What does transgender mean?

The term transgender refers to someone’s expression of gender. Gender expression (or gender identity) is unrelated to the physical attributes of a person (i.e. sex). For individuals who are transgender, the sex they were assigned at birth and their gender identity do not match.

Cisgender individuals have the same gender identity as their birth-assigned sex. Furthermore, someone may identify as gender non-binary, meaning they do not associate themselves with any socially identified gender expression. Someone who is transgender, gender non-binary or intersex (born with a combination of male and female sexual anatomy) may further identify as queer, gay, bisexual, lesbian or asexual, to name a few. However, sexual orientation is not related to gender expression.

While research suggests the number of people who identify as transgender has increased, it is difficult to know for sure, as population surveys often do not include gender identity. Greater awareness and cultural understanding by society has led to increased visibility of transgender people. This also impacts how research protocols are developed and established. Studies are continuing on a large scale, including a consortium of five research institutions in Europe and the United States that is exploring whether there is a component in the genome that contributes to one’s gender identity.

Should RDNs use nutrition interventions for a transgender patient as birth-assigned sex or identified/ expressed gender?

Information found in the medical chart may not provide a clinician with the most accurate understanding of someone’s gender.

Situations still exist where an individual’s birth-assigned sex is listed as gender despite the person identifying as transgender. In fact, many medical institutions and insurance companies do not accept transgender expression as an option in the personal identifiers portion of the medical chart.

Maintaining rapport with patients is of the utmost importance when providing nutrition recommendations. Therefore, regardless of information in the medical chart, it is essential to ask patients about their gender expression and use those identifiers when referring to them and their nutrition status.

What are recommended nutrition guidelines for transgender people?

There currently are no specific nutrition guidelines for transgender patients. While evidence is limited on using gender identity for estimating nutrition requirements, research has shown testosterone hormone therapy to change metabolic needs. Health practitioners should use clinical judgment when making nutrition recommendations based on gender identity. Calorie, protein and fluid requirements are not significantly different than they are for cisgender individuals. For those who wish to undergo surgical interventions as part of the transition process, a standard elevation in protein and calorie needs post-surgery are applied for wound healing. Furthermore, many people who identify as transgender may use hormone therapy as part of the transition process. Because the time it takes for hormone therapy to produce results varies from person to person, it is sometimes difficult to tell where an individual is in the process. For those individuals, hormone therapy may cause weight gain and glucose intolerance. As for specific transgender considerations regarding hormone therapy:

Transgender Men (Female to Male): Testosterone hormone therapy (“T”) increases muscle mass, possibly resulting in bone tissue production and an increase in bone mass, at least in the short term. However, long durations of “T” may decrease bone mass and contribute to an increased risk of osteoporosis. Additionally, the effects of “T” may significantly reduce or eliminate the menstrual cycle, which would impact iron needs. It is important to note that once “T” is initiated, it typically is used indefinitely.

Transgender Women (Male to Female): Estrogen may increase risk of thromboembolic disease and progesterone can cause weight gain. In those who have their testicles removed, estrogen replacement can play an important role in preserving bone mass. Compared to cisgender females, whose natural estrogen can decrease over time, consistent estrogen replacement use has been shown to have no negative changes in bone density.

Transgender Adolescents: In 2017, the Endocrine Society published a clinical practice guideline for endocrine treatment of adolescents who are gender-dysphoric/ gender-incongruent. There are multiple considerations for this population. Hormone suppressants may cause complications related to bone health. Recommendations include weight bearing exercises and supplementation with calcium and vitamin D may be warranted.

Use clinical judgment when seeing a patient who identifies as transgender. It is completely reasonable to ask the patient if hormone therapy is being administered as part of the transition process. Because not every person who is transgender goes through the physical transition process (the out-of-pocket cost of physical transition is high due to lack of insurance coverage), the only way to know is to speak to the patient directly. Additionally, using nutrition-focused physical examination tools, such as the triceps skinfold measurement, to assess alterations in lean body mass may help determine how to assess protein requirements in someone who may or may not be on “T,” which increases muscle mass and therefore affects protein needs.

Collaborate with the medical team and other ancillary medical services to ensure consistent care is maintained. In a survey of transgender individuals, 50 percent reported having to teach their medical providers about transgender care. The more information an RDN can provide to the multidisciplinary team, the more comfortable the patient will be receiving nutrition and medical care.

