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Matthew Harmon,  USJ Dietetic Intern, ’17

About a month ago, a supplement rep came to my school to talk about the company’s catalog of products, and given my long history of working with supplements, I was very excited about the lecture. The rep explained to the class about all of their various wonderful products, such as nutrition formulas for pediatrics that contain real food ingredients, specialized tube feeding formulas and many others. As the rep was explaining about this next supplement, my ears immediately perked up because this product continues to use L-arginine as an active ingredient in their wound healing supplement. Most researchers in the sports nutrition world have already taken their attention off of L-arginine and redirected their work onto L-citrulline. Athletes, both the runner and the weight lifter, now recognize its benefits in decreasing fatigue and enhance endurance. So, it begs the following question: If sports nutrition supplement companies are making the switch, is it warranted for medical nutrition supplement companies to follow?

L-Arginine and Wound Healing

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Here is a quick overview of L-arginine: It is a conditional amino acid, manufactured endogenously in the body, and it can be consumed from various foods, turkey has the highest amount. The main benefits include the stimulation and release of growth hormones and insulin. But it really made its mark in the health world for its nitric oxide (NO) producing ability. Studies have demonstrated that NO is a key player in many biological processes, such as vasodilation, brain health and the immune system.

NO is a vasodilator. Vasodilation is a critical step in the recovery/wound healing process. NO participates in antimicrobial activities and allows for more blood flow into tissues and organs, which allows the inflamed/injured site to receive an increasing demand of nutrients and oxygen for optimal repair (1). In addition, ornithine plasma is increased, and it serves as an active player in collagen development and increases the wound integrity from breaking (2).

It is manufactured in the body and can be obtained from some fruits and vegetables, watermelon being the highest source. Like L-arginine, L-citrulline possesses the same ability to assist in the stimulation of growth hormones, insulin and NO. This is accomplished by the kidneys by converting L-citrulline into arginine. In other words, health benefits are similar in a lot of ways due to the fact that it is a precursor to the amino acid, L-arginine.

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L-Arginine versus L-Citrulline

Arginine

Oral consumption of L-arginine poses several problems: The primary concern lies within absorption. Research has indicated its bioavailability ranges of 57–77% at a 6-gram dose, and 20% at 10 grams (3,4). Moreover, in the same study conducted by Tangphao O, et al., noted a range as low as 5–50% absorption (4). The other possible concern, if taken with food, the absorption of the amino acid can decrease, making it cumbersome for consumers/patients that may follow a random eating schedule. Therefore, in order to maximize L-arginine absorption, it is best recommended that the amino acid should be taken on an empty stomach. Furthermore, large doses of L-arginine have been reported to cause gastrointestinal distress and diarrhea.

Citrulline

For athletes, it seems that the research suggests the effective dosage is 6 grams of L-citrulline, and compounded to a malate molecule. It does not trigger gastric distress or diarrhea when taken at 15grams (5). It is absorbed at a higher amount in the gut than L-arginine (6). Studies suggest that approximately 83% of the supplement is absorbed by the kidneys (7). Moreover, L-citrulline consumed at 0.18g/kg produces an increase and a sustainable plasma level of arginine than arginine itself (8). It also produces a higher plasma count of ornithine by approximately 200 percent (9), which has been demonstrated in studies as one of the key amino acids involved in the healing process (2).

Conclusion 

Although the athlete’s motivation is a lot different than the patient, both consumers can still receive L-citrulline’s benefits. As stated earlier, it does not cause any issues with intestinal distress. It is better absorbed and outputs a higher arginine and ornithine serum count in the body over L-arginine supplementation itself. Therefore, in theory, a higher increase of arginine and ornithine in the human body should result in a better wound healing supplement. So, back to my question: if sports nutrition supplement companies are making the switch, is it warranted for medical nutrition supplement companies to follow?

I think the answer is yes.

