For Food to Be Medicine

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A long, long time ago, presumably in Greek, Hippocrates famously said: “let food by thy medicine, and medicine be thy food.” About a week ago, Anahad O’Connor said: nah, not gonna’ happen.

OK, that’s a bit harsh and warrants some elaboration. Mr. O’Connor writes on nutrition for the New York Times. In this particular instance, he was addressing recent studies highlighting the profound liabilities of “ultraprocessed” foods, and the obvious remedy embraced by the nutrition community: people should avoid such foods, and eat minimally processed foods instead. That, in turn, invites home preparation of meals, a tactic also widely invoked by health experts. 

Citing a recent book on the topic, O’Connor’s article goes on to explain why home cooking is an unlikely solution among low income families because the same socioeconomic challenges that make “junk” food appealing in the first place make it especially difficult to “unjunk yourself,” and your family. The list of barriers is mostly self-evident: neighborhoods that qualify as food deserts/swamps; financial challenges; lack of time; and lack of basic kitchen equipment.

But what if, for instance, we could provide healthy, convenient, economical, family-friendly recipes on-line? We can, and do. That one is easy. What if, for instance, we could provide on-line cooking instruction at any given level of detail? That, too, of course, we can, and do.

What if, for those who haven’t the time or inclination to learn cooking, we instead relied on technology? What if we could make available “smart ovens” that cook everything on a single tray, at the push of a button, and while we’re at it- in half the time of conventional ovens? And what if we could populate smart phones with an inventory of healthful recipes that could be uploaded directly to that oven, so the button push corresponded exactly to a given meal- selected in advance for its particular, medicinal benefit? Yes, that, too- we can, and do- in this case, courtesy of a company called Brava.

We could potentially curate the ingredients for those very meals, and offer them already assembled, either in a supermarket, or via home delivery. And for those who have trouble eating well not just because good food is elusive, but for other reasons- from stress to insulin resistance, anxiety to insomnia, basal metabolism to body image- we might need artful, compassionate, state-of-the-art, artificially (and naturally) intelligent health coaching available 24/7. And yes, we have that, too.

The big question: How, on earth, do those most in need pay for all of this? The answer, of course, is they don’t- at least not directly. Hippocrates’ ancient proposition contains a hidden provocation to a modern world awash in diet-related chronic disease: food is not the only medicine, and all medicine costs you something. If you don’t spend on food as such, you will be spending more on the alternatives. Food comes in daily ounces of prevention (although it can do much more, too); Pharma dishes out the far costlier pounds of cure.

I am not suggesting that health insurers become everybody’s free lunch. I am saying that we can, and should, conduct studies to determine when, and for whom, whatever it takes to make food be thy medicine, makes it cost-effective medicine into the bargain. For food to be medicine for those most in need, we have the means, and know the promising ways. 

Fighting for the Common Ground of Better Diet

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Last week, the world recognized the 75th anniversary of the D-Day invasion that marked the slow but triumphant end to World War II. Looking back, we see the colossal effort required to hoist a communal flag, and establish common ground. There were flaws in that new order, of course- humans are never perfect. But perfect is the enemy of good, and along with other enemies, the Greatest Generation overcame that one, too- paving the way for much good, from NATO, to the United Nations, to the European Union.    

Common ground is hard ground, but it is fertile ground- and this is likely true in all domains. Certainly it is true of diet, where battles born of personal preference, ideology over epidemiology, and overheated dogma roil routinely. This is my world, and as in other battles, lives are at stake. Meaning not the least disrespect to the honored memory of military heroism and loss, diet—as the single leading cause of death in the modern world—imperils many, many more of us with injury and early death than even so great a war.

Many factors challenge efforts to establish the common ground of better diet. We may think of it as a Promised Land of sorts, known, and not all that far away, yet seemingly elusive just the same.

There is profit in dietary dissent, and pseudoconfusion, for many industries- from Big Food, to Big Pharma, to media, to publishing. There is cover in denial, the latitude needed to manufacture willfully addictive junk foods without evoking the collective outrage of loving parents and grandparents. 

There are the insidious, perverse incentives for experts to throw one another under the bus. But lives are at stake. Diet truly is the leading cause of premature death in the modern world. Unsustainable dietary practices, and forays into misguided fads, are a threat to almost all that matters to the human community- our land, our air, our water, our climate; social order itself; the beauty of our common planet, and the treasure of biodiversity.

