Nutrition tips & advice during COVID-19

Ben:                 Good afternoon, everybody. Thank you very much for joining us today. My name is Ben Stansfield. I'm one of the Gowling partners based in our London office and it's my absolute pleasure to welcome you to today's webinar. If you haven't yet dropped by the Gowling booth please do so. We can't meet you in person, unfortunately, but we'd love to buy you a coffee so please come by, pick up a Starbucks voucher so that your next flat white with coconut milk is on us. Also, we can set up a free consultation with any of our lawyers across the firm so please do take advantage of that, and also please do enter our competition to win a state of the art Peloton exercise bike, for a really amazing price. So this is the second in our ACC Conference event which focuses on well-being. Living in lockdown has been quite tough. It's taken a toll on all of us mentally, physically, emotionally as we rush through one Zoom meeting to another, wanting our friends, families and colleagues and home schooling. In my case utterly demotivated children and it's all too easy to forget to fuel our bodies properly so I'm really thrilled to be welcoming Mary Cranmer-Byng who's agreed to speak to us today. Mary's a registered dietitian working in both community and hospital settings and she teaches undergrad courses at the University of Toronto and the University of Guelph. Mary, thank you so much for taking time to speak to us today and sharing your knowledge. Over to you.

Mary:               Thank you. It's a pleasure to be here. So I'm going to share my screen and show you some slides as we go along. Today we're talking about nutrition and tips and just different strategies we can use to stay healthy during COVID-19 and these things really just go beyond COVID-19 as well. We're going to focus on how to navigate through the pandemic and our relationship with food. I'll talk a little bit about our immune system and different nutrients that are important for it. As well as how to handle food safely and then we'll talk more about planning meals, planning snacks and, if you're interested in changing your behaviours based on the information today, a framework to use to get that process started. Here's me. My contact information is there if anyone does have any questions that they think of later on, you can reach out. I'm also going to have a little disclaimer is that this isn't necessarily medical advice that's specific to you so if you do have something that is really specific that you'd like to know, I recommend reaching out to your doctor, another health care practitioner, for a specific answer for you.

                        I'd like to start off with this quote. This is from the World Health Organization pleading that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. There's also tons of evidence that shows prevention is worth so much more than trying to cure something that's already happened. So, with all the things we've been going through in the past 6 or 7 months, we've definitely seen changes to health in all sorts of these aspects. I think it's really important that as you listen to today you think about your current health status. Just to keep in mind that everyone is in a different position and all you can do is your best right now and that your situation is going to keep changing.

                        So we can start off with a little reflection. You might think how has your personal situation changed in the past 6 months. Are you at home more? Are you able to cook more? Are you more busy, less busy? How is your stress level? Do you have time to cook? Are you snacking more? I've heard that a lot, more so at the beginning of the pandemic, I heard a lot of people talking about pandemic 15 and that seems to have fizzled out as we've gotten used to it. And then, if you're interested in making changes in your health, where you thinking about doing that before? Is it as a result? So either way now actually is a really good time to focus on your health. Not only to help prevent your risk of any severe illness, or if you were to contract COVID-19, but also just because it sounds like we're going to be in this state for quite a while. So don't wait to make changes if you were ready to make them before this happened.

                        These are just some situations I thought of. We're all in a different place right now and your situation might be changing, month by month, as the seasons change. So as you listen to this and think about your own health just keep in mind that everyone's situation is different and try not compare yourself to others.

                        When it comes to our immune system, three basic components or things that we can do to keep it healthy and up and running, are eating well, exercising and getting enough rest. So, I took this information from ..., by no means an expert in the immune system but we basically have two components. The innate immunity, which is those protected barriers such as our stomach acid, mucus membranes, even just our skin and our immune cells that attack foreign components. This does include the process of information. We often will hear information used as a buzz word and these foods are anti-inflammatory. So it's important to recognize that inflammation is actually part of our immune system. It is a normal response and it is a helpful response which is when inflammation becomes prolonged. You might be very low grade, that we don't really notice any symptoms of it, then that kind of inflammation can be harmful. We also have our adaptive or acquired immune system and that involves learning how our body learns to recognize those pathogens. It involves different organs such as the spleen, bone marrow and lymph nodes. That's the process that leads us to produce antibodies against things like viruses and increase white blood cell production to fight the virus or bacteria. All these parts of our immune system are going to be influenced and deteriorated by a lack of sleep, a poor diet, our immunity decreases with age and that's why our older populations are more at risk of contracting illnesses such as COVID-19 and other chronic diseases. Possibly including obesity, which is now being really well recognized as a chronic disease, in Canada and globally as well and then chronic stress. If I think about really the only time I ever get that common cold is when I am not eating well, or not sleeping enough, you're trying to fit more into your day and then you often end up getting sick and so keeping the sleep, the diet, the exercise all in mind, if we're not doing that we're at increased risk of getting sick.