Bibliography

  1. Stechmiller JK, Childress B, Cowan L. Arginine Supplementation and wound healing. Nutr Clin Pract. 2005;20(1):52–61. doi:10.1177/011542650502000152. http://ncp.sagepub.com/content/20/1/52.long. Accessed October 21, 2016.
  1. Shi HP, Fishel RS, Efron DT, Williams JZ, Fishel MH, Barbul A. Effect of supplemental Ornithine on wound healing ☆☆☆. Journal of Surgical Research. 2002;106(2):299–302. doi:10.1006/jsre.2002.6471. http://www.sciencedirect.com/science/article/pii/S0022480402964711. Accessed October 21, 2016.
  1. Bode-Böger SM, Böger RH, Galland A, Tsikas D, Frölich JC. L-arginine-induced vasodilation in healthy humans: pharmacokinetic–pharmacodynamic relationship. British Journal of Clinical Pharmacology. 1998;46(5):489-497. doi:10.1046/j.1365-2125.1998.00803.x. Accessed October 21, 2016.
  1. Tangphao O, Grossmann M, Chalon S, Hoffman BB, Blaschke TF. Pharmacokinetics of intravenous and oral l-arginine in normal volunteers. 1999;47(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014227/. Accessed October 21, 2016.
  1. Moinard C, Descartes UP, Nicolis I, et al. Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: The Citrudose pharmacokinetic study | British journal of nutrition | Cambridge core. British Journal of Nutrition. 2008;99(4):855–862. doi:10.1017/S0007114507841110. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dose-ranging-effects-of-citrulline-administration-on-plasma-amino-acids-and-hormonal-patterns-in-healthy-subjects-the-citrudose-pharmacokinetic-study/914C4C4EA85887DC2935740ACF8E36DE. Accessed October 21, 2016.
  1. Curis E, Crenn P, Cynober L. Citrulline and the gut: Current opinion in clinical nutrition & metabolic care. September 2007. doi:10.1097/MCO.0b013e32829fb38d. http://journals.lww.com/co-clinicalnutrition/pages/articleviewer.aspx?year=2007&issue=09000&article=00010&type=abstract. Accessed October 21, 2016.
  2. Windmueller HG, Spaeth AE. Source and fate of circulating citrulline. Article. 1981;241(6):473–480. http://ajpendo.physiology.org/content/241/6/E473.abstract. Accessed October 21, 2016.
  1. Rougé C, Robert CD, Robins A, et al. Manipulation of citrulline availability in humans. MUCOSAL BIOLOGY. 2007;293(5):1061–1067. doi:10.1152/ajpgi.00289.2007. http://ajpgi.physiology.org/content/293/5/G1061.long. Accessed October 21, 2016.
  1. Demura S, Yamada T, Yamaji S, Komatsu M, Morishita K. European journal of clinical nutrition – abstract of article: The effect of L-ornithine hydrochloride ingestion on performance during incremental exhaustive ergometer bicycle exercise and ammonia metabolism during and after exercise. European Journal of Clinical Nutrition. 2010;64(10):1166–1171. doi:10.1038/ejcn.2010.149. http://www.nature.com/ejcn/journal/v64/n10/pdf/ejcn2010149a.pdf. Accessed October 21, 2016.

by Ewelina Borkowska-Coghlan MS, DTR/Dietetic Intern at the University of Saint Joseph

Have you ever heard the word ‘pulse” and instantly though that the information you were about receive, or a conversation you were about to carry, will regard a heartbeat? If you had that experience you were probably surprised to learn that ‘pulse’ is also a food and not just a vital sign measurement. As a dietetic student, with broad exposure to various foods and diets, I thought I had a good understanding of the nutritional benefits of pulses. However, looking back I can admit that I wasn’t fully aware how much pulses have to offer, and how important these “ancient grains” are to our health and well-being. My recent visit to FNCE, Boston 2016, and particularly a presentation by John Sievenpiper (Associate Professor and a Faculty of Medicine in the Department of Nutritional Sciences, University of Toronto) helped me realize that I, as a future dietetic professional, need to reinforce the need of including pulses in my diet, but most importantly in the diet of my future clients.

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Ó http://www.youbeauty.com/nutrition/healthy-beans/

Before I start explaining why we all should put more effort into including these often overlooked nutrition reservoirs in our everyday living…

What exactly are pulses?  

