Today's Dietitian (February 2020)

CPE MonthlyExamination1. Which of the following compounds in garlic is the least bioavailable?a. Diallyl sulfideb. Diallyl trisulfidec. Allicind. S-allyl-cysteines2. Aged garlic extract (AGE) can lower blood pressure due to which of the following mechanisms of action?a. It acts as an antioxidant.b. It lowers heart rate. c. It increases blood flow.d. It heals damaged arteries.3. Which of the following two lipid measurements have been shown to improve after treatment with garlic preparations?a. HDL cholesterol and LDL cholesterolb. Triglycerides and total cholesterolc. Total cholesterol and HDL cholesterold. Total cholesterol and LDL cholesterol4. What is the suspected mechanism by which garlic supplements lower blood sugar?a. Increasing insulin secretionb. Decreasing glucose production by the liverc. Contributing to weight lossd. Decreasing appetite5. According to research, AGE, garlic oil, and raw garlic all may protect against the development of which disease?a. Diabetesb. Cancerc. COPDd. Cystic fibrosis6. In rats with induced ischemia, Colín-González and colleagues found that AGE did which of the following?a. Decreased inflammatory markers by 50%b. Increased inflammatory markers by 50%c. Decreased inflammatory markers by 75%d. Increased inflammatory markers by 75%7. What type of garlic preparation appears to be the most effective, safe, and bioavailable?a. Garlic oilb. Garlic powderc. Raw garlicd. AGE8. When examining the effect of different garlic prepa-rations on gastrointestinal mucosa in dogs, what type of preparation did Hoshino and colleagues find to cause erosion and severe damage?a. Raw garlicb. Garlic essencec. Garlic oild. Dehydrated raw garlic powder9. In their epidemiologic study, Jin and colleagues found that those who ate raw garlic two or more times per week had a 44% lower risk of developing which of the following conditions? a. Breast cancerb. Lung cancerc. Prostate cancerd. Skin cancer10. In one of their clinical trials, Ried and colleagues found that 480 mg AGE per day for 12 weeks led to a significant reduction in what measurement related to heart health? a. Systolic blood pressureb. Diastolic blood pressurec. HDL cholesterold. LDL cholesterolRegister or log in on CE.TodaysDietitian.com to complete the online exam and earn your credit certificate for 2 CPEUs in our CE Learning Library.For more information, call our continuing education division toll-free at 877-925-CELL (2355) M-F 9 am to 5 ET or e-mail [email protected] 2020 •WWW.TODAYSDIETITIAN.COM  51

THANK YOU TO OUR 2020 SPRING SYMPOSIUM SPONSORSMarlene Koch, RDN Reducing Added Sugars Eileen Myers, MPH, RDN, LDN, CEDRD, FADA, FANDMotivational InterviewingCarolyn O’Neil, MS, RDN, LDN, and Liz Weiss, MS, RDNOn-Camera Skills for TV and VideoChris Mohr, PhD, RD, and Dana White, MS, RD, ATCRecovery for RDsMichele Redmond, MS, RDN, FANDNutrient-Dense ContinuumLauren Swann, MS, RD, LDNFood LabelingBonnie Taub-Dix, MA, RDN, CDN, and Mitchell Dix, EsqInterpreting and Negotiating ContractsJill Weisenberger, MS, RDN, CDE, CHWC, FANDPrediabetesVictor Yu, PhD, RD, BC-ADM Nutrition Care in Kidney DiseaseKathleen Zelman, MPH, RDN, LDWeb Writing SkillsMary Purdy, MS, RDN, CDAn Update on DetoxSharon Palmer, MSFS, RDNChris Vogliano, MS, RDKate Geagan, MS, RDSherene Chou, MS, RDKate Scarlata, MPH, RDN, LDNWilliam Chey, MD, AGAF, FACG, FACPMegan Riehl, PsyDWORKSHOP: Sustainable Food Systems Master ClassWORKSHOP: Therapeutic Treatments for IBS PatientsOur Presenters and Their Carrie Dennett, MPH, RDN, LD, CDAddressing Weight StigmaConnie Diekman, MEd, RD, CSSD, LD, FADA, FANDEthics of PracticeToby Amidor, MS, RD, CDN, FANDYear in Review & A Look AheadDina Aronson, MS, RDNDietary AssessmentJanice Newell Bissex, MS, RDN, FAND, and Bonnie Johnson, MS, RDNCannabis and BeyondLeslie Bonci, MPH, RD, CSSD, LDNEffective Communication Strategies With Athletes

THANK YOU TO OUR 2020 SPRING SYMPOSIUM SPONSORS ContentThe Heartbeat of Our Spring SymposiumUnlike any other event for dietitians, our Spring Symposium offers a level of engagement, interaction, and meaningful contact between our attendees, presenters, and sponsors that is truly unique for a professional meeting or conference.In addition to sessions, presentations, and workshops that can earn you at least 15 CEUs, our 2020 event will offer a variety of opportunities for networking with fellow RDs, including our presenters. Our high-energy Exhibit Hall features product sampling from our sponsors, and we have numerous special events planned to keep attendees engaged throughout.After spending your days learning in the classroom, enjoy our host city of Savannah. Located in the Savannah Historic District, with direct access to cobblestoned River Street, the Hyatt Regency puts you steps away from a rich downtown culture that includes monuments, shops, local restaurants, historic parks, and live music. YOUR REGISTRATION INCLUDES:• All continuing education sessions and workshops• Networking opportunities with peers and presenters• Product sampling from our sponsors• Keynote address• Fitness activities• Special events* Registration does not include accommodations at the Hyatt Regency or travel to and from Savannah.Show yourself some love this year and join us to experience the heart of the 2020 Spring Symposium. Register Now at www.TodaysDietitian.com/SS20.