                        So when it comes to food specifically there is no nutrient or supplement that will boost your immune system but nutrition is involved in having a healthy immune system. So if we think about eating a well balanced diet, if that's something you feel like you're doing, chances are your immune system is functioning as well as it can in terms of nutrition. If you think, you know what, I don't eat very well. If you admit to yourself a lot of my diet is fast, ultra processed foods, then certainly changing your diet could boost your immune system and get it back up to speed. But if your diet is already full of fruits and vegetables, you're getting enough micro-nutrients such as zinc and iron, then chances are taking extra of those things is not going to increase your immunity. So some of the ones that we'll focus on are vitamin C, vitamin D and zinc and then I'll touch on protein as well.

                        Vitamin C often touted as a vitamin that can help the common cold. I just realized I got cut off a little bit, but adult men need about 90 milligrams per day and women is 75 milligrams per day. That's the recommended dietary allowance which is a number but it's set to meet about 99%25 of the needs of most people. So if you're eating enough fruits and vegetables chances are you are getting that amount. The upper limit for vitamin C is 2,000 milligrams per day. Beyond that you could be at risk for some side effects. Then people who smoke cigarettes need 35 milligrams extra per day and that's just to account for the oxidative properties of tobacco smoke and the body uses more vitamin C to combat that. There is some new evidence that suggests up to 200 milligrams per day might be ideal but if we think about where vitamin C is found, in fruits and vegetables, if you're getting fruits and vegetables with every meal and snack, chances you're getting more than that 200 anyway. Vitamin C is common in supplements and so if you are taking a supplement, say you're taking that 2,000 milligrams per day and your body is already saturated, you don't need anymore vitamin C, you'll just excrete it in your urine. It's not something that's going to do too much harm, especially compared to other vitamins, but if you're already getting enough from food there's no reason to pay extra for a supplement that's not really having any benefit. I have here a label coming from an orange juice bottle. I thought it would be interesting just so everyone understands how to read the label for something like vitamin C. Typically it's just listed in our Canadian and American labels, just not sure about everyone's labels, as a percentage. So the percentage that this is based off of is 120%25 of the 90 milligrams that's recommended for adult men. If you have a glass of juice you're getting 108, is what I calculated, milligrams. The other thing to note with vitamin C is that it is so well consumed in North America that we're actually taking it off our nutrition facts panels. I know here in Canada we have another couple of years before all the companies have to change to our new label which no longer includes vitamin C because it's not something that Canadians are deficient in.

                        I thought I would share this as well. It's a great visual showing us where vitamin C can come from and how much of a whole food we would need. It's comparing vitamin C from foods to a supplement of 1,000 milligrams. We think of vitamin C, I know I used to always just think of citrus, so your orange. So that cup of orange juice had more than 100%25 of the need for vitamin C. You could also get that amount from one and a half oranges and you'd have to eat 15 oranges to get that 1,000 milligrams. Bell peppers is actually one of the highest sources of vitamin C. So eating half a bell pepper a day will allow you to have enough vitamin C to meet your body's needs. Cantaloupe is another one.

                        Moving on to vitamin D. Vitamin D is something that most adults in colder climates during the winter will be deficient in or not getting enough from their dietary sources alone. Our need is 600 IUs, or international units, per day and we do have an upper limit set at 4,000 IUs. So again, most adults, we're not getting this from food. It comes from food such as a fatty fish, salmon is one of the best natural sources, a 3 ounce serving could give you that 600 IUs. Eggs are also a good source and we do have vitamin D added to products that contain calcium, such as milk and non-dairy milks, and that's because our vitamin D helps us to absorb calcium later on. It's not the vitamin D in that glass of milk, that helps you to absorb the calcium in that glass of milk, it'll help you absorb in a future glass of milk. A supplement is recommended in the winter. You could take in the summer as well if you know you're not outside with arms and legs exposed, without sunscreen, very often. Supplement recommendation is at least 400 IUs per day but common doses are typically 1,000. Those recommendations will vary depending on the source. The 600 is recommended by the Institute of Medicine, who has set the recommended intakes for vitamins and minerals, and then Endocrinology Society will recommend up to 2,000 a day so it just depends. Apart from bone health, which is what vitamin D is know mostly for, it does have roles in neuromuscular and immune function. Reducing inflammation, regulating blood pressure and it could also be linked to blood sugar control and autoimmunity.

