Some Type I diabetics engage in diabulimia, a dangerous practice of skipping or decreasing the prescribed insulin dose to control weight. The complications include uncontrolled blood glucose, possible eye sight, kidney, and nerve irreversible damages. Sadly, the goal for permanent weight loss is seldom achieved.
This condition cannot be taken lightly. As soon as possible, the individuals and families should find professional help from three medical disciplines: an endocrinologist, a psycho-therapist with medical understanding, and a
registered dietitian (RD) who has passion with eating disorders but most importantly is expert in diabetes.

Eating Disorders

Ms. Shih has treated over 1,000 men and women, from ages 8 to 53, who have suffered from eating disorders. Her unique counseling skills have provided guidance for these individuals, helping them develop a better understanding of their bodies, health, and nutrition. She serves as a teacher, a counselor, a motivator, a nutritionist and a mentor to those who come to her for help.

Most individuals who have complied with nutrition recommendations from Grace and have also worked closely with a team of physicians and therapists, have not only avoided serious medical complications and hospitalization, but also moved toward a satisfying relationship with food and their weight.

Recognizing the Signs of an Eating Disorder – Help Someone You Care About

Signs of an Eating Disorder 

If you suspect someone you know and care about may have an eating disorder, there are signs to look for. The following is a list of behaviors and attitudes you may observe in someone who has an unhealthy attitude towards food and body image…

• Completely cutting out fats and sweets
• Skipping meals or snacks
• Obsessed with counting calories or fat grams
• Complains of being ‘fat’
• Feeling guilty after eating
• Feeling guilty if not exercising often enough

Who Can Help:

• School counselors/teachers
• Parents
• Health Professionals
• Doctors, therapists, nutritionists

How Can a Registered Dietitian Help?

For Anorexics:

• More energy, better concentration and attention
• Improve growth
• Improved bone health
• Able to exercise
• Avoid hospitalization

For Bulimics:

• Stabilize metabolism
• Healthy weight loss

Cognitive Behavior Approach

For Bulimia:

• Prevent restricted eating
• Decrease the amount of food binged
• Disrupt the cycle of purging after binging

1. Does your child have multiple food allergies? And you are not sure if he gets all the nutrients he needs.
2. Is your child/baby on a special diet/formula and needing guidance?
3. Is your child falling behind in growth? 
4. Do you know how much to feed your baby or toddler?
5. Are you frustrated by a picky eater at home? 
6. Why doesn’t your son eat vegetables? Does he have texture or sensory issues?
7. Does your child use a feeding tube? Is your child having problems transitioning from tube feeding to eating food by mouth? 
8. Do you have one child who needs to lose weight and another who needs to gain? 

Ms. Shih helps parents feel confident about feeding their kids. She takes over the tension between parents and their children at meal time.

Grace has over 25 years of experience working with the pediatric population both in and outpatient settings at LPCH (Lucile Packard Children’s Hospital) Stanford Medical Center. She has also worked  at LPCH gastrointestinal (GI) clinic helping patients with failure to thrive, GI nutritional problems, feeding difficulties, and their special diets.

Many pediatric facilities consult Grace’s expertise in managing their patients/clients’ nutritional care and education. These facilities include Children’s hospital at Northern California, Palo Alto Medical Foundation, and pediatricians in private practice setting.

Below are some useful tips and tools for ensuring your child is getting proper nutrition.

1.Introducing Solid Foods

2. Getting Picky Eaters to Eat

3. Healthy Snack Ideas

4. Serving Kids fruits and vegetables.

Introducing Solid Foods

Many first-time parents wonder when to start feeding their baby solid foods and what to give them. Use these guidelines to gradually begin introducing your infant to solid foods. Teaching them to feed themselves table food is a process done with “baby steps” over the first year of a child’s life.

