The Iron Tablet

An Action Plan for a New Year and New You

2010-12-31T10:27:00.000-08:00

I often sit and wonder how to crack a person's code. Why are they constantly engaging in detrimental behavior (lack of exercise, poor eating habits) and how do I motivate them to change. It's an area of science that scientists are well, stumped about. Why do people lose a ton of weight and then put it back on? Why does a pro athlete go through their workout sessions but end up so tempted by fried food and alcohol that they don't lose the weight they need to drop to perform at their best. SMART goals be damned, you have to first have some sort of intrinsic motivation to change or an actual push over the edge (and everyone's edge is different) to make a change and stay on course.

So where do you get this motivation? You work on your head first and foremost. And, it's my firm belief that everything you say to yourself and your goals should be deep entrenched with positivity versus negative, beating yourself up behavior (oh and try to avoid people who constantly nag you about your smoking, drinking, eating etc. because that does nothing for your self esteem; though I do think sometimes there is a place for Dr. Phil moments). The majority of people I've seen that spend long periods of time flip flopping back and forth trying to change haven't completely made up their mind that what they want (say weight loss) is actually better than the alternative (eating whatever, whenever, not exercising) and they also go about their goals with very restrictive, unrealistic expectations and then see just about anything as a setback that totally derails them.

So for instance, here's a few switches I commonly help people incorporate into their thinking pattern:

1) Instead of: I have to eat X calories per day or cut out carbohydrates to lose weight.
Try: Adding what you want to eat to your diet. Focus on all of the good food you want to incorporate into your daily nutrition
plan, and recipes you'd like to try. There are a ton of foods that are delicious and nutritious (oh and by eating more of these,
you'll displace some of those less than healthy foods).

2) Instead of: I'm injured, I'll never lose weight now, I can't walk or do aerobics.
Try: Focus on your physical therapy, getting better and a chance to get stronger.

3) Instead of: I ate a piece of cake, I went way over my calories for today, now I'll never lose weight.
Try: Wow, that tasted great! (let it go, enjoy it for what it is and eat a reasonable portion). Get used to eating enough to
satisfy that craving but not consuming the entire cup, bowl, plate or basket of food.

4) Instead of: I never stick to anything, logging my food just isn't for me.
Try: Logging my food intake is not for me, I'm going to try another approach.

Think of any goal as a road trip. If you are on your way from FL to NY I can just about guarantee you'll have to change lanes multiple times, stop for gas a few times, you may have to take a detour and you'll probably get stuck in traffic when you hit my hometown (the Washington DC area). But, never once will you question the fact that you actually will indeed make it to NY. Now, take this thinking and incorporate it into your daily life. Your road trip may not be perfect and it may include points where your speeds slows or stops but if you keep traveling, you will reach your goal.

Your Medical Tests: When Normal Isn’t Quite Normal

2010-12-27T18:40:00.000-08:00

Any time you go to a physician’s office and have a lab test done, x-rays taken or any other diagnostic test performed, get a copy for your records and, if you go to another healthcare provider for the same issue, bring a copy of your test results. Never settle for “they said it was a little low but I don’t need to take anything.” On many occasions I’ve asked people to bring in their lab tests only to find that a “little low” isn’t acceptable. And, the most common tests that doctors aren’t aggressive enough with – vitamin D and iron.

While the “normal range” of vitamin D is 30 – 74 ng/mL, experts recommend doses of 50-70 ng/mL for optimal health. And, even if you are just a little below normal, supplemental doses of vitamin d may take a long time to get your blood levels up above the lower cutoff. Keep in mind that people respond very differently to both supplements and prescription doses of a vitamin or mineral. Some of us need less while others need a lot more to maintain adequate levels of the nutrient in our body.

Testing for iron isn’t so clear cut, mainly because you should, optimally, get a full iron panel to see where you stand. Just getting your hemoglobin and hematocrit tested may mean very little. And, even if your ferritin (your storage form of iron) levels are within normal limits they may still be indicative of iron deficiency anemia. For more information, see Figure 1 on this page titled Diagnosing Iron Deficiency Anemia.

Be your own health advocate by doing your homework so you are informed and know what questions to ask. After all, you know your body and how you feel better than anyone.

Tackling Weight Loss in the New Year

2010-12-23T11:01:00.000-08:00

There are two times during the year that I hear a dramatic spike in talk about calories and weight - Nov – January and pre-beach weather. The questions come late at night in atypical settings after a food & alcohol guilt sets in. First, I’m listening to a conversation about the NFL lockout and all of the sudden, just like that, there’s an abrupt change in topic:

“I heard there are some foods that help you burn fat, have you heard about this? And what do you think about carbs? Do I need to cut out all carbs to lose weight? I’ve got this belly I just can’t seem to lose.”

After a month of throwing moderation out the window and choosing the shopping mall and holiday parties over the gym, its panic time for many people. Clothes aren’t fitting, work is about to get busy and the gym will be slammed in the New Year. So what’s a person to do? Follow these steps to lasting weight loss in the New Year:

• Consider what works and what doesn’t work for you. While the sound of a brand new diet promising big results is very enticing, it may not fit your weight loss style. Likewise, if you hate the idea of attending meetings and counting the points in food, Weight Watchers is not for you. Just because it worked for your neighbor, why start something you know you’ll quit when you could design a plan that fits your needs and lifestyle (a dietitian/personal trainer combination can help you figure this out).

• Always think success. If I had a dime for every time I heard the words “I can’t lose weight” I’d be sitting outside my vacation home in Tuscany right now picking grapes. The saying “if you think you can’t, you can’t” is oh so true. I don’t care if you don’t believe yourself right now, continue positive self talk: “I can and will lose this extra weight.”

• You must combine good nutrition habits with an effective exercise routine. I have seen many people go to the gym year after year and not lose the weight. And, they are doing one or two things wrong – not exercising the right way and not watching what they eat. I don’t care if you do CrossFit every day, if you don’t change what you are eating, you’ll never get the results you are looking for.

• Surround yourself with people you want to be like. Oprah says this all the time for a reason. When it comes to weight loss, there are people who will, often unknowingly, want to sabotage your efforts. Why? Because they don’t feel good about themselves or they feel guilty so they want you to eat that plate of chili cheese fries with them. Do you have any friends that weigh you down? If so, you’ve got to watch this Oprah Show on this topic.

Weight loss can be boiled down to finding what works for you, incorporating it into you life, surrounding yourself with people who cheer you along the way and sticking with it. It isn’t magic but it is easy once you find a plan that fits your lifestyle.

Weight Loss: 1+1 Doesn’t Always Equal 2 in the Human Body

2010-12-14T12:18:00.000-08:00

Lately there’s been much chatter about the new Weight Watchers PointsPlus program (I’ll get to that in my next blog). Participants are confused, they think a calorie is a calorie and the machines in the gym tell the truth “I burned 700 calories doing 40 minutes on the treadmill!” And then, Weight Watchers catches up to the body of science over the past 3-4 decades and Bam! Everything dieters have been clutching onto for years must be thrown out the window. They have to learn a new system and attempt to release their firm grip of the belief that 200 calories is the same whether it comes from a fat free chocolate cake or turkey meat. Worse yet, they must embrace the fact that semi-starvation and deprivation interspersed with “I’m just going to eat anything I want” just doesn’t work.

So what’s a dieter to do? First, be flexible. Science changes and sometimes it takes a program a while (in this case decades) to catch up. Second (and this is critical), stick with it. If I had a dime for every time a weight loss client disappeared into thin area or dropped off the radar then popped back up again, I’d be home day trading right now. It’s critical that you stick with it through the days of fresh salads and grilled fish as well as the days you down your weight in chips and cheese dip. And, that brings me to my third point – let it go. So you ate some chips and chased them down with a few brewskies. Get over it and move on. Don’t let that slip become a slide into a period of “whatever, I can’t lose weight, I’ll just eat anything and everything.” Because it’s times like this that the most damage is done. And last, but not least, believe you can do it and set yourself up for success. Tell everyone (well, the supportive people) around you about your goals and team up with someone to go to the gym (or hire a trainer), take classes or make you accountable to that boot camp. See a dietitian….regularly and tell them you want the accountability! Or, join Weight Watchers and get to know the people in your group so you can’t pull the disappearing act one day without anyone noticing.

Now, why did I title this blog post 1+1 doesn’t always equal 2 in the human body? Because, you can’t trust the machines at the gym – most overinflate how many calories you are burning. And, most people (especially those who are obese) underestimate how much they eat. And finally, calories are not all the same. A diet of 1,500 calories may make you lose weight or it could keep your weight steady depending on what you are eating and to an extent, when you are eating it. Oh and P.S., those calories you eat between Friday at Happy Hour and Sunday morning, they count too. If you are my client, I’ll make you account for those hours. If you aren’t and I’m out somewhere dining with you, don’t tell me with a guilt-ridden voice what you plan or ordering or start counting the calories or fat grams because, I’m off duty ☺

Vitamins and Minerals Added to Food, Does it Really Matter?

2010-12-08T15:29:00.000-08:00

Once in a blue moon I like ice cream. But, I’m certainly not walking up and down my local grocery store searching for the ice cream with added calcium and vitamin D. I’m ISO (in search of) whatever mint chocolate chip looks closest to the stuff I’d get from Candy Kitchen on the boardwalk. I choose ice cream based on taste, not on it’s nutrient content. But, there are times when you should pick up a fortified food and others, like when you get a chocolate hankering, where it makes little sense to. (Unless of course you know about Vita Muffins which taste so good you won’t know they are healthy).

Food fortification has been in place over 90 years and was one brilliant public health intervention that has helped curb or eradicate several diseases due to nutrient deficiencies including goiter, rickets, beriberi and pellagra. Early on, iodine was added to salt, milk was fortified with vitamin D and flour was enriched. The purpose behind fortification is simple – people are going to eat. And, why not put a vitamin or mineral most people aren’t consuming enough of in popular food items to ensure they get it? Pure brilliance.

Now, close to 2011, fortification has reached a whole new level. Yet we are still lacking in key nutrients across the globe. From iron to vitamin D, there are plenty of us who don’t get enough the nutrients we need for good health. So when should you choose a fortified food? When you don’t eat a widely varied diet of at least 2,000 calories daily (the more food you eat, the greater the chance that you’ll consume the nutrients you need every day). In addition, if you don’t take a multivitamin mineral supplement but you avoid certain foods or food groups rich in vitamins or minerals, it may be time to make some simple switches so you are adding foods rich in the nutrients you are missing. Take a look at these fact sheets on vitamins and minerals and see what you may be missing.

The Most Common Nutrient Deficiency in Bariatric Patients

2010-12-02T12:21:00.000-08:00

If you’ve had bariatric surgery, congratulations on the new you! Now its time to learn to take care of the different nutrition needs brought on by your surgery. Though surgery will help you take and keep weight off, it also increases your risk of developing several nutrient deficiencies. And, because the best defense is a good offense, it is wise to talk to your physician and dietitian about the nutrient deficiencies common in bariatric patients.