Exercising With Heart FailureFebruary is American Heart Month. Efforts to increase awareness and prevention have resulted in declining mortality rates for coronary artery disease (CAD), the most common type of heart disease. However, while mortality rates associated with heart attacks from CAD have decreased, mortality and preva-lence of heart failure are increasing. Much of this increase is related to the overall aging of the US population, but heart failure also is increasing among younger adults due to higher rates of obesity and CVD in this age group. According to the American Heart Association (AHA), the most current data, from 2016, indicate that approx-imately 6.2 million Americans over 20 years of age have heart failure—an increase from the 5.7 million estimated in 2012. In 2017, there were 960,000 new cases of heart failure diagnosed in the United States. The AHA projects that the prevalence of heart failure will increase by almost 50% by 2030, with more than 8 million Americans aged 18 or older developing the disease. Medical costs of heart failure will increase by more than 127% by 2030.1In heart failure, the heart’s perfor-mance is impaired—it doesn’t fill prop-erly with blood and/or is unable to pump enough blood. Therefore, the body doesn’t get enough oxygen. Heart failure is a progressive condition, and the heart gets weaker over time. Some causes of heart failure include CAD, previous heart attack, heart valve or muscle dis-ease, certain lung conditions, and sub-stance abuse. Symptoms of heart failure include the following:• increased shortness of breath/labored breathing (dyspnea) on exer-tion or lying down;• fatigue and weakness;• persistent coughing or wheezing;• fluid retention leading to swelling in the lower extremities and/or weight gain; and• reduced tolerance of exercise.Patients with heart failure are staged based on the severity of their symptoms and degree of exercise limitations using the New York Heart Association (NYHA) Functional Classification, grouped as follows:• NYHA I: No symptoms or limitations during normal physical activity;• NYHA II: Mild symptoms and some limitations (eg, fatigue, dyspnea) during normal physical activity;• NYHA III: Marked limitations during normal or lighter-than-normal physi-cal activity due to fatigue and dys-pnea, but patient is comfortable at rest; and• NYHA IV: Severe limitations—unable to perform any physical activity with-out discomfort, and symptoms of heart failure even at rest. Patients generally are evaluated with a six-minute walking test and other clinical tests to determine NYHA status, which will determine how they’re man-aged. Despite several medications and device-based treatments for heart fail-ure, between 50% and 75% of those with heart failure will die within five years after diagnosis.2Exercise is used not only to assess heart failure symptoms but also as a therapeutic intervention. A large body of high-quality published evidence sup-ports the benefits of regular exercise for heart failure patients who are able to perform physical activity. Systematic reviews and meta-analyses have shown that exercise reduces risk of hospitaliza-tions and mortality and improves qual-ity of life and functioning for patients with heart failure.3,4Cardiac rehabilitation—medically supervised exercise commonly pre-scribed after a heart attack—is recom-mended for patients with heart failure. Cardiac rehabilitation for a prescribed number of sessions helps patients learn how to exercise appropriately to manage their heart failure. Current guidelines from the AHA, American College of Cardiology, Heart Failure Association, Canadian Cardiovascular Society, and European Society of Cardiology recom-mend regular exercise for patients with stable chronic heart failure who are able to exercise to improve functional status, symptoms, and quality of life, as well as reduce hospitalization and mortality.3,5Guidelines emphasize aerobic endur-ance exercise performed at moderate to vigorous intensity for up to 30 min-utes at least five days a week. Resistance training on two to three days a week is recommended as a complement to aerobic exercise. Note that this inten-sity, duration, and frequency of exercise mirrors AHA recommendations for all American adults. Exercise guidelines for heart failure do emphasize that exercise must be individualized for each patient depending on their functional status, age, comorbidities, and preferences.5Research published since these guidelines were established suggests Focus on Fitness By Jennifer Van Pelt, MA54 TODAY’S DIETITIAN• FEBRUARY 2020

that the type of exercise is less impor-tant than the patient’s engagement and commitment. A 2018 systematic review and meta-analysis of 40 studies (total-ing 5,411 patients) found significant improvements in quality of life and physical functioning associated with regular exercise. The researchers evalu-ated different factors that might affect outcomes and found that type of exer-cise, intensity, level of supervision, and exercise setting didn’t affect the signifi-cant improvements in quality of life and physical functioning associated with regular exercise. Exercise programs in all studies in this review were struc-tured to ensure patient engagement and adherence, leading researchers to conclude that engagement and adher-ence contributed to improvements for patients. The study included patients with all NYHA functional statuses; most patients were NYHA II or III. 2Other recently published system-atic reviews and meta-analyses have reported the following regarding exer-cise and heart failure: • Interval training, continuous aero-bic exercise, strength training, and combined aerobic/strength interval training all improved quality of life and functioning.6• Aquatic exercise (eg, swimming, water aerobics, water walking) was comparable to land-based exercise in improving exercise capacity, mus-cular strength, and quality of life for patients with stable heart failure.7• Resistance/strength training alone or combined resistance/aerobic exercise improved quality of life, walking abil-ity, and peak oxygen uptake.8• Yoga significantly improved quality of life, exercise capacity, and clini-cal heart failure outcomes as much as aquatic exercise. In addition, yoga significantly reduced anxiety and depression.9• Tai chi significantly improved walk-ing distance, quality of life, and cer-tain cardiac performance measures in patients with heart failure.10Despite guideline recommendations and proven health benefits, only about 10% of heart failure patients are referred to cardiac rehabilitation after diag-nosis or hospitalization for heart fail-ure. Patients therefore aren’t receiving 11much-needed guidance and encourage-ment to jump-start an exercise program on their own. Regular exercise is severely underutilized in managing patients with heart failure.3-5Research suggests that helping cli-ents with heart failure recognize their barriers to regular exercise and find exercise activities that they enjoy might be more helpful than prescribing a tra-ditional and generalized exercise regi-men. Because those with heart failure often have other comorbidities, exercise activities should be appropriate for age and physical abilities. NYHA III and IV clients may require supervised exercise sessions. The safest exercise options for most clients with heart failure include aquatic exercise, walking, gentle or chair yoga, tai chi, and strength training with light handheld weights. Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.Like us on Facebook. Follow us on Twitter./TodaysDietitian@TodaysDietitianGET SOCIAL WITHwww.TodaysDietitian.comDiscuss articles Share ideas and experiencesInteract with other professionals in your field of expertiseFor references, view this article on our website at www.TodaysDietitian.com.FEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  55