How can we approach body acceptance and psychological support for people who are transgender?

Although RDNs are not therapists or licensed mental health counselors, they have a valuable ability to listen. Emotional sensitivity, understanding and acceptance are key not only to establishing rapport, but also to gaining knowledge about where the patient may be regarding body acceptance and other psychological markers.

According to the National Transgender Discrimination Survey, those who are transgender have an increased risk of eating disorders and an increased risk of abusing diet pills to meet social norms. This increased prevalence affects transgender females disproportionately more than males and is related to feeling the need to meet ideal body standards, emotional trauma from the process of accepting gender identity, and stress from social stigma and discrimination. In the same survey, 28 percent of participants reported postponing medical care due to discrimination from their health care providers, while 19 percent reported being refused medical care completely.

RDNs should provide a welcoming and judgment-free atmosphere for patients. The slightest hesitation in confidence during a session can make a patient feel uncomfortable and uneasy about the abilities of the clinician. RDNs with advanced training in nutrition interventions in the treatment of eating disorders find there is little difference between transgender and cisgender individuals when it comes to eating pathology. Because the etiology of the eating disorder can assist in the determination of nutrition recommendations, understanding the overall struggles of the transgender community can be a useful tool in the development of quality dialogue and patient goals.

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This sponsored recipe is brought by the Almond Board of California as part of Food & Nutrition‘s Recipe Roundup program. Click for more recipes.

Chipotle Lime Almond Crackers

Recipe by Zachari Breeding, MS, RDN, LDN

Ingredients

• 2 cups (300 grams) almonds, roasted
• 1 egg (46 grams)
• 1 tablespoon + 1 teaspoon (20 milliliters) water
• ¾ teaspoon (6 grams) kosher salt
• 1 teaspoon (3 grams) chipotle chili pepper seasoning
• 1 tablespoon (3 grams) fresh lime zest
• 2 teaspoons (10 milliliters) lime juice
• 1 tablespoon (3 grams) black sesame seeds

Directions

Preheat oven to 350°F. Grind almonds to a fine crumble in food processor. Meanwhile, in small bowl, combine egg and water. When almonds are ground, add egg mixture, then salt, chili pepper seasoning, zest, and juice. Continue mixing in food processor until dough ball forms. Remove from mixing bowl and divide into 2 equal sized balls. Roll out onto parchment paper to 2 millimeters thick. Use parchment on the rolling pin if the dough sticks. Cut the dough into squares, sprinkle with sesame seeds and lightly press into dough. Bake for 10 minutes. Remove and allow to cool. Serves 8.

Nutrition Information

Serving Size 8 crackers (35 grams)

CALORIES 228; TOTAL FAT 19g; SAT. FAT 2g; CHOL. 19mg; SODIUM 318mg; CARB. 9g; FIBER 5g; SUGARS 2g; PROTEIN 9g; POTASSIUM 293mg; PHOSPHORUS 194mg

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This sponsored recipe is brought by the Almond Board of California as part of Food & Nutrition‘s Recipe Roundup program. Click for more recipes.

Caponata with Toasted Almonds

Recipe by Zachari Breeding, MS, RDN, LDN

 Ingredients

• 5 tablespoons (74 milliliters) olive oil
• 4 cups (360 grams) eggplant, ½-inch cubes
• 1 cup (125 grams) onion, diced
• 2 tablespoons (18 grams) garlic, minced
• 14.5 ounces (411 grams) reduced-sodium canned diced tomatoes
• 2 tablespoons (30 milliliters) red wine vinegar
• 4 tablespoons (55 grams) drained capers
• 2 tablespoons (6 grams) fresh basil, chiffonade
• ¾ cup (100 grams) almonds, sliced, toasted
• 1 teaspoon (7 grams) kosher salt
• 1 teaspoon (2 grams) crushed red pepper flakes

Directions

In sauté pan, add olive oil and sauté eggplant, onion and garlic for 10 minutes; eggplant will have softened significantly and onions will be translucent. Add canned tomatoes, vinegar and capers; simmer 15 minutes until mixture has thickened. Add toasted almonds, basil, and season with salt and pepper flakes. Serves 4.