Age: 4-6 Months

• Semi-liquid at first; gradually add less liquid for a semi-solid
   consistency
• 1 or 2 teaspoons at first; gradually increase as baby gets older
• One to two times a day 

Age: 6-9 Months

• Soft foods and some finger foods that dissolve easily
• 3 to 4 tablespoons of semi-solid foods; bite-sized pieces of soft
   foods
• Two to three times a day
• Mashed bananas, Applesauce, Cottage cheese, Graham
   crackers, Mashed potatoes, Ground meat or poultry

Age: 9-12 Months

• Finger foods and most table foods
• Small, bite-sized portions
• Three times a day
• Examples: Apples, peeled and cut in eighths; Soft cheese, well-
   cooked noodles, spaghetti with meat sauce; tender meats,
   such as tuna, chicken or turkey

Getting Picky Eaters to Eat

Many parents struggle with getting their little ones to eat healthy foods. There are some tips and strategies you can use to encourage your children to eat a variety of foods and to ensure they are getting good nutrition. Remember your primary responsibility as a parent is to determine what, when, and where your child eats. Your children are responsible for how much and whether or not to eat. 

As a parent you should provide the following:

An inventory of healthy foods
Presenting meals to your child
Insisting that children show up for meals
Making mealtimes pleasant
Teaching children good table manners
Setting the timing for meals and snacks

How Do I Get My Child to Try New Foods?

Set a good example
Offer one new food at a time
Be realistic about serving sizes
Don’t worry if he won’t try it. Offer it again another time.
Make it fun by including your child in meal preparation

What Do I Do If My Child Won’t Eat at All?

Keep meal times within reasonable time-frame (20 minutes),
     then take the food away
Limit milk, juice, and other sweet drinks between meals
The next meal or snack is around the corner
He/she will make up for it at the next meal
Kids are more in tune with hunger and satiety signals than
     adults

Remember to Involve your children in grocery shopping and meal preparation – kids are more likely to eat what they have invested their time in creating!

Healthy Snack Ideas

In today’s busy world in can be tough to find snack foods that are not only = easy to prepare, but also healthy. Too often ‘convenience foods’ are highly processed and loaded with unhealthy fats, refined sugars, or too much salt. Grabbing something healthy to eat doesn’t have to mean eating prepared foods that are packaged and sold as ‘snack foods’. Try some of the ideas below and you’ll soon find that healthy snacking doesn’t require a lot of time and effort.

Dairy

Cheese sticks
Yogurt
Frozen yogurt
Milk
Pudding made with milk

Protein

Nuts
Turkey slices
Hard-boiled egg
Edamame
Cottage cheese (try it with fruit)

Fruit

Sliced apples or oranges
Raisins
Dried cranberries
Grapes
Try slicing a banana, then freeze. Tastes like ice cream!

Vegetables

Carrot, celery and zucchini sticks with yogurt dip
Cherry tomatoes
Sliced bell pepper
Marinated artichoke hearts

Grains

Whole-grain crackers
Pretzels
Popcorn
Bowl of cereal
Rice crackers, rice cakes
Cookies made with whole grains and/or real fruit

Serving Kids Fruits and Vegetables

Here are some fun and delicious ideas for serving fruits and vegetables to your child that may encourage your picky eater to eat! 

Serving Fruit to Kids

Breakfast

Serve pancakes, waffles, or French toast with fruit such as berries, sliced peaches, bananas, or applesauce

Try fresh or dried fruit with cold or hot cereals (raisins or dried cranberries in oatmeal)

Salads

Carrot and raisin salad can be made with added apples or pineapple

Fruit salads go with any meal or snack

Snacks or Anytime

Fresh or canned fruit can be blended to make refreshing smoothies and shakes

Bake muffins or breads with added fresh, frozen, or dried fruits or grated carrots for extra sweetness

Bananas, apples, carrots and celery are good with peanut or almond butter

Use a French-fry cutter for potatoes to slice an apple and make ‘apple fries’

Fruit kabobs are fun to make, but more fun to eat

Desserts

Fresh fruit pies or cobblers count, too!