Alexis JosephSocial Media Star With a Fresh Approach to Nutrition CounselingAlexis Joseph, MS, RD, LD, has been moving at a nonstop pace from the very start of her career. A mere few months after earning her RD creden-tial, Joseph helped launch a successful Columbus, Ohio–based restaurant concept called Alchemy, which now has a thriving second location called Alchemy Kitchen. The restaurants uniquely combine foodservice and nutrition guidance under the same roof. Joseph says she was looking for a way to pair her love of food with her understand-ing of how it fuels the body.With both restaurants growing, Joseph and her partners at A&R Creative Group are in the process of expanding the brand beyond brick and mortar with Alchemy Meal Prep, a line of prepared meals launching in 2020. She recently hired a dietetics intern to assist with the additional work this pro-gram will require.As if the restaurant operations and seeing clients weren’t enough, Joseph runs Hummusapien, a highly successful food blog she started in 2011 and currently runs full time. She even publishes recipes for some of her restaurants’ most-loved items on her blog—truly wanting the best for her followers and cus-tomers. Joseph is a social media star, with more than 70,000 followers on Instagram and nearly 20,000 followers on Face-book—all of which drive traffic back to her blog. Joseph also is involved in freelance writing for national outlets and participates in televised cooking segments, all part of her passion for getting accurate nutrition information to the general public. Her goal is to make delicious food and smart nutrition accessible to everyone, using multiple channels to get there.She resides in Columbus with her fiancé, Jeff. When Joseph isn’t at work at home, or in one of the restaurants, she can be found spending time outdoors, cooking, reading, and dancing. She loves brunch dates and discovering new places to eat.Today’s Dietitian TD(): Where did the idea for Alchemy originate, and how do you use your expertise as a dietitian to run it?Joseph: The concept evolved from an idea that my close friend—and now Alchemy business partner—had during a nutrition class at Ohio State University. We recognized that there was a unique opportunity to combine food and nutrition guidance under one roof. My training in dietetics gave me the foundation for how to fuel our bodies without sacrificing flavor or fun—and that’s evident on our menus. I’ve also found that a lot of people don’t know how to access a dietitian. By inte-grating health care into the place where they are making food choices, we’ve made it really easy for them. We’re providing an accessible way for people to talk about nutrition.TD: What types of foods are on the menu, and what’s the overall food philosophy?Joseph: While the restaurants are plant-forward, we do serve meat. Our goal was for Alchemy to be a place where everyone, no matter their diet, could come together and share a delicious meal. We wanted it to be approachable to the masses and, more importantly, a no-judgment zone for food. We encourage our guests to try new things and view that as a teachable moment. While we have plenty of unique menu items, like Coconut Bacon Avocado Toast and Superfood Donuts, we also offer more traditional options. The Egg Sand-wich is super popular, made with baked eggs, havarti, zesty cashew cream, and arugula—and, of course, our eggs come directly from the local farmer. Our smoothies are popular, too, but that’s not what it’s all about.TD: How do you structure your nutrition coaching? Can clients book a one-time session upon visiting the restaurant?Joseph: I actually don’t offer one-time visits because I find there’s never a situation where nutritional guidance is a once-and-done venture. I’m not booking the clients that want to lose 5 lbs or find a quick fix. The clients I take on are those who are committed to improving their lifestyle or who are struggling with disordered eating. My goal is to help clients better their relationship with food and be able to live full lives again that don’t revolve around micromanaging what they eat. This is a journey for most people, and the minimum I usually see clients is for three visits—but usually more.Get to Know … By Lindsey Getz56 TODAY’S DIETITIAN• FEBRUARY 2020

TD: Do you foresee your model of combining food and nutrition under one roof as the future of dietetics?Joseph: I absolutely think that having dietitians integrated into the food industry makes nutrition more accessible to the masses and we might see more of it in the future. In general, people embrace personalized health care and health care that is provided outside of the traditional setting. The fact is, we want to help people before they end up in the hospital. I think that’s where health care is headed—toward a model that priori-tizes prevention and wellness. We don’t push our dietetics ser-vices constantly, but it’s an inherent part of our mission. TD: What’s the nutrition philosophy behind your incredibly popular blog?Joseph: It’s about bringing joy back to the table. Whether working with food brands, individual clients, or customers at the restaurant, I want to inspire people to get to a place where they can celebrate vs restrict food. We live in a time where a lot of people, young and old, feel controlled by food choices in a way that harms their mental and physical health. I hope my blog and social media channels can change that. I love nutri-tion and the ways in which food can fuel the body, but I also honor the fact that food doesn’t have to serve a nutritional pur-pose to be enjoyed. Food is about so much more than nutrition.TD: Between televised cooking segments and being quoted in articles, you’re well known for your media work. How did you delve into that?Joseph: I have always loved nutrition communications. I feel at home creating content. I started my blog purely because writing is a passion. That said, I grew slowly and organically. I didn’t make money for the first five years as a blogger—it was just a hobby. My advice to anyone starting this type of work would be to stay true to yourself, be patient, and stay consistent. Success is a journey.Don’t be afraid to pitch to brands you love. Tell them you’re a dietitian interested in supporting them. Many companies really value dietitians and their credibility. There’s plenty to offer as an RD beyond recipes and pretty photos—brands need nutrition materials, webinars, and articles on their website, too.TD: How do you balance all of this work? Do you have assistance?Joseph: To be honest, I struggle with balance like anyone else. That said, I’ve been working at least two jobs for as long as I can remember. I love to be doing multiple things at once—it’s in my DNA. I don’t have a perfect system, and sometimes I am all over the place. But I do have a set list of things that I need to get done each day, and I make sure at least those are completed. My day-to-day sched-ule might include bouncing around the restaurants, doing blog work, or meeting with clients. I do have a part-time assistant who helps me with scheduling and social media—smaller tasks—but I admittedly struggle with letting many tasks that I handle myself go. My assistant handles my entire Pinterest account, which is a big source for blog traffic and something that’s easy to outsource. I also outsource some of my food photography, particularly if I’m reshooting recipe photos from past recipes. I’ve slowly started thinking about what consumes my time and how to get some of it off of my plate. What can I do more efficiently? It’s an ongoing process.TD: What meals do you prepare in your own kitchen, and what foods do you keep on hand?Joseph: I love making these tacos with chickpea walnut meat. I’ll sauté onions, garlic, zucchini, tomatoes, mushrooms, chickpeas, garlic, toasted walnuts, and taco seasoning—all mashed with a potato masher and served in tortillas with homemade guacamole. There’s also this vegan lasagna on my blog that is one of my most popular recipes and happens to be one of my favorite dinners. I’m a big snacker. I love crackers and hummus, homemade muffins, and anything with nut butter. I also love pickles and olives and other fun acidic foods. And I always have dark chocolate–covered pretzels on hand for dessert!TD: What do you do for fun when you get a break from work?Joseph: I love being with my friends and scheduling breakfast dates to catch up. My fiancé and I love to explore new restaurants, take walks, cook together, work out, and watch our favorite TV shows. I’m a strong believer that you have to find time to do what you love!Lindsey Getz is an award-winning freelance writer based in Royersford, Pennsylvania.FEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  57

