Uncategorized Wellness + Medical Tips

A Registered Dietitian’s Tips for Staying Committed to Your Health Goals

We are a month or so into 2021, and if you set New Year’s  Resolutions, it might be getting a little more difficult to stay motivated and stick to your health goals. Or, perhaps the stress of 2020 spilled into the new year and you didn’t find the time to set any 2021 resolutions. Either way, CF Nutrition is here to help you get on track to make 2021 YOUR year to become the healthiest and happiest version of yourself. In this article, we discuss ways to set realistic and sustainable fitness and health goals that you can actually keep. 

1. Don’t overestimate how much time you have to dedicate to fitness

I ‘m going to workout 7 days a week for an hour and a half in the New Year. Sound familiar?

There are several factors that go into how much time you can spend on fitness. If you work from home and don’t have children, you might have more time to dedicate to fitness than a parent who has to work in an office. Work and kids are just two of the many factors that may decrease someone’s available time in the day or week to dedicate to fitness. When creating a fitness New Years Resolution, it’s important to evaluate all of the responsibilities you have and be realistic with how much time you can spend being physically active. Overestimating how much time you can spend on fitness is one of the main reasons people don’t stick to their new health goals. 

If you have a busy schedule, HITT workouts may be the most effective and timely way to get in your workout. A short 30-minute HITT class can burn a lot of calories and give you more energy boost to go about the rest of the day. There are several online HITT classes to explore so it’s easy to find one that you enjoy.

Setting a goal for how many days per week to be active is a great way to make sure you reach your health goals. If you’re new to exercising, maybe start small and aim to be physically active 3 times per week. Once you’re comfortable with this workout schedule, you can then gradually work to increase your weekly fitness goal. If you start with unrealistic expectations, it’s easy to give up altogether and go back to your old ways, leaving you feeling discouraged. 

2. Don’t have the ALL or NOTHING approach

This year I will not eat any sweets. (Eats one cookie, throws in the towel)

Having an all or nothing approach to diet can be detrimental to your health goals. When we are too strict with ourselves, eating one cookie can lead to a whole day of poor eating and junk food binges. If you are craving a cookie, eat the cookie and go on with your day. Eating something that doesn’t align with your normal healthy diet is perfectly normal. Try not to overthink it. 

This all-or-nothing mentality can affect your fitness goals as well. If you miss a workout on Monday, don’t think your whole week is ruined. Instead, get right back on track the following day. Having an all-or-nothing approach is very common for people when they are starting new habits but trying to avoid this mentality will help you stick to your health goals and create a healthier YOU.

3. Focus on what you put into your body, rather than what you’re cutting out.

No sugar, no white bread, no alcohol, no pasta, no gluten. Sound familiar?

Ever think about how many restrictions you implement with your diet? There’s low carb, vegan, sugarfree, dessert-free, starch-free…. the list goes on and on. But what if we focused instead on what we ARE eating. Instead of telling yourself you can’t have any chocolate this year, set a goal to make sure you eat 5-7 servings of vegetables each day. Or, instead of restricting white bread, make sure you get the right amount of fiber each day. By putting so many restrictions on our food intake, we make food the enemy. I know it sounds crazy, but food is not the enemy. IT FUELS US. So maybe this year, you consider setting health goals like:

  1. Eat 5-7 servings of veggies each day
  2. Eat the rainbow
  3. Consume 2-3 servings of fruit in each day
  4. Eat healthy fats like omega-3’s
  5. Adequately hydrate each& every day
  6. Get in the recommended daily amount intake of fiber

By focusing on what you put into your body, your relationship with food will heal and you will look to food as a way to nourish and fuel your body, rather than depriving it.

5. Remember that weight loss is a gradual process

The recommendation for weight loss is 1.0-2.0 LBS/week not 20LBS in 2 weeks. 

Do you expect to become a millionaire overnight? Unless you are a very lucky lottery winner, you probably won’t become a millionaire overnight. I love to use this analogy as a Registered Dietitian when working with patients to reach their weightloss goals. Just like you can’t expect to strike it rich overnight, you can’t achieve sustainable and lasting weight loss instantaneously (and you definitely shouldn’t attempt to either). Weight loss is a gradual process and it takes time, hard work, and patience. If weight loss is something you are looking to achieve this year, keep in mind that this process takes time, so be patient. Try not to dive into fad diets that make you eliminate carbs or consume juices instead of meals. Research shows that chronic dieting leads to weight gain and an unhealthy relationship with food. If you follow a restrictive diet you will eventually give in and binge eat whatever you were restricting. This unhealthy cycle is known as the dreaded yo-yo diet and can not only lead to weight gain but also health complications. Trust me, I know it seems like giving up carbs and sweets is the straightforward answer to finally achieving your weight loss goal but I can assure you, it’s not. Sure, you might lose weight quickly at first, but after a few weeks, it’s very likely that you will gain it all back when your body adjusts to this new way of eating (or you ultimately give in to your very normal cravings). I cannot stress the importance of eating a well-balanced diet enough: all the food groups play an important role in keeping you healthy, strong, and energized. 