Perhaps diet requires its particular version of D-Day. Perhaps it is time for the righteous to charge the beach, and secure a place of common understanding.

Imagine a world where we did not waste time debating what we already know to be true about diet and health, but all worked to turn common knowledge into the power of routine action. Imagine the years we could add to lives; the life we could add to years; the defense we could lend to our imperiled planet.

There is overwhelming, global consensus among experts about the fundamental truths of diet for the health of people and planet alike; a consensus born of science, and the sense required to interpret and apply it. The True Health Initiative exists to make that reality common knowledge.

What follows is common understanding, then common cause, on common ground; a strength derived only from unity; the chance to translate knowledge shared into the power of collective action.

These remain, as they have long been- things worth fighting for.

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Diet is a Vital Sign

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Click here for Dr. Katz’s complete, original article.

Vital signs, measurements of essential body functions to indicate health and physical condition, include body temperature, blood pressure, heart rate, and respiratory rate. While it’s true that these measures are vital to health, they are bounded by something else that is only implied: time. They are not just time-honored, they are time limited. In other words, this short list was assembled because they indicate threats (or safeguards) to health over a span of seconds, minutes, hours, and days. These are the vital signs that are vital to health in the emergency room.

But such vital interest in health frequently runs to other time horizons. If vital signs indicate how health is now/soon, then both “health” and “soon” warrant operational definitions. If the conventional “vital signs” are fine, but fatty plaques are accumulating in the coronary arteries, “health” is not truly intact. Indeed, this process increases likelihood of heart attack in a timeframe that would constitute “soon,” indeed all too soon.

So while the conventional vital signs are vital, their assembly is arguably narrow and primitive. It overlooks major threats to health and overt disruptions to “essential body functions,” from corrosion of the coronaries to grave hormonal imbalances, from aberrant immune system responses to decimation of the microbiome. The list represents a Paleolithic perception of time.

Our perception of survival and time is rooted in evolution. Each of us has, at some point, felt that animating, irritating tingle as our adrenal glands reacted to some startle or threat, real or imagined. The instant physiologic response we experienced was bounded only by the speed of glandular release and neuronal reaction. Within mere seconds, we were already in the dwindling aftermath.

When flight or fight were the literal options, the vital was immediate and fleeting.  We remain hard-wired to think this way.

But we can no longer limit vital sign significance to primitive survival. In modern times, thinking of health bounded by seconds, minutes and days is yesterday’s antiquated reality. Health is now something we perceive across a span of years and decades. This is the essential truth not only of the fields of  Preventive Medicine and Lifestyle Medicine, but of life outside of medicine, where most of us consider it vitally important to live to see our children and ideally our grandchildren grow up, with sufficient vitality to enjoy it.

Accordingly: diet is a vital sign.  Diet is the vital fuel that runs every “essential function” of the human body. Diet is the construction material for the growing bodies of those children and grandchildren we yearn to see grow up. The objectively measured quality of diet is robustly correlated with all-cause mortality and total chronic disease risk, and thus- is a key indicator of “health and physical condition” by any sensible interpretation. Diet is the single most potent predictor of longevity and vitality, morbidity and mortality in the modern world. 

We manage what we measure, and must measure what matters.  Diet has not taken its rightful place on that list despite its established importance - for want of a 21st century measurement tool. Such a tool now exists; I know, because I invented it.

Diet is a vital sign- and like all the others, warrants measurement as a standard of practice, and routine management.  With new tools, we have new opportunities to do just that.

Ultraprocessed Food Makes Us Fat- Who Knew?

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Ultraprocessed foods make us overeat, and get fat.  Who knew?

Click here for Dr. Katz’s complete, original article.

Last week, a groundbreaking study was published by Dr. Kevin Hall and colleagues at the NIH. It is the first ever randomized controlled trial that specifically isolated the effects of eating mainly “ultraprocessed” foods on calorie intake, weight, and other measures. Ultraprocessed foods are basically junk foods — with industrially processed ingredients, chemical components, and/or significantly manipulated in a lab or factory (see examples below).

