The DASH (Dietary Approaches to Stop Hypertension) Diet — This diet has strong research to support its effectiveness, particularly in lowering blood pressure and LDL (bad) cholesterol. It is actually very similar to both the Mediterranean Diet and vegetarian diet principles with a focus on whole grains, fruits, vegetables, legumes, low-fat dairy, and fish, poultry and healthy oils.
Inan era dominated by pharmaceutical solutions, there is a rising consciousness about the incredible healing and preventive powers of food. As the age-old saying goes, “Let food be thy medicine, and medicine be thy food.” But how does this translate in today’s world? Can we really use nutrition as a potent tool against sickness and disease? How does one curate a diet that supports health, longevity, and wellness? In this series, we are talking to nutritionists, dietitians, medical professionals, holistic health experts, and anyone with authoritative knowledge on the subject. As a part of this series, we had the pleasure of interviewing Christine Lothen-Kline from ModifyHealth.
Christine is the Dietitian Director at ModifyHealth where she has provided leadership for the clinical nutrition services and team to guide clients through the FODMAP protocol to ensure that they get the best possible health outcomes. As a Registered Dietitian (RD) and a Master Certified Health Education Specialist (MCHES), Christine has over 25 years of experience and holds a B.S. in Food and Nutrition from the University of Idaho, as well as a Master of Public Health from The George Washington University. She has completed extensive training on implementing the FODMAP protocol both through Monash University, the birthplace of FODMAPs, and by international expert Patsy Catsos.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
Igrew up on a small farm in the heart of Wisconsin Dairyland. There are three girls in my family, and we were very active in caring for the animals and planting, growing, and harvesting the food that we grew. Between what we had from our farm and swapping with our neighbors, we got very little from the grocery store. I have to say that as a kid, I didn’t appreciate how lucky we were to have access to fresh, healthy, locally grown food. Now we call that Farm to Table, but growing up, we just called it time to eat!
What or who inspired you to pursue your career? We’d love to hear the story.
When I first started college, I wasn’t sure what I was going to major in, but in my sophomore year, I took a nutrition class which showed me how I could combine my loves of food, cooking, science and people. From there, my future was set and I decided to transfer schools to attend an institution with a Food and Nutrition major. Since then, I have never regretted my choice for a career.
It has been said that our mistakes can sometimes be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
While this wasn’t a funny mistake, it was a valuable learning experience. My first job as a Dietitian in the Army was as the Manager of the Outpatient Nutrition Clinic on post. In that role, I taught classes and provided individual appointments to active duty soldiers, retirees, and their families on weight loss, diabetes, prenatal nutrition and many other health issues. The diabetes classes provided very structured and prescribed nutrition education based on the American Diabetes Guidelines. We taught about measuring, counting, limiting foods based on current practice guidelines. It looked great on paper, but the problem was that many patients would either stop coming back to class, or they came back without implementing the very specific dietary guidelines provided. I was very discouraged, as I really wanted to help these people. After thinking a lot about it, I felt that the approach was beyond what most people needed and could realistically implemented. So, I went to my supervisor and said that I wanted to present a series of classes on practical principles for managing diabetes. The classes included topics such as eating out, healthy snacking, and easy meal ideas. For the eating out class, I collected menus from local restaurants, and in class people would select healthy choices that they would enjoy. The participants loved the practical tips and getting to know each other, and most importantly, their glucose levels improved! It was wonderful to hear them share their success stories, challenges, and tips for each other. This experience was a vital part of my growth as a dietitian, educator and human being. The lessons I learned have guided me through my career; meet people where they are, and less is more when it comes to facilitating healthy lifestyle changes. Small steps, big changes!
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
I would say that three character traits that have played a significant role in my life and career are that I am tenacious, proactive, and collaborative. I put myself through college, while working nearly full-time, and, for the last two years, I was also in Army ROTC. It was a challenge juggling all of those things, but there was nothing that was going to stop me from getting my degree. That tenacity has served me well throughout my career.
I have been fortunate to utilize my professional background as a Dietitian in many work settings to take on jobs and projects that hadn’t been done before, so there wasn’t an exact template to follow. That said, I love to learn new things and take on new challenges. These opportunities have required me to be proactive and collaborative. As the Dietitian Director for ModifyHealth, under the direction and vision of our CEO, GB Pratt, we have created a company that provides medically tailored meals and the support of Registered Dietitians who are experts in equipping patients to make healthy lifestyle changes that improve their health and quality of life. These positive outcomes require teamwork and commitment from every single person and area of the organization.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
One active project is a collaboration with a large health system that has identified patients with Type 2 Diabetes who have high hemoglobin A1c levels, a marker of diabetes control. In this 12-week program, patients are provided ModifyHealth’s healthy, prepared Mediterranean Diet meals to support them and serve as examples of simple, healthy meal options as they work on implementing healthy, lifestyle changes. Over the 12-weeks, each patient will meet four times with one of our Registered Dietitians who will provide education, motivational interviewing techniques, and resources to enable the patient to make and sustain realistic, measurable lifestyle changes to improve their diabetes and overall health. It has been so rewarding to see these patients reap the rewards of their hard work. Simple (although not always easy!) changes like decreasing portion sizes, increasing vegetable intake, and eating on a more consistent basis have resulted in remarkable health improvements. For example, one patient lost 26lbs and decreased his hemoglobin A1c levels from 9.5 to 5.8, a level indicating very good glucose control! The extra bonus is that these positive habits will also support additional health benefits for their heart, liver, mental health, and more!