Most of us are probably more familiar with the word “legumes” and often think of pulses as legumes. Well, you are right! Pulses belong to the legume family, but there is a distinction between these two. Legumes include plants which fruit/seeds grow in an enclosed case, called a pod, and include fresh beans, fresh peas and other fresh seeds, while pulses only include the dried seeds (1,2). There are 11 types of pulses that have been recognized by the United Nations Food and Agriculture Organization (FAO), which include: dry beans, dry broad beans, dry peas, chickpeas, cow peas, pigeon peas, lentils, Bambara beans, vetches, lupins and pulses NES (Not Elsewhere Specified) (2).  The legume species that are used as vegetables (i.e. green beans) or used for oil detractions (i.e. soybean) and sowing (i.e. alfalfa) are not considered pulses, by FAO. However, this selection is only a small representative of hundreds of pulse varieties grown and consumed by humans and animals around the world.

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Ó http://www.pulsecanada.com/about-us/what-is-a-pulse

 What about the nutrition?

What makes pulses such a great addition to our meals is their variety of colors, shapes and sizes along with the form they can be consumed in (whole, split or ground as flour). Moreover, pulses are packed with proteins, fiber and high levels of vitamins and minerals such as: zinc, phosphorus, iron, calcium, magnesium and potassium, as well as folic acid and other B vitamins, potent phytochemicals and antioxidants (3,4,5). As we know pulses are a key part of any vegetarian or Mediterranean diet, but they can be used in any diet or meal: including salads, side dishes, soups or as snacks. Combining pulses with other foods i.e. grains or foods rich in Vitamin C, and using appropriate preparation and cooking techniques, can contribute to better bioavailability of its nutrients, and lower activity of the anti-nutrients such as phytic acid, lectins and other compounds (4,5).

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Ó http://www.cookinglight.com/cooking-101/what-are-pulses

Turns out, this so called Protein for the poor”, can provide us with a wealth of nutrients.

and finally the health benefits

Considering a multitude of vitamins and minerals present in pulses, it should not be surprising that they possess a spectrum of health benefits. One of the recognized health benefits mentioned by Dr. Sievenpiper is the ability of pulses to offer better glycemic control. As mentioned before pulses are high in fiber, plant proteins and slowly digestible carbohydrates. A study conducted by Dr. Sievenpiper et al, based on meta-analysis of randomized controlled trials, investigating the effect of pulses on the glycemic control in people with or without diabetes, demonstrated that pulses contributed to improved markers of long term glycemic control (5). Additionally, the research shows clinically meaningful improvements of blood pressure, blood lipids and weight, which is strongly associated with lower rates of cardiovascular disease, obesity and other chronic diseases. Considering the multifaceted benefits, it is important to encourage consumption of pulses amongst communities and slow down the onset, and progression of these highly mortal diseases.

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Ó https://foodal.com/knowledge/how-to/pinto-beans-cheap-nutritious-meal/

Wait! There is more…

It is also important to mention that pulses are considered one of the most sustainable crops in agriculture. Nitrogen is an essential nutrient in crop production. Legumes, including pulses, have the ability to fix the nitrogen into the soil, because of their relationship with the bacteria living in the soil, therefore improving the quality of the soil and reducing the need for additional fertilizers (6). The water usage estimates suggest that it takes approximately 43 gallons of water to grow a pound of pulses, compared to 216 gallons for soybeans, and 368 gallons for peanuts (2). This can result in decreased greenhouse gases, improved soil health and less water usage. Therefore…

Let’s allow these “ancient grains” to lead us into a healthy and sustainable future!!

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Óhttp://www.pulsecanada.com/environment/sustainability/non-renewable-energy/how-do-pulses-help

References:

 

Tips on how to shop for healthy, affordable food for one person!

by: Erika Grover, USJ Dietetic Intern, ’17

As a person who is new at “adulting” I have had to learn how to go grocery shopping for just me while also trying to keep it low cost and mostly healthy (chocolate can be good for you!). Here are some tips that I have come up with to become a master solo shopper!