Ten men and ten women with stable, normal weighs were admitted to metabolic ward of a controlled medical facility for a month so that everything eaten and burned was closely monitored. Each participant was assigned to consume either an ultraprocessed diet or a minimally processed diet, and was instructed to eat as much or as little as they wished. Then after two weeks they swapped diets. Such a trial is called a “crossover,” and by allowing each study participant to serve directly as her/his own control, adds greatly to the minimization of potential noise in the data.

The resulting signal was perfectly clear.  The ultraprocessed foods led directly to overconsumption of roughly 500 calories daily, with a weight gain of about 2 pounds per person over the two weeks. Surveys showed that both diets were equally satisfying and enjoyable. Remember, the participants got to eat as much or as little as they wanted, showing that weight management is not only about quantity, but about a focus on food quality.

The two diets were matched for many key elements of nutrition, including calories, macronutrients (fat, carbohydrate, and protein), sugar, sodium, and fiber.  (In the real world, however, such nutrients are widely divergent between minimally processed and ultraprocessed foods. In particular, high concentrations of added sugar and salt and low fiber content are characteristic of “junk food,” and almost certainly contribute to the effects of such foods on total intake.  As the investigators themselves noted: “Had the experimental diets used in our study allowed for greater differences in sugar, fat, and sodium content more typical of differences between ultraprocessed versus unprocessed diets, we may have observed larger differences in energy intake.”)

So, the real-world effects of ultraprocessed junk foods on overconsumption are almost certainly greater than this study demonstrates.  Be that as it may, we now have proof that ultraprocessed food leads directly to overeating and weight gain.  That is an important milestone, and one that rightly resulted in widespread media attention to the study.

With the proof of such effects now revealed to us all, there is one vital question the randomized trial cannot answer: what are we going to do about it?

Example: Lunch Day 5:

Minimally processed menu:

Grilled beef tender roast

Barley with olive oil and garlic

Steamed broccoli

Side salad (green leaf lettuce, tomatoes, cucumber and baby carrots)

Olive oil and vinegar

Salt and Pepper

Apple slices

Ultraprocessed menu:

Spam sandwich with American cheese on white bread

Potato chips

6 Ways A Diet Coach Guarantees Results

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As a health pro in the know, you have been asked countless times, “What’s the best diet for losing weight?” While any one of many health-supporting diets is potentially a right answer to this question, the best answer is, of course: “The one that works for you and your goals.”

But: “Ok, then how do I figure out which diet will work for me?” The key response: Work with a qualified professional to help motivate, support, and guide you to achieve your own personal weight loss goals.

Coaches and dietitians constantly sell the notion that losing weight is about much more than knowing how many calories you need, which foods to avoid, or how much cardio you should do. It’s about thinking in new ways. It’s about facing and conquering barriers head-on. It’s about learning from mistakes and getting back on your feet. It’s about creating healthy lifelong habits around eating and exercise -- forever. All that is really difficult to do alone.

Clients need to understand that in order to truly change your life, you need to identify and overcome obstacles, to constantly set and work towards new goals, and to implement a practical and effective system for success.

Behavior change experts advocate for health coaching, as there is solid evidence behind this recommendation. In a weight loss trial published recently in the UK, researchers compared two groups of young adult dieters: those receiving counseling plus health coaching and a smartphone app, and those receiving just counseling. The first group lost significantly more weight than the second, citing benefits from use of a health coach for optimal results.

Another study published in the journal Obesity in 2013 compared three types of weight loss coaching – professional, peer, and mentor – on weight loss outcomes of 44 obese individuals. All three approaches resulted in weight loss, but the folks working with the professional coaches lost the most weight of the three groups.

A qualified professional with experience and expertise in nutrition, weight management, fitness, and wellness is necessary to design the perfect diet and exercise program for each client. This includes not only diet assessment, meal planning, and tips, but ongoing communication, motivation, and support every step of the way. This involves helping clients set reasonable goals, providing the tools needed to succeed, answering questions, and helping them adjust to their new healthy lifestyle.

Using time-saving, state of the art tools to help assess your clients’ diets, set goals, and navigate toward behavior change is one way to really set you apart from your competition. That’s what Diet ID allows you to do with your clients in a matter of minutes. If you would like to learn more about Diet ID and how it can help pros like you be more impactful, set up a demo with one of our sales experts.