OK, thank you for all of that. Let’s now shift to the core focus of our interview about cultivating wellness through proper nutrition and diet. To begin, can you tell our readers a bit about why you are an authority on the topic of nutrition?
I am a Registered Dietitian (RD) and Master Certified Health Education Specialist (MCHES) with 30 years of experience in a variety of health settings, to include university, clinical, community, government, faith-based, worksites and private practice. I hold a Master’s Degree in Public Health in the area of Health Promotion/ Disease Prevention from The George Washington University, and a B.S. in Food & Nutrition.
I am a lifelong student of food, nutrition, and health. The more I have learned, the more I realize how much information there really is to discover!
We all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?
There are many challenges that make it difficult for people to know what and how to make the best lifestyle changes for themselves. And while many of the changes are “simple” (such as eating more vegetables), that doesn’t mean they are “easy” (I am too busy. They spoil before I can use them. They are too expensive. My kids don’t like them. The list goes on..). I have listed a few of the barriers below.
- All or nothing approach: Many people who want to start eating healthier try to change everything at once, and that is stressful and not likely to be sustainable. Then when they “cheat”, they feel that they have “failed” and return to where they started.
- Not measuring and defining progress: If we are too vague with our goals, it is hard to celebrate and sustain progress. Set two or three small, measurable goals weekly. For example, instead of saying “I am going to eat more vegetables,” write down, “I am going to eat at least 2 vegetables per day at least 3 days this week, one at lunch and one at dinner.”
- Limiting definition of success: The American culture, even our medical system, is very focused on weight as a measure of health and “success”. The problem is that weight is not a behavior, it is an outcome, and one influenced by many factors. Instead, focus on measuring the behaviors that promote health; sometimes that will result in weight loss, but sometimes it doesn’t. That doesn’t mean that you “failed”. Include a wider range of measures of success, such as energy level, sleep quality, blood pressure or glucose level improvements.
- Not acknowledging that it is not a linear process with an endpoint: That is one of many reasons that “diets” don’t work. There is a beginning and an end. Healthy habits are part of our ongoing health journey. Our health needs and priorities change; our challenges change; science changes. This journey is not a linear journey. We make progress, and then we can slip; it is not a failure if we learn from it. Give yourself some grace in this journey. I am a big believer of progress not perfection!
From your professional perspective, do you believe that nutrition plays a pivotal role in supporting the body’s natural healing processes and overall well-being, particularly in cases of chronic diseases? We’re interested in hearing your insights on the connection between a holistic approach to diet and its benefits for individuals facing health challenges.
I absolutely believe that nutrition plays an essential role in our overall health and well-being. We truly are what we eat. What we eat impacts every function in our body. We have much more control over our health than we realize. While we may have a family history of a particular health condition, often our lifestyle choices can determine whether or not that condition is “activated”. When faced with a chronic health condition or crisis, at minimum, healthy eating will help you to be at your best while you face it, and often can actually reverse the progression of the disease.
Another important thing to keep in mind related to our food and health is beyond the food itself. For example, our health and nutrition is impacted by the soil and water in which the food was grown and the pollutants that may be in them or the nutrients that may not be in them. Fertilizers, pesticides, and chemicals are also added during the growing, harvesting, and processing of the food. Additives, such as artificial colors, flavors, and preservatives can also impact our health. Our big and small food choices impact our health in many ways.
While that can sound scary and overwhelming, it is important that some key principles will take you a long way with our health and nutrition. These things have been constant over the 30 years that I have been a Dietitian. Eat whole, minimally processed foods, such as whole grains, legumes, fruits, vegetables, lean protein sources and healthy fats. Now, the devil is in the details, and that is where getting professional support can be invaluable. Many health insurance companies now cover nutrition counseling even without a diagnosed health condition, so contact your health insurance provider to see what is covered in your plan. Even a few appointments with a Registered Dietitian can go a long way with helping you to move in the direction that is best for your health, lifestyle and values.
In fact, ModifyHealth makes it easy to connect with my team of expert dietitians who will work on a sustainable plan to help achieve your goals, while also taking the stress out of having to meal-prep or grocery shop as ready-to-eat, healthy meals catered to your exact needs will be sent to your doorstep each week.