1Telomere Diet & Cookbook: A Scientific Approach to Slow Your Genetic Aging and Live a Longer, Healthier LifeBy Maggie Moon, MS, RD2019, Ulysses PressPaperback, 208 pages, $15.95While some people enjoy extremely active and healthy lives as they age, others spend the later years of their lives bur-dened by heart disease, dementia, and other age-related dis-eases. Until recently, this was chalked up to luck or “good” or “bad” genes. However, new research suggests that telomeres, the protective caps on chromosomes, are directly linked to aging and, when protected, lead to a longer, healthier life. One of the keys to protecting telomeres is a balanced diet. Maggie Moon, MS, RD, explores ways to keep telo-meres healthy for optimal aging in her new title, Telomere Diet & Cookbook. Moon is a best-selling author, Columbia University–educated dietitian, and nutrition science com-munications professional with culinary school training. She completed her clinical training at NewYork-Presbyterian Hospital and holds a master’s degree in nutrition and edu-cation from Columbia University’s Teachers College, with a Bachelor of Arts degree in English literature from the Uni-versity of California, Berkeley. She’s the lead author of the chapter “Medical Nutrition Therapy for Neurologic Disor-ders” in the 15 edition of the textbook thKrause’s Food & the Nutrition Care Process. Telomere Diet & Cookbook is a practical, evidence-based guide to living more years in good health, by way of the kitchen. The book offers an easy-to-read, targeted overview of telomeres and nutrition and includes detailed meal plans and shopping lists, a simple step-by-step starter program, and more than 75 delicious recipes.The first three chapters explain telomere basics, includ-ing foods for telomere health. These include whole grains, nuts, legumes, seafood, green tea, coffee, and 100% fruit juice. Chapter 4 discusses a four-week jump-start telomere health plan and how to make slow changes that stick. It includes numerous self-assessment quizzes and charts to help readers make positive health changes. Chapter 5 provides recipes for breakfast, soups, salads, sandwiches, appetizers, snacks, side dishes, entrées, desserts, and drinks. Recipes include Turkey Sweet Potato Stew, Poached Chicken and Buckwheat Soba Bowls, and Harissa-Spiced Sea Bass. Overall, the book incorporates healthful foods, especially plant-based foods many Americans are lacking in their diets, that would boost any client’s health. RDs can use this book to better understand an emerging area of aging science that may be new to them. The practi-cal information in the book may help them address multiple aspects of healthy aging when counseling clients.Toby Amidor, MS, RD, CDN, FAND, is the founder of Toby Amidor Nutrition (http://tobyamidornutrition.com) and a Wall Street Journal best-selling author. Her cookbooks include Smart Meal Prep for Beginners The Easy 5-Ingredient Healthy Cookbook The , , Healthy Meal Prep Cookbook The Greek Yogurt Kitchen, , and the forthcoming The Create-Your-Plate Diabetes Cookbook and The Best Rotisserie Chicken Cookbook Ever. She’s a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Runand Muscle&Fitness.com.Bookshelf1.2.3.58 TODAY’S DIETITIAN• FEBRUARY 2020

2Kick Diabetes Essentials: The Diet and Lifestyle GuideBy Brenda Davis, RD2019, Book Publishing CompanyPaperback, 285 pages, $24.95Brenda Davis, RD, an esteemed expert on plant-based nutri-tion and a popular international speaker, is an authoritative voice on the effects of a whole-foods, vegan diet on diabetes prevention and reversal who’s been the lead nutritionist for the Diabetes and Wellness Project in the Marshall Islands for more than a decade. In this definitive guide, she explains the series of meta-bolic events that leads to diabetes and why this illness is so catastrophic for health. Kick Diabetes Essentials cites the latest research into why a diet based on whole plant foods could reduce diabetes risk and, in many cases, reverse dia-betes. Davis outlines how plant foods lead to better health and diabetes management and/or reversal, which foods are the most effective, and how to construct a plant-based, dia-betes-friendly diet. The book outlines how diet, fitness, rest and renewal, social engagement, and stress management all play impor-tant roles in a prescription for better health.To jump-start recovery, Davis recommends a modified fast, with three menu options from which to choose, and suggests readers work closely with their physicians if taking medications. The book includes seven days of “Meals at a Glance” and suggested recipes. Davis also offers cooking tips for legumes and grains, a list of kitchen equipment to optimize cooking, and a comprehensive chart of pantry staples.As a private practice RD, I think this book is a valuable tool to use with clients dealing with type 2 diabetes and prediabetes who have struggled to manage their condition through more conventional diet and lifestyle changes. While plant-forward diets are certainly beneficial, 100% plant-based diets can be incredibly challenging for some cli-ents to follow logistically and financially. Also, most of the recipes contain either soy or nuts, which could be a concern for those with allergies, and some are higher in total carbo-hydrate than typical diabetes-friendly meals. Overall, it’s important for RDs to be aware of the research behind this approach to treating diabetes and prediabetes to best serve our clients.Lauren Harris-Pincus, MS, RDN, is a speaker, author of The Protein-Packed Breakfast Club, and owner of Nutrition Starring YOU, LLC in New Jersey, where she specializes in weight management and prediabetes. Follow her on Twitter, Instagram, and Pinterest LaurenPincusRD and at [email protected] in One: Complete, Healthy Meals in a Single Pot, Sheet Pan or SkilletBy Ellie Krieger2019, Hachette Book GroupHardcover, 242 pages, $30If you’re not familiar with James Beard Award–winning cookbook author Ellie Krieger, RD, by now, where have you been? Krieger is the host and executive producer of the public TV show Ellie’s Real Good Food and previously hosted the Food Network hit Healthy Appetite. She’s a New York Times bestselling author who has received awards from the James Beard Foundation and the International Association of Culinary Professionals. Whole in One is her seventh book. Krieger has done it again. Whole in One is filled with practical, nutritious, and beautiful recipes that will make home chefs eager to get cooking. In our fast-paced world, who has time to get multiple pots, pans, and dishes dirty? Whole in One has readers use one cooking vessel—be it a sheet pan, skillet, or pot. Thanks to her mouth-watering egg recipes, such as Potato Swiss Chard Frittata and Spinach and Artichoke Shakshuka (a Middle Eastern dish of eggs simmered in spiced tomato sauce), Krieger has me looking forward to breakfast! There’s just something so convenient and satiat-ing about a one-skillet egg dish in the morning. The book also includes several delightful soup reci-pes, such as Ancho Black Bean Chili With Orange Essence, Chickpea and Farro Stew, Split Pea Soup With Sun-Dried Tomato “Gremolata,” Butternut Squash Soup With Tahini and Crispy Chickpeas, and Red Bean Tortilla Soup. Other unique and enticing recipes include her Loaded Potato Nachos and Pesto Spinach Stuffed Spaghetti Squash. Krieger includes nutrition information with each recipe. Each of her books has been developed based on her food philosophy of always, sometimes, rarely—asserting that all foods fit in appropriate amounts. I love this approach to embracing delicious, nutritious cuisine, where food is celebrated with a flexible outlook. The color photographs throughout the book highlight the beauty of these recipes and beg the reader to get in the kitchen. As I have with Krieger’s other books, I will certainly be recommending Whole in One to clients, friends, and family who appreciate good food with the convenience of a single pot, pan, or skillet.Janice H. Dada, MPH, RDN, CDE, is a lover of books who maintains a Newport Beach, California, private practice and consulting business (SoCal Nutrition & Wellness, www.socalnw.com). Follow her on Twitter and Instagram SoCalRD and @Facebook SoCalNW.@FEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  59