We hope these tips help you set realistic health goals for yourself this year and become the happiest and healthy version of yourself.


Preoperative Carbohydrate Drink for Enhanced Recovery After Surgery

When it comes to enhanced recovery after surgery, one of the major pillars of any ERAS is a clear, complex carb rich preop beverage that nourishes and hydrates patients in the immediate preop. Carbohydrate loading patients with a preoperative carbohydrate drink like ClearFast reduces the chance postop insulin resistance, thereby improving recovery and shortening length of stay. For the drink to work and be absorbed better, it is important that the patient be warm and comfortable. You can do this by wrapping yourself in a warm rug (плед in Ukrainian) or a blanket to keep you warm.

In “Enhanced Recovery After Surgery: A Review,” Doctors Ljungqvist, Scott, and Fearon elaborate:

“Enhanced Recovery After Surgery programs typically contain several elements with 1 emphasis in common: they minimize stress and improve the response to stress. By maintaining homeostasis, the patient avoids catabolism with consequent loss of protein, muscle strength, and cellular dysfunction. The reduction of insulin resistance promotes adequate cellular function during injury to the tissue. The following series of elements contributes to this goal: preoperative nutritional support for the patient who is malnourished, carbohydrate loading before surgery to minimize postoperative insulin resistance, epidural or spinal analgesia to reduce the endocrine stress response, anti-inflammatory drugs to reduce the inflammatory response, early feeding after surgery to secure energy intake, and optimal pain control to avoid stress and insulin resistance.”

Read the full JAMA Surgery ERAS Review here.


ERAS® Pre Surgery Drink Reducing Length of Stay

San Diego—Implementation of enhanced recovery after surgery (ERAS) protocols for pancreatic surgery decreased hospital length of stay (LOS), a study concluded, which ultimately improves quality of care, accelerates recovery, improves outcomes and optimizes utilization of health care resources.

“Enhanced recovery clinical pathways are really a paradigm shift that serve to evaluate our traditional practices and make evidence-based recommendations for improvement,” said Lavinia M. Kolarczyk, MD, assistant professor of anesthesiology at The University of North Carolina at Chapel Hill School of Medicine. “Nevertheless, the pathways themselves are not novel. The innovative aspect of enhanced recovery is learning how to work together in multidisciplinary teams to implement these best-practice guidelines.

“Ultimately, ERAS serves as the vehicle to promote quality improvement research; break down practice silos between anesthesiologists, surgeons and perioperative nurses; and really challenge why we do what we do every day.”

Goals of ERAS

Given that previous studies have shown a beneficial effect of ERAS pathways on hospital LOS after pancreatic surgery, the investigators decided to follow suit using a multidisciplinary approach with stakeholders from the Departments of Anesthesiology, Surgical Oncology and Perioperative Nursing. “Our institution is a very busy pancreatic center, but prior to ERAS, the quality of care was inconsistent,” Dr. Kolarczyk said. “This was unacceptable for a patient population at highest risk for perioperative morbidity and mortality.”


Benefits of Reducing Pre Surgery Fasting

ClearFast applauds Doctor De Jonghe and his co-investigators on their recently published manuscript entitled “Reducing pre-operative fasting while preserving operating room scheduling flexibility: feasibility and impact on patient discomfort”, Acta Anaesthesiologica Scandinavica 2016. This study is a novel effort to reconcile some of the now well-recognized benefits of pre-operative oral carbohydrate loading (with ample complex carbohydrates) with the practical flexibility needs of busy ORs around the world. While the authors fully recognized some of the shortcomings of their study, including a lack of randomization and various “organizational constraints”, their message was clear: the need to reduce the duration of the traditional pre-op liquid fast with appropriate true carbohydrate-rich beverages is no longer debatable… it is a mandate!

Of note, in the “CHO Group”, the percentage of patients actually receiving the drink preceding operations scheduled at 10:00 or later was similar for inpatients and outpatients. However, that was clearly not the case for surgeries scheduled before 10 am. Patients were deprived of the drink 100% of the time if they were admitted on the day of surgery for procedures scheduled at that time or earlier. Conversely, 89.5% of their in-house counterparts were “carb-loaded” for operations scheduled for the same time. The explanation for this discrepancy appears procedural and systematic: possibly for standardization purposes, the drink was re-constituted from a powder, not by the patients, but by respective hospital staff members who diluted one sachet “in 400 ml of water in a graduated shaker.” Unfortunately, “organizational constraints” apparently prohibited such mixing and delivering to those arriving so early on the day of surgery. This bias dramatically impacted that statistic.

