A Taste for Water

A while ago I wrote about beverage choices in Nicaragua. Today I am revisiting that topic with a focus on water. Whenever I have volunteered in health clinics in Latin America the issue of dehydration comes up with surprising frequency. Of all the frustrating and difficult health conditions one sees in these clinics I never anticipated that dehydration could rank so highly as a major concern. Dehydration worsens dozens of common health problems and was almost single-handedly responsible for the numerous daily cases of urinary tract infections and kidney problems (including kidney failure) that walked through the Nicaraguan clinics I volunteered at.

These home carbonation gizmos are getting quite popular. One of my favorite drinks is carbonated water, a few squeezes of lime and a few drops of Stevia

Even more interesting is that when I talk to patients about staying hydrated they say the exact same thing that people in the States say: “I don’t like the taste of water.” How can we lose our taste for water? Our species drank water, and only water, for hundreds of thousands of years. Three quarters of our body weight is water. All animals on earth, indeed almost every living organism, consumes water. We are the blue planet; if the Earth had a flag there would be water on it. If we had a sports team it would be called The Flood, if we had a mascot it would be…well you get the point.

I trace water’s fall in popularity to the three “Cs”:

1)    Competition – It is a challenge for water’s simple taste to compete with wide variety of highly sweetened and processed beverages available. The complex tastes, textures, colors, and smells make water seem lackluster by comparison.

2)    Contamination – our water supplies include many elements that alter water’s taste (the chart below contains a few common examples but there are thousands..), this is true even in Nicaragua where both natural  (volcanic soil) and man-made (agricultural run-off and factory waste) elements influence water’s taste.

3)    Containers – water picks up the taste of plastic, metal, and some ceramics. Glass containers solve this problem well.

In addition to keeping the urinary tract and kidneys healthy, staying hydrated also helps with reaching and maintaining a healthy weight. The signals for thirst and hunger are similar and often get confused with the result being that often when people think they are hungry, they are actually dehydrated. Staying hydrated decreases overall calorie consumption.

Pollutant Effect of water flavor
Iron Metallic taste
Chlorine the taste and smell of disinfectant, for most people it brings to mind a swimming pool
Decay of organic material or non-harmful bacteria Musty, moldy, or woody smell
Hydrogen sulfide gas and or sulfate reducing bacteria Rotten egg odor
Chlorides Salty or brackish taste
Sulfates Salty or brackish taste
Phenol An industrial waste. Can cause an objectionable taste in chlorinated water due to the formation of chlorophenols.
Zinc From corrosion of plumbing





Beverages and status in Nicaragua

A while back I assisted on an eco-tourism project in Padre Ramos, in the remote Northwestern corner of Nicaragua. One of our tasks was to improve the palm thatched, wall-less and floorless, restaurant in town so that they could host foreign tourists. I was in charge of re-making the menu and noticed the only beverage offered was Coca-Cola, despite the fact that right next door was a house that processed coconuts. The operation consisted of three grinning teenage boys jamming to salsa while hacking away with machetes to slice off the nuts’ thick green husks. A tall glass of delicious coconut juice from the machete boys ran 12 cents while the restaurant charged 40 cents for a glass of Coke. In spite of this, the locals, who had an average salary of a few dollars a day, never drank coconut juice and loved Coke. I was inspired to dig deeper into the matter, from then on I talked to every Nicaraguan I met about beverages.

The restaurant in Padre Ramos, they had a large pig that roamed around eating scraps, we recommended that they keep the pig in the back, away from the customers.

Water has an image problem in Nicaragua. The poorest Nicaraguans drink only water, they don’t have money for juice, soda, sports drinks, coffee, or any other beverage. To drink something other than water says to your peers, “I have expendable income, I am doing well.” If you are hosting a social event here it is an absolute must to provide sweetened beverages, if you only provide water people will gossip about how cheap you are for weeks.

It goes beyond water is bad and everything else is good. There is a beverage hierarchy in Nicaragua. Water is at the bottom, above it are home-made juices and coconut water, sold in little plastic bags or ladled out from 5 gallon buckets, the next step up is domestically made bottled juices, coffee, sweetened drinks and sodas and on top of the heap are American brands of drinks and sodas such as Gatorade, Sprite, and the undisputed king, Coke.

Water’s place at the bottom is not just a matter of fashion, getting parasites or toxic exposure from water supplies occurs frequently. Even in urban areas with water treatment plants there are problems, the plants have frequent mechanical failures and when heavy rains come the run-off from agriculture and industry can overwhelm the treatment plants and contaminate the water. The enforcement of environmental regulations here is near nonexistent.

The consequences are an increase in chronic disease (such as obesity, heart disease and diabetes) from all the sweetened beverages and widespread chronic dehydration, many people just won’t drink anything if water is the only option. At the health clinics where I have volunteered patients come in frequently with conditions caused, at least partly, by dehydration: urinary tract infections, chronic headaches, and every variety of kidney disorder.




Why you might be eating too much protein

One frequent concern I hear is “Am I eating enough protein?” Ironically, overconsumption of protein is far more common than deficiency. When I interview patients I notice that people overestimate their protein needs while, at the same time, underestimate how much protein is in their diet. Let’s look at both issues.