News BitesAdded Sugar Intake Too High for Infants, ToddlersA new study in the Journal of the Academy of Nutrition and Dietetics found that nearly two-thirds of infants (61%) and almost all toddlers (98%) consumed added sugars in their average daily diets, primarily in the form of fla-vored yogurts (infants) and fruit drinks (toddlers). Infants were 6–11 months old, and toddlers were 12–23 months old. The analysis documented some good news in the decline over the study period (2005–2006 and 2015–2016) in the per-centage of infants and toddlers whose daily diets include added sugars, as well as the amounts they consumed. Yet the widespread intake points to a serious and persistent problem: the early devel-opment of eating patterns associated with negative health conditions. “Our study, which is the first to look at trends in added sugars consump-tion by infants and toddlers, documents that most infants and toddlers con-sume added sugars. This has important public health implications, since previ-ous research has shown that eating pat-terns established early in life shape later eating patterns,” explains lead investiga-tor Kirsten A. Herrick, PhD, MSc, of the Division of Health and Nutrition Exami-nation Surveys at the National Center for Health Statistics, part of the Cen-ters for Disease Control and Prevention. She cited an earlier study that found that 6-year-olds who had consumed any sugar-sweetened beverage (SSB) before age 1 were more than twice as likely to consume an SSB at least once a day com-pared with 6-year-olds who hadn’t con-sumed any before age 1. Herrick notes, “Previous research into the diets of children over 2 years old associ-ated sugar consumption with the develop-ment of cavities, asthma, obesity, elevated blood pressure, and altered lipid profiles.” Health organizations in the United States promulgate guidelines that rec-ommend limiting sugar intake to 9 tsp or less for adult men and 6 tsp or less for adult women and children between 2 and 19. With no comparable research available for infants and toddlers prior to this study, only one organization, the American Heart Association, provided any guidance for children younger than 2. “Our study’s findings about infant and toddler diets should raise awareness among health organizations and practi-tioners and inform future guidelines and recommendations,” Herrick says. The investigators analyzed data for 1,211 infants and toddlers (6–23 months) from the National Health and Nutrition Examination Survey 2011–2016. They used the Food Patterns Equivalents Database and the USDA’s What We Eat In Ameri-ca’s list to categorize foods. Sugars con-tained in breastmilk and formula weren’t included in the consumption estimates. The results showed that infants con-sumed about 1 tsp of added sugars daily (equivalent to about 2% of their daily caloric intake), while toddlers con-sumed about 6 tsp of sugars (about 8% of their daily caloric intake). No dif-ferences were detected in added sugar consumption by sex, family income level, and head of household, but there were some distinctions by race/His-panic origin; non-Hispanic Asian tod-dlers consumed the fewest added sugars (3.7 tsp), and non-Hispanic black tod-dlers consumed the most added sugars (8.2 tsp). The top food sources of added sugars for infants included yogurt, baby snacks and sweets, and sweet bakery products. For toddlers, the top sources included fruit drinks, sweet baked prod-ucts, and sugar and candy. According to Herrick, parents should be mindful of added sugar levels in the foods chosen when weaning their infants. “The transition from a milk-based diet (breastmilk and formula) to table foods has an impact on nutrition, taste preference, and eating patterns. More work is needed to understand this critical period.” She recommends dis-cussing which solid foods to introduce during weaning with a child’s health care provider and pointed to the Nutri-tion Facts label as another resource to support informed decisions. SOURCE: ACADEMY OF NUTRITION AND DIETETICS60 TODAY’S DIETITIAN• FEBRUARY 2020

Social Media Could Be Used to Study Health Behaviors Among GroupsWhether it be arguments about the merits of pumpkin spice or who makes the best chicken sandwich, food is an ever-popular subject on social media. Michigan Medicine researchers turned to Twitter to see what this online culi-nary discussion reveals about the people behind the posts and whether the platform could serve as a real-time tool for assessing information valuable to public health researchers.“We wondered whether Twitter-based analysis could help us understand com-munities better,” says V.G. Vinod Vydis-waran, PhD, an assistant professor in the department of learning health sciences at the University of Michigan (U-M) Medical School and assistant profes-sor of information at the U-M School of Information, who’s lead author on a new paper in the Journal of the American Medical Informatics Association.Researchers used community-based surveys to gather demographic and health-related behavior information that might help explain health status and dis-parities between groups. For Vydiswaran and an interdisciplinary group of U-M researchers, the focus was on food and whether there were differences between how groups of residents of a given region discussed food.Their analysis began by scoring dif-ferent food-related keywords, including types of foods, modes of preparation, and popular restaurants based on their healthfulness. Foods were defined on a scale of very unhealthful to very healthful based on dietary attributes such as trans fat and added sugar content.Next, using Twitter’s API, an interface which allows software access to Twitter’s data, the group gathered geo-tagged tweets from more than 1,200 census tracts around the Detroit area. With a data set of more than 800,000 food-related tweets from over 62,000 unique tweeters, the group conducted sentiment analysis, determining whether the con-tent of each tweet trended negative or positive. They removed tweets belong-ing to celebrity influencers or marketing tweets that might artificially affect the online conversation.“We found differences in the kinds of foods people tweet about in neigh-borhoods,” Vydiswaran says, with the top keywords in more affluent neighborhoods including terms such as Starbucks, coffee, and vegan vs terms such as pizza, tacos, and bacon in less affluent neighborhoods. Net health-fulness scores were best explained by affluence, fast food density, and the number of tweets, with less affluent areas discussing less healthful foods.Next, they looked for correlations between Twitter content and neighbor-hood demographics, finding that neigh-borhoods with a higher percentage of African American residents had more positive sentiment about food, both healthful and unhealthful. Vydiswaran says, “We hypothesize that one possible reason behind this is that the enjoyment of food is a part of the culture.”They also found that more affluent areas had less positive sentiment about food than other topics, with less affluent areas having more positive food sentiment.Finally, they looked at the corre-lation in food-related tweeting and mortality rates from the top five obe-sity-related causes of death: diabetes, heart failure, kidney failure, stroke, and heart disease.“In the multivariate regression analy-sis, accounting for other neighborhood measures such as affluence and per-centage African American, our Twitter-based food healthiness measure was still significantly correlated with one obesity-linked condition, heart failure,” Vydiswaran says.The authors note that tweets are an imperfect measure of behavior (for example, they don’t necessarily account for the amount of food consumed) and that Twitter users may not represent the total population of an area. However, more traditional surveys also suffer from bias and often are much harder to con-duct than social media analysis.“We are proposing using social media as an additional source of input for poli-cymakers to understand neighbors,” he says. “Social determinants of health, such as neighborhood walkability, mentions of food deserts, safety concerns—these kinds of references show up in tweets and could act as additional input for researchers wanting to understand how they affect health more generally.”SOURCE: MICHIGAN MEDICINE – UNIVERSITY OF MICHIGANFEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  61