Ice cream, frozen yogurt, or sherbet topped with fresh fruit is a great finish to a meal, or for a snack

Serving Vegetables to Kids

Breakfast

Add fresh spinach, onions, or bell peppers to scrambled eggs, or an omelet

Salads

Leafy green salads have infinite variety, good with almost any fruit or vegetable added, served with a light vinaigrette, or low fat ranch dressing

Cabbage and carrot slaw, or cole slaw is also good with added pineapple

Pasta salads are yummy with lightly steamed and chilled vegetables, such as broccoli, green beans, fresh pea pods, sweet red peppers, carrots, or even fresh pear or cantaloupe

Side Dishes or Main Course

Corn on the cob or “Mexican corn” made with peppers and onion is popular with kids

Spaghetti squash with a red sauce is a change of pace. Kids love how it looks like real pasta!

Grilled or roasted vegetables are special when served with polenta, pilaf, or pasta

Steamed assorted vegetables can be served plain, with a sprinkle of cheese (try Parmesan or cheddar), or a bit of soy sauce

Acorn squash or other winter squashes, are wonderful baked or microwaved and served with a little butter/margarine and brown sugar, or stuffed with rice pilaf or risotto

Slice carrots, red bell peppers and zucchini and sauté in olive oil and fresh garlic, or cook in foil on the grill – the color combination has visual appeal

Brush fresh asparagus spears, or corn on the cob with olive oil and cook right on the grill

Potato pancakes with grated carrots added are good served with warm applesauce

Try pizza with green or red peppers, onions, mushrooms, pineapple, and tomatoes, or a white pizza with lightly cooked broccoli

Fried rice or noodles are a great vehicle for a wide variety of vegetables such as carrots, onion, broccoli, peppers, green beans and peas (snow peas or sugar snap peas)

Fajitas can be made with grilled vegetables in addition to meat of your choice and served with fresh tomatoes, avocado and leafy lettuce

Many wonderful soups can be made with vegetables from the traditional to root-vegetable soups. Gazpacho, a cold tomato and vegetable soup, or creamy soups made with tomato or winter squash

Vegetable chili made with beans, carrots, onions, peppers and tomatoes is great with a corn muffin and a sprinkle of cheese

Vegetable lasagna with a tomato sauce, or a white cream sauce with such vegetables as tomato, broccoli, zucchini, spinach, mushrooms and onion can’t be beat

Pesto made from fresh basil or parsley can be eaten with pasta, on pizza, or as a spread on a sandwich

Ratatouille, a dish made with eggplant, zucchini, tomatoes, onion, and peppers can be seasoned with Italian herbs and served with Parmesan cheese, or try it flavored with a little cinnamon and dill and served with feta cheese for a delicious variation

Snacks or Anytime

Ripe, round sweet cherry tomatoes make a great, bite-sized snack

Pickled beets offer a tangy complement to many meals as a side dish

Baby carrots, celery sticks, cucumber spears, and red bell pepper rings make a crunchy complement to a meal or snack. Try with a low fat ranch dressing

Sautéed vegetables with or without your favorite meat can be wrapped inside a tortilla to make a “wrap”. Try cheeses, herbs and spices for different taste combinations

Add your own ideas to this list and keep it handy for some quick ideas! 

Adult type 2 diabetesA can be managed by nutrition and healthy life style.
Without the knowledge of nutritional management for diabetes one may worsen the condition even with the right intension. 

* Should I avoid all sweets?
* How much carbohydrates can I eat?
* What are the good snacks for me?
* What can I drink and how much?
*  How big of the portions are too big?
*  What is the good weight for me to maintain?

Nutrition till age 100 yr

* Do Keep Up with Daily Activities?
* Do I protect my bone with calcium intake?
* Do I take enough fluid?
* Do I eat good amount of protein?
* Do I need vitamin supplements?
* Do I keep blood glucose, blood pressure and
    cholesterol under controlled?

Ms Shih would guide you through your nutritional challenges at any stage of your life.  

Guidelines for Good Nutrition

Worried parents often wonder if their infants and toddlers are getting enough nutrition from the food they eat. Sometimes, they seem to eat so little food, or want to eat only foods that don’t offer much nutritional value (like, cheese puffs, or fruit candy). The US Government has developed nutritional guidelines based on scientific testing that will promote good health and prevent chronic disease. For more information about the guidelines, see their website here;

www.healthierus.gov/dietaryguidelines 

Here are the basic dietary requirements to remember when feeding your children… 

Protein – 2X day
Important for building body tissues and brain cells!