The most common nutrient deficiency you are likely to experience is iron deficiency anemia. And, a related issue to this deficiency is pica – a condition where a person craves and eats non-food substances such as laundry starch, ice, dirt, clay, cigarette ashes and more. Patients who have undergone operations such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BD), with or without duodenal switch are at an increased risk of developing pica.

Additional reasons bariatric surgery increases your risk of developing iron deficiency anemia and pica include:

• Immediately post surgery your intake of iron rich foods may be minimal
• Surgery means decreased hydrocholoric acid production in the stomach and this acid is essential for the absorption of some micronutrients
• Food and supplements now bypass the typical iron absorption sites in the small intestine
• There are fewer receptors to transport iron and change iron to the form that is absorbed best by the body

All of these issues make it essential that you talk to your physician about getting checked for iron deficiency anemia and how best to supplement if you are low in iron.

Reference: Bariatric Times 2010;7(11)22–23

Something to be Thankful For: An Abundance of Good Food

2010-11-24T16:32:00.001-08:00

4,000 calories, hundreds of grams of fat and a food hangover. I’ve heard a lot the past few weeks about how much people eat on Thanksgiving, how they’ll stay on their diet and how much exercise it takes to burn off the calories they consume. And, I get it, people are worried and feel like their confessions to a dietitian will ease their anxiety and keep them on track.

But, for all of those dieting and freaking out this time of year, I ask that you turn that attitude around to a little gratitude. Approach the Thanksgiving spread before you thankful that you have food on the table and delicious, nutritious choices to fuel your body and mind. Get rid of the food fear mentality and look at the plate before you a bit differently. Sure, be aware of what you are consuming – but do so in a “am I still hungry or did I eat enough and I can save this until tomorrow” type of way.

While I don’t advocate gorging on food, ever, a few extra calories won’t put a dent in your weight loss efforts if you are tuned into your hunger and satiety cues. Our bodies typically compensate if you listen hard enough. Eat too much one day and you probably won’t be so hungry the next day. Under eat and you’ll be hungrier the next day. You just need to listen closely.

Thanksgiving food should be enjoyed and shared with family and friends. After all, hunger is still a problem across this country and abroad. And food banks are in desperate need to make up their shortages. If you have food on your table, be thankful! And if it tastes great, be extra thankful!

Gluten – the New Trans Fat?

2010-11-13T11:18:00.000-08:00

Looking to lose weight? Improve digestive health? Feel better? Then you better get gluten out of your diet, according to popular fad diets and the media buzz surrounding this protein. Those in search of one single ingredient or food to shake their finger at have found gluten willingly sitting in time-out for the past few years. But, is gluten really that bad? Or simply misunderstood?

Gluten is a protein found in wheat, barley and rye. It provides elasticity to dough giving bread its characteristic spongy texture. You’ll notice that gluten free products often taste different, due to the different grains used to create them and the altered texture of the final product. Though gluten has a very beneficial role in the development of food products, it can wreck havoc for consumers with celiac disease or gluten sensitivity.

If you do not have celiac or gluten sensitivity, there is no research-based reason for you to remove gluten from your diet. Will doing so help you lose weight – possibly. But, that isn’t because of the gluten but instead due to the fact that you’ve removed a ton of foods (and therefore calories) from your diet! Will you be less bloated without gluten? If you cut carbohydrates (gluten is found primarily in carbohydrate-rich foods), you may notice that you are carrying less water since carbohydrates store 3-4 times their weight in water. Will you miraculously feel better? Doubtful. Unless you have celiac disease, gluten sensitivity, a wheat allergy or you are experiencing a placebo effect.

The signs and symptoms of celiac disease vary tremendously among individuals both in severity and types of symptoms they experience which include: diarrhea, abdominal pain, bloating, irritability, depression, anemia, stomach upset, joint pain, itchy skin rashes (dermatitis herpetiformis), weight loss, mouth sores and neuropathy. But, this disease isn’t so straightforward since many people go undiagnosed for years! If you think you have celiac disease, first, you must keep eating foods that contain gluten (so that the disease can be detected). Initially, your physician will probably order a blood test (TTG or EMA). If this test is positive, then you should ask for bioposies of the duodenal bulb. IF the intitial test is negative but your symptoms are consistent with celiac, push for the biopsy! Or, you could do genetic testing for DQ2 and DQ8 at www.myceliacid.com.

Now, what about gluten sensitivity? “The only way to "determine" whether you are gluten sensitive/intolerant is to compare how you feel when eating gluten with how you feel after being on a gluten-free diet. The time it takes to start feeling better after being on a gluten-free diet varies. However, symptoms should gradually subside after 3-4 weeks on a strictly gluten-free diet, although it could take longer. Right now, there is no reliable blood test to determine gluten sensitivity,” says Rachel Begun, MS, RD. For more information on gluten sensitivity, see Rachel’s blog.:

For great podcasts about gluten, click here.
And, for a fantastic overview of gluten in foods, click here.

Eat This, Get More Antioxidants

2010-11-02T07:00:00.000-07:00

More and more people are shoveling antioxidants in their body with gusto. Sun damaged skin? Just take antioxidants. Trying to prevent heart disease? Drink some POM Wonderful. Want to lower your risk of cancer? Reach for Juice Plus. Now granted, I'm totally making these up but, I hear statements like this from consumers all the time. And, after all, we are bombarded with the message that “antioxidants are good” and we should search for the best sources of these little compounds that fight free radicals and therefore, may, over time, reduce our risk of some types of diseases and conditions. So, where can we get the most bang for our buck?

Despite ORAC scores and other measures of total antioxidant capacity, there is no one best source of antioxidants. These scores only tell us about the total antioxidants within a particular food but they don’t tell us a darn thing about how well our bodies absorb these antioxidants or use them. In a nutshell: ORAC means nothing, nada, for you as a consumer.

And, while there are certain antioxidants with specific functions in our body, lutein and zeaxanthin for eye health for example, there is a lot we still do not know about antioxidants and how they may work synergistically with other compounds and other antioxidants in fruits and vegetables. Therefore, it’s way to premature to rely on just one source of antioxidants from a pill or bottle. Instead, turn back to what dietitians have been talking about for years – eat a diet loaded with a variety of colorful fruits and vegetables Why look for color – the color often signifies different antioxidants. And finally, consider antioxidant supplements as just that - supplements to make up for your shortfall. But, look to food first. Because I guarantee you'll come up short when you don't consume the recommended 2.5 cups of veggies and 2 cups of fruit daily.

Widdle Your Waistline and Improve Your Health: the Flexitarian Diet

2010-10-28T10:10:00.000-07:00

Last Saturday I had the most delicious grilled artichoke at Taste of Atlanta, an outdoor festival celebrating a variety of different foods, cooks and restaurants. It was simple to make yet something I haven't done at home in a while (click here for a good recipe). So, this delightful, simple dish, bursting with flavor, reminded me about the many ways we can enjoy seasonal produce. And, if you aren't sold yet, by the wonderful magic of mixing together a variety of tastes and eye appealing colors, consider the benefits of a plant-based diet which are nothing short of amazing. More produce means you'll likely cut your risk of cancer, heart disease, age-related macular degeneration and various other diseases while maintaining a healthy weight, beautiful skin and a longer lifespan.

You can get all these benefits and more without giving up meat, poultry, turkey and game by becoming a part-time vegetarian (also called Flexitarian). Now, this may seem daunting to you at first but, by being a Flexitarian, you get the best of both worlds - you can still eat your favorite meat or poultry while gaining all the health benefits found in fruits, vegetables, whole grains, nuts and seeds.

How do you start? Plan ahead by looking up recipes and trying something new. For great veggie recipes, check out the www.foodnetwork.com. Look for soups, stews, ways to saute vegetables and more. I love this one from Giada De Laurentiis: Grilled Veggies.
In addition, you can read all about becoming a Flexitarian including suggested ways to incorporate more produce in your life, by reading this book: The Flexitarian Diet by Dawn Jackson Blatner.

Vegan – a Path to Better Health?

2010-10-25T09:01:00.000-07:00

Every vegetarian and vegan I know strongly defends their choice to abstain from eating meat and meat byproducts. And, with good reason, they obviously chose this lifestyle because they believe doing so will improve their health. Here’s the rundown on the pluses and minuses of becoming a vegan:

Benefits:
Higher intake of fiber, folic acid, vitamins C & E, potassium, magnesium and many phytochemicals (plant based healthy compounds).
Less saturated fat and cholesterol (beneficial? For some, possibly)
Vegans tend to be thinner, have lower total cholesterol and lower blood pressure reducing their risk of heart disease.
In general, vegetarians typically have lower rates of cardiovascular disease, obesity, type 2 diabetes and some types of cancer.

Drawbacks:
Vegan diets increase the risk of some nutrient deficiencies including vitamins B-12 and D, calcium, omega 3 fatty acids.
Iron and zinc status may be compromised because of the limited bioavailability of these minerals in a vegan diet (compounds in grains, seeds and legumes as well as some other foods and beverages interfere with the absorption of iron and zinc).

Recommendations
Consume B-12 fortified foods such as rice and soy milk and breakfast cereals (check out the Nutrition Facts panel).

Consume calcium-fortified plant foods such as breakfast cereals, fortified beverages, in addition to natural sources such as green leafy vegetables, tofu and tahini.

Consume vitamin D fortified foods.

Eat omega 3 rich vegetarian foods (which contain the omega 3 fat ALA) including flaxseeds, walnuts, canola oil, soy products, hemp seed beverages. Also, consider taking EPA and DHA supplements or eating foods and consuming beverages fortified with these two omega 3 fatty acids.

Click here for references.

Does Salt Cause High Blood Pressure?

2010-10-22T14:03:00.000-07:00

According to the CDC, one in three Americans has high blood pressure. And, though we’ve pushed the “watch your salt intake” message to death (yes, even I recommend this for the masses, with a caveat or two though) it’s time to take a closer look at what really causes high blood pressure and also take the anti-salt mantra with well, a grain of salt.

First, let’s take a look at what causes high blood pressure. Blood pressure is a measure of the force of blood pushing against artery walls. And systolic (the higher number) is the pressure when your heart beats and pumps out blood to the body while diastolic is the pressure in your arteries at rest. Over time high blood pressure damages artery walls leaving behind areas that plaque can stick to very well. Plus, high blood pressure makes your heart work harder.

Those at greater risk for high blood pressure are:
- men over 45 and women over 55 (your artery walls are not as elastic when you age )
- family history
- lifestyle habits including:
- inactivity
- being overweight or obese
- smoking
- drinking too much alcohol
- excessive sodium consumption
- too little dietary potassium

And 90% of the people I’ve seen with high blood pressure are overweight and inactive. Amazingly enough when they drop some lbs and start exercising, their blood pressure often normalizes.