Research BriefsLifestyle May Help Prevent Liver-Related DeathsData from a new study pre-sented at The Liver Meeting, recently held by the Ameri-can Association for the Study of Liver Diseases, found that a substantial burden of hepatocellu-lar carcinoma (HCC)– and cirrhosis-related deaths may be prevented by lifestyle modifications to diet, alcohol use, and exercise. HCC and cirrhosis incidences are on the rise in the United States, and deaths related to these illnesses also are accel-erating at an alarming pace, prompting researchers from Massachusetts General Hospital and Harvard Medical School to analyze whether adopting a more health-ful lifestyle might reduce HCC incidence and deaths from cirrhosis. “We wanted to conduct this study because there is growing evidence that both HCC- and cirrhosis-related mortal-ity are largely preventable. Several prior studies have found that individual life-style factors, which include body weight, exercise, alcohol use, smoking, and diet, contribute to the risk for developing HCC. However, no prior study had quan-tified the overall contribution of multiple lifestyle factors on the risk for HCC and liver-related mortality,” says Tracey G. Simon, MD, an instructor of medicine at Harvard Medical School and Massachu-setts General Hospital, and the study’s lead author. “We wanted to estimate how many cases of HCC and deaths from cirrhosis could have been prevented in our study population if everyone had adhered to a healthy lifestyle.” The study was driven by the rising epidemic of nonalcoholic fatty liver dis-ease worldwide, and the need to develop treatment approaches that are both feasible and effective at the population level, Simon says. “Right now, there are not yet any effective medications to reverse liver fibrosis or prevent HCC. It is essen-tial that we focus on controlling risk factors through primary prevention. Lifestyle modification represents a pri-mary prevention effort that is likely to be a more effective and feasible way to prevent HCC and liver-related mor-tality at the population level,” Simon explains of the focus.This nationwide, prospective cohort study included data on adult men and women with no known liver disease at the beginning of the study. Study par-ticipants provided detailed clinical, life-style, and dietary data every other year from 1986 through 2012. All new HCC cases and deaths were confirmed. A low-risk lifestyle group met all of the fol-lowing criteria: never smoked or prior smoking less than five pack-years, no or moderate alcohol use, a BMI between 18.5 and 24.9, weekly physical activity, and a healthful diet ranking in the upper 40% of the Alternative Healthy Eating Index. All other study subjects were placed in a high-risk group. The researchers used Cox proportional hazard regression modeling to estimate multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident HCC and cirrhosis-related mortality. They calculated the population-attributable risk (PAR) of nonadherence to a low-risk lifestyle by comparing relative risks and incidence rates between the two groups, and then assessed the PARs for each modifiable lifestyle risk factor to estimate the percentage of cases that could be prevented by modifying those factors in isolation.Among 121,893 adults followed for 2,388,811 person-years, the researchers confirmed 121 new HCC cases and 350 cirrhosis-related deaths. Multivariate-adjusted HRs for five vs zero modifiable risk factors were 3.59 (95% CI 1.5–7.42) for incident HCC and 4.27 (95% CI 56–98) for cirrhosis-related mortality. The PAR for a high-risk vs low-risk lifestyle was 90% (95% CI 2.06–11.69) for incident HCC and 89% (95% CI 43–98) for liver-related mortality. Women and men had similar associations. Overall, overweight/obesity was the most significant modifiable risk factor, with a PAR of 36 for HCC incidence and 42 for cirrhosis-related mortality.“Our findings strongly support con-tinued efforts to develop public health policies for lifestyle modification to pre-vent HCC and liver-related mortality. Our data suggested that adherence to a healthy overall lifestyle could poten-tially prevent more than 30,000 liver-related deaths in the United States each year,” Simon says. “We are working to validate these findings in additional population-based cohorts, and look for-ward to planning large-scale studies of multidimensional diet and lifestyle interventions for patients with estab-lished liver disease.”SOURCE: AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES62 TODAY’S DIETITIAN• FEBRUARY 2020