Nutrition Information

Serving Size: 1 cup (231 grams)

CALORIES 306; TOTAL FAT 24g; SAT. FAT 3g; CHOL. 0mg; SODIUM 818mg; CARB. 20g; FIBER 8g; SUGARS 7g; PROTEIN 8g; POTASSIUM 672mg; PHOSPHORUS 179mg

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This sponsored recipe is brought by the Almond Board of California as part of Food & Nutrition‘s Recipe Roundup program. Click for more recipes.

Almond Flour Galette with Gorgonzola, Green Apple, Fennel and Sliced Almonds

Recipe by Zachari Breeding, MS, RDN, LDN

Ingredients

• 4 cups (250 grams) finely ground almond flour
• ½ tablespoon (8 grams) granulated white sugar
• 1 teaspoon (6 grams) kosher salt
• 1 ¾ cup (190 grams) vegetable shortening
• ¼ cup (60 milliliters) water
• ½ tablespoon (7 milliliters) white vinegar
• ½ egg (23 grams), beaten
• 3 tablespoons (44 milliliters) olive oil
• 2 cups (175 grams) fennel, halved, sliced thin
• 1 cup (100 grams) yellow onion, halved, sliced thin
• ¾ cup (85 grams) sliced almonds, toasted
• 1 ½ cups (115 grams) green apple, quartered, sliced thin
• 2.8 ounces (80 grams) blue cheese crumbles
• 1 tablespoon (1 gram) fennel fronds

Directions

1. Preheat oven to 350°F. Mix almond flour, sugar and salt in food processor. Add shortening and pulse until combined. In separate bowl, mix water, vinegar and egg; add to flour mixture and pulse until well combined and ball has formed. The mixture will be looser than standard pie dough. Divide into 2 equal balls, then flatten them. Wrap in plastic wrap and rest 45 minutes under refrigeration. Remove one dough disc and place in center of 9-inch pie pan. (Reserve remaining disc for another use.) Press, do not roll, dough evenly to make pie crust, leaving about 1-inch of dough to fall over the ends. Bake 8-12 minutes or until firm and slightly golden brown.
2. Meanwhile, heat olive oil in sauté pan and sauté fennel and onion until softened. Reduce heat, cover and simmer over low heat 8-10 minutes. Remove cover, increase heat to high and cook until caramelized. Fill pie crust with mixture, then top with ½ almonds, followed by green apple, blue cheese, then remaining ½ almonds. Top with fennel fronds and close by gently folding the ends over the mixture (most of the mixture will remain exposed). Return to oven covered loosely with aluminum foil; bake 30 minutes. Allow to cool before slicing/serving. Serves 6.

Nutrition Information

Serving Size 1 slice (120 grams)

CALORIES 458; TOTAL FAT 42g; SAT. FAT 8g; CHOL. 17mg; SODIUM 380mg; CARB. 15g; FIBER 6g; SUGARS 6g; PROTEIN 11g; POTASSIUM NA; PHOSPHORUS NA

Note: Reliable potassium and phosphorus nutritionals for almond flour could not be identified. Analysis used fresh dill weed springs as substitute for fennel fronds.

The post Almond Flour Galette with Gorgonzola, Green Apple, Fennel and Sliced Almonds appeared first on HealthStylz.

One study took a closer look at the intersection of the circadian system, the behavioral cycle — including the sleep/wake and fasting/feeding cycles — and the impact of these patterns on glucose tolerance levels. In this study, some participants were monitored during “normal” days in which they ate meals at the same times, while others were studied during flipped sleep and meal schedules: breakfast was eaten at night, dinner in the morning, and there was wakefulness through the night. In the end, those whose circadian rhythms were altered resulted in an increased risk of Type 2 diabetes. There are two theories as to the cause of the glucose tolerance changes: one, a reduction in the function of beta cells, which are responsible for producing insulin to manage blood sugar levels, and two, a possible decrease in insulin sensitivity.

The misalignment of our internal clock is perceived to be due to light exposure. Light works as a main cue to reset the brain clock. When our meal times do not match our sleep-wake cycles, there is a disconnect in this otherwise natural process.  This has crucial implications for those who alter their circadian rhythms in some way. Shift workers, who work outside of a typical 9-to-5 schedule (usually at night), are at increased risk for certain ailments, including Type 2 diabetes. For those who are nighttime snack food grazers, weight gain may be more likely to occur when someone consumes foods rich in carbohydrates closer to bedtime.

