peppercorns in cooking dates back to 2000 BCE. Peppercorns were one of the first ingredients to be traded in the western spice trade. They were so popular, Marco Polo recorded the locations in which it was sold and grown in great detail. Through the spice trade, peppercorns grew in populari- ty and became one of the most used spices in cuisines across the globe. Black pepper was often referred to as “black gold” in historical trade texts and was used as a form of currency. Peppercorn has been discovered in reci- pes from ancient China, Rome, Egypt, and Mesopotamia as far back as 1213 BCE and then spread to Europe and the Americas by the early 1500’s.

Peppercorn Taste

Peppercorns come in a variety of colors and varieties including black, red, white, and green. All varieties of peppercorns have slightly different flavors which range from citrus, sweet, tart, floral but all varieties are peppery. They are all best suited for different types of dishes. The most com- mon and versatile variety, black peppercorns, have the strongest, most pungent flavor and have an earthy, spicy zest.

Nutritional Benefits of Peppercorns:

Rich in Vitamins and Minerals. Black pepper is high in vitamin K which promotes blood flow, iron which helps deliver oxygen to muscles, and magnesium which supports muscle and nerve function. ½ tablespoon of ground black pepper contains 6% DV of vit- amin K, 5% DV of Iron, and 9% DV of Mag- nesium.

Boosts nutrient absorption. Piperine, a com- pound found in black pepper, helps absorb nutrients like iron and beta-carotene as well as antioxidants such as curcumin and resveratrol (antioxidant found in red wine and grapes). It is especially powerful when combined with turmeric because it helps your body absorb the curcumin compound which also has antioxidant and anti-inflammatory properties. 1/8th of a teaspoon of black pepper is enough to aid in mineral absorption.

Promotes digestion. Black pepper can stimulate gastrointestinal functionality by aiding in the release of enzymes in your pancreas and intestines that helps digest fat and carbs. It also helps you feel full after a meal and ease food’s transit through the GI tract.

Antioxidant properties. Piperine, has been found to help fight free radicals. Some re- search has linked the use of black pepper marinades to the elimination of hetero-cyclic amines, which are cancer causing chemicals formed when meat is charred. A group at Kansas state university found that mixing ½ tsp black pepper with 8 oz of meat almost completely eliminated the formations of heterocyclic amines during cooking!

How to use peppercorns

Peppercorns are one of the most diverse spices and can be used literally in almost any- thing. Peppercorns provide an earthy pungent kick to anything you’re making. They are ideal for seasoning any favorite food. Black pepper enhances the flavor of meat, gives a bite to soups and stews, and adds flavor to vegetables. You can also add whole pepper- corns to stocks, brines, and pickles. Fresh ground peppercorns are even a great addition to sweets. Add them to shortbread cookies, chocolate frosting, or vanilla ice cream for some added nutrition and spice!

 

 

peppercorns are healthy
Mixed peppercorns red black and white in bowl – Close-up.

Homemade Peppercorn Chicken Stock

This chicken stock is a great way to use up old veggies and leftover chicken bones. It is versatile and chocked full of vitamins and minerals. You can use leftover chicken carcass or ask your butcher for chicken bones. Use as a base for soups or drink on its own with toast for breakfast.

Total Time: 4.5 hrs, Prep Time: 30 minutes, Cook Time: 4 hours, Servings: 8

Ingredients:

1 whole chicken carcass 6 quarts water

  • Carrots, chopped
  • sticks celery, chopped

1 whole large yellow Onion

½ cup Fresh Ginger, sliced 2 bay leaves

1 head garlic, sliced in half 4 sprigs thyme

1 bunch parsley stems

1 Tablespoon whole black peppercorns 1 cinnamon stick

1 tablespoon kosher salt

1 Tablespoon white wine vinegar 1 lemon, sliced into wedges

Preparation:

  1. Place all ingredients through salt in large stock
  2. Bring the stock to a boil over high
  3. Then, turn down the heat to a
  4. Skim off the foam that rises to the Add vinegar.
  5. Simmer the stock at medium-low heat for 4 Turn off heat and let cool.
  6. Strain the stock through a fine mesh
  7. To serve, heat stock and add juice from lemon
  8. Stock may be refrigerated for 5 days or frozen for up to 3 months for later

How Does Motivational Interviewing Help You Succeed as a Healthcare Professional?

