Home ยป RD Q&A vol. 30

RD Q&A vol. 30

Short Q&A today! Where are all the inquisitive minds?! 🙂

Samantha: I was wondering if you could explain more about fatty liver disease. I have been hearing about it a lot recently in magazines like First magazine, and in the news. It seems to be affecting people of all ages, when I was always told it affects older people. Can you clear up some of this confusion? What is this disease and who is more susceptible? Thanks!!

Prevention RD: In my first job as an out-patient dietitian, I saw so many cases of non-alcoholic fatty liver disease. Those who are overweight, obese, diabetic, or consume high carbohydrate/high sugar diets are at highest risk of fatty liver disease. With some small changes to the diet, the fatty liver should resolve and the liver enzymes trend towards normal in a matter of weeks. In short, high levels triglycerides (“fat”) cause the liver to accumulate fat from the filtering of blood that is excessive in fat. The excessive fat causes the liver to become scarred and over time, causes damage. Because the liver is responsible for blood filtration, controlling the amount and types of fat in the blood becomes crucial. Most every fatty liver patient I’ve seen has elevated triglycerides. Adhering to a carbohydrate controlled diet that is rid of alcohol and low in simple sugars (and sodas, juice, etc.) is the best way to lower triglycerides through the diet. Great question! Fatty liver is one of my favorite nutritional topics to counsel on 🙂


Nicole: Last year, we went to the local high schools for a practicum site. The new school lunch policy was getting ready to take full swing so many of the school systems were already in play. Part of the policy is that the kids don’t just receive about 850 calories for lunch, but the food is more nutritious, which will keep them full longer. Instead of all refined starches and cheese and “junk” food, the lunch ladies are starting to have to cook again. This means real turkey breast, fresh fruits and vegetable salads, low sodium and nutrient dense foods. When I did my practicum, I had to ask the kids what they thought of the new lunches and 90% of them hated it! They said everything from, it was bland, they didn’t like the spices, it was too colorful, too crunchy, and they wanted their old food back. So the kids just wouldn’t eat their lunch. I just found this new video on yahoo about a high school that made a music video about how much they hate the new food policy. You may recognize the song! I think this may spark a debate on your blog, because if you watch the video, you realize the kids are saying their friends who picked up food, such as Funions and soda, from the nearby gas station are full for the entire day. And the kids who ate the school lunch are starving. Just a thought to put this up on the next Q & A. I have a personal interest in this topic and the music video is actually pretty good.

Prevention RD: Hi Nicole! Miss you 🙂 (Nicole is a fellow student of mine!). I am so glad you brought this video to my attention and it sounds like your rotation in the schools was very eye-opening. I have to say, I think Obama was on the right track with this one. If there were more athletes than sedentary, obese children, I may think differently, but that’s not the case. With programming cut, such as gym classes, kids are burning less calories than in years past. The movement towards cooked meals that are high in nutrients and low in calories lends to a very balanced and filling diet. Perhaps the problem is, as you indicated, is that the kids aren’t actually EATING the, meals because they don’t “like” them. The 600 calories for an elementary school lunch, 700 calories for a middle school lunch, and 850 calories for a high school lunch are perfectly appropriate. Of course this is assuming that kids 1) eat an adequate and appropriate breakfast and 2) eat an adeqcheuate and appropriate evening meal. The video quotes 2,000-5,000 calories for growing kids, and I would have to err on the lower side of that range for most every school-aged kid. I would love to hear others’ thoughts on this as I don’t have kids! Great topic, Nicole!

Please feel free to send your question to me at preventionrd at gmail dot com!

Wednesday already! Yesterday was BANANAS at work. What a whirlwind of a day. Thanks again for all the well wishes for my computer – xo!

Be well,

Share With Your Friends!


  1. October 10, 2012 / 6:37 am

    I lectured on Obesity in class yesterday and we watched Jamie Oliver’s TED Talk and I’m all fired up about school lunches again! It’s also re-inspired me to want to be a home ec teacher and get the kids some knowledge of how to cook food!

  2. October 10, 2012 / 7:48 am

    I think it’s very important to reform the school lunch program, but even more important is the education to go with it. For younger elementary school children limiting options makes sense, they’re likely too young to make larger scale decisions regarding their health, but this is when nutritional education should begin. Teach them about what their eating, still allow “treats” but talk about moderation, and the importance of activity.

    At the Jr. High/High-school level – I believe additional options should be made available. They don’t have to be absolute “junk” but I don’t feel that any food should be completely demonized, and by this time they hopefully will have a pretty sound base of nutritional knowledge to make wiser decisions.

  3. October 10, 2012 / 11:06 am

    Love this Q&A! I actually am waffling a bit about the new USDA school lunch standards. Having worked on school menus and nutrient analyses both before and after these new guidelines (including currently), it’s very interesting to see what kind of changes were made and why, and how that affects the kids. As you know, the guidelines are much more strict with regards to amounts of proteins (meats and meat substitutes) and grains that can be served, while the fruits and vegetables and often milk can be used to make up the amount of calories needed. I am all for more fruits and vegetables, especially since as I was recently modifying and revamping older menus, the amounts of fruits and especially vegetables doubled and sometimes more (yes!). The limits on fruit and vegetable juices remain the same, with which I also agree.

