The LILI Letter - November 2023

The month for gratitude and inclusion. Everyone celebrates Thanksgiving! As we head into the holidays, it is wise to have a strategy for managing rich food, our exercise routine, finances and higher stress levels. Wishing you and yours a blessed Thanksgiving. We also observe All Saints Day/Day of the Dead, Veterans Day, Diwali and Giving Tuesday. And don’t forget to vote!

In good health,
Jennifer James

Success story

We have an inspiring story this month. This person found what worked for them. If we eat a healthy diet that is sustainable, which includes exercise, I am all for it. This person found intermittent fasting worked for them. Read “W’s” story:

“I have been overweight most of my adult life. I didn't start gaining weight until I was in my mid 20's, and with each kid I just got bigger. I tried everything from counting points on Weight Watchers, to counting calories and measuring every bite of food, to even carb cycling. It wasn't until I discovered intermittent fasting that I finally felt hopeful. I have never been a fan of breakfast so waiting until lunch to eat wasn't a big deal for me. The hard part was stopping after dinner and not snacking late, which seemed to be a nightly routine. I started intermittent fasting for the first time in September of 2019. I lost over 60lbs in just 5 months. I maintained that weight loss for a good year. I got comfortable and started going back to my old ways of snacking late and slowly gained all but 9lbs back. It wasn't until a girls’ trip to Disneyland last September that I realized how far off track I had gotten. We took a lot of pictures and I hated every second of it because of the way I looked. I knew exactly what I needed to do to get back on track. As soon as I returned home I got right back to fasting. One year later, I not only lost the weight I had regained but lost an additional 15lbs.

I know that several diets can and do work if you are consistent with them. The trick is finding one that is sustainable for you. I knew I wouldn't be able to track calories long term. This way of eating allows for me to be in a calorie deficit without counting, tracking or weighing every bite. I also believe that with any diet, fruits and vegetables need to be a priority. I limit sweets and red meat, and try to stick as much as I can to whole foods. Exercise is also a very important part of any healthy routine. I tried to stay active even if it was just getting in my daily steps.”

Wonderful story!! Great job “W”!

Do you really know green beans?

A very popular vegetable, green beans, was originally grown in the Andes thousands of years ago. Indigenous peoples spread the beans to various regions, and would grow them with corn so the bean plant could grow around the corn stalk. Christopher Columbus took the beans back to Europe. Originally tough and stringy, cross breeding produced the green beans we enjoy today. There are over 500 varieties of this green veggie. Who knew? They contain small amounts of vitamin C, vitamin A, calcium and iron. Try the recipe below for a healthier twist on the legendary green bean casserole.

Celebrating beans — Information about green beans in history

The mouth

I remember a movie where the father admonishes his son for swearing and then kissing his mother with the same mouth. Our mouths can get us into a lot of trouble or create a happy and joyful life. We communicate with the world through our mouths. What we say, what we eat and drink, who we kiss, if we smoke or chew tobacco and our oral hygiene. If you have a habit of cursing, like I do (not proud of it), or smoke, drink too much alcohol or sugary beverages, complain a lot, yell at people, eat unhealthy food and kiss the wrong people, listen up.

Let’s look at working on our “oral hygiene”. We could start with the words that come out of our mouth. Are they complaints, or compliments? Are they curses or statements of gratitude? Do we encourage people or tear them down? Do we lie or speak the truth? Are we a pleasant person to be around?

Next, we could look at what we eat and drink. Are they healthy, whole foods entire bodies will appreciate? Or highly processed foods, the sugary/salty/greasy ones, that only the tongue and reward center in our brains like?

Do we take good care of our teeth and gums? Do we brush our teeth and floss regularly? Visit the dentist? Avoid sticky candy and acidic foods like soda that wear away the enamel?

Do we smoke, vape or chew tobacco? The third week of November is the American Cancer Society’s “Great American Smokeout”, a day encouraging smokers to give up tobacco for 24 hours. Here is their website: How to quit using tobacco.

So, my friends, let’s pay attention to our mouths this month. What goes in and out of it can make us a joy to be around, or a smelly malcontent. The choice is ours.

Stones and sugar

If you have a love/hate relationship with sugar, there is new research that may push you to the “hate” side a bit more. The higher the intake of added sugars, the greater the chance of developing kidney stones, according to some new research. Yes, you read that correctly, kidney stones. If you have ever passed one of these, it is not a pleasant experience. Far from it. Akin to giving birth, albeit a much smaller “baby”.

Let’s clarify what “added sugars” are. They are not innately in a food, such as an apple or a glass of unsweetened cow’s milk. They are ADDED. A caramel apple would qualify, but just the sugar in the caramel would be considered “added”. We can check food labels which have a line for “added sugars”.