By Wenyan Wang, MS, RDN

Motivational Interviewing (MI) is an evidence-based and person-centered communication method to facilitate behavior changes. It is practical and now has been widely applied to various settings. As a healthcare professional, it is often to encounter situations that need to help people change behaviors. However, change is not always happening. After many clinical studies and

research, MI has been shown as an efficient approach for changing behaviors. How could

healthcare professionals practice MI? The key concept is to collaborate with individuals to create an equal partnership, facilitate the expression of thoughts and feelings, summon motivation, and strengthen actions for making changes. Most importantly, MI emphasizes autonomy. Individuals are empowered to make changes, but individuals make the final decisions.

DO:

  • Express Empathy – putting yourself in someone else’s shoes
  • Develop Discrepancy – acknowledge current behaviors and clarify future goals
  • Roll with Resistance – identify problems and work on solutions
  • Support Self-Efficacy – discover strengths or learn from past successes

OARS:

  • Open-ended Questions – offer chance to express
  • Affirmation – recognize strengths and successes; support efforts to change
  • Reflection – show active and reflective listening
  • Summaries – express mutual understanding

Let’s see how RDs apply MI to real-world situations. One of the residents has a diagnosis of Chronic Kidney Disease and is on a renal diet. You heard from your CDM that he orders food

and soda from outside. You checked the most recent labs and found out that his labs are off. You decided to talk with him. Here is your conversion with him and how you utilized MI during the talk.

Resident: I am getting tired of following a renal diet.

RD: I understand how hard it is to follow a renal diet. It is challenging. 【Express Empathy】

What are some good things about ordering food and drinks from outside? 【Develop Discrepancy】【 Open-ended Questions】

Resident: I enjoy the taste of the food, and I have more choices to eat.

RD: What are some of the less good things about ordering food and drinks from outside?

【Develop Discrepancy】【Open-ended Questions】 Resident: It could hurt my kidney.

RD: Do you see any benefits if you keep doing what you have done before? 【Develop Discrepancy】【Open-ended Questions】

Resident: My kidney may not be getting worse quickly. But I do not care anymore.

RD: It sounds like you are feeling burdened to keep doing it.【Roll with Resistance】【Reflection】 I appreciate the efforts you have already made so far. 【Affirmation】It is possible to make some adjustments that will let you feel it is not that difficult to follow a renal diet. If you are happy to hear, we could discuss more. 【Support Self-Efficacy】

Motivational Interviewing does take time and effort to apply to daily conversations. Let’s start practicing MI today!

Lu Rou Fan (Taiwanese Braised Pork Rice Bowl)

By Allen Twu RDN

Every culture has one distinct comfort dish that comes to mind. This is reflected in the abundant choices in cuisine available in our very own state-California. Although a va- riety of restaurants exist, the signature items among these establishments remain constant. This is because food is often used as a means of retaining cultural identity.

As many of you may know, I am Taiwanese-American. Growing up my parents en- sured that my siblings and I would learn about the history and culture of Taiwan. Unfortu- nately for my dad, despite the countless hours in classes and the summers spent in Tai- wan’s humidity, memories that have remained at the forefront are the meals that I shared with my grandparents.

Taiwan has a food culture dependent on delivery and dining out so I rarely have memories of us having home cooked meals during our visits. What I do remember are the times my grandfather came home with boxes of food during the mid evening full of my favorite items-my grandfather and I shared similar tastes in food. Out of the numerous dishes that my late grandfather would purchase for me, I wanted to share one of my fa- vorites: lu rou fan.

Lu rou fan is a popular Taiwanese dish consisting of braised fatty pork, hard boiled eggs flavored in meat broth and vegetables over a bed of rice. While this specific recipe calls for blanched vegetables, I usually prefer to have my lu rou fan with pickled vegeta- bles. The vinegar taste within the pickled vegetables helps cleanse the palette from con- tinuous bites of pork belly to give it the perfect combination.