Now back to salt. While I think people should be mindful of their sodium intake, I think they need to spend more time focused on losing weight, getting active and quitting smoking. Secondly, people’s response to sodium varies tremendously. And lastly, it isn’t a good idea to cut out all salt from your diet because we need the iodine in iodized salt for proper thyroid functioning and according to some of the foremost nutrition scientist in the world, the recommendation to consume less than 2,760 mg sodium per day (CDC recommends 1,500 mg) is wrought with many assumptions including: "1) that the basic biology of the organism should be ignored; 2) that intakes below this threshold are not potentially harmful; 3) that the food industry can produce foods of such reduced sodium content and its attendant changes in texture, taste, and stability that people will change their eating habits; and 4) that people will desire to make these changes rather than see them as unwarranted constraints on a fundamental element of human behavior, ie, choosing the foods they eat."

For the most accurate blood pressure reading, follow these guidelines from the National Heart Lung and Blood Institute.

Sure, you can cut the sodium down from 4,000 mg a day but, don't go too low.....

Don't Let Your Weekends or Road Trips Derail Your Diet

2010-10-19T07:02:00.000-07:00

Traveling and weekends are the top two roadblocks to weight loss. Diet record after diet record, I see people who “diet” during the week cutting their calories and sweating it out at the gym yet they just aren’t losing weight. They blame genetics, their thyroid, a slow metabolism or age but the reality often lies in what they don’t realize they are eating. Once they start tracking what they eat (in an app, spiral bound notebook, sparkpeople, etools or other) the lightbulb comes on. Ah, it’s all the alcohol, restaurant food and munchies that are consumed on the weekend and can totally outweigh all the weekday calorie counting. But, a person has to live a little….

Therefore, I came up with my Top 5 Tips for Tackling the Weekends and Traveling:

Top 5 Tips for Tackling the Weekends and Traveling
1) Don’t skip meals. Just because you are out running errands or shuttling kids between events and birthday parties, it is imperative that you don’t go hours without eating. Bring a mini-meal with you or even a snack. Skipping meals is one surefire tactic to make you want to eat everything in site later.

2) Search first. Those who have cracked the weight loss code plan ahead and decide where they are going to eat and what they will get on the menu. With the internet, google and websites devoted to calorie information, it’s relatively easy.

3) Eat before you go out. I know, I know, this isn’t new and in fact, you’ve probably heard it a million times. However, many people still don’t do it. Instead, they wait until they are famished, and dive into the chips/bread or appetizers on the table and then a full meal.

4) Eat in order. Strategically eating your vegetables first and then your protein and then your carbohydrate will fill you up so you aren’t downing the entire plate of fries in a minute flat. Produce fills us up with volume and protein satiates our appetite.

5) Watch your alcohol consumption. Aside from the notorious beer gut, alcohol drops our inhibitions to resist plates of food laid out before us.

Do Supplements Work?

2010-10-17T10:29:00.000-07:00

Friday night, while looking at the Dali exhibit in the High Museum, my friend’s cousin asked me “do multivitamins work?” Startled I responded, “wow that’s one loaded question. Work for what? What result are you looking for?”

Neither supplements or the entire broad topic of nutrition for that matter, are cut and dry like an algebra problem. For x + y = z in your body, you must take the right form of the supplement, take it at the right time (with or without food; noting attention to specific types of foods that may help or hinder your supplement’s absorption) and look at how much you are taking at a time. In addition, to notice a benefit, many supplements need to be taken for a period of time, not just a one stop, pop it and bam! you feel amazingly better. Because of all of these factors, part of the responsibility of taking supplements falls on you, the consumer. But, here’s a quick cheat sheet for some common nutrition supplements.

In addition, I encourage people to follow this train of thought when considering a dietary supplement:

McDonald’s Happy Meals, Buy One Now, Eat it 6 Months Later

2010-10-14T10:15:00.000-07:00

In a horrific display of food preservation, Sally Davies, a photographer and vegetarian, posted her McDonald’s science experiment on Facebook. She took a Happy Meal home six months ago and took pictures of it over time to see if it molded or changed the way we expect food to go rotten. Click here to see pictures.

First off, I have a difficult time believing this story since I’ve seen the changes in a McDonald’s hamburger bun after my 6 year old niece, Sticky Fingers (because she sneaks her fingers in icing when I’m decorating cakes), left part of her unfinished meal on the table for hours. It didn’t mold but it did start to get hard like fresh bread will if left out. Secondly, I’m wondering why the McDonald’s hatred? I don’t work for McDonald’s, I can’t recall the last time I ate there but, I can tell you their McCafé drinks are darn good, their portion sizes for anything not supersized haven’t morphed into linebacker-sized meals and there’s no study to date showing a direct correlation between fast food and the obesity epidemic.

Now I know what you are thinking, what is a dietitian doing defending McDonald’s? Here’s my take on nutrition: I take people where they are and help them make positive changes based on their lifestyle and goals. If I get a client who eats fast food daily because they work, have kids and are going to school and don’t have time to cook, we’ll look at the options available and explore better fast food choices. Though it sounds good on paper, it is completely unrealistic to think that everyone has the time, motivation or desire to buy all organic, local produce and grass-fed beef and make fresh meals every single day. And asking someone to do something they won’t do just sets them up for failure and frustration. Instead, I can direct them to better choices at home, in the grocery store and even at fast food chains (gasp!). Most fast food places have salads, Chick-Fil-A has delicious wraps loaded with vegetables, Wendy’s has the new “Pick 2”.

The choice is yours. You can get a McDonald’s hamburger for cheap, on the fly and just 250 calories while getting some protein and meeting 10% of your calcium needs and 15% of your iron needs. Or, you can go to a “fine” restaurant and blow a good part of your daily calorie budget on a thick, juicy burger and sides. Fast food isn’t making anyone fat but their choices at fast food restaurants, choices in the grocery store and lack of activity are likely to blame.

Beat Breast Cancer

2010-10-11T05:11:00.000-07:00

This month is the 25th anniversary of Breast Cancer Awareness Month and though this is the 2nd leading cause of cancer in women, there are several things you can do to help decrease your risk:

1) Eat a diet loaded with colorful fruits and vegetables. According to the National Cancer Institute, fruits and vegetables are our best dietary bet for reducing our risk of this disease. Produce is loaded with antioxidants that may help us decrease the risk of some types of cancer. Aim for ½ - 2/3 of your plate from plant based foods.

2) Bone up on calcium and vitamin D. Some studies show that those with a higher intake of calcium and vitamin D from their diet, have a reduced risk of developing breast cancer.

3) Drink tea. Black, white, green and oolong tea are loaded with antioxidant polyphenols that may decrease our risk of some types of cancer. Add a slice of lemon, lime or an orange to further enhance your absorption of these disease fighting compounds.

4) Maintain a healthy weight and exercise. Overweight and obesity increases one’s risk of breast cancer, breast cancer recurrence and a poorer prognosis.

5) Aim for omega 3s. Omega 3s from fatty fish like salmon, mackerel, herring, halibut, sardines, anchovies and lake trout decrease inflammation and keep our cell membranes fluid in structure (this is important so insulin can bind to it’s receptor site on cell membranes and because rigid membranes hold estrogen in the receptor for a longer period of time).

6) Support the Susan G Komen foundation by buying products with the pink ribbon on them or running the Race for the Cure.

Small Health Clues: Constipation

2010-09-28T13:12:00.000-07:00

While constipation isn’t exactly a dinner hour topic, as a dietitian, I hear about it so often that it doesn't phase me at all. My clients start talking about one thing and then, toward the end of our visit they shyly bring up their struggles with constipation. And, it isn’t a matter of just adding fiber and wa-la! no more worries. Constipation is more complicated then that because there could be several causes including:

- Inadequate fiber intake
- Inadequate water intake
- Stress
- Inactive lifestyle
- Change in diet or schedule due to travel
- Overuse of laxatives
- Medications
- Supplemental iron (especially if taken in large doses)
- Hypothyroidism
- Eating disorders
- Irritable bowel syndrome (IBS)
- Certain diseases
- Colon cancer

And, some people are just more prone to constipation. So, what can you do? Take a look at this list and start figuring how the potential contributing causes that may apply to you. Next, see what you can do about them. You may not be able to switch medicines but you can exercise more, drink more water and boost both your insoluble and soluble fiber intake. You can also treat IBS by finding out which foods bother you (LEAP tests are recommended by some) and taking a probiotic (Align is often recommended), switching to an iron supplement that doesn’t constipate (or at least decreases the likelihood of constipation) and be very cognizant of what you eat when traveling.

To see Dr. Oz’s depiction of constipation and his recommendations, click here.

Wounds that Don't Heal

2010-09-23T20:43:00.000-07:00

If you have a wound that won't heal or bleeds what seems like a river for a small area, it's time to get it checked out. Wounds that won’t heal or random spots on your skin that bleed excessively, could mean a number of things from skin cancer or diabetes to poor nutrition.

Skin cancer isn't always very easy to spot. Patches of skin that look rough or like acne (pearly bumps) may actually be actinic keratoses (precursor to skin cancer), basal cell or squamous cell carcinoma. Check out the signs of skin cancer as well as a few pictures here.

Another contributing cause to wounds that are slow to heal is diabetes.

And finally, poor nutrition shows up in your skin and may delay wound healing, especially if you haven't been consuming good sources of zinc and vitamin C.

If there's something wrong with your body, oftentimes you get a warning sign or even a few warning signs. The problem is, many of us ignore those warnings until they start to interfere with our daily life. Start paying close attention to changes in your body and, when something doesn't seem right, talk to your doctor or nurse.

More than Just a Bad Hair Day: Thinning Hair

2010-09-17T09:44:00.000-07:00

Volumizing sprays, thickening shampoos, oxygen delivery directly to the scalp - there are a number of products and services on the market that target people with hair loss. I equate this to the weight loss market. If you aren’t vein about your hair, holding on to every strand you’ve got, you might be after you drive down the highway and see a larger than life billboard with before and after pictures of a man with hair plugs. Do I look like the before picture? Wait, do I need this procedure?

While some men lose hair in patches and others have general thinning, women typically lose overall volume, which may make their hair loss very subtle and easy to overlook initially. Regardless of whether you are a man or woman, if you want to save your strands, it’s time to get to the root of the problem. And, the majority of hair loss is considered genetic and therefore medication (either topically, like Rogaine) or orally such as Merck’s Propecia (for men only) will decrease hair loss and possibly stimulate hair growth. But, you shouldn’t just assume that your hair loss is due to your genetic makeup. There are several causes of hair loss including:

- chemotherapy

- alopecia areata (an autoimmune disease)

- hypothyroidism

- androgenic alopecia (pattern baldness, this occurs in men and women)

- physical or emotional stress

- anorexia
For help with anorexia nervosa or other eating disorders, see EDIN or Something Fishy.