Here’s a little sales toolkit for you awesome coaches, nutritionists, and dietitians to use with your weight management clients.

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I teach you what, why, when, and how.

Anyone can learn how to lose weight from any one of a zillion books, web sites, and well-meaning family and friends. But an expert takes the time to understand your unique goals and needs, and teaches you not only what to do step by step, but why, when, and how to do it. Only then will your new behaviors become meaningful and effective over the long term.

I monitor your progress and modify your program as needed.

An effective lifestyle plan can’t be static. It must be adaptable and adjustable to your ever-changing needs and goals. A pro will make sure that you stay on track and remain challenged, and will respond when there’s a need to tweak your program.

I respond to issues as they arise.

Ongoing communication is paramount to your success. Coaches listen, understand, and respond to your questions and concerns as they come up. This keeps you on track.

I support you.

Changing habits is hard. Some days are tougher than others, and sometimes you may feel like giving up. A good coach will know how to get you back into a positive mindset and effectively guide you back on your path. I am on this journey with you.

I hold you accountable.

You are ultimately responsible for your own successes and failures, but a coach has a responsibility to ensure that you experience ongoing progress. If you backslide or become frustrated, your coach will make sure to identify the root of the problem, address it with you, and help you readjust your goals and expectations.

I am your confidante.

Weight loss and gain, food issues, and body image are very emotional in nature. But these issues are an integral part of your journey. A health coach is non-judgmental and objective, helping to build a trust that enhances your relationship and, ultimately, leads you to victory.

Why Do Your Clients REALLY Eat?

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If you’re a health coach or nutrition practitioner, you know how important it is to help your clients and patients understand not only WHAT to eat, but WHY they eat. To change behavior, we need to understand the motivations behind food choice; in an ideal world, we would eat because we need food. We are hungry, we need nutrition. But in the real world, tasty temptations are everywhere and healthy meals are often few and far between.

Here’s why people really eat… let’s help our clients recognize and change these habits. Eating mindfully and for the right reasons play a huge role in weight management and optimal health.

To get rid of it.

You know what I’m talking about. The 3 French fries the kids didn’t finish. The last gulp of OJ in the carton. The meh dessert at a restaurant. Stuff we wouldn’t eat or drink if it wasn’t screaming, “Finish me up!”

It’s hard to resist the temptation to “not waste” food, make room in the fridge, make it disappear, or risk offending someone because you left one cookie in the huge package. We need to honor our body’s needs, not make excuses. One message that has helped my clients: If food is not salvageable for later, don’t eat it as the alternative. Throw it away. Whether food you don’t need ends up in your stomach or in the garbage, it’s wasted food. Why waste it inside a body that doesn’t need it? Optimal health and successful weight management are worth more than that. If food gets wasted, we need to forgive ourselves and plan better for the future.

 

Because “My body needs it”

Do your clients eat ice cream because “my body needs calcium”? A burger because “I need extra protein”? Remind them that nutrients are found in hundreds of different foods. If we truly craved what our bodies actually need for real, we’d all be tearing through a bunch of kale for the calcium, and if protein were an issue, our mouths would water just thinking about lentils. Chocolate is a super good source of magnesium, but we don’t fool ourselves into thinking that M&M cravings are due to a magnesium deficiency.

 

Because it’s a “special occasion.”

Back in the old days, special eating occasions were, well, special. Nowadays everything seems to be a reason to eat. An office birthday, a baby shower, anniversary, a good report card, a promotion, a new iPhone, happy hour, or just because it’s Tuesday. Celebrations are about the people and the event, not the food. Unless the food is truly special (like Grandma’s once a year lasagna or the winning apple pie at the state fair), remind your clients: pass up the junk. Think about those “I-can-get-this-food-anywhere/anytime” foods, like packaged snacks and fast food--they’re just not worth the damage.

 

Because it’s there.

Don’t underestimate the power of the Seefood diet – see food and eat it. The opposite holds true as well: out of sight, out of mind. I’m talking about the dish of chocolate candies your clients walk by every time they visit the office restroom. The cookie jar on the counter by the sink while they’re doing dishes. The bag of chips they keep on the kitchen counter (because…. the bag doesn’t fit in the cupboard!). The out of sight/out of mind technique is simple yet powerful.

