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.

 

 

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Should fruits & veggies get a divorce?

 

We always talk about them together, they sit together in the store, they are practically married, so what’s the big difference?

“Eat your fruits and vegetables” “Two cups a day of fruits and vegetables” “Make half your plate fruits and vegetables” Public health officials, doctors and dietitians all repeat the same message. Since fruits are sweet and don’t require preparation time most people respond enthusiastically to upping their fruit intake but conveniently forget about the veggies. Well that’s ok, it’s one or the other, right? Unfortunately that’s not the case and for the overweight the difference is especially significant, fruits and veggies have entirely distinct effects on weight.

How do you define the difference?

Nutritional definitions: 1) Vegetables are low in sugars and calories, high in fiber and complex carbohydrates. 2) Fruits are high in simple carbohydrates (sugars) and contain moderate amounts of calories and fiber.

Fruits, Veggies and your Gut

Vegetables average four times the fiber per calorie as fruits. Whole grains, which are widely praised and advertised for their high fiber, average only 1/8 the fiber per calorie as vegetables. The high fiber of veggies combined with its complex carbohydrates give vegetables a unique role in digestion. Our small intestine needs time to breakdown the long chain carbohydrates and our large intestine works on the extensive fibers, as well as extracting the plentiful water out of the vegetables. When our intestines are busy, weight loss is easier because: 1) hard working intestines send signals to the brain saying we are full 2) the intestines are lined with muscles, which burn calories 3) the additional time it takes to digest veggies slows down the whole digestive process; our meals turn to energy slower and our blood sugars stabilize for longer which in turn delays and diminishes hunger. Meanwhile fruits, being mostly water, simple carbohydrates/sugars, and some fiber, digest rapidly.

Most importantly for weight loss, the divide in sugars and fiber impacts calories. Fruits average 60 calories per serving while vegetables average only 25 calories per serving. The following list shows calories content per 100 grams/3.5 ounces – equivalent to a small apple, 4-6 strawberries, an average sized carrot or a large bell pepper

Fruits Veggies
Watermelon 26 Mushroom 18
Orange 53 Bell Pepper 20
Apple 56 Lettuce 21
Plums 56 Broccoli 25
Cherries 70 Spinach 26
Mangoes 70 Cauliflower 30
Strawberries77 Cabbage 45
Banana 95 Carrot 48
Dates 281 Onion 50

In summary, vegetables are as close as there is to a magic pill for weight loss while fruits are fairly neutral. Raw fruits can be a useful player in a weight loss diet, particularly when used as a substitute for sweets. However fruit, when processed into juices, dried fruit, or in smoothies will contribute to weight gain, but that is topic for another blog.

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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

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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.

 

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Culinary tradition versus ecology in Nicaragua

The iguanas are a startling sight, you can buy them live (their limbs tied with string) or this lady will butcher them on the spot.

Over past decade Nicaragua has slowly take some steps towards preservation of endangered species. Two of the recent government policies have conflicted with century old culinary traditions in the country; the ban on eating green iguanas and sea turtle eggs.

The iguana meat is most commonly cooked with vegetables and ground corn to make a dish called Indo Veijo (“Old Indian”). It is eaten year round but is a particularly popular during the Lent, the catholic ban on red meat during Lent drives this tradition. Since Lent occurs at the height of the Iguana’s reproductive cycle the tradition has had significant impact on iguana populations. The iguana meat is believed to have medicinal value, traditional healers here say it can improve a variety of ailments, including impotence. Turtle eggs, which look exactly like ping-pong balls, are consumed in the same way as chicken eggs, boiled, fried, or in soups. The popularity of turtle eggs is due to the ease of harvesting, for the impoverished coastal populations it’s a free food, a large basket of turtle eggs can be collected in less than an hour.

Sea turtle eggs for sale in the market in Rivas, Nicaragua

Despite the laws one still encounters the foods for sale in markets, as I did recently. In general, laws here are difficult to enforce. The police force is underfunded and many laws are interpreted unpredictably; exceptions are common for certain groups, times of year, and of course the occasional bribe works as well.

Further inquiry regarding the iguana and turtle egg laws yielded a wide array of answers. I was told by several policemen and merchants in the market that the fine for those caught selling or eating Iguanas is $5 per iguana, about 1-2 days average salary in Nicaragua. I could not get a consistent answer regarding fines on turtle eggs, some said the police will just take them, other reported you can get arrested, jailed and fined a few hundred Cordobas (a hundred Cordobas is a little over $4). Most of the enforcement of the turtle egg harvesting is done by non profit organizations (one such group: http://pasopacifico.org/). Though they have no legal authority, the presence of volunteers has, in many areas, been successful in preventing illegal egg harvests.

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