On to the research findings. Over 28,300 US adults were surveyed who had a history of kidney stones from 2007-2018. Detailed diet histories were obtained for two 24-hour periods. At the start of the study, the average added sugar intake was 272 calories per day, or roughly 4.5 tablespoons of sugar (13.2% of total food intake). People who consumed 25% of their calories from added sugar (500 calories out of 2000, the equivalent of 10 tablespoons of added sugar), had an 88% greater odds of developing kidney stones, than those who consumed 5% of their calories from added sugars (100 calories/2 tablespoons). The lowest amount of added sugars consumed in this study equals the amount of added sugar the American Heart Association recommends per day for women (2 Tbsp/24 gm per day). For men it is more, 3 Tbsp/36 gm per day, due to an overall higher food intake. I have counseled patients who were consuming an astounding 12 regular sodas per day. This amount of sugar is nearly 1900 calories per day, the equivalent of 2.3 cups of the stuff.

If passing kidney stones isn’t your “jam”, then pass on eating too much added sugar in your diet. This is not a perfect study, as all factors could not be controlled, but it does provide, yet another reason, to limit our added sugar intake.

Yin, S. et al. (2023, August 04). Association between added sugars and kidney stones in US adults: Data from National Health and Nutrition Examination Survey. Frontiers in Nutrition.

A note to my patients, class attendees and coworkers

When I see patients or people who have attended my class in the cafeteria, in a restaurant, or at the Farr’s ice cream counter, there are some things I would like you to know — I am not judging whatever you are buying/ordering/eating at the time. I wish for you to have a happy, healthy life. Yes, it may not be what we had discussed, or what you wanted to do at the time, but please don’t think you need to hide from me, feel ashamed or embarrassed. I am more interested in you as a person, and how you are doing, rather than how much you weigh or what you are eating. Please don’t brand me as the “food police”.

My coworkers may react around me like this as well, even some of the doctors and nurse practitioners! I don’t care if you drink chocolate milk with your lunch, or eat a piece of cake or get the Nachos Grande with a large Coke. If you want my opinion on what you are eating, I am happy to help you out. But if you don’t ask me, I really don’t care. Really!

My diet is not “perfect”. I have times when I eat more than I should, such as on vacation, and I understand how disappointing it can be to regain the weight you have lost. I cycle through times like that too. Not in 20-pound increments, but I feel I have to be a good example. I teach a weight loss class, for heaven’s sake! To tell you the truth, I feel self-conscious when I occasionally go through the Wendy’s drive-through and order a cheeseburger, fries and a Frosty after a tough day of skiing or hiking. Someone might see me! The dietitian!

If you see me in the hallway, hospital cafeteria or out in the community, say “hi”, without thinking you need to hide from me (and I won’t hide from you). Even if one of us ordered bacon, eggs and cheesy hash browns for breakfast. Ok?

Healthier green bean casserole

The green bean casserole is a staple at many Thanksgiving dinners. I put this together from looking at a variety of recipes online. It is lighter but still tastes quite good. I hope you like it. If you want a richer flavor, substitute butter for the oil and add a little grated cheese to the topping.

• 2 pounds of green beans, washed and trimmed
• 1 pound of sliced mushrooms, Baby Bella or white
• 2 cups of thinly sliced shallots (~3 large)
• 2 Tbsp. canola or olive oil
• ½ cup panko bread crumbs
• 1/3 cup grated parmesan or Romano cheese
• 1 cup 1% cow’s milk or unsweetened soy milk
• 1 cup low sodium chicken broth or vegetable broth
• ½ tsp. garlic powder, divided
• ¼ cup whole wheat pastry flour
• 1 tsp. dried thyme
• 1/8 tsp. ground nutmeg
• ¼-½ tsp. salt
• Freshly grated black pepper

Preheat oven to 375 degrees. Spray a 9 x 13 baking dish with cooking spray.

1. Blanch the green beans in a large pot of boiling water for 3 minutes. Transfer to a cold/ice water bath. Drain well.
2. Heat 1 Tbsp. of oil in a medium skillet. Add the sliced shallots, sautéing until golden brown over medium heat. Turn down the heat a bit, add the bread crumbs, 1/8 tsp. garlic powder, and a few grinds of black pepper. Stir until the bread crumbs start to just brown. Remove from heat, set aside.
3. Heat 1 Tbsp. of oil in a large skillet over medium heat. Add the sliced mushrooms, thyme, nutmeg, remaining garlic powder, salt and pepper, sautéing until golden brown and reduced in size, ~5 minutes. Break up any large pieces. Sprinkle the mushrooms with flour, stir for a minute, then slowly add the broth, followed by the milk, stirring constantly. Bring to a low boil, stir occasionally for 4-5 minutes, or until thickened. Stir in grated cheese until melted. Remove from heat. Add green beans, stir to combine.
4. Pour green bean mixture into prepared pan, top evenly with onion mixture. Bake uncovered for 30-35 minutes or until bubbly. If topping starts to burn, cover with tin foil.
5. Enjoy!

1/8 recipe = 170 calories, 345 mg sodium w/ ¼ tsp. salt
(1/8 traditional recipe ~210 calories, 1033 mg sodium)

November support groups

Mondays, 2:00 p.m. to 3:00 p.m.
Heart Center Conference Room,
ORMC Medical Plaza, Suite #200

Free to LILI graduates

Wear gratitude like a cloak, and it will feed every corner of your life.

— Rumi