    Now, here’s where I waffle: in revamping menus, I had to cut way, WAY down on protein and grain sources, to the point where I was having to include foods that some food service companies don’t even produce yet, much less provide (this will change with the new guidelines). I completely agree with you, Nicole, that for many kids in each of the three designated age ranges, these portions will be fine health-wise (as long as, as you said, they’re getting enough at home). There will be grumbling, there will be harsh words, but it will be enough. For larger, more active students, older boys, athletes — no. That’s why they’re going out to buy less healthy options from the corner store. We could argue that these students should bring snacks, but now we’re talking about something happening at home, which we can’t control.

    (As a side note on the cutting down of proteins/grains: along with the new guidelines, the USDA released continuously-changing documents with instructions on amounts of certain proteins/grains that can be counted as servings based on the density or type of item. Frankly, I was a little shocked at some of the conversions when I first saw them. For example, in a high school breakfast (which I know many public schools don’t offer, but I work with a residential center), you may only offer a combined two “servings” combined of meat/meat alternative and grain. Note that something like 1/2 egg is considered a serving, so that if a school wanted to serve a whole egg, the rest of the meal would need to be fruits, vegetables, and/or milk. This may work — I’m not sure yet, these guidelines being so new. However, my experience suggests not. My RD colleague who goes in the children’s residential center often talks about how hungry the kids are. As a residential center, the circumstances are different — there are behavioral issues, and difficulties with medication that need to be managed — but there are some similarities to public schools in that kids are growing, AND they have access to the kinds of food outside of school that the USDA is trying to steer them away from. In addition, with the new three age/grade categories going on, places like residential centers that cater to kids of all ages at once means that there are potential “riots” on your hands when an 8th grader gets a different serving of food than his 9th grader friend. Just things that have come up and things to think about.)

    I agree that I think some of the grumbling is related to kids not being used to these new guidelines. Fruits and vegetables (the latter, especially) are not the centerpieces of most kids’ meals, at home and up until recently, at school. If they’re getting more “traditional” meals at home, they may feel they’re being gypped at school. In addition, doubling or more the amount of vegetables that a kid is served means that necessarily veggies are hanging out on their own on trays. In my experience, many kids enjoy veggies more when they’re incorporated into other meal components (proteins, grains), but that’s impossible when you’re serving 1.5 cups at a meal. Food service companies have not caught up with these changes and are not offering compliant — and appealing — foods, and many school and residential centers do not have the capital and skilled manpower to produce the foods themselves. Unless there are major government subsidies coming to these institutions, they will have difficulty complying with these guidelines and keeping their students satisfied.

    As a final note (ha! ๐Ÿ˜‰ ), I will add that these new guidelines were pretty sudden and the changes, drastic. I’ve been working on government-subsidized menus for nearly five years, and I’ve never heard as much stress-induced panic as I’ve heard recently. Yes, the guidelines definitely needed changing. The way the guideline changes came out was probably less than ideal. They have been trickling out bit by bit, with constant changes. As someone who went just about crazy trying to keep track of the latest modifications USDA kept coming out with every week this past summer, I can say that working on these menus, particularly with the lack of resources to make the changes needed, is less fun than it used to be. And I’m not alone in this.

    Lest you think I’m down on everything about these changes … ๐Ÿ™‚ I absolutely champion the inclusion of more fruits and veggies in the average kid’s diet. These recent changes have been difficult, but I hope it will spur more food service companies, more schools and residential centers, more government organizations, and — dare I say it? — more families to reexamine how they feed kids and make steps toward a healthier future.

  4. October 10, 2012 / 3:37 pm

    Interesting about the fatty liver. My colonoscopy/CT scan/all the tests I had results came back telling me I have a fatty liver, but I eat very healthfully. I wonder why I have it!

  5. October 10, 2012 / 11:15 pm

    It’s interesting to see the Nicoles debate!

  6. October 11, 2012 / 7:14 am

    Ok, definitely going to watch this video. Sure, kids are probably hungry after school if they don’t eat the school lunch! Funions and soda would fill you up more than NOTHING (yuck).
    Can’t wait to watch!

  7. Nicole Olson
    October 12, 2012 / 8:49 am

    YAY! I am so glad my topic sparked some interest! In the last couple of weeks I have had some clients tell me that their kids are going to boycott the new lunches at their school ( middle and high school). The parents were mad because since the kids didn’t want to eat the lunch, the parent had to spend more time making lunch and cleaning to-go containers ( OMG! God forbid you pack lunch for your child) Obviously, their boycotting will do no good since this is on a federal level. I have looked further into this and it seems that in the next few years it will be much better. One reason is because the elementary age kids now seem to like the food and are adapting easier. So, as soon as the now older kids graduate and the now younger kids get older, it will be much easier. And I agree with Jessie, hat this did come quite quick with a bit of a punch on the strict guidelines and yes, it does all depend on what the kids get at home, but in that case, thank goodness there are other programs for breakfast/after school snack, etc.

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