- poor nutrition – diets low in protein or iron (and possibly vitamin D), crash diets, gluten intolerance or celiac disease (possibly), fad diets and eating disorders can all lead to hair loss. If the other causes listed here do not apply to you, get a full iron panel done (not just hemoglobin and hematocrit) because iron deficiency without anemia can cause hair loss. And, get your vitamin D levels checked.

- illness

- hormonal changes (high testosterone levels in women)

- hair treatments – dye, bleach, straighten or perm your hair one too many times and it will become damaged and weak. Over-styling hair can also cause problems.

- scalp infection – ringworm or a fungal infection to your scalp can lead to hair loss. Most experts believe that dandruff is due to overgrowth of the fungi pityrosporum ovale or malassezia globosa. If you treat the dandruff, dandruff-related hair loss should subside. Anti-fungals such as zinc sulfate, salicylic acid and ketoconazole (found in Nizoral Shampoo and this ingredient supposedly kills the fungus) help. In addition, coal tar can reduce the appearance of flakes. And finally, you can try an age-old remedy for stopping the fungus – apple cider vinegar. And one more trick of the trade – never wrap wet hair in a towel or bunch it up on top of your head or put it in a ponytail. Yeast thrives in a damp environment!

Hair loss can impact how you feel about yourself, your morale and confidence. If you notice even the first sign of hair loss, instead of racing for the drug store for volumizing products, turn to the American Hair Loss Association for self-help and to find a dermatologist or endocrinologist. Starting early will lead to better results. And, finding the root of the cause will help you find an effective solution versus taking a shot in the dark.

Small Health Clues: Brittle Fingernails

2010-09-16T08:00:00.000-07:00

Your nails keep breaking off or splintering and coming off in layers. So, what’s the obvious fix? Buy a nail strengthening polish and brush on a few coats prior to putting color on. But, doing this would be like continually slapping a Band-Aid on a wound that just won’t heal. There’s a reason for both and until you find the underlying problem, you’ll never actually “fix” anything. So, we are going to play a little game of sleuth and uncover some of the common issues that occur with your fingernails and what causes them:

Lines across your fingernails – these lines may pop up after an illness or if you are malnourished.

- Brittle or splitting nails – hyperthyroidism, hypothyroidsism or lack of adequate nutrition (most often iron deficiency or low biotin intake) can lead to brittle nails. If your toenails are strong and fingernails are not then an environmental cause may be to blame (winter heat, use of strong household cleaners or constantly washing and drying your hands).

If you have brittle nails, start wearing gloves when you wash dishes and clean your house, try non-acetone nail polish remover and apply lotion to your nails and cuticle areas often. Also, increase your intake of biotin-rich foods or can take this B vitamin as a supplement alone or in a B complex vitamin. Biotin rich foods include: tomatoes, romaine lettuce, carrots, oatmeal, onions, strawberries, Swiss chard, halibut, almonds and walnuts. Also, avoid raw egg whites or products that contain raw eggs since a protein in egg whites, avidin, can bind biotin preventing adequate absorption of this vitamin. When eggs are cooked, avidin no longer binds biotin.

- Abnormal shape (koilonychia) – if your fingernails have raised ridges are thin and curved inward, you probably have iron deficiency anemia.

- Pitting – depressions in your nail may be caused by psoriasis.

- General damage – disease, injury or illness can cause general damaged nails.

Here’s the bottom line – if you have issues with your fingernails that just won’t go away, even after your injury or illness has, it’s time to see a doctor. Sometimes seemingly little cues mean larger issues lie underneath.

Small Health Clues: Cracks at the Corner of Your Mouth

2010-09-15T18:12:00.001-07:00

They say a dentist can tell a lot about your overall health by examining your mouth. Likewise, an optometrist or ophthalmologist can also tell you about various aspects of your health by examining your eyes. In the meantime though, there are little signs we should pick up on to make us realize there may be a bigger issue we need to address.

But, it’s the little telltale signs that we may dismiss as irrelevant. But, simple things like ridges in your fingernails and cracks at the corner of your mouth can sometimes be the first warning sign you notice. So what about those painful cracks at the corner of your mouth?

Technically, cracks at the corner of your mouth are called angular cheilitis and there are a few causes:

- Infection – you know how you close your mouth and a little saliva gets stuck at the corners? Yeast loves saliva and therefore
fungal infections are the most common infections at this site. Watch how much you lick your lips and ask your physician
for an anti-fungal medicine. They work like a charm.

- Denture problems, missing teeth, ill-fitting braces – when your bite is thrown off, a number of other things are as well and
this can cause painful cracks.

- B vitamin deficiency –deficiency in one or more B vitamins can lead to issues in your mouth including a red tongue, a
swollen tongue, cracks at the corners of your mouth, and throat swelling.

- Iron deficiency – this is rarely the cause of cracks here but, iron deficiency is the most common nutrient deficiency
worldwide. If you’ve ruled out all other causes, get your iron levels checked.

Even if something on your body seems minor though a bit annoying, get it checked out. There are many small cues to bigger problems.

Why You Should Take Nutrition Information with a Grain of Salt

2010-09-07T19:54:00.000-07:00

Today starring me in the face, I remembered why I often tell people to listen to the message but then take decide if it applies to you. If you don’t know, ask your dietitian or physician. But, always keep in mind that there isn’t a one-size-fits all approach to nutrition. What you hear in the media may have nothing to do with you. An above average BMI may mean little to nothing as long as you are otherwise healthy and active. And just because your co-worker thinks she needs to lose 5 lbs, that doesn’t mean you should jump on that bandwagon.

So my personal wake up call of the day was about sodium. I agree with CDC’s take that many people consume too much sodium and hypertension (high blood pressure) is prevalent. I discuss this message in the media, advocate that most sedentary people watch their sodium intake yet carefully monitor how much sodium my athletes get to ensure they don’t cramp or worse yet, end up with dangerously low blood sodium. However, somewhere in this mix of people to look after and messages to convey, I forgot the very thing that has helped me for years - regularly salting my food. You see, I’m on the opposite end of the spectrum compared to the majority of Americans. My blood pressure is very low. Normally my body warns me, I get dizzy or end up with postural hypotension (get dizzy and my vision blurry when standing up too quickly). But today an ordinary blood pressure cuff and a nurse with a puzzled look on her face made me realize I had slacked on the advice a doctor gave me years ago: “salt your food!” This just goes to show you how subconsciously, messages seep in and we think “yes, I need to take vitamin C daily” or “everyone else is taking fish oil, I’ll take some and see what it does.” And, that my friends, is like playing a game of Nutrition Scrabble. Taking a ton of advice, mixing it up and seeing if you can spell out a health prescription.

As your own health advocate, read, ask and listen but consider what is good for your own body, not your neighbors, the general public or your coworker’s body. There isn’t a one-size-fits-all approach to nutrition or health. And sometimes, you have to ignore what the people around you say and do what’s best for you. And, be diligent about it…..even if it goes against popular opinion.

And, here I go, back to the odd looks people give me and comments like “that stuff’s gonna kill ya, you should know better” when they see a dietitian salting her food.

Does Supplemental Iron Improve Athletic Performance?

2010-09-04T08:25:00.000-07:00

Studies report a high prevalence of iron deficiency and iron deficiency anemia in female athletes and soliders. And, iron needs may be higher in athletes due to the demands of training and iron loss (for example, blood cells actually break down from running – something termed foot strike hemolysis). In addition, women lose iron through menstruation every month.

Iron deficiency occurs in 2 main stages:

1) Iron deficiency – too little iron in the body. This is the most common nutrient deficiency worldwide and, according to the NIH, as much as 80% of the world’s population may be iron deficient!

2) Iron deficiency anemia – by the time you reach anemia, you have advanced iron depletion. Your iron storage is deficient and your blood levels of iron cannot meet your daily needs. A general CBC (Complete Blood Count) includes a test for hemoglobin, which will show up below normal when you are anemic. According to the NIH, 33% of the world may have iron deficiency anemia.

While iron deficiency and iron deficiency anemia can slow you down, taking iron will improve performance and help you feel significantly better (though if you have normal iron levels, taking iron isn’t warranted and doing so will have no effect on performance).

Symptoms of iron deficiency and iron deficiency anemia include muscle weakness, fatigue, feeling cold often and impaired cognitive performance.

Yo-Yo Dieting Could Have Long Lasting Effects on Weight Control

2010-08-30T14:11:00.000-07:00

I’ve never understood how people crash diet and get very thin. The level of self-deprivation and glucose for brain functioning would make me more irritable then a 2 year old who hasn’t had a nap in days. I do, however, get the 2nd half of that equation – when the former master dieter gets so doggone hungry and sick of their POW status (prisoner of weight) that they eat everything and gain their weight + some back. And, my problem with this pattern is that it wrecks havoc on a person’s psyche. The dieter is exuberant and on top of the world after their weight loss and then feels like an absolute failure and hides from people and social activities after they gain the weight back. And that, my friends, is no way to live life.

But, aside from sabotaging self-confidence, yo-yoing could make it harder to keep that weight off in the long run. A newly published study in the Journal Nutrition and Metabolism found that gaining weight, even in the short term, is difficult to shed later. In this study, eighteen young adults overate and under-exercised for 4 weeks (all in the name of science). Average weight gain was about 14 lbs (6.4 kg). After the study ended, they were monitored for a 12-month period during which the subjects collectively lost a good bit of their excess weight gain (10 lbs or 4.7 kg) within 6 months. However, at the end of the 12-month period, they gained a few lbs back. Two and one-half years later their weight was still an average 6.6 lbs +/- 8.8 lbs (3.1 kg) higher than their initial weight and this weight gain wasn’t muscle – it was fat. The age-matched controls showed no changes from their initial weight at the start of the study.

What can we make of this study? According to the authors, brief periods of overeating and under exercising may have longer-term consequences. And the lesson learned here is that we should leave yo-yos to the toy manufacturers and instead stick with a nutrition plan that we can maintain for a lifetime. Even if that means your progress is gradual – at least you’ll be moving forward consistently versus taking one step forward and two steps back. For those who have struggled with yo-yo dieting in the past, it’s time to get off this road to nowhere and work on a healthy diet, weight and body image. Learning to love your body pays great dividends that no diet can match.

For a great video that depicts this shame and yo-yoing, check out this video from Oprah’s TV show.

Egg Recall: What You Need to Know

2010-08-21T08:37:00.000-07:00

Eggs are one of my favorite foods, packed with protein and nutrients, but, I do play it safe when it comes to food safety. And, you should too. If you are concerned about the current egg recall, check the FDA’s website for continuously updated information: click here. Or better yet, click here for information on the exact brands and lots recalled.

And, if your eggs are among those recalled (Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Tafficanda, Farm Fresh, Cal Maine, Shoreland, Lund, Dutch Farms, Kemp, and Pacific Coast – though there may be more as this recall is growing) or you aren’t sure, return them for a refund and then throw them out.