Intermittent Fasting May Increase Longevity in Cardiac CatheterizationIn a new study at the Intermountain Healthcare Heart Institute in Salt Lake City, researchers found that intermittent fasting was associated with longer lifespan among cardiac catheterization patients compared with cardiac catheterization patients who didn’t practice this dietary pattern. In addi-tion, the study found that patients who practice intermittent fasting are less likely to be diagnosed with heart failure.“It’s another example of how we’re finding that regularly fasting can lead to better health outcomes and longer lives,” says Benjamin Horne, PhD, principal inves-tigator of the study and director of cardio-vascular and genetic epidemiology at the Intermountain Healthcare Heart Institute.In the study, researchers asked 2,001 Intermountain patients undergoing car-diac catheterization from 2013 to 2015 a series of lifestyle questions, including whether they practiced routine intermit-tent fasting. Researchers then followed up with those patients 4.5 years later and found that routine fasters had greater survival rate than those who didn’t.Because people who fast routinely also are known to engage in other health-ful behaviors, the study also evaluated other parameters including demographics, socioeconomic factors, cardiac risk fac-tors, comorbid diagnoses, medications and treatments, and other lifestyle behaviors such as smoking and alcohol consumption.Correcting statistically for these factors, long-term routine fasting remained a strong predictor of better survival and lower risk of heart failure, according to researchers.The Intermountain Healthcare Heart Institute has the opportunity to closely study intermittent fasting because a large portion of its patients do it regu-larly; a significant portion of Utah’s pop-ulation belongs to the Church of Jesus Christ of Latter-day Saints, whose mem-bers typically fast the first Sunday of the month by going without food or drink for two consecutive meals, and thus not eating for about one day.While the study doesn’t show that fasting has a causal relationship with better survival, these real-world out-comes in a large population do suggest that fasting may be having an effect and urge continued study of the behavior.“While many rapid weight loss fast-ing diets exist today, the different pur-poses of fasting in those diets and in this study should not be confused with the act of fasting,” Horne says. “All proposed biological mechanisms of health benefits from fasting arise from effects that occur during the fasting period or are conse-quences of fasting.”Horne previously has conducted studies about risk of diabetes and coronary artery disease in patients and found that rates are lower in patients who practice routine intermittent fasting. Those studies were published in 2008 and 2012 and suggested that the decades-long development of those chronic diseases may be ameliorated by long-term routine fasting.Why long-term intermittent fasting leads to better health outcomes is still largely unknown, though Horne said it could be a host of factors. Fasting affects a person’s levels of hemoglobin, red blood cell count, and human growth hormone, and lowers sodium and bicarbonate levels, while also activating ketosis and autoph-agy—all factors that may reduce risk of heart failure and coronary heart disease.“With the lower heart failure risk that we found, which is consistent with prior mech-anistic studies, this study suggests that routine fasting at a low frequency over two-thirds of the lifespan is activating the same biological mechanisms that fasting diets are proposed to rapidly activate,” Horne notes.Researchers speculate that fasting routinely over a period of years and even decades conditions the body to activate the potentially beneficial mechanisms of fasting after a shorter length of time than usual.Typically, it takes about 12 hours of fasting for the effects to be activated, but long-term routine fasting may cause that time to be shortened so that each routine faster’s daily evening/over-night fasting period between dinner and breakfast produces a small amount of daily benefit, they note.Further studies that will answer this question and other questions related to possible mechanisms of effects on devel-opment of chronic disease and survival are ongoing. Additional research also will examine potential psychological effects of fasting and possible effects on appe-tite and perception of hunger.Fasting isn’t for everyone. Research-ers caution that pregnant and lactating women shouldn’t fast, as well as young children and frail older adults. People who have received an organ transplant, who have a suppressed immune system, who are experiencing acute or severe chronic infections, and who have an eating disorder also shouldn’t fast.People diagnosed with chronic dis-eases—especially those who take medica-tions for diabetes, blood pressure, or heart disease—shouldn’t fast unless under the close care and supervision of a physician because of the severe adverse effects, such as hypoglycemia, that medications in combination with fasting can cause.SOURCE: INTERMOUNTAIN HEALTHCAREFEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  63

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MARCH 6, 2020Alabama Dietetic Association Annual MeetingMontgomery, Alabamawww.eatrightalabama.orgMARCH 6, 2020North Carolina Academy of Nutrition and Dietetics Regional Meeting Near CharlotteGastonia, North Carolinawww.eatrightnc.orgMARCH 13-16, 2020American Academy of Allergy, Asthma & Immunology Annual MeetingPhiladelphia, Pennsylvaniawww.aaaai.orgMARCH 22-24, 2020American Society of Preventive Oncology 44 Annual ConferencethTucson, Arizonahttps://aspo.orgMARCH 23, 2020Georgia Academy of Nutrition and Dietetics Annual Conference and ExhibitionDecatur, Georgiawww.eatrightgeorgia.orgMARCH 23, 2020Maryland Academy of Nutrition and Dietetics Annual MeetingBaltimore, Marylandwww.eatwellmd.orgMARCH 26-27, 2020Kansas Academy of Nutrition and Dietetics Annual ConferenceWichita, Kansaswww.eatrightks.orgMARCH 27, 2020Illinois Academy of Nutrition and Dietetics Spring AssemblyOak Brook, Illinoishttps://eatrightillinois.orgMARCH 27, 2020Pennsylvania Academy of Nutrition and Dietetics Annual Conference & ExhibitsKing of Prussia, Pennsylvaniahttps://eatrightpa.orgMARCH 28-31, 2020ASPEN Nutrition Science & Practice ConferenceTampa, Floridawww.nutritioncare.orgMARCH 30-31, 2020Louisiana Academy of Nutrition and Dietetics Annual ConferenceBaton Rouge, Louisianahttps://eatrightlouisiana.orgAPRIL 1-3, 2020Wisconsin Academy of Nutrition and Dietetics Annual ConferenceElkhart Lake, Wisconsinwww.eatrightwisc.orgAPRIL 3, 2020Massachusetts Academy of Nutrition and Dietetics Annual ConferenceNorwood, Massachusettswww.eatrightma.orgAPRIL 3-4, 2020Indiana Academy of Nutrition & Dietetics Annual MeetingIndianapolis, Indianahttps://eatrightin.orgAPRIL 16-17, 2020Arkansas Academy of Nutrition and Dietetics Annual Meeting and ExhibitsLittle Rock, Arkansaswww.arkansaseatright.orgAPRIL 16-17, 2020Kentucky Academy of Nutrition and Dietetics Annual ConferenceCovington, Kentuckyhttp://kyeatright.orgAPRIL 16-18, 2020California Academy of Nutrition and Dietetics Annual Conference & ExpoRiverside, Californiawww.dietitian.orgAPRIL 17, 2020Colorado Academy of Nutrition and Dietetics Annual Conference and ExhibitionParker, Coloradowww.eatrightcolorado.orgAPRIL 17, 2020DC Metro Academy of Nutrition and Dietetics Annual MeetingWashington, D.C.http://eatrightdc.orgAPRIL 17-18, 2020New York State Academy of Nutrition & Dietetics Annual Meeting & ExpoSaratoga Springs, New Yorkwww.eatrightny.orgAPRIL 19-21, 2020Washington State Academy of Nutrition and Dietetics Washington State-Idaho Educational ConferenceSpokane, Washingtonwww.eatrightwashington.orgwww.eatrightidaho.orgAPRIL 20, 2020Connecticut Academy of Nutrition & Dietetics Annual Spring MeetingProspect, Connecticutwww.eatrightct.orgMAY 1, 2020Maine Academy of Nutrition and Dietetics Annual ConferenceFreeport, Mainewww.eatrightmaine.orgMAY 7-8, 2020Michigan Academy of Nutrition and Dietetics Spring ConferenceTraverse City, Michiganhttps://eatrightmich.orgMAY 8, 2020Hawaii Academy of Nutrition and Dietetics Annual ConferenceWaikiki, Hawaiihttps://eatrighthawaii.orgDatebookDatebook listings are offered to all nonprofit organizations and associations for their meetings. Paid listings are guaranteed inclusion. All for-profit organizations are paid listings. Call for rates and availability.Call610-948-9500Fax610-948-7202E-mailTDeditor@gvpub.comSend Write with your listing two months before publication of issue.FEBRUARY 2020 •WWW.TODAYSDIETITIAN.COM  65