1)    How much protein do I need?

The American Heart Association and the National Institutes of Health recommend 50-60 grams of protein for most adults, which is about 10-12% of total calories. The WHO (World Health Organization) puts protein requirements as 5% of daily calories, for a 2000 calorie diet this is about 25 grams of protein. The US government advises .36g per pound, a smidge over 1/3 your weight, so for a 180 pound adult that is 65 grams of protein.

All protein estimates, including our government’s recommendation, are calculated with lean body mass in mind. It is our muscles and our organs which need protein, any excess fat we carry does not increase our protein needs. (However excess weight that is from muscle, such as a heavily muscled athlete, does increase protein needs but that is a topic for another day.) For instance, if when you were at a healthy weight (appropriate to your height and build, neither under or overweight) of 180 pounds during your college years but gained 20 or even 50 pounds of fat since then, your protein needs remain the same.

If these protein recommendations sound low consider that in infancy we consume only breast milk, which is a mere 10% protein. Our protein needs are never higher than during this time of frenzied muscle growth,  and organ development. We can get away with lower protein than one might think because, unlike fat and carbohydrates, protein is only burned for energy as a last resort. Protein is constantly recycled, worn out proteins are reassembled by the liver to be used over and over again.

2)    Why we underestimate how much protein we eat

Protein is not only available in what we traditionally consider protein foods (animal flesh, diary, legumes, nuts/seeds), both starches and vegetables also have protein. There is even a little bit of protein in some fruits, particularly those with edible seeds such as strawberries and blackberries.

Protein grams per 100 calories: Spinach 13g, Broccoli 6.8g, steak (depending of the cut) 5-10g,, 2oz Roasted Skinless Chicken Breast 20g

Take a look at two days worth of Food Sobriety style meals (1/4 protein, ¼ starch, ½ veggies) with the protein grams (g) listed. To keep things simple I left out menu-style descriptions/condiments/herbs etc… Despite the small, by American standards, portions of protein both days easily exceed recommendations, and this is without counting snacks.

Breakfast: 2 egg omelete (14g) with 1 cup peppers (3g) and 1 cup asparagus (4g) 1 cup rice (5g)

Lunch:  3 oz turkey burger with bun (28 g) lettuce, tomato, onion (1g) and a cup of vinegar style coleslaw (1g)

Dinner: 3oz of baked chicken (28g) with 1 c. of steamed broccoli (4g) and 1c. of corn (4.5g)

Total Protein: 92.5 grams

Vegetarian version

Breakfast: 1 c. oatmeal (6g) with ½ c. strawberries (.5g), 1.5 c. of steamed peas and carrots (10g) with a ½ cup yogurt dressing/sauce (4g)

Lunch: 1 c. cooked spinach (6g), medium bowl of lentil soup (12g), 1c. rice (5g)

Dinner: 1 c. of mushrooms (3.5), 1 c. of cauliflower (3g), 1 c. beans (16g), baked potato (9g)

Total Protein: 76 grams


Our plan for weight loss: The Sober Plate Part 1

Thank you to my friend Kristy Simmons, who took my chicken scratch sketches and made them shine.

The Taoist philosophy of yin-yang is founded on the belief that darkness and light exist in a balance. Neither is good, nor bad; instead, both exist to bring out contrast in the other and to provide balance. Borrowing this philosophy for a diet design I divided food into two main categories: those that are heavy/weight promoting (proteins/starches) and those that are light/promote weight loss (non starchy vegetables). Again, neither is good or bad, it is only the relative proportion that dictates the meaning. Continuing with this reasoning I assigned the most potent weight promoting elements, the fats and sugars, to the smallest circles.

If you want to lose weight, eat accordingly, half the plate veggies, a quarter protein, a quarter starch. If you are happy with your weight you can divide the plate into three even parts and/or add fat. If you need to gain weight, well, let us just say there are a lot of options out there.

I was inspired to create this plate design from my experience with the plate method. The plate method was developed by the American Dietetic Association, as a blood sugar management tool for diabetics. I began using this diet years ago because it was so simple that I could teach it to the illiterate Latino populations that I often worked with. As I tracked patients’ diets and weight I noticed a variety of trends that correlated with both weight loss and weight gain. That information inspired me to research ways to overhaul the Plate Method to maximize weight loss.

A real life example – 1/4 plate protein (beans), 1/4 plate starch (rice, brown would be better but its hard to get in Latin America) and 1/2 plate of veggie, both stewed and as salad, lime juice dressing

Although the Plate Method is great for managing blood sugars there are several aspects of it that make weight loss difficult: 1) the lack of distinction between starchy and fibrous vegetables 2) the inclusion of generous amounts of dairy products (I count dairy as a protein or a fat, depending on the product) 3) the lack of any visual guideline on fats or sugars. Additionally the Plate Method does not discuss the degree of processing in the food, the water content, or the fiber content. I have made all these and more modifications. In the coming weeks I will post details about the diet and each of the seven categories: Proteins, starches, vegetables, fats, sugars, fruits, and beverages.

For now consider as a final thought: Our plate is both a mirror and a crystal ball, what we see on our plate reflects who we are now and who we will become in the future.