Here is the main question of our interview. Based on your research or experience could you share with us some examples of foods or dietary patterns that have demonstrated remarkable potential in preventing, reducing, or managing specific health conditions? If you can, it would be insightful if you could provide real-life examples of their curative properties.
- The Mediterranean Diet — There is a reason that the US News (Best Diets 2023 | Weight Loss, Healthy Eating & More | US News) has chosen the Mediterranean Diet as the #1 diet for several years running. It has a strong scientific foundation supporting the prevention and management of many chronic health conditions, to include diabetes, cardiovascular disease, high blood pressure, obesity, as well as healthy aging and improved longevity. (The Mediterranean diet and health: a comprehensive overview — PubMed (nih.gov)). This diet has a plant-based focus on legumes, whole grains, fruits, vegetables, and healthy fats. At ModifyHealth, I have worked with patients with many health conditions who have incorporated the Mediterranean Diet principles into their diets with significant health improvements. These include patients with inflammatory bowel disease (Crohn’s and ulcerative colitis) who have decreased their GI symptoms and improved their quality of life, and patients with diabetes who have decreased their hemoglobin A1c levels to prediabetes levels and been able to significantly decrease or even get off medications.
- Low FODMAP Diet — Many people with Irritable Bowel Syndrome (IBS) and other GI issues have an intolerance to certain carbohydrates that can trigger their GI symptoms. These symptoms include bloating, gas, abdominal pain, and constipation and/or diarrhea, and for some people can severely limit their ability to function in their day-to-day life.
- Even though “Diet” is in the name, the Low FODMAP Diet is more of a protocol with three phases which was developed by the Monash University in Australia. In the elimination phase, foods higher in FODMAPs are removed from the diet to see if the patients GI symptoms improve; in the reintroduction phase, each FODMAP subgroup (such as lactose, fructose or sorbitol) is challenged in a structured way to identify which subgroup(s) are triggering GI symptoms and to what degree. The third phase is the personalization phase, where the results from the challenges are used to liberalize the patient’s diet as much as possible, while avoiding a recurrence of GI symptoms.
I have had patients who have been dealing with severe GI symptoms, such as urgent diarrhea 10 or more times a day, for years that limited their ability to work or go out for fear of not getting to a bathroom soon enough even while severely restricting their diets to try to find the culprits. After going through the FODMAP protocol with the help of ModifyHealth, they have been able to get back control of their health and life and return to work and socializing. It is lifechanging for them, and an incredible honor as a Dietitian to play a small role in making this possible.
4. Vegetarian Diet — There are different versions of the vegetarian diet, with vegan on one side, where all animal foods are eliminated from the diet, to a more liberal approach of the flexitarian diet where animal proteins are eaten, but infrequently. While there can be many health benefits from limiting or avoiding animal products, I have met with vegetarians that were eating a lot of processed vegetarian products, which when consumed frequently isn’t necessarily a healthier choice. For vegans, a lot more effort must be put into insuring that they are getting enough of certain nutrients, to include protein, iron, B12, and calcium.
5. The DASH (Dietary Approaches to Stop Hypertension) Diet — This diet has strong research to support its effectiveness, particularly in lowering blood pressure and LDL (bad) cholesterol. It is actually very similar to both the Mediterranean Diet and vegetarian diet principles with a focus on whole grains, fruits, vegetables, legumes, low-fat dairy, and fish, poultry and healthy oils.
Do experts generally agree that merely choosing healthy foods isn’t sufficient, but that understanding how to consume them is key to unlocking their full health benefits? (For example, skins on/off, or cooked/raw, or whole grain/refined grain) Could you provide advice on how to approach this and sidestep common errors or misconceptions?
While there are many common elements in the healthy diet options above, it is not a one-size fits all. For example, if someone with Crohn’s disease is having a flare, then they are more likely to benefit from having cooked versus raw vegetables, and they will likely tolerate applesauce better than a whole apple with the peel.
Raw produce is often considered to be healthier than frozen or cooked, but if produce is out of season in an area, the produce might be raw but not fresh. It may have been picked before it is ripe, traveled a long way, and sat in a warehouse until it is artificially ripened and sent to the store. So, the frozen broccoli in the freezer section that was steamed for dinner might be more nutrient-rich than the raw broccoli in the produce section that traveled thousands of miles to the store.
I often get the question, “Should I always buy organic produce?” While choosing to buy organic produce can significantly decrease your exposure to pesticides and other chemicals that can have negative health and environmental impacts, it is not always feasible to buy everything organic due to costs, availability, or as mentioned above, freshness. With all of these nuances, it is understandable that people get confused and overwhelmed!