  1. Plan your meals! – Pick a few meals to cook each week and eat leftovers for the other nights. How many meals you make will depend on how much food you have left over and how many meals you eat from home. If you still have a lot of food left, then wait another day or so to cook again.  You can also cook multiple meals on one day and eat leftovers throughout the week.  This is a good idea if you have a full schedule but be careful not to make too much.1. Shopping Meal planning (3)
  2. Make a list! – Write down anything you need for recipes and any staple items that you are getting low on, like bread or milk. This keeps you on track and prevents you from buying food you don’t need. I have the items I need in red and items I already have in blue, find a system that works for you. Remember: You must bring the list with you to the store!
  3. Become a coupon queen or king! – Look for weekly circulars, find them online or get an app for coupons. Search for them after making your list and only clip coupons for items you need. Make sure to keep an eye on the expiration date, some coupons are good for a week and some are good for months. If you don’t need a product right now but could use the coupon before it expires then clip it just in case. Weekly circulars will also tell you what items are on sale and you may want to make substitutions to your meal if a similar option is on sale, like buying fresh green beans instead of broccoli.2. Coupons (3)
  4. Watch the dates! – Look for the “use by” or “sell by” date and pick one that is reasonable for you. Items at the back of the shelf usually have a date that is further away. Remember that you don’t have to throw away food on the use by date, you can if want to but you can also use your best judgement and keep eating it for few more days. You may also want to write the date on containers, like milk or cereal, when you open them so you know how long it has been open and if you need to use it up.3. Check dates (3)
  5. Your freezer is your friend! – Buying in bulk is cheaper but only if you are actually eating the food you buy. If you buy in bulk or if one package is just too big for you, you can section out the food you will use for the week and freeze the rest in plastic baggies. This is good for meat, bread, vegetables, pretty much anything can go in the freezer. Freeze the food into single servings so you only have to take out one baggie at a time. It’s a good idea to label and date the food so you know what it is and how long it has been there.4. Freezer (3)
  6. Cut out the junk! – It’s easy to avoid cookies and chips when you are on a budget. Do you really need ice cream for $4.99 when you could buy 3 bags of carrots for a similar price? That ice cream may last a few days but those carrots could last for months (in the freezer, of course). I know you’re not going to completely get rid of the less healthy stuff, at least I know I’m not, so instead watch for these items to be on sale and make them a special treat.5. Cut out the junk (3)

    By using these tips I have been able to reduce my food waste which makes me feel better and helps me to save money. Now, I’m still figuring this all out for myself but I hope these tips can get you going in the right direction and help you begin the process of becoming a master solo shopper!

By: Megan Beyer,  USJ Dietetic Intern, ’17

We have all seen how much criticism that high fructose corn syrup (HFCS) gets, but do we really know why it is getting all this attention? We are told that we need to stay away from it and it is bad for our health.  It is confusing to look at a package and recognize if a product has high fructose corn syrup in it. I think at this point it is important for consumers to be able to get these questions answered without bias of companies dominating the food industry!

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In order to crack this case, we need to go back to the basics of what exactly is high fructose corn syrup to make a better a more educated decision.  High fructose corn syrup is corn syrup that undergoes enzymatic processing where it is converting glucose into fructose and then mixed with pure corn syrup to reach the desired sweetness. Okay, so simply put it is a liquid sweetener that is similar to sugar.  Traditionally high fructose is modified to exist as HFCS 42% which is composed of 58% glucose and 42% fructose.  HFCS 42% is found in processed foods, cereals and baked goods and then HFCS 55% is composed of 45% glucose and 55% fructose is used soft drink beverages. There was a huge increase in adding high fructose corn syrup to carbonated beverages in the 1960’s and 1970’s due to the way in which it is stable in acidic foods and beverages. And unfortunately, high fructose corn syrup has become one of the most successful food ingredients in modern history. What is the common trend here, most processed food contains high fructose corn syrup and most of us don’t know it is in there. And on top of people being unaware that HFCS is in our products, it is causing detrimental effects on the health of our nation.

The next thing that that makes me think, is if HFCS is simply a type of liquid sugar that is used to sweeten our food, why is it so harmful to our bodies.  When normal glucose, or table sugar is digested in our bodies it has two options to be converted and used as energy if needed or it can be converted to be stored as fat.  When we compare glucose to fructose and evaluate the digestion, absorption, and metabolism in the body we see a lot of differences.  When fructose is digested in the liver the chemical composition does not stimulate certain hormones that control hunger and blood sugar levels in the body.  Although some of us may understand the science behind, is it most important to recognize that HFCS is stored because it bypasses the steps that glucose goes through.