While the traditional recipe calls for fatty pork, a way to make it healthier is to use a leaner cut of meat. You can also try using low sodium soy sauce or coconut aminos instead of regular soy sauce to reduce the sodium levels. To make this dish gluten-free, use gluten free soy sauce (or coconut aminos) and skip the rice wine.

Total preparation time: ~1.5 hours , Servings: 4 Ingredients:

  • 250 ml neutral cooking oil
  • 140 g shallots (or red onion), thinly sliced
  • 450 g pork belly, skin on
  • 5 cloves garlic, minced
  • 20 g rock sugar (or 1 tablespoon white sugar)
  • 2 tablespoon light soy sauce
  • 1 tablespoon dark soy sauce
  • 2 tablespoon Shaoxing rice wine
  • ½ teaspoon Chinese five-spice powder
  • ¼ teaspoon ground white pepper
  • 5 shiitake mushrooms, rehydrated and diced
  • 4 hard-boiled eggs
  • 4 portions plain steamed rice

Blanched green vegetable (Bok choy is a popular option however I usually prefer mine

Instruction:

  1. Heat up oil over medium Add sliced shallots. Fry until they become golden and crispy.
  2. Drain through a Set the shallots aside for later use.
  3. Cut pork belly into Put into an empty wok (without oil) over medium-high heat. Fry until the fat has been extracted and the meat browns slightly.
  4. Stir in garlic and rock Fry until fragrant and the sugar has melted.
  5. Add light soy sauce, dark soy sauce, Shaoxing rice wine, five-spice powder, white pep- per, diced shiitake mushroom, fried shallots (leave some for topping) and hard-boiled eggs.
  6. Pour in the water in which the mushrooms were Top up with more water to immerse the meat completely. Bring it to a full boil. Turn the heat down to the lowest. Cov- er with the lid and leave to simmer for at least 1 hour until the pork becomes very tender (check the water level halfway through and top up if it seems too dry). This step can be done in a stovetop pressure cooker or an instant pot. Adjust time accordingly.
  7. If there is still quite a bit of liquid left, turn the heat to high and cook uncovered to re- duce its volume and thicken (Do not dry it out though as you’d need some liquid to serve with the meat).

Put freshly cooked rice in serving bowls. Top with blanched vegeta- ble and halved eggs. Then spoon the pork, along with some thick- ened broth, over the rice. Add the rest of the fried shallots. Serve immediately. Yes Patricia, you can still eat your cake.

Cami Mandell Gorden RDN CDCEF

We’ve probably all been called in to the room of a resident on a CCHO diet who wants the dessert their roommate has. They are mad/frustrated/confused/annoyed that their roommate has a delicious looking piece of cake and they have…a bowl of fruit. Or maybe you’ve been stuck between a doctor wanting the resident to be on a “diabetic diet”, and the resident wanting to eat whatever they want. Residents with diabetes present a unique challenge: balancing quantity of life with quality of life. And while good diabetes management usually leads to increased longevity and better management of comorbid conditions, it may also greatly reduce a resident’s quality of life. So what can we do? What does the research say is the most beneficial? What is the CCHO diet? Can our residents with diabe- tes eat cake?

What the research (and the medical community as a whole) says: American Diabetes Association (ADA)

The ADA says that there is no one “diabetic” or “ADA” diet. It emphasizes creating an indi- vidualized plan of care that includes a balanced diet full of nutrient dense foods without

stringent restrictions. The ADA recognizes that a person with diabetes is first and fore- most, a person. Their diabetes management should take their whole self into account.

American Medical Directors Association (AMDA)

The AMDA also emphasizes an individualized plan of care; including focusing on the often atypical symptoms an elderly patient may have with low blood sugar (ie. irritability, de- pressed mood, increased sleepiness, behavior change). It specifically recommends switch- ing from the sole use of sliding scale insulin (SSI) to basal/bolus. Basal/bolus insulin can more effectively take into account a resident’s diet preferences, appetite changes, and ac- tivity levels.

Joint goals and strategies from the ADA, AMDA, International Association of Geron- tology and Geriatrics, and European Diabetes Working Party for Older People

  • Establish goals of care at time of admission Hypoglycemia should be the most important factor when deciding goals of care and blood sugar target ranges (especially in patients on insulin)
  • Aim for simplified regimes and liberalized diets
  • Recognize physical activity (within the confines of a residents’ ability) as an important part of treatment.