Perhaps, the overall outcomes might have been significantly influenced by the use of a pre-mixed carb-rich beverage, such as ClearFast®. Some of the obvious advantages would include simplicity of the delivery system, reliable standardization of the product volume and mixture and expedited refrigeration, if desired.   It would allow for early and convenient distribution to patients – days to weeks prior to the date of surgery, thus facilitating consumption by a greater number of candidates, potentially resulting in fasting times closer to the proposed 3-hour window. As the authors suggest in their discussion, “The opportunity for these patients to consume the CHO drink before arriving to the hospital warrants further consideration.”


Pre Surgery Carb Loading

Pre-Operative Oral Carbohydrate Loading is Safe and Improves Patient Satisfaction

With Elective Ambulatory Surgery and Anesthesia: It’s Time for Change

Ahmed S Suliman, MD, Jeannette T Crenshaw, RN, Arthur J  Mischke, MD,  Richard E  Gilder,  MS, RN, StevenR Cohen, MD.


Background & Objective:

Most plastic surgeries are performed on an ambulatory basis.  While patient safety is a priority for plastic surgeons, many are unaware of the current ASA preoperative fasting guidelines.  Decades of research attest to the safety and health benefits of consuming carbohydrate-rich clear liquids 2 hours before elective surgery.  This best evidence is rarely put into practice.  The objective of this study was to assess the effects of such a beverage (Clearfast®) on patients’ discomforts from preoperative fasting and their safety and compliance.


A two-part multicenter, prospective clinical trial involved ASA Risk I-II adult patients having elective plastic, orthopedic or general surgical procedures at 5 hospitals.  Part I was a descriptive observational pilot (n=263: Controls =108; Intervention =155).  Part II was an IRB approved randomized trial (n=34: Controls =21; Intervention =13).  All sites had previously adopted the ASA guidelines that determined patient eligibility.  Exclusion criteria were pregnancy, obesity and GERD.  Control groups observed the traditional midnight fast; Intervention groups consumed a carbohydrate-rich drink (Clearfast®) about 2 hours pre-op.  Patient demographics, length of fasting, occurrence of regurgitation and/or aspiration and patient preoperative questionnaires assessing thirst, hunger, headache, nausea, anxiety about fasting and surgery plus discomfort were analyzed by a biostatistician.


Regurgitation, aspiration, or other perioperative complications did not occur in Part I or II.  Binary logistic regression model of Part I showed that if patients (1) did not have Clearfast®, (2) had surgical anxiety or (3) had fasting anxiety, or (4) had all three, they were (1) 5.7, (2) 4.1, (3) 2.7 or (4) 63 times more likely to be uncomfortable with their preoperative experience.  Mann Whitney mean rank scores from the pooled data (n=297) indicated that, if patients did not consume Clearfast®, they were more likely to be thirsty (P=0.00), hungry (P<0.05), nauseous (P<0.05), anxious about both fasting and surgery (P<0.05) and uncomfortable (P=0.00). Control vs. Intervention fasting times were markedly different:  5-20 vs. 2-5 hours (P=0.00).


In appropriately selected patients, following the ASA guidelines and using a preoperative carbohydrate-rich beverage 2 hours prior to elective ambulatory surgery resulted in significantly shorter fasting times, reduced thirst, hunger, anxiety and nausea and improved comfort.  Plastic surgeons should be aware of and comply with these guidelines to improve patient safety and satisfaction.

Disclosure/Financial Support:

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Clearfast® was supplied by the Manufacturer, BevMD, for the purpose of conducting the study.


Research: Pre Surgery Drink Can Reduce Insulin Sensitivity Post-Op

Preoperative oral carbohydrate administration reduces postoperative insulin resistance.

Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.



Infusions of carbohydrates before surgery reduce postoperative insulin resistance. We investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative metabolism.



Insulin sensitivity, glucose turnover ([6,6, 2H2]-D-glucose) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery. The drink group (n = 7) received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100 g carbohydrates), as well as another 400 ml (50 g carbohydrates) 2 h before the initiation of anesthesia. The fasted group (n = 7) was operated after an overnight fast.


After surgery, energy expenditure increased in both groups. Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups (P < 0.05). The supressibility of endogenous glucose production by the two step insulin infusion was similar pre-and postoperatively in both groups. At the high insulin infusion rate postoperatively, whole body glucose disposal was more reduced in the fasted group (-49 +/- 6% vs -26 +/- 8%, P < 0.05 vs drink). Furthermore, during high insulin infusion rates, glucose oxidation decreased postoperatively only in the fasted group (P < 0. 05) and postoperative levels of fat oxidation were greater in the fasted group (P < 0.05 vs drink). Only minor postoperative changes in cortisol and glucagon were found and no differences were found between the treatment groups.