Some of the ways it works with our immune system, it stimulates that innate immunity and modulates are acquired immunity. Through things like helping us to have those immune response cells be made properly. There are currently studies that are looking at vitamin D status and acquired respiratory infections and there are a number of different observational and, I think, supplemental trials looking at the role of vitamin D in COVID-19 prevention and treatment. However, it's really important to recognize that vitamin D is so important for a number of our body's functions that COVID-19, yeah maybe it could be serving as a motivator for us to make sure we're getting enough vitamin D, but regardless of it we should always be trying to get enough. It is something that we can get a blood test for. I know here in Ontario, where I live, it's not covered by our Provincial health care system unless you have a certain medical condition that requires the test. But it is relatively inexpensive, about $30.00 for a check. So if you are curious to see if you're getting enough or not, that would be my recommendation, is get your levels tested. Depending on how low someone is you might need super high doses of a supplement to bring you back up really quickly and then you could maintain with that 400 or 1,000 IU supplement each day.

Then zinc. So zinc is a mineral that is found in mostly meats as well as dairy products. There's some in whole grains, legumes, so beans and lentils as well. Adult men need a 11 milligrams per day and women need about 9 milligrams per day. The upper limit for zinc is set at 40 milligrams. This is really important to note because zinc is found in things like zinc lozenges which are commonly taken if someone feels like they have cold symptoms or a sore throat. The zinc contained in that you could easily reach that upper limit with just a couple of zinc lozenges in a day. Zinc, when we consume it, we have to store it. So it's stored in a protein called metallothionein. This protein also stores copper. So that upper limit is based on the interaction of zinc and copper. Copper is required for iron metabolism and so, if someone is having too much zinc then they might not be able to properly use the iron that they've consumed from their food or their supplements, and they could run into problems with iron deficiency. I really wanted to highlight that because we often think, "Oh, I'll just take a supplement",  but there is too much of a good thing. So even though zinc is important it is best to get from food, or just have a small amount from a supplement if you feel like you need it, if your diet is low in the things that contain high levels of zinc. Another thing when it comes to zinc is that we don't actually have very good ways to measure it. So we can test our serum, our plasma, like blood zinc levels but we know that there is some inaccuracies with that test and alternative tests are still being developed. Zinc is also lost by some processing such as heat and we don't absorb all the zinc we ingest so these numbers, the 11 milligrams per day for men and 9 milligrams for women, were set to account for the fact that you're not going to absorb all the zinc that you ingest.

I also mentioned protein as something that was important. So I have these lists of different items you could consider having on hand, in case you do get sick and you have to self-isolate at home, and you don't have anyone who could readily bring you food items from the store. So proteins are also really important for building our cells. Protein is involved in everything in our body. If we're not getting enough protein then that could impact our immune system as well. Some great sources of protein are the legumes, beans, lentils, they're about half protein/half carbohydrate. Most of that carbohydrate is fiber. Tofu is another great one and those are great options because tofu will last a really long time in the fridge. And then those dry or canned legumes you could have them in your cupboard just ready to go for any rainy day or if you do get sick. Stock up on meat if you have room in your freezer. So fresh meat you don't want to leave more than a couple of days but if you're lucky person that has tons of freezer space then that would be another option. Cheese and eggs are also good sources of protein. Then they have nut and seed butters, sort of purposely a step below this. Often we think of nuts and seeds as an alternative to meats. They do contain some protein but I actually like to think of them as more of a healthy fat food because you would have to eat a lot of peanut butter to get the same amount of protein as you would get from tofu or meat. So if you are trying to use the nuts for all your protein, in all your meals and snacks, you're going to have a hard time and you're not going to get all the different types of amino acids, which is what protein is, that your body needs. Greens and starches, easy to have on hand. Pasta, pasta gets a bad reputation but the whole wheat pasta is actually a very nutritious food. It's very high in fiber. Quinoa is also great. There's a quinoa called NorQuin which is grown here in Canada, and it has a really nice taste and texture, and is easy on the wallet compared to quinoa grown elsewhere. Then fruits and vegetables. Like I said, eating enough fruits and vegetables is the best way to get your vitamin C needs. So these are some ideas that you could have on hand just in case you get sick. Just easy things to always keep on hand in case you just run out of food and don't intend to go to the grocery store. Green peas, very easy vegetable to heat up and have for an easy dinner. So don't be afraid to keep those things on hand even if you're not going to be sick.