Young children, the elderly and those with a weakened immune system need to be especially concerned about consuming anything that can put them at risk for a food born illness such as salmonella. However, everyone should employ food safety standards at home and when eating out (check the restaurant, is it clean? Do the employees use gloves? What’s the Department of Health Score for the restaurant)? Because, it just makes good sense to do so!

At home, keep cold foods cold and hot foods hot. Be wary of buffets and avoid food that has been sitting out for hours on end (or touched by many people; think twice about that office picnic or office party – you never know how people handle food at home). Wash your hands thoroughly (for 20-30 seconds with soap; I can’t emphasize this enough as I’ve seen people go to the bathroom and eat without washing their hands more times then I can count). In fact, washing your hands is the easiest thing you can do to prevent yourself from getting sick and passing germs to other people!

For more information about safe egg handling, click here.

Cooking eggs thoroughly kills salmonella. However, when there is an outbreak, if your lot of eggs (or any other food) has been recalled, it’s best to play it safe and avoid eating them.

Got Fatigue?

2010-08-16T20:28:00.000-07:00

Sleep is way underrated. In fact, I often overhear people bragging about how they go to bed late, wake up early and run through their days. I'm not sure if I believe all of these stories but a lack of sleep is nothing to write home about. It's the fastest route to poor performance and mental fuzziness. And, you'll look tired!

Besides a lack of sleep, sometimes there's something else going on and you have to do a little detective work to figure out what's causing your daytime yawning and daydreams of getting some zzzz's. Check out this article on FitnessRx Magazine's website about the top causes of fatigue in women.

If any of these sound like you, it's time to talk to your physician. If not, it's still time to go to the doctor and find out what's going on. After all, walking around like a zombie is no way to live.

Restless Leg Syndrome: Tips for Prevention

2010-08-09T12:31:00.000-07:00

A few years ago I first heard about restless leg syndrome and just couldn’t imagine it was a real phenomena. An urge to move your legs at night because it feels like something is crawling up them, they ache or feel pulled? That would constantly make a person wake up! Indeed, it does... and restless leg syndrome is one of those things that scientists just don’t know much about, which makes it really tough to treat. However, there are a few key things you can do (this list is compiled from a mix of the research and what my dietitians colleagues, with decades of combined experience, have uncovered from working with their clients):

1. Avoid emotionally upsetting events. Or rather, learn coping skills since life can throw you a curveball sometimes.

2. Get a good bed. After all, your sleep will improve no matter what if you have a good mattress, sleep in a room cool in
temperature with no lights (cover up those bright red displays on TVs, clocks etc. and turn your phone off or put something
over it so it doesn’t light up incessantly).

3. Get your storage form of iron, your ferritin, checked (this is a must, don’t settle for only having your hemoglobin and
hematocrit checked). Iron deficiency anemia can cause restless leg syndrome. Your ferritin levels will likely need to be
above the lower limit (12 ng/mL) to alleviate your RLS symptoms. A ferritin level above 50 ng/mL is necessary.

4. Consider a nighttime calcium/magnesium supplement to help you sleep.

5. Relax before bedtime, avoid any stimulants (caffeine, nicotine) and of course, avoid alcohol.

For more information restless leg syndrome, check out this blog.

Vegetarian? Make Sure You Eat these Key Nutrients!

2010-08-07T12:56:00.000-07:00

Vegetarianism is a healthy way of life for many. Some research shows vegetarians live longer, are leaner and their diets include more fiber and disease fighting antioxidants. There are four main categories of vegetarians and a fourth one for those who just don’t want to go all the way: Flexitarians. Here’s a brief description of all of these categories in descending order of how completely they follow a vegetarian diet in addition to what nutrients they need to be especially cognizant of consuming:

Flexitarian – a Flexitarian is someone who is a semi-Vegetarian. They choose vegetarian meals the majority of the time but sometimes fit in poultry or turkey. Most Flexitarians avoid red meat completely. Flexitarians are not really considered vegetarians but, their diet still consists mainly of plant-based foods. For more information, check out this book on the Flexitarian diet.

Pesco-vegetarian – this diet includes fish, eggs and dairy but excludes all meat and poultry. The main nutrient of concern for a pesco-vegetarian is iron. However, if you eat fish, opt for oysters and clams for your heme iron (the most well absorbed type of iron).

Lacto-ovo vegetarian – this person excludes meat, fish and poultry but eats eggs and dairy products. With good planning (and by including eggs and dairy) the lacto-over vegetarian can easily meet most of their nutrient needs (though they may fall short on iron, copper and zinc).

Lacto-vegetarian – meat, poultry, fish and eggs are excluded but milk and milk products (butter, cheese, yogurt) are allowed.

Vegan – this is the most strict type of vegetarian. Vegans exclude all animal flesh as well as eggs and dairy.

The top vegetarian sources of commonly missing nutrients:

Iron – vegetarians who avoid fish need about twice the amount of iron as non-vegetarians. Why? Vegetarian source of iron (non-heme iron) are poorly absorbed so you need more. Choose from fortified cereals, instant oatmeal, soybeans, lentils, beans (kidney, navy, lima, pinto), tofu, spinach, and black-eyed peas. Consume your iron rich foods with a source of vitamin C such as tomatoes and citrus fruits to enhance the absorption of non-iron. You can also cook in an iron skillet (add foods rich in vitamin C to your skillet meal).

Iodine – this forgotten nutrient is found in iodized salt. If you avoid salt, eat kelp.

Calcium & Vitamin D – dairy is your best bet. If you avoid dairy, choose calcium and vitamin D fortified soy or rice milk. Vitamin D insufficiency and deficiency is emerging as a huge issue in all people, vegetarian or not.

Vitamin B 12 – is found in animal flesh and animal products. Therefore, vegans are very likely to fall short on this crucial vitamin and should therefore focus on consuming fortified cereals (check for B12) and fortified tofu or, talk to your physician about taking a supplement.

Zinc – is found mostly in some types of seafood and meat. For vegans, opt for fortified breakfast cereals, cashews, almonds, kidney beans and peas.

Copper – sesame seeds, cashews, crimini mushrooms, cooked soybeans, cooked barley, sunflower seeds, cooked tempeh, garbanzo beans, navy beans.

Omega-3 fats – are mainly found in fatty fish. If you avoid fish, opt for walnuts, soybean oil, flaxseeds, hemp seeds, dark green leafy vegetables and canola oil. These contain the omega-3 fatty acid alpha linolenic acid.

In general, the more you cut out of your diet, the more diligent you must be to ensure an adequate nutrient intake. It can be done, though sometimes not through food alone and therefore supplements are necessary. Vegans, in particular, should consider supplementing with a B complex (which includes B12), iodine rich foods, vitamin D and calcium or consider a multivitamin which will help make up for dietary shortfalls.

What's the Point of a Raw Food Diet?

2010-08-03T16:21:00.000-07:00

Every once in a while I pick up US Magazine, People or a similar publication while waiting in line at the grocery store (I know I know, I’m the only person around who isn't glued to facebook mobile). And, I always turn to the sensational (i.e. crazy) stories about how stars got their celebrity bodies. What they report about their diet is pure entertainment for me. Like the actress who said she didn't eat carbohydrates and then listed her daily diet which consisted of, among other things.....fruits and vegetables - both of which are otherwise known as forms of... *gasp* carbohydrate!

But when it came to Raw Food Diets, I pretty much ignored the stories. And then one day, while doing something random (probably driving) I sat there thinking and thinking trying to figure out why someone would take the deep plunge into a raw food diet.

Here are some of the benefits as I see it:
• Enzymes - that doesn't really jive though as our body has the enzymes it needs to break down food during digestion. Next...
• No Acrylamides. Acrylamides are formed during high temperature cooking and may be carcinogenic (cancer-causing) in high doses.
• No heterocyclic amines, carcinogenic compounds formed by cooking meat at high temperatures.
• Loads of fresh fruits and vegetables
• Little prep time

Drawbacks:
• Boring!
• Where’s the protein? If you can load up on fish (including oysters), you’ll get the protein and minerals you are missing if you cut out meat and poultry (zinc, iron, copper). If you don’t eat fish, good luck with many missing nutrients since fortified cereal is… cooked! PS, you need that fish for EPA and DHA (omega 3s) too so, enjoy your sushi!
• No dairy (and therefore little to no calcium or vitamin D – unless you want to eat 10 cups of leafy greens a day to get your calcium and bake in the sun for your vitamin D).

The raw food diet has some perks but some serious drawbacks as well. If a person is doing it solely for health reasons I think it should be a short-term thing. Otherwise, I just don't see the point of living without ever eating a nice chocolate dessert.

It's Time for a Diet Overhaul

2010-07-29T06:31:00.000-07:00

You’ve heard about shopping the perimeter of the store. And by now you probably also know that creating a list and sticking to it (regardless of what is on sale) will help you save money by preventing you from buying food you either won’t use or probably shouldn’t be eating. But, have you ever considered taking a close look at your diet and considering if you need a overhaul? Here are some keys to a healthy diet as well as some food groups you should include in your diet (or supplement somehow).

1) Variety – eating a variety of foods increase the likelihood that you will obtain a wide variety of nutrients (vitamin, minerals) and antioxidants.

2) Consider the staples:

a. Dairy – got milk? Or yogurt or cheese? If not, try a calcium fortified soy milk, cheese or yogurt or, consider
supplementing with calcium + D (D especially in the winter in states north of Atlanta, GA).

b. Fruit – are loaded in vitamins, minerals and antioxidants to keep you healthy and functioning in tip-top shape. Most
adults need 2 cups of fruits per day. If you aren’t getting that now, consider adding fresh or frozen fruit to your dishes.

c. Vegetables – like fruit, vegetables pack a nutrient-rich punch. Think variety and different methods of cooking and
preparation. You can choose salads or opt for steamed veggies. Top your pizza with veggies or load your sandwiches,
soups and stews to get the recommended 2.5 cups per day.

*There really is no substitute for not eating fruits and vegetables. So, find ones you enjoy eating and load up (you can eat
more than the recommendations, especially for vegetables).

d. Lean meats & poultry – are your best bet for iron, zinc and ……How much you need really depends on what your
individual needs are but, every single adult should aim for 25-30 grams of protein per meal (yes, that includes
breakfast).

e. Fatty fish – salmon, mackerel, herring, halibut, sardines and anchovies are packed with EPA and DHA, the two fatty acids
that are best for preventing certain risk factors for cardiovascular disease as well as potentially decreasing the risk for
depression in some individuals – notably women and the elderly). How much do you need? I use the American Heart
Association’s recommendations: eat at least
two 3.5 ounce servings of fatty fish every week (after all, cardiovascular disease is the number one cause of death
in men and women in the U.S. as well as many other countries). If you don’t consume fatty fish, add walnuts, flaxseeds
and flaxseed oil to your diet or, talk to your physician about omega 3 supplements.