Patients given a carbohydrate drink shortly before elective colorectal surgery displayed less reduced insulin sensitivity after surgery as compared to patients who were operated after an overnight fast.

PMID: 10205319  [PubMed – indexed for MEDLINE]


Research: Oral Supplements on Hospital Outcomes & LOS

Oral Nutrition Supplements’ Impact on Hospital Outcomes in the Context of the Affordable Care Act and New Medicare Reimbursement Policies

Sunday, October 20, 2013

Key Ballroom Foyer (Hilton Baltimore)

Poster Board # P1-29

Health Services, and Policy Research (HSP)


Darius Lakdawalla, Ph.D.1Julia Thornton Snider, PhD2, Daniella J. Perlroth, MD3, Chris LaVallee, MS2, Mark Thomas Linthicum, MPP2and Tomas J. Philipson, PhD4, (1)University of Southern California, Los Angeles, CA, (2)Precision Health Economics, Los Angeles, CA, (3)Stanford University, Stanford, CA, (4)The Harris School, The University of Chicago, Chicago, IL



To assess the effect of oral nutrition supplements (ONS) on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients, aged 65 and over, with diagnoses affected by new Medicare reimbursement rules under the Affordable Care Act (ACA): acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA).


Analyses were conducted using the Premier Perspectives Database over an eleven-year period (2000-2010) on Medicare patients aged 65+ and carrying a diagnosis of AMI, CHF, or PNA. One-to-one matched samples of ONS and non-ONS episodes were created using propensity score matching, producing samples of 20,870, 38,418, and 47,477 AMI, CHF, and PNA episodes, respectively. To eliminate bias from confounding, instrumental variables (IV) regression analysis was performed to quantify the effect of ONS on the probability of 30-day readmission, as well as on LOS and episode cost. For comparison, analyses were also conducted on elderly Medicare patients with any primary diagnosis, with a 1:1 matched sample of 667,684 episodes.


Use of ONS decreased the probability of 30-day readmission, LOS, and episode costs among hospitalized aged 65+ Medicare patients. Most notably, ONS use was associated with a statistically significant (p<0.01) reduction in the probability of readmission within 30 days of 12% for AMI episodes and 10.1% for CHF episodes. The effect on LOS and episode cost was greatest for the comparison population (all primary diagnoses), with decreases of 16.0% and 15.8% (p<0.01), respectively.

Table: Percent change in outcome due to oral nutritional supplements
Population 30-Day Readmission Probability Length of Stay Episode Cost
65+ Medicare patients with acute myocardial infarction -12.0%** -10.9%** -5.1%*
65+ Medicare patients with congestive heart failure -10.1%** -14.2%** -7.8%**
65+ Medicare patients with pneumonia -5.2% -8.5%** -10.6%**
All 65+ Medicare patients -8.4%** -16.0%** -15.8%**

Note: * indicates significance at the 5% level; ** indicates significance at the 1% level.


In the aged 65+ Medicare patient population with AMI and CHF, ONS improves 30-day readmission, LOS, and episode cost outcomes.  This also holds true for all aged 65+ Medicare patients.  Among patients with PNA, ONS improves LOS and episode cost outcomes. ONS use in hospitalized Medicare patients aged 65+ may present an inexpensive, evidence-based solution for hospitals seeking to meet the quality targets established by the ACA.


Improved HCAHPS with CF(Preop)®

Source: The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.

While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Three broad goals have shaped the HCAHPS survey:

First, the survey is designed to produce comparable data on the patient’s perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Third, public reporting will serve to enhance public accountability in healthcareby increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS project has taken substantial steps to assure that the survey is credible, useful, and practical. This methodology and the information it generates are available to the public.

HCAHPS Content and Administration

The HCAHPS survey contains 21 patient perspectives on care and patient rating items that encompass nine key topics: (1) communication with doctors, (2) communication with nurses, (3) responsiveness of hospital staff, (4) pain management, (5) communication about medicines, (6) discharge information, (7) cleanliness of the hospital environment, (8) quietness of the hospital environment, and (9) transition of care.

The survey also includes 4screener questions and 7demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes. The survey is 32 questions in length. Hospitals must survey patients throughout each month of the year.

BevMD’s Clearfast® can positively impact the following HCAHPS categories:

Doctor Communication
Nurse Communication
Pain Management
Communication About Medicines
Overall Rating of Hospital
Willingness to Recommend Hospital

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