Now we're going to transition and talk about safe food handling. When it comes to this the key, other than handwashing of course, which we have all been hearing so much about, is when in doubt throw it out. If you're not sure if something has been sitting there for too long in your fridge, just throw it out, because the risk of getting sick from it is not worth eating a dollars worth of food that you might have been wasting otherwise. When it comes to food preparation some key points that I thought I would highlight is that we don't need to wash all of our food. I remember seeing news articles and videos spraying down all the boxes and things when you got home from the grocery store. But I think the consensus has come to be that that's not necessary. Always continue to wash your produce well and wash your hands before cooking and eating. The reason this food safety is important is because those COVID-19 symptoms can include vomiting, diarrhea and abdominal pain which could be confused with a food borne illness. So if you had any of those symptoms then you might be required to self-isolate, or wait for a test and then wait for the results, and that's obviously going to impact your life.

Key things that I was thinking about, what would I see my friends not doing, things I wanted to highlight would be having separate cutting boards. So having one for different types of meat. Your red meat, your poultry, your vegetables and really washing those well. If you put meat on a plate when it's raw make sure it's cleaned before you put it back on to that plate once it's cooked. This is sort of my biggest pet peeve is we shouldn't be using sponges to wash dishes or to clean off counters. Sponges take a long time to dry and bacterial populations can grow readily on a sponge. It's best to use a paper towel if you're wiping down the counter, or use some sort of dish scrubber that can be sanitized properly in between uses, or use something here like a cloth that is reusable. Just a dish cloth that you can use and then put it in the wash and keep reusing the clean ones.

In terms of when we're thawing and chilling food, how many times have you seen someone, "Oh, I'm just going to thaw this chicken for dinner." and maybe put it on the counter. So if we're thawing things at room temperature that increases the risk of bacterial growth. Ideally, if you think ahead and if you're doing meal planning to try and get as many nutritious meals in your week as possible, you could think ahead, put that meat or whatever it is into the fridge the night before you want to use it so that it thaws properly in the fridge. If you forget you could always use a little bit of cold water, or a microwave, just avoiding that thawing at room temperature. Check your fridge. Make sure your fridge is at 4° and your freezer at 18°. So we often think it's in the fridge it's safe, especially in the freezer it's safe, but we know there are bacterial species that do grow and thrive at those colder temperatures. You want to keep those in mind as well because the danger zone is between 4 and 60° Celsius. The danger zone is also why we want to put away food within 2 hours after it's been cooked so that's not left out in the danger zone too long. So I do recommend leaving food on the counter for a little bit of time to cool so that you're not putting it into your fridge or into your freezer and then having that the way it would get cooled down in that scenario would be the cold air around it would freeze it but it would also ... ... ...  Avoid overstocking your fridge so that food stays safe. It allows proper air circulation and things like eggs and milk should not be kept on the shelves on the door of a fridge because the temperature, when it gets opened and closed very frequently, the temperature in that tends to be a little bit higher and so those foods could spoil more quickly if they're left there.

Then finally, just a note about those best before dates. They are exactly that. It is best before that. The food manufacturer wants you to have the food before that so that you think their product tastes as good as possible. But it is safe to have foods that are past that date. Some foods whose date is a month out could be unsafe. For example, something that's been open like milk will spoil within 7 days and so it matters more so when you opened it and not the best before date on the container. Then just one idea is just to plan your meals and use what you've bought before those dates so that you can use them fresher and you can ensure you're giving yourself the right nutrients and avoiding food waste.