Meats, poultry (chicken, turkey), seafood (tuna, salmon,
     shrimp)

Eggs (try hard-boiled for a handy snack)

Nuts (peanuts and peanut butter are kids’ favorite), lentils,
     tofu, edamame

Beans (pinto, red, black, kidney, lima, garbanzo, black-eyed
     peas)

Dairy – 3X day
Important source of calcium for building bones.

Milk, yogurt

Cheese (cottage cheese, hard cheese, goat cheese)

Grains – 6-11X day
Important source of B vitamins and enzymes.

Cereals (oats, wheat, rice, barley, millet, corn)

Pasta, rice, bread, crackers

Vegetables – 3-5X day
Important sources of Vitamin A, C, K, and dietary fiber.

Leafy greens (spinach, romaine, kale, collard greens, Belgian
     endive)

Sweet potatoes, squash, pumpkin, beets, carrots, turnips

Corn, green beans, snow peas, sugar snap peas

Bell peppers, artichokes, asparagus

Tomatoes 

Red and green cabbage, broccoli, cauliflower (cole slaw
     counts as vegetables!)

Fruits – 2-4X/day
Important source of Vitamin A, C, fiber, antioxidants.

Cantaloupe, honeydew melon, casaba melon, watermelon

Strawberries, blueberries, blackberries, raspberries, cranberries
     (try dried ‘red raisins’)

Bananas, plantains, breadfruit

Oranges, tangerines, grapefruit, pineapple

Grapes and raisins

Plums, apricots, peaches, nectarines

Apples, pears

If you are overweight you’re probably tired of the constant struggle with food. If your child is overweight you are probably ambivalent about what food to serve, sweet? no sweet? Take heart. Expert help is available to get you past the obstacles to your good health. Grace Shih helps clients from childhood obesity to, teens and adulthood with creating a healthy life style and making sound food choices. Grace focuses on learning intuitive eating and promoting a positive self-image. She often takes away tension between parents and their children. She serves as a behaviorist, a nutritionist, a counselor and a teacher.

• Tools and Tips for those Struggling with Obesity
• Why Diets Fail
• 5 Easy Steps for Making Changes Now
• Shopping List for A Healthy Family
• Quick and Healthy Dinner Ideas
• Common Portions

BARIATRIC SURGERY

Ms. Grace Shih works with Bay Area renowned bariatric surgeons. She conducts pre-surgery nutritional evaluation; and helps clients with post-surgery nutritional care to prevent any nutrient deficiency due to limited intake or mal-absorption.

Why Do Diets Fail? (children and adults)

• When starting a diet, many dieters set unreasonably high expectations
• Diets focus on restricting certain types of foods and are often so low calorie that hunger is a major obstacle
• Foods that are on the ‘bad’ or ‘forbidden’ lists become more desirable and difficult to avoid
• Psycho-social and emotional issues that led to overeating in the first place are not resolved by dieting

With childhood obesity, the American Dietary Association has found evidence of the following contributors to obesity in children or teens

• Skipping breakfast
• Eating out often
• Increased portion sizes in restaurants and food packaging
• Parental restriction of highly palatable foods (e.g. candy, cookies)

Five Easy Steps for Making Changes Now

Work on lifestyle changes one step at a time…

Step 1
Identify the problem area and choose one habit to change

Keep healthy snacks in a back pack
Redefine meal times
Do your grocery shopping once a week

Step 2
Minimize restricted eating behavior
Have at least 1-2 food items for breakfast
Pack a food bag
Take few minutes to plan ahead before you sit down to eat

Step 3
Practice proper portion sizes – avoid ‘Portion Distortion’
Read nutrition labels
use appropriate cup and plate sizes for serving food
Work on preparing and serving a meal using correct portions, see what it looks like on the plate!

Step 4
Metabolic fitness – rev up your body’s engine!
Exercise for health for 30 to 60 minutes daily

Step 5
Listen to your body – read your body signals
Ask yourself, “Am I really hungry?”
Do I need to eat this, or can I substitute something healthier?
Is this a good portion size, or can I cut it back some?
Am I still hungry after eating?