The best way to promote a healthy circadian rhythm is to try to get the right amount of sleep and eat regular meals at times that are relatively distributed throughout the day. And, most importantly, be consistent. Though difficult, consistency is the best way to create and set a circadian rhythm that benefits you and helps to reduce your risk of developing nutrition-related conditions.

The exciting news is that unlike our genetics that can predispose us to certain chronic illnesses, we can choose what we eat and when we eat it. These choices allow us to play a role in prevention of illness and management of our health.

The post The Right Foods at the Right Time: Circadian Rhythms and Nutrition appeared first on HealthStylz.

I have never been one to reach for a scale when I cook. As a restaurant chef, a pinch of this and a dollop of that was the tried-and-true approach to making meals delicious — albeit relatively inconsistent. As a dietitian and recipe developer, however, the scale is one of the best tools for the kitchen.  Not only does a scale allow you to objectively educate patients on portion control, but it helps you produce recipes with consistent quality.

I had the opportunity to explore the EatSmart Precision Elite Digital Kitchen Scale, and I decided to make Stromboli, using the scale to perfect the quantity of dough and ingredients.

Pros

The scale is big enough to weigh a melon, but also compact and lightweight, easily fitting next to a stack of cutting boards in my cupboard. It comes with a calorie-counting booklet, which allows the user to know how many calories are in a given weight of commonly consumed food items. The platform is stainless steel, and the scale has a large backlit display. Four included AAA batteries power the scale, and if there is one thing I hate in the kitchen, it’s messing around with power cords. Plus, the mobility of the scale makes it super easy to move to heavy objects, instead of the other way around.

Now to the functionality. The scale offers weights in ounces (to the nearest hundredth), grams, pounds and kilograms, with a maximum capacity of 7 kilograms.

There also is a tare feature, which allows you to subtract the weight of whatever container you’re using to measure your ingredient. This is a perfect way to keep the scale clean and allows users to weigh liquids. The EatSmart scale is very similar to one I used while working in a food lab, where each ingredient I used had to be weighed to the gram. I found it very user friendly with a sleek design that produced accurate results.

Cons

There were very few things I didn’t like about the scale. The biggest enhancement I would like to see is the ability to weigh in grams to the tenth decimal place as opposed the nearest whole gram, although the latter is honestly useful in most circumstances. And, though this wasn’t an issue for me, it might be beneficial to include separate buttons to power on/off and to switch between units (the power button does both). Besides that, this was one of the best kitchen scales I have used.

The efficient and accurate response time for taring the scale and weighing the items for my Stromboli made the process seamless and enjoyable. If you’re interested in developing consistent recipes or are in the market for a new scale, go ahead and check out the EatSmart Precision Elite Digital Kitchen Scale – you’ll thank yourself for making the choice. 

The post A Kitchen Scale That Pulls Its Weight appeared first on HealthStylz.

Making granita at home is very simple! All it takes is a few ingredients and several hours in the freezer. This Blood Orange Granita is light in flavor but very sweet — the perfect treat to enjoy (in moderation) on a hot late-summer day.

The post Blood Orange Granita appeared first on HealthStylz.

Product Reviewed:
SMEG Stand Mixer

As a chef, I put a lot of value in the efficiency of the performance in any kitchen tool. Knives should be sharp and have a good grip, food processors should assemble and detach with ease, and pots and pans should heat with an even distribution.

That’s why the SMEG Stand Mixer gets high marks from me. Not only does it work beautifully, but its sleek design makes you want to display it on your counter for all to see.To test it out, I decided to do something I don’t normally do: bake! Typically, I have no patience for creaming butter and whipping eggs, but this mixer made it a very stress-free experience. The mixture in the Lemon-Ricotta Biscuits came together very quickly, despite several steps of add-ins to develop the dough. And, since I was on a roll, I figured I would make homemade lemon curd too!

Each part of the SMEG mixer washed quickly. There were no grooves or crevices that hid food particles. (The parts are also dishwasher-safe, which is just another way SMEG designed it with the busy cook in mind.)

If you are used to a mixer with a side-lever for lifting the motor head, you may have to retrain yourself to get used to the back-button release. I feel like this mechanism actually makes more sense, since the only lever on the motor head is the one that controls speed. Instead of using the lock-lever mechanism to hold the motor head in place, this SMEG mixer automatically locks into place until the release is pushed again.