Moving forward, how are we actually going to create those meals? It doesn't have to be complicated. I think we often get caught up and oh these fancy looking meals on recipe websites and books. It can be really simple. So this is just a really easy visual to follow. It's the plate method. I don't think anything beats it. So on the left here we have a plate that comes traditionally from diabetes management, and I say healthy eating is just diabetes prevention, so having half a plate of vegetables, a quarter plate of a starch or a grain, and then the other quarter of a plate being a protein food, as a good way to think of what should I have to eat. So very easy meal. You come home from work and you don't have a lot of food left. You don't really feel like cooking. You don't have a lot of time. You could easily have some toast with two eggs and a salad. Or you don't have any salad greens. You've got those green peas in your freezer and you could have some green peas and maybe you've got some carrots. So something like that. It doesn't have to be simple. The plate on my right comes from Canada's Food Guide so it's a little bit different in the sense that they are including fruits and vegetables on this side of the plate. The reason I'm highlighting the other plate instead is that there's a tendency for us to group fruits and vegetables together and when we do that consistently some people can forget about the importance of vegetables and just think, "Oh, well, it said fruits and vegetables and I'm having no fruit all throughout the day." and then they go the whole day without having vegetables. So I like to consider them two separate groups just so that you're trying to get each of them because they are both important. So focusing on half that plate being vegetables could be the way to go and then having a piece of fruit off to the side for a desert or fruit in your snack instead. When it comes to breakfast, I'll add this in, you don't necessarily have to follow this at breakfast. I find that, personally, hard as well. So aiming for at least a half of plate of vegetables at lunch and supper, if you're not already doing that, and then if you think, "Oh, I missed my vegetables at breakfast." you could have them later on in a snack.

So some questions to ask yourself just like I had at the beginning. When it comes to meals and snacks, if you were having regular meals and snacks at the beginning of 2020 and you're not doing so now, why is that? If you skip lunch could you change and have lunch now? I've heard some people say that lunch, they kind of end up skipping lunch when they're working at home, because they don't have their friend that they used to go out for a walk with or sit and eat lunch together. So, I propose that you can still do those things. If the friend isn't close by you could plan a lunch. Have a Zoom lunch together once a week or something like that where you both eat and you catch up and you try to normalize your new lunch hour. Then another thing just to think about is are you drinking water? So sometimes we often will feel hungry when we're really thirsty. If you haven't been drinking enough water, if you start doing so, you might realize, "Oh, I'm not actually hungry for a snack. I don't need to graze throughout my day. I just needed to hydrate."

So there's been a lot of talk about comfort food. Food is very important to our culture. It helps us to feel better when we're feeling sad. When we're feeling lonely. So we can still have comfort foods and eat a very nutritious meal that's good for us. I have here a picture and the nutrition facts from a butternut squash mac 'n cheese. I really like this recipe because it makes a number of servings. This is based off of 7 servings and it's a complete meal. It has, if you think about that plate concept, when you're making this even though it's not going to look the same, it's not going to all be separate on your plate, but it still has those components in it. The pasta is the grain and starch and then pasta also actually has a fair amount of protein compared to other grains. It has some milk and some cheese. You could try non-dairy alternatives as well and that would be the protein. It has a great amount of fiber so per serving, this is using a whole wheat pasta, so it has 12.2 grams of fiber. There's pasta like Smart pasta that is the benefit of the whole wheat so it would have the same amount of fiber but it would taste and look like white pasta. So if that's your preference that's also a great option. Then in terms of vegetables it is butternut squash, roasted, mixed with the milk and cheese and that's the base of the sauce. Then steamed broccoli and cauliflower added in as well. So you take a slice of this. You have it for your meal after you make it and then any leftovers could easily be frozen in individual servings. So that if you don't feel like cooking, you're not feeling so great one day, or you just don't have the time because you're extra busy with home schooling your kids and job demands, then you've got a healthy meal ready to go. It just required a little bit of thinking ahead and preparing it maybe the weekend before.

We can also still bake. I remember back in April and seeing tons of things. People baking bread, the flour was all sold out from the stores. So we can still bake and bake things that are more nutritious then cookies and cakes. This is one idea that I really enjoy is baked oatmeal. So it's perfect for those mornings when you're rushing. There's a number of different varieties. You can find recipes on Pinterest. I have some of these recipes on my website. But it's the same idea to the mac 'n cheese. You have a complete meal, minus the vegetables here, and you can freeze portions really easily for times where you just don't have time to make anything and this works as a grab and go breakfast as well.

I thought I'd share some of the recipe websites that I often look to. There's tons of things out there. If you find a recipe or you have an old family favourite, and you're not sure if it's the best meal to be making, I would suggest thinking about, "Okay, in the portion that I'm eating, am I eating about half a plate of vegetables?"  If not, could you add more vegetables. When that chili recipe calls for one cup of Bell pepper, and you've got one and a half, just add that other half. The pepper's probably going to go to waste anyway if you don't. You'll put it in the fridge and forget about it. Add more vegetables into things. If you are trying to use up ingredients, trying to minimize your shopping trips, then just search websites such as these, looking for recipes featuring that key ingredient you're looking to use up. Then also you can use these websites or any others to think abut planning meals ahead with your family just so you're not as rushed when it comes to actually making a meal.