When you add any of these foods that are missing to your diet, you will force out some of the not so healthy foods that you are eating while adding a variety of nutrients you need for optimal health.

Common Nutrition Pitfalls for Women

2010-07-24T18:41:00.000-07:00

In general, there are some patterns I frequently seen in the dietary choices made by men and women. Men typically opt for more meat and starchy carbohydrates (as well as beer) while women tend to have more fruits, vegetables and sweets in their diet. Athlete or not athlete, I help each person balance out their dietary choices while figuring out how to get what they need given their current lifestyle (fast food only, they cook, can’t boil water, tight food budget etc.). With pre-menopausal women, I can scan their diets in just a few minutes and find out that >90% are missing one or more of the following categories: dairy, red meat, fruits or vegetables or fatty fish. Some supplement while the others have no idea just what they are missing out on. So, we do a little dietary juggling to find out if they will or will not eat those foods (those who will just add food make my job easier!). But for women (or men) who avoid any of these categories, we have to find a way to get calcium, vitamin D, magnesium (all from dairy), iron and zinc (red meat) and omega 3 fatty acids (fatty fish).

Got Milk?
The next best thing to dairy is calcium and vitamin D fortified soy milk (yes I know greens contain calcium but you’d have to eat more greens to meet your calcium needs than I have ever seen in the thousands of diet records I’ve looked at). Otherwise, it is important to supplement (it is especially important to supplement with vitamin D in the winter time if you live north of Atlanta, GA).

Where's the Beef?
Red Meat is the absolute best source of dietary iron. If you hate it or watch your food budget, opt for the runner's up: dark turkey and chicken. Plant based sources aren’t absorbed as well but you can maximize your absorption of vegetarian sources of iron if you eat them with vitamin C rich foods and without foods rich in compounds that bind iron. Zinc – oysters, beef and crab are your best bet. If you shun any of these foods, choose a cereal fortified with zinc (it should contain at least 25% of the DV).

Stock the Pond with Fatty Fish
If you avoid fatty fish, opt for walnuts, flaxseeds, flaxseed oil and omega 3 rich soy oil. All of these contain ALA, not EPA and DHA (the two fatty acids with the most research behind them for preventing cardiovascular disease, decreasing depression in some populations and fighting inflammation – and possibly helping athletes return to competition sooner after concusions). But, consuming foods rich in ALA is better than consuming little to no omega 3s at all!

Whatever you do, look for the missing gaps in your diet and fill those with the right foods, the next best choices or, dietary supplements.

Good Food, Bad Food

2010-07-19T20:27:00.000-07:00

Many people I meet put food into one of two categories: good or bad. Like a small child who has to go to timeout, they wag their finger and get this look of disgust on their face while watching you pick up yet another piece of soft, fresh cinnamon swirl bread. Their eyes stare with intense focus and, without even a word uttered, you can sense just how disturbed they are. ''

As I walked through the large exhibit hall at the Institute of Food Technologists annual conference in Chicago this past weekend, it dawned on me just how much food scientists, companies, researchers and processors are doing to provide us with a diverse, tasty food supply that meets our nutrition and health needs. The exhibit hall was packed with companies that produce plant sterols (to lower cholesterol), unique types of fiber, amino acids, vegetarian sources of protein, omega 3s, gluten free flours, sugar substitutes and a variety of other functional ingredients to enhance health. These people can make a delicious high fiber pizza that packs a nutrition punch, caffeinated chewing gum for our country's military to "stay alive if you stay alert", and great tasting electrolyte replacement beverages. Indeed, we are very lucky consumers to have so many options to meet a variety of health needs and personal tastes.

And, while the "good food, bad food" mentality will persevere, I'll leave you with this: you can choose just about any food you want in American and for the most part, find it quickly and easily. Sure, we may be a fast food nation and one with a ton of convenience foods but, this should make choosing wise choices that much easier.

How to Lose Weight Quickly for an Event

2010-07-07T06:25:00.000-07:00

First, let me say I’m not a fan of rapid weight loss. Why? Because I’ve seen way too many people lose weight and gain weight in a pattern that repeats itself more than a politician makes promises he can’t keep. They go on some version of a grapefruit, hot lemon water diet, lose pounds, go to an event, eat everything in sight and gain the weight back plus a few for the road. Then they get frustrated with dieting, throw the towel in and gain more weight, then go on another quick weight loss diet….. ah, well, you get the drift.

And though I’m not a fan of taking off pounds quickly, I get this question so often that I figured it was time to tell the world how to lose weight quickly and safely for an event. So, here are my rules of the road (in no particular order):

• Don’t believe the hype. Celery doesn’t have negative calories and hot lemon water or dousing your food with pepper isn’t going to speed your metabolism. Sure, you can drink hot lemon water or diluted cranberry juice but the only effect you’ll notice is frequent urination and possibly a placebo effect.
• Keep a food journal. Doing so will keep you accountable. Be sure to write down every BLT (bite, lick and taste).
• Lower your sodium intake. Sodium makes you retain water. Yes, we do need some sodium but I don’t recommend cutting it during exercise. Instead, cut down on sodium throughout the day when you are not active.
• Eat 300-400 calorie meals evenly spaced throughout the day.
• Make ½ of your plate vegetables or a mix of vegetables + fruit (do not consume large amounts of fruit at one time).
• Add protein to every meal.
• Add a portion of whole grain carbohydrates (1/4 of your plate) to your meals if desired.
• Cut out added sugars.
• Cut out all alcohol.
• Exercise!

Don’t stay on a low calorie and/or restrictive diet for a long time or you may end up with several nutrient deficiencies. Or, you might just end up grouchy. Neither one is very good.

What about quick weight loss pills and services? Steer clear of the pills/supplements (oftentimes they combine diuretics with laxatives). Diuretics alone are generally safe if used as directed. However, they can lower your blood sodium (called hyponatremia; this can be very harmful for the body) and cause a drop in blood pressure so, use with caution. As for the body wraps etc., I don’t know anything about these and, until something has research to back it’s use or I’ve tried it myself and noticed a difference, I just can’t recommend it. If you are going to give a body wrap a try, opt for one with a guarantee.

If worse comes to worse and you don’t fit into your favorite dress or suit, look at this as an opportunity to buy a snazzy new outfit that will make you look more in style and hide that extra 5 lbs at the same time.

Low Calorie Diet Concerns

2010-07-05T12:39:00.000-07:00

Low calorie diets have their place – they can help morbidly obese persons shed weight rapidly thereby modifying their disease risk factors and enhancing their quality of life. But, for the person who needs to lose 20 lbs or so, low calorie diets are not my favorite option unless they use them for a short period of time (2 weeks or so) or alternate low calorie days with higher calorie days (this takes diligence and commitment).

Why the distain for very low or low calorie diets? According to research out of Baylor University, conducted on Curves participants, a low calorie diet can quickly drop metabolism which means you are burning fewer calories at rest (in this particular study, they put women on a 1,200 calorie diet for 2 weeks). And that counteracts exactly what you are trying to do.

Secondly, low calorie diets can make you feel fatigued (especially if you aren’t eating the right foods). And when you are lethargic, all you want to do is sit on the couch – not exactly a good prescription for weight loss.

And lastly, low calorie diets often make it tough to get all the nutrients we need everyday. You have no calories to spare when you aren’t eating much, which means every single food must be packed with nutrition value. And, even then, you won’t meet your nutrient needs making a multivitamin and possibly supplemental vitamins or minerals (in addition to the multivitamin), very important. Some of the most obvious nutrient deficiencies and the foods you must eat to obtain enough of each nutrient include:

- Omega 3s ~ fatty fish
- Vitamin D ~ salmon, mackerel, fortified milk, some yogurts, some mushrooms, sunlight
- Calcium ~ dairy
- Iron ~ red meat, dark turkey meat, chicken
- Magnesium ~ halibut, mixed nuts, cereal

If you want to try a low calorie diet, do so only under the care of a Registered Dietitian and/or a physician who specializes in bariatrics (few physicians are versed on diet and nutrition but bariatrics is the study of obesity).

Micronutrient Smackdown: The Best Time to Take Your Vitamins and Minerals

2010-06-21T15:16:00.000-07:00

When I meet with people for nutrition coaching, I always ask about their medicine and supplement intake in addition to what they are eating. Why? Because I can quickly spot gaps in their diet and want to be sure they are filling those gaps with supplements. Especially if they don't plan on adding food sources of the missing nutrients in the near future. And, I want to be certain they are taking their supplements the right way because many people were never told by their physician (or the supplement bottle doesn’t mention this) how to take a particular mineral.

You see, like sorority girls, minerals are finicky. There are many forms for each one (calcium carbonate, calcium citrate, calcium phosphate for example) and some just don’t like each other (calcium interferes with iron absorption) or certain medications (calcium decreases the absorption of some antibiotics) and others have formed a team and help one another (magnesium and calcium for example). So, how do you know what to take when? Here’s a quick rundown of some of the common ones people need and how to take them:

Multivitamin – take with food and preferably food with a little fat (to enhance the absorption of fat soluble vitamins you need fat in your gut).

Calcium – take up to 600 mg at a time. If your physician told you to take 1,200 total mg/day, take them in two separate doses of 600 mg, spaced apart. Your body only absorbs up to 500-600 mg at a time.

Calcium carbonate – take with food to enhance absorption.
Calcium citrate can be taken at any time of the day.

Magnesium – no single pill multivitamin contains 100% of your magnesium needs per day (it is a very big mineral) and according to population based data, many people don’t consume enough magnesium through their food intake. Diuretics and antibiotics can contribute to magnesium depletion. Magnesium can decrease the absorption of tetracycline (an antibiotic); so take it at a different time of the day. Many antacids and laxatives contain magnesium –be careful consuming these due to the potential for elevated blood magnesium levels. Enteric coating of magnesium supplements can decrease their absorption.

Iron – there are two types of supplements.
Non-heme iron is the most popular (all over the counter kinds of iron unless it says it contains heme iron) and should be taken with vitamin C rich foods, a heme iron source (meat) and not taken close in proximity to calcium containing foods or supplements. In addition, it’s best not to take this with leafy greens or bread as each has compounds that decrease the absorption of non-heme iron.

Heme iron – easy, take anytime of the day. You don’t need to worry about what you take it with or without.

Zinc – taking an iron supplement with large quantities of iron may decrease zinc absorption. According to NIH, taking iron between meals will help (see note above about iron). High intakes of iron can impair absorption of copper.

Potassium – found in very minor amounts in multivitamins. Don’t take extra potassium unless your physician tells you to do so. Having too much or too little potassium can be very serious.

Given that so minerals are picky and like to be treated a certain way, you are probably wondering why you should even bother taking a multivitamin mineral supplement. However, I do believe in multis and take one myself and I supplement with minerals as needed. After all, I try to eat a wide variety of foods but, I realize that there are probably vitamins and minerals I am missing out on.