Go Plant-Based for Cancer PreventionPlant-based eating is everywhere. As of the end of 2019, the hashtag #plantbased has been used 25.3 million times on Instagram, and even fast food burger chains now serve plant-based burgers. This diet trend may help to protect against cancer.While February is widely known as American Heart Month, it’s also National Cancer Preven-tion Month, making it the perfect time to educate clients regarding a cancer-protective diet. Cancer is the No. 2 leading cause of death in the United States, but research-1ers estimate that between 30% and 50% of cancer cases are pre-ventable. As part of its cancer 2prevention recommendations, the American Institute for Cancer Research recommends eating a diet rich in whole grains, vegeta-bles, fruits, and beans. A predom-inantly plant-based diet that’s rich in fiber and water also sup-ports another cancer prevention recommendations, to maintain a healthy weight. The Institute’s New American Plate is a visual tool for helping clients transition to a diet rich in plant foods. At each meal, clients should be encouraged to fill two-thirds of their plate with plant foods, including nonstarchy vegetables, fruits, whole grains, and beans or lentils, and limit animal-based proteins to one-third of the plate or less. This realistic approach can be used to empower clients to make gradual transitions for lasting lifestyle changes. For example, a client who typically eats a large portion of beef or pork at dinner nightly can be encouraged to reduce their portion of meat while increasing their portions of nonstarchy vegetables and whole grains. Basic education regarding appropriate portion sizes with food models, especially for meat and poultry, can be eye-opening for clients. Dietitians who develop reci-pes or host cooking demonstra-tions or classes can show clients how to incorporate these guide-lines in their meals. Examples could include creating a recipe for a blended burger wherein one-half of the meat is replaced with mush-rooms; this same substitution can be used in other recipes such as meatloaf. Try making a Bolognese sauce with veggies and lentils to introduce clients to an easy-to-cook pulse. Prepare a power bowl with a whole grain, vegetables, and a small serving of shredded chicken or flaked salmon. This hearty meatless chili served in a spaghetti squash boat is full of flavor and nutrient-rich vegetables and beans without any meat. Jessica Ivey, RDN, LDN, is a dietitian and chef with a passion for teaching people to eat healthfully for a happy and delicious life. Ivey offers approachable healthful living tips, from fast recipes to meal prep guides and ways to enjoy exercise, on her website, JessicaIveyRDN.com.Culinary Corner By Jessica Ivey, RDN, LDNVegetarian Chili Spaghetti Squash BoatsMakes 4 servings (1 spaghetti squash half filled with about 11/2 cups chili)Ingredients2 small spaghetti squash (11/2 lbs each)1 cup water, divided11/2 tsp olive oil1/2 cup chopped onion 1/4 cup chopped carrot1/4 cup chopped celery1/4 cup chopped bell pepper (any color)3 cloves garlic, minced4 tsp salt-free chili powder blend11/2 tsp ground cumin1 tsp smoked paprika1/2 tsp dried oregano1 15-oz can no-salt-added black beans, drained and rinsed1 15-oz can no-salt-added pinto beans, drained and rinsed1 14.5-oz can no-salt-added diced tomatoes 1 8-oz can no-salt-added tomato sauce 1/2 cup chopped walnuts1/2 tsp saltHot sauce (optional)Chopped fresh cilantro (optional)Directions1. Preheat oven to 375˚ F. Pierce both squashes sev-eral times with a sharp knife. Microwave each squash on high power for 2 minutes. Cut each squash in half lengthwise, and remove seeds with a spoon. Place squash halves, cut sides down, in a large baking dish; add 1/2 cup water to dish.2. Bake 40 minutes or until squashes are tender when pierced with a fork. Let stand 10 minutes. Use a fork to scrape into spaghetti-like strands, leaving a 3/4-inch shell. Place spaghetti squash strands on a clean towel, and squeeze out excess moisture. 3. While squash bakes, heat oil in a pot over medium heat. Add onion, carrot, celery, and bell pepper, and sauté 5 minutes or until vegetables are tender. Add garlic, chili powder, cumin, paprika, and oreg-ano, and sauté 1 minute or until fragrant. Add beans, tomatoes, tomato sauce, walnuts, 1/2 cup water, and salt to vegetable mixture in pot. Bring to a boil. 4. Reduce heat and simmer 30 to 40 minutes, or until spaghetti squash is ready. Stir spaghetti squash into chili, and spoon evenly into spaghetti squash shells. Sprinkle with hot sauce and cilantro, if desired. Nutrient Analysis per servingCalories: 330; Total fat: 13 g; Sat fat: 1.5 g; Sodium: 370 mg; Total carbohydrate: 44 g; Dietary fiber: 14 g; Sugars: 11 g; Protein: 13 gFor references, view this article on our website at www.TodaysDietitian.com.66 TODAY’S DIETITIAN• FEBRUARY 2020

WATCHIt’s 2020 and everyone’s watching. Watching video, that is. On YouTube, on their favorite news and information websites, on TV via streaming services, all over social media. Continuing education is no exception and webinars have become one of the most popular platforms today for professionals to earn the credits they need. Dietitians have told us they enjoy our presentations because they’re informational, instructive, and interactive.INFORMATIONALWe proudly produce webinars through the Today’s DietitianCE Learning Library that earn dietitians those important CEUs, as well as provide them with in-depth information and current research on important subjects.INTERACTIVEOur platform allows attendees of our live webinars to ask questions of our presenters both during and after their presentations. Quite often, presenters will make contact information available for webinar attendees to follow up with questions, ask for clarifications, or seek advice.INSTRUCTIVEOur webinars are led by engaging and well-respected professionals in their field on topics vital to RDs’ career development and their treatment of patients and clients. Recent webinar subjects include telehealth, the Mediterranean diet, being a better communicator, plant-based family meals, counseling skills, food claims’ impact on consumer behavior, digestive health, choline, and so much more. Your Knowledge Base Grow Your CEU Total Rise Our Webinars!In addition to the live presentations, all of our webinars are recorded and posted on the CE Learning Library website for viewing and earning CEUs.Visit CE.TodaysDietitian.com/webinars to see what’s coming up and which recorded webinars you’d like to watch and learn from.

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