So, after meals, a lot of people like snacks. There's no set rule. Some people do really well with three meals a day. Some people do three meals and two or three snacks and whatever works for you is what's best for you. There's no one size fits all approach to meals and snacks. But what we want to avoid is grazing. I thought this meme was pretty funny. On average a giant panda eats 12 hours a day. Confined a human eats like a panda. Hence the name Pandemic. So you keep going to the kitchen every single hour and getting a little something. That eventually can lead to you never have those feelings of fullness or satiety and you also never actually feel true physical hunger just because your body is constantly digesting food. So, if you're about to go have a snack, things you can think about are, are you actually hungry? Is it physical hunger or is it mental, emotional hunger? Maybe you're thirsty, like I mentioned. Do you just need some water? Are you bored? A lot of times we'll eat because we're bored. Or it could be something else. So, first, if you find you're a grazer, next time you go to eat stop and think. Why am I eating? Am I really hungry? Or do I need something else? Do I need to go for a 5 minute walk? Get some fresh air. Do I need that water? Do I need a nap? Maybe there's something else that you actually need more than food.

When it comes to snacks, how to have a healthy one, is to include two of those food groups. So apple and nuts. Fruit and yogurt. Vegetables and humus or some sort of other dip. Granola bar, granola bites. Something that's giving you not just say carbs, not just protein, not just fat, but some sort of combination of at least two of those things. The reason we want to do this is it also helps us to get more a variety of foods in our day. Which helps us to get a variety of nutrients which supports the immune system. Then if anyone has issues with blood sugar control, then if we're ever having a carbohydrate containing food, like an apple, if we have something like the nuts with it, it slows down our digestion therefore our blood sugars don't increase as quickly and that snack could sustain you for a little bit longer then if you just had the apple on it's own.

Here's an idea for some homemade granola bites. These are no bake so you just combine the oats, coconut, peanut butter or any other some sort of plant based seed butter that you like, ground flax seeds, a little bit of honey, vanilla. If you want it to be a higher protein food then you could add some protein powder and then chocolate chips. All those are optional. So something like this, really easy to make and have on hand, you can put them in the freezer and they'll last a little bit longer. Then when you need an easy grab and go snack you've got it available. There's also a number of good commercially available like sort of granola or snack bars out there right now. My one word of advice is if you're looking at those to try and find something that has fiber and protein as well. So if you look at the nutritional information for this recipe, often I hear people, "Oh, I don't want that. It has too much sugar." So sugar is right here. This is how much sugar is either naturally occurring or added to the food. But this sugar is included in the total carbohydrate. So if there's say 6 grams of sugar I would also like to see at least some fiber. This has 2. It could be a little bit higher. The some protein as well. The fiber and the protein and the fat is all going to balance out that sugar and make it something that is slowly digested and gives you energy for say an hour or two. Versus just something that's super sugary like a candy bar or Nutri Grain Bars, those are pretty sugary which would make you feel really awake and energized for a short period of time, and then you might feel sort of a sugar crash after that.

Then finally, if any of this is resonating with you, if you're thinking, "You know what? I'm ready. I need to improve my diet, take control of my health." Talking about our values is a way that we can give ourselves an internal motivation. So our values are things that are constantly guiding us to make our food choices. A value is different from a goal in that a goal is something that you can achieve where a value is something you can never achieve. It's constantly there and guiding you. So if you think about you have two cookies. One cookie is a nice delicious warm chocolate chip cookie freshly baked. Then the other cookie is a burnt hard chocolate chip cookie, and it was made for you by your niece or grandchild or child, and they spent all day making it just for you because they wanted to do something nice for you. So at first, you probably thought well obviously I'm going to choose the fresh baked delicious chocolate chip cookie but after you realize that it was made by that child and the amount of love and attention they put into it, everyone I've asked this question to before, they choose the hard burnt cookie. That gets to their value. They value their relationship with that child and the person's feelings so that guides and changes their decision. Often if people are looking to improve their health, they say they want to improve their health, but we want to think about why. Why is change worth it? Change is going to be hard so what is guiding you? What's going to actually take you through those hard choices and hard days? Typically it comes down to a value of being around for your friends and family. Being a good role model for your kids. Being able to see them grow up. Being able to see your grandkids grow up. We want to use that value to power your decisions. So as you go through your day these are some reflection questions you can use. You can do it at the end of the day, or you could even use them half way through, or when you're about to make a choice. Define your values and then think are my food choices aligned with my values. So if I eat this bag of chips is it taking me down the path where I'm likely to have better health and live a long healthy life and be there for my family? Or is it taking me down an opposite path where I'm at higher risk of chronic diseases and I might have a poor quality of life later on? So think about which path you want to go down and let that guide your choices. If you're using it as reflection you will also want to think, okay, if you were on track, if your choices were good, how does that make you feel? Does it help you to keep going? That's typically what most people would say. Gives you motivation. You're like I can do this. Sometimes you're going to have off track days. So it's also important to reflect on those and think why did I give in to that food? Why did I not have a balanced meal? And think what could I do differently? It could have been you just didn't have time. So a solution to that could be preparing food on the weekend or having those frozen meals ready to go for yourself. The most important thing when you're doing that reflection is just to avoid becoming self-critical, and kind of spiraling down into your thoughts, because that can throw you off track for the long term. One off track day or one off track choice doesn't mean that you can't get back on track with your health goals the next day or the next moment.