Recent behavioral studies show that people are more likely to take candy they pass by when it’s in a clear rather than opaque candy jar. Classic studies from the 1960s comparing the gobble rate of sandwiches wrapped in clear plastic versus foil reveal that people invariably eat more sandwiches that they are able to see.

The mere sight of foods gets us thinking about it, both consciously and subconsciously. Thinking about it is the first step towards eating it, whether we’re hungry or not. The solution is simple: help your clients learn to hide foods they don’t want to eat, and how to make it more convenient to munch on healthy stuff. For example, suggest that they get the junk out of sight and decorate their environment with a bowl of fruit or a plate of raw vegetable strips or a whole grain and fruit bar. These are the weapons against the more malicious mindless munching.

 

Because they’re stressed. Or sad. Or bored. Or tired.

No doubt about it, most of us eat for emotional reasons at some time or another. Whether it’s grazing on chips to procrastinate a dreaded project, head-first diving into that pint of ice cream late at night, or tearily popping Jelly Bellies by the handful after a breakup, deep down we all know that this habit of emotional eating piles on the pounds. And it’s no mystery why we do it, even though we know it’s not a good idea: Food is comfort. Food is associated with good feelings. Food is nurturing. But to combat emotional eating issues, we really do need to help our clients examine their relationship with food and have them ask themselves why they’re eating. It’s important to separate hunger from cravings, needs from urges. How can we help hem do that? Help them through these steps:

  • One, figure out if you’re hungry or not. You know what true hunger feels like: low blood sugar, growling tummy, and it’s been a while since your last meal. Chances are, you can comfortably go another hour or two before sitting down to your next meal or snack.

  • Second, identify exactly why you are considering eating even though you’re not hungry. Once you identify the emotion and its cause, think of ways you can solve the issue or get through it. Get help from a friend, attack the problem head-on, come up with a series of action steps or coping mechanisms that address the root cause.

  • Next, try the 5-D approach: Delay, Determine, Distract, Distance, Decide. The 5 D’s force us to really think about our actions beforehand, preventing unwanted binge eating.

  • Finally, forgive yourself if you overdo once in a while. We are all human after all, and we are always striving to learn from our mistakes and improve. Start over and be better each time!

Diet ID Brings Personalized Wellness Tool to the Meal Kit Delivery Industry through Partnership with Sun Basket

We are happy to have formalized our announcement of our partnership with Sun Basket! Here is the press release.

Diet ID, the world’s only image-based dietary assessment and tracking tool, has joined forces with Sun Basket, to help thousands of customers get healthier with clean, whole-foods based meals curated specifically for their personal health goals and preferences.

Sun Basket customers already enjoy high-quality, health supporting meals tailored to their dietary and lifestyle preferences. The added benefit of Diet ID lies in a unique, personalized wellness experience designed to help users discover how to use diet to achieve their personal health goals. Customers who use the Diet ID tool receive personalized meal recommendations based on their ideal diet and health goals, and ongoing behavior change tips for a healthier lifestyle overall.

Sun Basket CEO and co-founder Adam Zbar says, “Sun Basket’s focus is on bringing together the power of nutrition and lifestyle to help people live healthier lives through food as medicine. I started Sun Basket to make healthy, delicious eating easy and I’m thrilled we are partnering with Diet ID to help bring personalized nutrition and lifestyle recommendations to more and more people every day. Importantly, Diet ID will help our customers reach their personal healthy eating goals in an easy, fun way.” Dr. David Katz, a nationally recognized nutrition leader who founded the Yale-Griffin Prevention Research Center and Diet ID’s founder and CEO, agrees. “Diet ID is a fast, user-friendly tool that will support Sun Basket customers in a meaningful and personal way. The combination of Diet ID and Sun Basket represents a powerful synergy in the service of better eating, and we are both honored and delighted to join forces.”

A select group of Sun Basket customers have been invited to use the complimentary Diet ID tool during this pilot phase. The partnership underscores Sun Basket’s commitment to helping people achieve health through food as part of its “Spring Into Healthy” Challenge. The results of this initiative will be used to strategize new, innovative ways to make healthy eating exciting, delicious, and personalized.

For interviews please contact Alison Hankins at 303.709.5246 or ahankins@dietid.com.

www.sunbasket.com

www.dietid.com

Could your diet be too low in protein?