Shopping list for a busy family

Unavailability of healthy foods in the house is one of the reasons contributing to over eating. The family eats out more; and individuals snack or graze on high calorie foods.  

Protein:

Meat patties
Frozen salmon
Frozen grilled cooked chicken
Tofu, veggi-burger patties (if vegetarians)
Eggs
Assorted canned beans
Non-fat refried beans
A jar of peanut butter
Nuts

Grains:

Assorted dry pasta, a jar of spaghetti sauce
A pkg of rice
A box of cereal
A container of oatmeal
Few rolls of ready to bake croissants
Frozen bread products
Instant potato, instant rice
Frozen cheese ravioli

Dairy:

Cheese sticks
Non fat assorted cheeses as desire
A container of parmesan cheese
A box of dry milk

Fruits:

Oranges
Whole melons
Frozen strawberries
Canned pineapple or fruit cocktail, non-syrup

Vegetables:

Frozen vegetables
Baby carrots
A bag of fresh cut broccoli (if available)
A bag of salad mix (if available)

Snacks:

Pkgs of non-sweetened jello
Molds to make popsicles
Wheat crackers
Pkgs of non-buttered popcorn
A jar of strawberries preserve
Mini-bagels
Assorted dry fruit

Weekly or quick stop shopping items:

Protein:

Lunch meat
Fresh seafood (such as cooked shrimp)
Fresh meats ( such as boneless & skinless chicken)

Grains:

A loaf of bread
Baquette
Tortillas

Dairy:

Milk
Yogurt
Cottage cheese

Fruits/Vegetables:

Fresh fruits
Fresh vegetables

Snacks:

Frozen yogurt
popcorn

Healthy and Quick dinner ideas:

Cook a pot of rice or pasta ahead of time (once a week, maybe on Sunday afternoons)

Defrost meats or salmon in the refrigerator the night before

Gather salad and/or put frozen vegetables in micro-wave at the dinner table

Have milk and drink ready

Grace’s 15 minute protein Entrée

1. Cook meat patties (or stir cooked shrimp) with spaghetti sauce together in a pan, may put chopped fresh tomato or/and chopped fresh mushroom if desire. When done, pull over pasta and top with parmesan cheese.

2. Sprinkle pepper and a little bit salt on both sides of salmon, pan fry 4 minutes on each side; serve with rice. 

3. Put cooked grilled chicken in a pot; add BBQ or teriyaki sauce (approximately ½-1 Tbsp/piece of chicken depending on your taste). Use a separate bowl:  ¼ -1/3 cup water with 1 Tbsp of cornstarch, mix it well; then pull into the pot. Put it on high heat for few minutes until the chicken is warm and the sauce is thickened; serve it with rice.

4. A lazy day: Cooked meat patties and serve with hamburger buns;

                         Or warm up grilled chicken and serve with bread.

5. A hot summer day: serve cold grilled chicken or cold cooked shrimp with salad.

Common Portions for Each Food Group

Dairy:  One Serving=

             8 oz milk,  6 oz yogurt,  4 oz Cottage Cheese  

Protein:  One Serving=

                Palm size of meats and hand size fish;  2 oz cheese;  one egg;
                ½ cup of lentils/beans + ½ cup rice; 2 Tbsp Peanut butter

Grains: One Serving=

               ½ cup cooked pasta or rice; 1 slice bread; one tortilla, 6 crackers; ½ cup cereals; ½ cup of
              mashed potato;   ½ baked potato,  ½ cup corn or peas;  one dinner roll

Fruits: One Serving=

              ½ cup juice;   ½ cup melons or berries;   one piece of any fruit,  except  ½ banana

Vegetables: One Serving=

             ½ cup cooked vegetables

Fats:  1 Tbsp butter or oil; a handful of nuts, 1 Tbsp Peanut butter;  1 Tbsp salad dressings,  1/8 avocado

Free Food or Sweets:  One Serving=

             ½ cup ice cream; 1 cookie; 1 small slice of cake or pie