Just as I mentioned at the beginning it's really important, especially now, to not compare yourself to others. If you see other people doing challenges and losing weight and doing different things, if your situation is different, everyone has unique circumstances. So don't compare yourself to them. Just start by thinking what are the things that I can control and focusing on those. Keeping in mind that every day is going to be different. There will be those on track days and those off track days. Reflection can really help you to recognize when you're off track and how to get back on track.

Last point I really wanted to end with is just a reminder that weight does not equal health. Just because someone is thin doesn't mean they don't have issues with their relationship with their body or food choices. So it's best now and after, especially once we see people in person a lot more, just to refrain from commenting on each others weight. We don't know what people have going on. Someone could be losing weight because of cancer treatment or they could have an eating disorder. We just don't know what we don't know so it's best not to comment on it. They could be internally unhealthy or not healthy and their weight won't show that.

Another reminder is that all foods can fit. So there is a difference between healthy and nutritious. A donut might not be very nutritious but having a donut as a treat every once in a while could be mentally healthy. If you're allowing yourself to eat a variety of foods and not constantly depriving yourself or restraining. So there is a time and place for all different foods.

The different take home messages, other than those two, is that nutrition is important for overall health and disease prevention but there is no supplement or nutrient that you should be focused on increasing in your diet unless it's already deficient. So if you were thinking, "You know what? I don't drink milk. I don't eat eggs and I don't take a vitamin D supplement and I'm never outside in the summer." Then chances are you could be vitamin D deficient and so in that situation a vitamin D supplement would be recommended. But if you're already taking a vitamin D supplement, taking more is not necessary, it's not going to boost your immune system further. Sleep, exercise and stress management are just as important to your health and to immune system health as those foods, as well. So don't forget about those things. Hopefully you go and try to win that Peloton bike because that would be an easy way to get exercise in at home. Now is also a great time, if you are looking to make changes with your health, to seek support. Providers are operating virtually which allows us and you a lot more flexibility. Especially if they are not located close to you. If you've been thinking about accessing some services now is a great time to do so. This is another place you can go to if you have questions. It is the unlockfood.ca. It's Dietitians of Canada's website where you can find articles, easy to understand, just about many different topics as well as links to find a dietitian. So if a dietitian is a health care professional you think you need to work with, you can go to that website in Canada and look to see who is in your area, and find someone that you think is a good fit for you. I've had questions in past webinars about kids and how to feed them so, I specifically focus on adults, not on child nutrition so this is a colleague's website and they focus solely on kids. So if you're looking for more information on picky eating and feeding your kids during the pandemic that would be resource that I would suggest to you.

So, questions. Just trying to think what could I have added. Is there anything else that are questions people might be wondering. Nope. I closed that. So, in other webinars I've had people ask about vitamin D. Why only that 400? And that is just the Health Canada recommendation and not necessarily, like you can take more than that. Another question, is there a difference between fresh and frozen vegetables? Between fresh and frozen, not really. Sometimes the frozen vegetables are actually better for you because they would have been left on the plant longer, if the producer knew it was going to be frozen. So it might have accumulated its max nutrients. So if you think about tomatoes, a tomato is typically traditionally picked when it's greenish, so that by the time it gets to you in the store then it's red. So a tomato that's left on the vine to ripen until it's red and then picked when it's red is going to contain more nutrition then that green tomato. The frozen ones are a great alternative. I keep them on hand all the time. There is a difference though between the canned vegetables and the fresh ones. So canned vegetables, if you're having those on hand, just look for ones that are packed in water. They don't have salt added and there usually is a little bit more of a texture change between the fresh and the canned versus the fresh and the frozen. So if you have the freezer room, I'm one of those people I freeze lots of things so I typically don't, but if you do the frozen vegetables would be a great thing to have on hand.