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Although there is a lot of contradicting information on studies done and what doctors have found, the bottom line is simply that HFCS is bad because of the effect it is having on the obesity epidemic of the United States and for that matter, around the world. As we know, added sugar to processed food is added calories, and no matter if we recognize it or not, a few hundred calories extra a day from having a soda, can result in a 3-pound weight gain in a month. Also for most individuals they are not going to drink only one soda a day, but instead have two or three where we see caloric over-consumption which is what we see lead to weight gain.

There are ways in which we are able to avoid HFCS, but that would include reading the label of a product.  If you are really trying to cut back on the amount of HFCS in your food depending on your diet would be reducing the amount of processed food you eat.  If this is not an option for your life style, it would be a great start to read the ingredient label. When reading the label most of the time it will not say “high fructose corn syrup” since food companies are trying to trick the customer and therefore put ingredients such as maize syrup, tapioca syrup, glucose/ fructose syrup, glucose syrup, dahlia syrup, fructose… but when it all boils down these are all the same as high fructose corn syrup, so stay away! Since we are not always able to avoid it, the best thing to do as a consumer is to moderate it.  If you are not eating a ton of highly processed foods and every one in a while have these foods, it is okay in moderation, but be sure to read the label so you know exactly what you are putting inside of your body.

After doing extensive research on the topic of HFCS I have learned there are a lot of misconceptions about it and why it could kill you and why you can never eat it and so on.  Always make sure that you are receiving information from a reputable scientific source to ensure the information is correct. Through further understanding I think we can all agree that at one point or another the foods we eat are going to have HFCS in them, and the best thing to do is simply reduce and monitor how much you are consuming!

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It is less than one week until Valentine’s Day and many of you are preparing for a day of sweet gestures, cupid-shaped cards and chocolate.

February often elicits thoughts of romantic evenings, flowers and candy conversation hearts…but not often heart health.

It is important to know that not only is February the “month of love”, but also American Heart Month. What could be more romantic than focusing on improving your health?

According to the CDC, “Heart disease is the leading cause of death for both men and women. Around 610,000 people die of heart disease in the United States every year, which is 1 in every 4 deaths (CDC, 2015).” Although those statistics are staggering, there are actions you can take today to decrease your chances of developing heart disease. Heart disease is preventable.

 What are the risk factors for heart disease?

  • Overweight and obesity
  • Poor diet
  • Physical inactivity
  • Excessive alcohol use
  • Age
  • Family history
  • Smoking
  • High blood pressure
  • High blood cholesterol levels
  • Stress

What heart healthy habits will assist in lowering the chances of developing heart disease?

  • Maintain a healthy weight. If you are currently at a healthy body weight, keep up the great work! If not, according to the Center for Disease Control (CDC), even a modest weight loss of 5 to 10 percent of your total body weight may produce improvements in blood pressure, blood cholesterol, and blood sugars.
  • Decrease intake of saturated fats, refined sugars and sodium. Limit intake of sugary beverages, fast foods, full fat dairy products, sweets, treats and processed foods. Hint: when you go to the grocery store, stick to the perimeter. Instead of buying out at lunch or dinner, pack your meals for work and trips.
  • Increase physical activity. Current recommendations state that moderate aerobic activity for 150 minutes per week or 30 minutes, 5 days a week, has heart health benefits.
  • Increase intake of plant-based foods. Including more fruits, vegetables, legumes and whole grains means more heart healthy fiber (the cholesterol lowering kind) and health protective vitamins and minerals as well as less saturated fat and refined sugar.
  • Quit smoking. There are many resources available to assist you in smoking cessation. Reach out today to start your journey towards better health.
  • Take time to breathe. Stress is known as the “silent killer”. Find ways to take mini breaks and practice self-care each and every day. That may include: taking a walk, reading a book, meditation, deep breathing, exercise and speaking with a close friend.

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Healthy Valentine’s Day Recipes:

Want More Information? Visit:

By Amy Woodman, USJ Dietetic Intern, ’17

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Health care in America is always a hotly debated topic, especially during an election season. Does our health care system serve patients as it should? Should we change how our health care system works? If so, how? Is our healthcare system adequate? One could identify wonderful advances within our healthcare system as well as egregious failures.