What is the CCHO diet?

The CCHO diet is often referred to as the “consistent carbohydrate” or “controlled carbo- hydrate” diet. The goal is to prevent blood sugar spikes by eating the same amount of carbs at every meal. Typically, the amount of carbs at meals can be tailored depending on the calorie and carb needs of the patient. In skilled nursing facilities/long-term care cen- ters there is one standard diet for all residents with diabetes.

What are the benefits of using a CCHO diet?

  • It’s simple and usually very easy to learn; the most common amount of carbs per meal are 30, 45 or 60. Snacks typically provide 0-20g of carbs.
  • Many patients like to eat the same types of They only need to learn how much of a few foods they can eat, versus making carb calculations at every meal
  • May help prevent diabetes burnout (it may use less brain power and make meal times much simpler and less stressful)
  • It can provide an easier way of dosing medication (especially for insulin), since carb intake is often much more consistent

What are the drawbacks of a CCHO diet?:

  • Residents on a CCHO diet may feel like they’re missing out on what everyone else is having (where’s my cake?)
  • It assumes hormone release and insulin sensitivity remain constant throughout the day and day to day (neither does)
  • Focuses mainly on restriction – telling residents what they can’t eat instead of focusing on all of the wonderful foods they can eat
  • Residents may feel their fear of low blood sugar is being ignored
  • It can get boring

What we, as dietitians, can do:

  • Educate facility on the individualized nature of diabetes and diabetes management.
  • Partner with residents (and/or their RP) on their diabetes management plan. Ask what their (or their RP’s) goals are in relation to their diabetes. Do they want to better manage their blood sugars? Are they end of life and want to enjoy whatever foods they want? Are they overwhelmed by living with diabetes and simply want to be told what to eat?
  • Discuss ways the resident can make their own decisions for self-management.

Self management may include:

  • Choosing to eat the dessert instead of the carb entree item
  • Timing when they get their favorite juice to be before their PT
  • Asking for more protein and/or vegetables if they are still hungry
  • Choosing water for most meals
  • Educate residents and their families on the
  • benefits of good blood sugar control that are specific to For example – A peri- od of a strict CCHO diet may help their wound heal faster and them feel better sooner.
  • Keeping their blood sugars in range may help them have more energy.
  • Acknowledge any fears they may have about their diabetes.
  • For example – Try implementing changes that lower blood sugar slowly.
  • This may help residents who are fearful of

The takeaway: residents can eat cake! Helpful Reference:

https://diabetesjournals.org/care/article/39/2/308/37209/Management-of-Diabetes-in

-Long-term-Care-and

Brussel Sprouts: A super food?

By: Danelle Willey, RD

If you are like many of us, includ- ing me, as a kid you disliked Brussel sprouts. And why was that? For me, it was because they were boiled and put off an awful smell, that turned me off immediately. However, now that I have grown up and learned how to cook, I love them! I cook them for dinner usu- ally at least once a week.

Brussel sprouts are considered a su- per food due to the Vitamin C and glucosinolates. Vitamin C is known to boost immunity and glucosinolates are known to have regulatory func- tions in inflammation and antioxidant activities, which can help fight cancer. Brussel sprouts are high in nutrients and fiber but low in calories, also known as a nutrient dense food. They are especially high in vitamin K, which is necessary for blood clotting and bone health. The high fiber content can also help regulate blood sugar levels, in addi- tion to keeping you regular.

brussel sprouts in dutch field in the netherlands ready for harvest in autumn

There are many ways to prepare brussel sprouts to make them taste great that even kids will like. My first tip is do not ever boil them. This way of cooking is what made me stay away from them for many years. The most flavorful ways to cook are either to roast in the oven or saute in a large pan. Add- ing garlic and olive oil or bacon are always great additions. I like to finish them with a drizzle of balsamic glaze. Keeping them crispy on the outside gives them a little crunch while keeping them delicious on the inside. If you haven’t tried brussel sprouts recently, give them another date. When they are cooked the right way with great seasoning, you will hopefully find them delicious! I know I do!