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Very, very unlikely.

If you’re getting enough energy (calories) from a variety of foods, your protein needs are already taken care of. Any nutritional imbalances are more likely about a shortage of phytonutrients (the protective components in vegetables, fruits, whole grains, beans, and nuts) and excessive refined carbs and processed fats.

The leading causes of death and disease are not about protein undernourishment. Healthy, active people need about 0.4 grams of protein per pound of body weight daily. For a 150-pound person, that’s about 60 grams per day, but the average American adult gets over 100 grams per day.

That said, we all still need good quality protein, of course — proteins from food build our body tissues, boost energy, curb appetite, and burn fat. Everyone knows that meat (including poultry, fish, etc.) is a source of protein. But it has no protective fiber or antioxidants, is not the most environmentally responsible choice, and has a short shelf life both before and after cooking. Plus it can quickly get boring – how much chicken can a person eat?   

Of course, we don’t require meat for protein or anything else, as billions of vegetarians around the world have proven. So think outside the box and get your protein from the healthiest sources in the world.

 (For comparison, a 3-oz chicken breast [measured raw] contains around 19 grams of protein.)

 Tofu, firm (1/2 cup): 20 grams of protein

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Tofu on its own is bland, but it picks up the flavors of whatever you cook it with, and is available in a slew of textures. Sauté it, stir fry it, scramble it like eggs, substitute in recipes that call for meat. You can even blend it up into smoothies, puddings, and pie fillings.

 

Lentils, boiled (1 cup): 18 grams of protein

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Lentils are chewy and nutty tasting, but with a more mild flavor than beans. Make a big batch of lentil soup to freeze and eat whenever you need a light but satisfying, healthy, fiber-packed meal. Red lentils are mildly pleasant and cook up super-fast.

 

Tempeh (1/2 cup): 16 grams of protein

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Tempeh, a fermented soybean product, is packed full of protein but it's an acquired taste. Chewy and mild-tasting, it’s really good as a burger or fried up and tossed with onions, peppers, and your favorite BBQ sauce or sriracha.

 

Black beans, boiled (1 cup): 15 grams of protein

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Pour beans on salads, into soups and chilis, in burritos, over rice with salsa, or mash them with a little oil and spices for a healthy bean dip.

 

Chickpeas, boiled (1 cup): 15 grams of protein

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Add them anywhere you'd add beans, or roast them on a baking sheet for 3 hours at 300 degrees for a crunchy snack. Of course, in a blender with some sesame tahini, lemon, and garlic, you’ve got amazing hummus.

 

Quinoa, cooked (1 cup): 11 grams of protein

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Pronounced KEEN-wa, quinoa is a quick cooking, gluten-free, mild-tasting whole grain that doubles as a protein. You can enjoy it warm, but cold quinoa salads are delicious and extremely filling. Try them with finely chopped veggies and lots of fresh lemon juice.

 

Peanut butter (2 tablespoons): 8 grams of protein

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Heavy on fat and calories as well as protein, nut butters are perfect in a pinch, just watch those serving sizes!

 

Spinach, boiled (1 cup): 5.5 g of protein

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One serving of spinach only has 35 calories so you can add handfuls to all your meals and watch your protein grams add up. In fact, greens in general have about as much protein as meat, calorie for calorie. Throw in smoothies, in sautes, salads, on sammies- keep a big bag on hand and add it into every meal. Greens are so good for you.

 

Hemp Seeds (1 ounce): 6 grams of protein

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These little golden nuggets are loaded with protein along with omega-3 fatty acids. They can be added to almost any meal with ease, just sprinkle it over cereals, salads, and grain dishes.

Green Peas (1 cup): 8 grams of protein

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A serving of green peas contains as much protein as single serving of peanut butter without all the fat and calories. It also has nearly 100% of your daily vitamin C and tons of fiber. Eat them as a side, in salads, or mashed up as a way to extend your favorite guacamole, with fewer calories and more fiber!

Pumpkin Seeds (1 ounce): 9 grams of protein

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Skip the pumpkin lattes and go for the seeds. Roast them yourself or find them premade at the store. Packed with trace minerals and fiber, they are a great grab and go snack, or add them to salads or your morning oats.