I also think maybe I'll just touch on iron a little bit. So iron does have important roles for our overall health. So iron is part of every red blood cell and it's also in our muscle cells and iron is part of the heme protein and it's what oxygen attaches to. So when you breath in the oxygen goes from the lungs into the bloodstream and it's part of the heme. That's where it goes. So if you're low in iron you might feel fatigue, low energy and those are also COVID-19 symptoms, so it's important to get enough iron. Iron deficiency is more common in women but it does happen in men as well. Especially if you are a frequent blood donor and you don't eat a lot of red meat then it could be something that you are at risk for. So iron is commonly found in red meats. It's in some plant foods like spinach and legumes. Very common to zinc, we don't absorb nearly as much from those foods. So the best way to maximize your iron absorption is to include a source of vitamin C with any iron containing food. So we need about 75 milligrams of vitamin C at a meal, with an iron containing food, to maximize the amount of iron that we're going to be able to absorb from that food. Similarly if someone knows that they have iron deficiency, or low levels of iron, so  iron deficiency is sort of a scale. You start off with just like lower levels and then you get to true iron deficiency anemia. If you get blood work done and you don't have low anemia, you don't have iron deficiency, but your iron stores aren't as high as they could be then iron could be something to work on or perhaps taking an occasional supplement. Taking a supplement, would be sort of the one time I would say to take a vitamin C supplement, would be if you're pairing it with an iron supplement to make sure you get as much iron out of that iron supplement, as possible.

Another question coming in, is there a time after which we should not eat in the evening or is that an old wives tale? So I say it's an old wives tale. It really depends on the person. So a couple of scenarios could be that you are very active and you eat three meals a day and snacks, and say you have dinner at 6:00 o'clock and you're not going to bed until 10:00, or maybe you have dinner at 6:00 and then do a workout at 8:00, you might actually be physically hungry and need something before you go to bed. In that case definitely a great idea to have a little snack. You might be able to fall asleep well. If you don't you might wake up in the middle of the night hungry and not be able to get back to sleep. So it would be better to have something small before bed then to brush your teeth again in the middle of the night after a snack. But a lot of the time in the evening, and this is probably where that wives tale comes from is that, we're eating and we're doing so mindlessly. You get through your day and then you're sitting on the couch and you have a bag chips with you. You're not physically hungry but you're just snacking on the chips. It's become a routine when you eat the chips. The reward center in your brain lights up and that reinforces the pattern every time you sit down to watch TV at night time then your brain says, "Oh! It's time to eat chips." and then all of sudden you get that craving for chips even though you're not physically hungry. If that sounds like you then late night snacking could be something to work on. So step one is you recognize am I physically hungry. If you're physically hungry always better to eat then not eat. Options for eating could be have some veggies and dip. Perhaps if you didn't think you had enough vegetables during the day, which would be a great alternative, especially if you like a crunch of a chip. Or something small like a little bit of yogurt. Just something to tide you over so that you can get rid of that hunger. Or if you're not sure is this hunger or am I just thirsty? Do I just need something in my stomach? Do I need to hold something in my hand? Put something to my mouth to occupy myself? Herbal tea could be a great alternative for that. Then you get some sort of flavour that you can enjoy with it. But ultimately everyone's different. Sometimes if I don't eat before bed I'll wake up on a Saturday at 6:00am hungry. I'd rather have a small snack before bed and enjoy a Saturday morning sleep in then worry about snacking at night being bad for me.

Unless there are any more questions I think we'll leave it there. So as I mentioned earlier my contact information is available there. Should you have any questions feel free to reach out to me or reach out to those websites that I showed you, unlockfood.ca is a good one. If you're searching for answers to nutrition questions just be mindful of looking at reputable websites because there is a ton of information out there. I often like to say that dietitians aren't sexy because we're telling you the truth. We're focused on the best evidence and recognizing that one study doesn't necessarily mean that something is true for you, especially if that study is done in cells or done in a rowed in model. So if you're looking up things just try to look for evidence coming from the highest level.

Alright. Thank you for watching today and have a great rest of your day.