That said, the Environmental Work Group puts out a guide every year of the Dirty Dozen, the produce with the highest pesticide levels. (EWG’s 2023 Shopper’s Guide to Pesticides in Produce | Summary). This year, the top three are strawberries, spinach, and kale. While we consider greens to be very healthy, if you eat these frequently, then choosing organic would decrease your exposure to harmful pesticides. On the other hand, avocados are #1 on the Clean 15 list, so you could skip buying organic if cost was of concern.
With the recent prominence of nutrition’s integration into healthcare, what’s your perspective on the collaborative approach between medical professionals, health coaches, and nutrition experts when it comes to delivering holistic patient care? Can you please explain?
I think that you would be hard pressed to find a Dietitian that would say that this is not long overdue. The U.S. “health” care system has been focused for far too long on “sick” care. We wait to provide resources and support until after the health issue is a problem, and then result to high cost interventions that may extend life but don’t always improve quality of life. Doctors can’t do it all; like most interventions, health promotion has to be a team effort. While people do and should look to their doctor for guidance on how healthy lifestyles can improve health, doctors do not have the time nor in many cases the training to provide the more intensive and specialized guidance patients need to implement these healthy habits.
It’s been suggested that using ‘food as medicine’ has the potential to reduce healthcare costs by preventing disease severity. However, there’s concern about the affordability of healthier food options. What solutions do you believe could make nutritious choices accessible to everyone, ensuring that food truly becomes a form of medicine for all?
While I can certainly understand concerns about the costs of eating healthy, in many cases we are able to redirect our food budget to healthier options. For example, meat is often one of the most expensive categories of our food budget; cutting back on portion sizes and frequency or beef, pork, lamb and poultry can free up funds for more fruits and vegetables. Cutting back on highly processed and low nutrient foods, like soda, chips, cookies, fast food, etc, can not only improve our health but also our budget.
There are also creative options at the community level that can provide healthy food options more cost effective, such as community gardens or “scratch and dent” sections in stores for produce that might not look as pretty but is still healthy.
Everyone’s body is unique, and what works for one might not work for another. How does one navigate the vast array of nutritional advice available today to curate a diet tailored to individual needs, ensuring health and longevity?
Choose your sources wisely. There are a lot of social media influencers that are providing health and nutrition information, and while they may be well-intentioned and have found something that works for them, it might not be accurate nor appropriate for you. Look for credible sources such as universities, medical systems, non-profit organizations, and government agencies. Also, listen to your body, while something may be healthy for most people, it may not be best for you . Keep in mind that science evolves and changes, so what might have been recommended previously based on our knowledge then, may no longer be best practices. Consult with a nutrition expert like a Registered Dietitian, who has had extensive education and training, with the credentials to provide the specialized guidance you need.
As our understanding of the intricate link between food and health continues to evolve, we’re curious to know which emerging trends or breakthroughs in nutritional science excite you the most. How do you envision these advancements shaping the future of healthcare?
I am very excited to see food as medicine become a movement with the clout and resources behind it, as evidenced by the White House Conference on Hunger, Nutrition, and Health. The research is there to support the return on investment of food as medicine initiatives, such as providing medically tailored meals to at risk patients. One study estimated the cost savings of providing medically tailored meals to targeted patients, the way that ModifyHealth does, could result in 1.6 million averted hospitalizations and net cost savings of $13.6 billion annually. (Association of National Expansion of Insurance Coverage of Medically Tailored Meals With Estimated Hospitalizations and Health Care Expenditures in the US | Health Policy | JAMA Network Open | JAMA Network). Our team at ModifyHealth is proud to be part of making changes like this possible.
How can we better educate the public about the medicinal properties of food, and what role do professionals like you play in this educational journey?
To change the culture of health in this country, we all need to be a part of it, not just health care providers. We need community collaborations bringing together all stakeholders to ask “what can I do”. It is more than a healthcare culture that needs to change, it is our country’s culture regarding health and nutrition that needs to change. That means places of worship, schools, workplaces, grocery stores, community organizations, gas stations, homeless shelters, restaurants, the list is endless. It is not a “they” problem, it is an “us” problem that can be solved. I am excited to be part of this evolution; I hope that you are too!
How can our readers further follow your work online?
You can read more on all these topics and follow along with my work at ModifyHealth.com.
Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success and good health!
About the Interviewer: Wanda Malhotra is a wellness entrepreneur, lifestyle journalist, and the CEO of Crunchy Mama Box, a mission-driven platform promoting conscious living. CMB empowers individuals with educational resources and vetted products to help them make informed choices. Passionate about social causes like environmental preservation and animal welfare, Wanda writes about clean beauty, wellness, nutrition, social impact and sustainability, simplifying wellness with curated resources. Join Wanda and the Crunchy Mama Box community in embracing a healthier, more sustainable lifestyle at CrunchyMamaBox.com.