The only real design flaw I noted was with the pouring shield. If you are using any attachment (especially the whip) with the pouring shield, you must remove the shield in order to remove the attachment. This might seem like an obvious step, but if you are switching attachments (say from a whip to a beater), this just adds an extra step. But after getting used to these minor changes, the SMEG Stand Mixer has more positives than negatives.

The post A Stand Mixer That Prizes Good Design appeared first on HealthStylz.

So what's someone who lives in a densely populated urban environment to do? Try composting!

Composting is the process of turning organic waste into a soil-like mixture rich in carbon and nitrogen. This is accomplished by a 50/50 mix of "green" and "brown" matter. "Green" matter usually consists of bark, leaves, sawdust and paper. "Brown" matter includes food scraps and coffee grounds. But before you start throwing everything into one container and thinking that's where your involvement ends, read these four guidelines on how to compost the right way.

To Worm or Not to Worm

Before starting, it's the question each composter has to ask himself or herself: Do I want to compost with worms or without worms? Choosing to compost without worms means you'll need a community composting program, a yard large enough for a compost vessel or a city bio-waste program. My experience is with worms, so that's where I'll focus my attention.

Before you worry about having worms in your home, fear not. These critters are magicians when it comes to composting: they work fast and leave little to no odor. The best worms are red worms — also called red wigglers — which can be purchased from online worm stores (yes, they exist). You'll want to keep your bin inside, as worms are sensitive to extreme temperatures. Add only as much food waste as your worms can easily eat; cut or shred food scraps into small pieces; and keep a good mixture of brown and green matter.

The Right Stuff

Unfortunately, not everything is compostable. Those worms are scavengers, but picky. Here is your list:

Yes: bread, grain, cereal, tea bags, coffee grounds and filters, fruits, vegetables

No: meat, dairy products, fatty and oily foods, animal or baby feces

Getting Started

You will need a sealed container with a few holes in it so oxygen can travel. You can use an aluminum or plastic trashcan, an under-the-sink compost bin, or a stone or ceramic container. Fill your container halfway with dry leaves, sawdust or newspaper. Add food scraps on a regular basis and mix with a gardening fork, or by rolling the can around on its side. Compost should be kept moist but not soggy, so add more dry material regularly.

How Long Will it Take?

If all goes well, you should have usable material in about one to two months. The material will look dank, brown and free of large chunks. Use your homemade compost in a small vegetable and herb garden wherever you have space: near a sunny window, in a hanging pot, in a window box or on your fire escape. Or, share your "black gold" with a friend to entice them to start their own composting bin.

The post 4 Guidelines You Need to Know about Kitchen Composting appeared first on HealthStylz.

As a chef, I know the restaurant industry has gone through dramatic changes in that time, too. Gone, for the most part, are the days when a chef would spend much of his or her day basting in butter and adding salt ad lib. Today, while many restaurants have embraced the use of fresher ingredients and simpler cooking techniques, there still is often very little attention paid to ideas such as nutrient balance, portion size or sodium content.

Will the Restaurant Industry Listen to the 2015 Dietary Guidelines?

The secret to many restaurants' bottom line is simple: "meat = money." For the most part, restaurants want consumers to focus on the protein aspect of the dish so they feel like they are getting their money's worth.

As dine-in restaurants serve double chicken breasts on beds of pasta with cream sauce, sprinkled with a few broccoli florets, all for $15, does it matter that the sauce is laden with sodium, there is a pound of cooked pasta on the plate or that there is barely a cup of cooked broccoli?

Or, what about the fresh and organic burrito place that regularly dishes out 1,000-calorie meals? — who is worried about the negative health impact this may have on the consumer? Or, what about the rapid growth of food trucks and gastropubs serving fried and salty foods?

Will we ever see MyPlate-inspired menus at mainstream restaurants?

The Dietary Guidelines state that the information it contains is meant for health and nutrition professionals, not the general public. Registered dietitian nutritionists must educate consumers how to eat out healthfully, but the restaurant industry has a role to play in making us healthier, too.

Chefs are increasingly aware of nutrition and, as more people understand the importance of healthy eating and demand healthier choices, it should be in the best interest of businesses to prepare more nutritionally balanced dishes. Today, chefs have the ability to turn food into art, turning out beautiful, delicious and nutritious meals. The real question is, when will they turn this capability into reality?

The post It’s Time for Restaurants to Heed the Dietary Guidelines appeared first on HealthStylz.