Nutrition Confessions from a Dietitian

2010-06-15T09:54:00.001-07:00

After writing my post the other day, I feel like I have a few nutrition confessions to make. These have weighed on me for some time because people have this perceived notion of dietitians even though we all have different specialties, different food likes and dislikes and very different food habits. So, here goes....my nutrition confessions revealed....

1) I'm a little afraid to try new foods. I am convinced this is a genetic trait as my mom still tells stories about how, at age 4, I picked bacon apart because I hated the "white stuff" and when I was a little older I sat at the table for hours because I wasn't about to put one single pea in my mouth. I've gotten better as an adult but even then, I struggle with the noted sliminess of oysters and mystery food like Cajun Boudin.

2) I don't like red meat. It was my freshman year of college and I had hit a record for fast food joints and all-you-can-eat buffets while on road trips with my college soccer and softball teams. One day after a particularly bad road trip where I didn't play and we lost, I decided, in a rather defiant mood, that I was done with red meat. That McDonald's hamburger was my last. I never liked the taste of red meat, the smell of steak reminds me of an ex-boyfriend whose table manners are trumped by 3 year olds and, I can find my protein, iron, zinc, creatine and B vitamins elsewhere.

3) I am not a foodie. *Gasp* I know, I've heard it before. I'm not totally sure what a foodie is but I imagine it to be the person who thinks about food throughout the day, reads cookbooks for entertainment and can't wait for their next gourmet meal. And, that isn't me. I am, however, fascinated with food as medicine and how food can fuel better performance, mentally and physically. And, I do enjoy the taste of various dishes. But, if you take me to a foreign country, you are more likely to find me wandering around taking in the sights then sitting at a restaurant for hours.

And, despite not being a foodie, I can cook just about anything (and will even cook red meat) and I'm one heck of a baker (or at least I like to think so) because my mom taught all of us how to cook when we were young and by 11 I had free range of the kitchen. Like a chemist in action I'd mix together ingredients, pop them in the oven and wait eagerly for my parents approval of my concoction. As a young teenager I made cinnamon swirl bread from scratch, multi-layered cakes, and infamous fat free muffins that had the consistency of a doorstop. And apparently, I passed my creativity on to my 5 year old niece who helped herself to the cabinets last night and found a strawberry cereal bar which she topped with cake icing and sprinkles. Absolutely brilliant! That's one I never thought of as a child but I see a future baker in the making....

4) I don't care what people eat. Okay, I care if you are a client or family member. But, unlike a dietitian friend of mine who slapped my wrist when I reached for dessert or my uncle who flipped out when I salted my food in front of him, I'm not going to shame you, comment or even pay attention. Eat whatever you'd like. Just don't make silly comments like "oh this is going straight to my hips" or (as overheard in a restaurant) "I really want your corn muffins but I'm trying to avoid carbohydrates, but they are really good, but..." or "I'm eating salad for a week straight after today". Please, for the sake of the people you are dining with, leave your shame and guilt behind and enjoy what you are eating.

So there you have it, I've confessed all of my dietitian sins. I'll cook or bake whatever you'd like but might not try a dish you made (don't be offended) and don't expect me to pay attention or comment on what you are eating. I'm off duty when I'm dining out :)

A Few Nutrient Packed Foods You Should Add to Your Diet

2010-06-13T18:53:00.001-07:00

Whenever I see lists of foods you "should" eat, I typically cringe. Why? Because I think it is absolutely ridiculous to single out the "Top 10 Foods You Should Eat" (no doubt after I say this some editor is going to ask me to write such a list). Who says blueberries are nutritiously superior to blackberries? Or that spinach contains more antioxidants than my favorite leafy green, arugula. What criteria are these lists based on and what if I don't like the food on there? (FYI: you'd have to pay me to eat spinach unless it is finely chopped and sprinkled on top of pizza so I can't taste it).

Despite my disgust in the "Foods You Should Eat Daily" lists, there are a few nutrition powerhouses that cross my mind as "maybes" as in "maybe one day I'll get up the gusto to try that food." These include liver, oysters and sardines. So when I saw this list on Dr. Oz's website (add clams in there), I felt a bit of shame and guilt for my wuss-like fear of trying new food.

So why are these 3 foods on my mind? All are loaded with iron (which is especially great for non-meat eaters). In fact, as Dr. Oz points out a serving of chicken liver contains 70% of your iron needs for the day and it contains heme iron (the kind your body absorbs more of). Different types of liver contain varying amounts of iron, pork liver contains more than twice the amount found in chicken liver. Liver is also a natural source of vitamin D (which is not found in many foods), packed with vitamin A, B vitamins, copper (very hard to find in food and some trace minerals.

Oysters remind me of one of my basic nutrition classes in college. We had to create one day's worth of food that contained 100% of the daily value of everything we needed. Then we had to do the same thing but we had 3 days to meet that 100% value. That one exercise made me realize that by my estimates, 99.99% of the population does not get what they need from food alone (unless maybe they are loading up on vitamin and mineral fortified foods and beverages). The nutrient hardest to get: copper. So, I added oysters to my mock diet and came out with a winning nutrition plan that I bet no one would ever eat. But, nevertheless, oysters are rich in iron, vitamin A, vitamin D, a few B vitamins, copper, magnesium, calcium, zinc, manganese and phosphorus. One day I swear I'm going to try one of those slimy little creatures.

And last but not least are an Italian favorite, sardines. Sardines are rich in omega 3 fats, vitamin D, a few B vitamins, iron, phosphorus and the trace mineral, selenium.

While all of these "Top 10" type lists contain no-brainer fruits and vegetables, it's also a wise idea to take a look at a variety of types of protein. If your mainstay is chicken, try chicken livers (I did eat my share of these as a kid), oysters and sardines. I promise I too will try oysters and sardines as soon as I get to a good seafood restaurant! Or, I may try a family favorite - sardines on pizza because, after all, if I can eat spinach on pizza, I'm sure I can try sardines!

Blood Tests for Iron Deficiency Anemia

2010-06-04T18:31:00.000-07:00

Iron deficiency anemia is a little confusing. Hemoglobin and hematocrit are the two most common tests for this kind of anemia but they really don't tell the full picture. Instead, a full iron panel can tell your physician more about what is going on in your body. Here's a look at what a full iron panel tests for:
Hemoglobin (Hgb) – is a protein in red blood cells that carries oxygen to your body’s tissues and carbon dioxide from your tissues to your lungs. Low levels of hemoglobin indicate that the body has a reduced capacity to carry oxygen throughout the body.

Hematocrit (HCT; or PCV, packed cell volume) – this measures the percentage of red blood cells in the blood. So for instance, if your HCT is 40%, this means that 40% of your blood volume is composed of red blood cells.

Red Blood Cell Count (RBC) – bed blood cells are your oxygen carrying cells. A low RBC signals anemia.

Transferrin – a transport protein that carries iron. If a person is iron deficient, transferrin levels will be high.

Serum Iron – measures the quantity of iron in the blood that is bound to transferring. Serum iron levels are low if you are deficient in iron.

TIBC (Total Iron Binding Capacity) – measures your body’s ability to transport iron. If a person is iron deficient, their TIBC will be high.

Ferritin – measures your iron stores in the body. When your blood levels of iron drop, your body can pull iron from your ferritin. Lower levels of ferritin signal iron deficiency.

Nutrition Concerns with Gastric Bypass

2010-05-25T12:11:00.001-07:00

Today I ran into a lady who had gastric bypass 6 years ago (that part I didn’t know). She’s 50 years old, has osteoporosis in one hip, osteopenia in her back and other hip, she’s anemic and deficient in vitamin D. So I asked her if, after her gastric bypass, her physicians told her about the potential for nutrient deficiencies and emphasized the importance of frequent follow-ups to examine her iron, B12 and vitamin D status as well as her bone density. While I’m used to other people letting me know their doctors don’t give them very in depth follow-up instructions, I figured surgery patients would be more closely monitored. But, I was wrong.

If you have had a gastric bypass, be certain to take your health into your own hands and schedule check-ups. Your body will have a tougher time absorbing iron, calcium, vitamin D and vitamin B12. Nutrient deficiencies are common in gastric bypass because the “bypass” part creates a bypass of part of the small intestine so you don’t absorb as many calories (nor will you absorb certain nutrients from food). Because a lack of B-12 and iron can both cause anemia, leaving you feeling fatigued and crummy and deficiencies in D and calcium can lead to brittle bones, it’s vital to monitor your status frequently, even if you are taking supplements per your physician’s orders.

The more extensive your surgery, the more likely you are to have nutrient deficiencies. Though the weight may come off immediately, you’ll need to resume the eating plan and supplements your physician gave you, for a lifetime. For some, gastric bypass is an absolute lifesaver but, you still need to pay close attention to your overall health even after the weight comes off.

Feeling Tired? What Lab Tests do You Need?

2010-05-20T07:01:00.000-07:00

If you are tired all the time, it's important to see your physician to rule out common causes of fatigue. Three of the top causes are iron deficiency anemia, hypothyroidism and mono. I know what you are thinking here, there's no way you have mono, that's for college kids. However, mono is actually very contagious. You don't need to swap spit with someone to get it. You can also catch it from someone sneezing or coughing near you, eating or drinking after someone and possibly just being in close contact with someone. And if you are at the doctor already, drawing a little more blood and getting a mono spot test is worth it!
Click here to find out what labs you need to test for iron deficiency and for more information about hypothyroidism, click here.

So what do you do if all three of these tests come up negative (meaning you have none of these conditions)? Now you look for other causes such as stress, depression, sleep apnea, a hectic busy schedule, lack of sleep (or lack of good quality sleep) and what you are eating (or not eating). Sometimes, figuring out what may be wrong is best done by process of elimination. You eliminate the potential obvious issues and then look for other possibilities causing the problem.

Got Sleep Apnea?

2010-05-17T17:14:00.000-07:00

Is it me or is everyone on a cpap machine? I can't even count the number of people who have told me they have sleep apnea and wake up (insert astounding number here) of times per night from sleep apnea. So what is the real deal on sleep anpea?

If you have sleep apnea, you have several episodes though the night where you temporarily stop breathing. Each time you stop, you wake up and disrupt your sleep pattern. What are the signs and symptoms of sleep apnea? Constant fatigue during the day, regardless of how much you sleep and snoring. In addition, those who are overweight or obese are more likely to suffer from sleep apnea.

Why does sleep apnea need to be treated? Well for one thing, if you don't treat it you are likely to suffer from fatigue and you may increase your risk of stroke and heart attack as well.

Celebrating Women's Health Week

2010-05-14T16:39:00.000-07:00

In honor of Women's Health Week, NIH Office of Women's Health recommends several important steps you can take to improve or maintain good health. All of these steps (listed below) are ones you've seen before. In fact, you've likely seen them many times. Therefore, it isn't the "what" but "how" you get these things accomplished with a busy, hectic schedule that can leave people stumped pondering their schedules over an ice cream sundae.