We often look to other countries as a comparison for how healthcare could be more effectively delivered. But there is one place right here in America that offers efficient, personalized healthcare that takes a holistic approach and treats the patient as a whole being, not just an agglomeration of its constituent parts. That place is your local veterinary hospital. That’s right, your local vet is way ahead of the game in several areas.

Veterinarians sometimes consult with physicians when they need advice within a given specialty for a patient, but very seldom do physicians look to veterinarians for advice on their patients. And that’s a real shame, because there is a lot we can learn from our veterinary counterparts.

For example, while everyone is touting the implementation of the electronic health record (EHR) as a result of the American Recovery and Reinvestment Act, few realize that dogs, cats, and even hamsters have had EHRs for well over a decade now. (Yes, that’s right, somewhere out there is a little hamster that had an EHR long before any of us humans!) Veterinary hospitals made the switch to paperless practice long ago, and did so without any legislation forcing them into it. They made the change because it served their patients better.

Another area where veterinarians excel is keeping accurate weight records. As a dietitian, how often have you had to calculate your patient’s needs based on a stated weight from a patient who can’t remember the last time they weighed themselves? Wouldn’t you love to have a button on your screen that would bring up every weight on record with the corresponding date? Well, our dogs and cats have that very thing. Next time you go to the vet check your receipt, it’s probably printed out right there at the bottom.

In my previous life as a veterinary technician, I remember obtaining accurate patient weights was non-negotiable. It was often just as difficult for us as I imagine it must be for nurses, but it was part of the culture – everyone gets weighed. An accurate weight was imperative, if it wasn’t recorded in the patient record, it wouldn’t be long before the veterinarian would request an updated weight. If the patient reeked of skunk, I had to pick it up and put it on the scale. If the patient was in pain, I had to gently put it on the scale. If the patient was a terrified cat who was trying to climb the walls, I had to figure out how to get it on the scale. If it was covered in parasites, trying to bite me, scratch me, attack me, or whatever else, I had to get it on the scale.

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So I’m not unsympathetic to the plight of all the incredibly busy nurses out there and I do understand there are hundreds of reasons why weighing patients is difficult. I also understand that when dealing with a patient who is in pain or surrounded by an anxious family, obtaining an accurate body weight may seem like a low priority, but it really shouldn’t. An accurate weight isn’t just important for us dietitians. An accurate weight is necessary for a host of reasons:  prescribing pharmaceuticals, calculating intravenous fluids, tracking progress of the fluid overloaded patient, just to name a few. Yet it continues to go unmeasured in the clinical setting. Somehow, though, we must make an effort to let other health care professionals know how important accurate weights are to the patient’s care and find a way to facilitate getting accurate weights in the EHR.

By: Sarah Rondinone,  USJ Dietetic Intern, 17′

Photo by Sarah Rondinone

I often run into some difficulty trying to find interesting snacks for my 4 year old that she will enjoy and won’t be allergic to. In addition to peanuts, my daughter is allergic to eggs, wheat, and dairy, so trying to come up with fun ideas can be challenging. One of my favorite snacks is peanut butter on bananas (which is not a good idea for a child with a peanut allergy) so I’d like to share an allergy friendly version that she enjoys. I like to use WOWBUTTER®, a soy based peanut butter alternative that is thick, creamy, and very closely mimics the consistency of real peanut butter. You could also use SunButter®, which is a sunflower seed based alternative and a helpful substitute if there is a soy allergy, but the oil from the sunflower seeds requires some mixing of the product before use.sarah-blog-finished-bites-1

Photos by Sarah Rondinone

One of the great tricks to this snack is you can make it simple or more involved by adding things like mini chocolate chips or raisins to the top. The Enjoy Life® brand of dairy free chocolate chips are very tasty and close to the real thing so they are the brand that I personally use but others are out there! Another way I like to make the banana bites is by sandwiching the WOWBUTTER® in-between two rounds of sliced banana pieces and then put them in the freezer to make a nice frozen treat!

I like to use ripe bananas and cut them into little rounds to make it easier to assemble and pick up to eat. I then add a small dollop of the WOWBUTTER® to the center and top it off with some dairy free “Mini Chips” by Enjoy Life®. Both products I used for the snack are pictured below, and of course, any bananas or alternative products that work for you are also great. Enjoy!

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