So first up to bad is physical activity. If you can't seem to meet the physical activity requirements, at the very minimum, strap on a pedometer or accelerometer and get 10,000 steps a day. Park further away, walk to your coworkers office instead of emailing, take a trip to a Super Target, and find other ways to add steps in. Also, start with small steps - do 15 minutes of activity a few days a week and work your way up. You'll soon find you have the time, you just needed to get better organized, make those phone calls while you walk or hop on a stationary bike if you want to watch the full hour of Dancing With the Stars.

Secondly, eat a healthy diet. Your diet does not have to be perfect, trust me, no one's is. However, it should be produce-packed, include low fat or fat free dairy, lean meats & poultry, fatty fish, nuts and seeds. If you are missing out on any of the major groups (meat for instance), take a look at the nutrients you may be falling short on as well.

As far as the last three on this list, they are no brainers. However, many people put other things first in life prior to going to their regular checkup (trust me, you can miss work for this), finding ways to manage stress and getting plenty of rest. As I always say, either pay now or pay more later. Think of it like interest on a car. If you pay for that car up front, you'll pay thousands less then if you pay 3 or 5% or more in interest. In a similar manner, if you take some time now, follow these steps below and take care of yourself, you'll pay a lot less later (both in terms of healthcare costs, lost time from work and lost time from life). For more about Women's Health Week and women's health in general, click here.

- Get at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both each week
- Eating a nutritious diet
- Visit a health care professional to receive regular checkups and preventive screenings
- Avoid risky behaviors, such as smoking and not wearing a seatbelt
- Pay attention to mental health, including getting enough sleep and managing stress

Dr Oz. on Exhaustion

2010-05-12T09:24:00.000-07:00

Exhausted? Pale, dizzy and cold? Check out Dr. Oz's top tips on anemia support, anemia research and anemia treatments by clicking here.

Even better though, I love this clip from Dr. Oz's show that shows : click here to view the video.

Why Overwhelmed Women Need to Take Care of Themselves First

2010-05-09T19:34:00.000-07:00

In honor of Mother's Day and just in time for Women's Health Week, I decided it's time to unveil the best thing women can do for themselves and their family: take some time to get healthy and stay healthy. It's common knowledge that women are the traditional "caretakers" and therefore, they take care of everyone else first. Then when things start going wrong and their body gives them warning signs, they get a wake-up call. Yet, it often falls on deaf ears. After spending decades putting everyone else (including volunteer work, colleagues, the random "friend" on facebook who asked for advice) first, it's a matter of retraining their thought patterns and practicing this new, yet uncomfortable, behavior.

You see, I've met many women who take on more than their fare share of tasks at home. And then among couples, if I ask the man something his response is often “I don’t know go ask {insert wife’s name here}” Clearly, the wife has taken on all of the holiday duties, scheduling appointments, waking up in the middle of the night taking care of the kids and other tasks that take mental and physical energy.

Not only does this take a toll on their energy levels, but, it takes a toll on their overall health because many of my female clients wait a long time before going to the doctor in fear that they are “complaining.” Aside from the burdens they often take on, women are also more likely to suffer from a variety of diseases and conditions including depression, autoimmune diseases, iron deficiency anemia (making them incredibly fatigued), endocrine and metabolic disorders including PCOS and thyroid problems such as Grave’s Disease and heart disease.

If you are an overwhelmed woman, my best piece of advice is to take some time for yourself without distractions. No cell phone, ipod, TV or conversations. Instead, take a walk, sit outside in a hammock and just think about what you need to take care of you. If it helps, journal about what you need to feel less burdened and live a healthy, joyous life. If you feel like your life has skidded off track, check out this article from Martha Beck (one of my favorite writers) titled: Wait! Stop! It’s All Too Much! Because, after all, as a well known public speaker once said: the best gift you can give this world is a healthy you.

Top Vegetarian Sources of Iron

2010-05-05T06:31:00.000-07:00

The best sources of iron are from meat, poultry and fish – all of which contain heme iron. Heme iron is absorbed better than the type of iron found in plants – non-heme iron. For vegetarians of course, this is a moot point since animal foods aren’t an option. Therefore, you’ll need to be extra aware of your iron intake.

The top vegetarian sources of iron include:
- Fortified cereals (look for 100% DV for iron)
- Instant oatmeal
- Lentils
- Lima, navy, lima, black, pinto
- Molasses
- Spinach
- Black-eyed peas

Be sure to include several of these foods in your diet and consume them with vitamin C to enhance the absorption of non-heme iron. Also, take your calcium supplements and antacids separately since they can inhibit the absorption of non-heme iron. Though the absorption of heme sources of iron are not affected by what is eaten concurrently, the absorption of non-heme sources is affected by what you concurrently.

Breaking Research: Iron Absorption during Pregnancy

2010-05-03T18:01:00.000-07:00

You're pregnant and hate your multivitamin (as if morning sickness wasn't enough and then you add constipation and vitamin burps on top of that) yet you want to do what's best for your developing baby. And, prenatal multivitamins serve a purpose - they provide more nutrients that regular multivitamins so both you and your little fetus stay healthy.

From B vitamins to the mineral iron, your need for certain vitamins and minerals increases during pregnancy. And, an abstract published this past week in the FASEB journal (Federation for the American Societies of Experimental Biology) outlines how important it is to pick the right form of iron. This study compared heme iron to non-heme iron. In food, heme iron is found in animal foods whereas non-heme iron is only found in plant-based foods. The majority of the iron in our diet is nonheme iron.

In this 2-day iron absorption study, 20 pregnant women (ages 16-32) and 12 non-pregnant women (ages 18-27) were randomly assigned to receive heme iron (in the form of a meal) or a non-heme supplement (ferrous sulfate). The results were astounding, heme iron absorption was significantly higher, by about 50%, in both the pregnant and non-pregnant women.

If you eat little red meat (the best dietary source of heme iron), it's a good idea to request that your prenatal contains heme iron as opposed to non-heme (the majority of iron supplements contain non-heme iron). Your iron requirements are much higher during pregnancy therefore putting you at greater risk for anemia. And, iron deficiency anemia isn't something to take lightly. During pregnancy, anemia can increase your risk of preterm delivery and low birth weight. In addition, it can leave you feeling absolutely exhausted.

The FASEB abstract can be found by clicking here.

Why is Anemia More Common in Some Ethnicities?

2010-04-30T14:39:00.000-07:00

There are many, many types of anemia with iron deficiency anemia the most common. And, anemia isn't really one of those nutrient deficiencies that is tied to certain ethnicities (the way vitamin D is for instance; where ethnicities with darker skin have a greater risk of deficiency). But, a study published a few years ago made me re-think the fact that some ethnicities may have an increased risk.

Among women, there's been a decline in the prevalence of iron deficiency anemia and folate deficiency related anemia. However, there's a tremendous difference by ethnicity: 3.3% for whites, 24.4% for blacks and 8.7% for Mexican Americans. Unfortunately, I'm left wondering and trying to figure out what is going on. According to this study, patient demographics, lab testing methods and known causes of anemia can't account for the differences. So, what's left? Is the data wrong? Have studies misinterpreted the prevalence data or have other factors contributed to this data? One potential factor mentioned is lack of adherence. For all the clinicians out there, we know this all too well. You can give someone a prescription or supplement and instructions, but, this doesn't mean they will indeed follow-through and take it as prescribed. Follow-up and monitoring are absolutely crucial with any deficiency.

Right now we have more questions than answers but hopefully future research will tell us why some populations have a higher incidence of anemia. Right now though, public health interventions can at the very least, target these groups to make them aware of iron deficiency anemia and increase testing in those who are displaying signs and symptoms of deficiency.

Am J Clin Nutr 2008;88(6): 1457-1458.

Top Vegetarian Sources of Iron

2010-04-26T06:57:00.000-07:00

The best sources of iron are from meat, poultry and fish – all of which contain heme iron. Heme iron is absorbed better than the type of iron found in plants – non-heme iron. For vegetarians of course, this is a moot point since animal foods aren’t an option. Therefore, you’ll need to be extra aware of your iron intake.

The top vegetarian sources of iron include:
Fortified cereals (look for 100% DV for iron)
Instant oatmeal
Lentils
Lima, navy, lima, black, pinto
Molasses
Spinach
Black-eyed peas

Be sure to include several of these foods in your diet and consume them with vitamin C to enhance the absorption of non-heme iron. And, take your calcium supplements and antacids separately since they can inhibit the absorption of non-heme iron.

Heavy Period? The Top Causes of Debilitating Menstrual Cycles Uncovered

2010-04-21T11:10:00.000-07:00

Some people share a little TMI (too much information). As one of my good friends said, as a dietitian, you are part nutrition expert, part behavioral expert and part therapist. And granted, I’d expect my female clients to ask me questions about their bodily functions (from constipation to the color of pee). But when random girls I don't know well start telling me about their heavy menstrual cycles and asking about herbal remedies, it’s TMI. I’m not a doctor, you’re okay and it's Friday night and we are at a bar for crying out loud. But, naturally curious, I began to wonder why some women complain about abnormally long periods, debilitating cramping, bloating and a 1-week a month total meltdown.

So I went searching and found some common causes of heavy periods include:

- Hormone imbalances - the pill can help, sometimes.
- Uterine fibroid tumors - these are typically benign (non-cancerous). The causes are not known but these tumors rely on estrogen for growth.
- Cervical polyps - small growths on around the cervix
- Pelvic Inflammatory Disease (PID) - typically caused by a STD though some women get PID after childbirth or a gynecological procedure.
- Cervical cancer - yearly pap smears are vital for catching this cancer early!
- Endometrial cancer
- Bleeding disorders
- Diseases such as lupus, cirrhosis of the liver, diabetes, thyroid and pituitary disorders

If you have heavy bleeding and/or cramping and pain, don’t just wait it out while popping Advil. Instead, talk to your physician to rule out any medical conditions that may be causing changes to your cycle. In addition, may sure your physician runs lab tests including CBC, thyroid functioning and an iron panel.

China Girl Eats Pounds of Dirt Daily

2010-04-18T17:16:00.001-07:00

This morning I found myself drawn in to a rather odd, yet interesting story my good friend Joey Antonio posted on facebook this morning. Joey has a knack for finding the strangest of strange news. And this story was no different.

A 19 year old Chinese girl named Bao Bao, tried eating soil, aka dirt, at age 7 and hasn't been able to stop since. In the brief article, she said "It gives me energy. I can live without rice but not soil." She only eats a yellowish, soft powdery soil and consumes about 1/2 to 2 pounds of dirt daily to "keep going." And apparently her boyfriend doesn't mind since she is a cheap date.

As odd as it sounds, Bao Bao is not alone in her dirt eating habit. She has what is callled pica, a pattern of eating non-food materials such as dirt, clay, animal feces, paint, sand or paper. If you are starting to have clear memories of the strange little kid from your pre-K who ate mudpies, you aren't alone, pica is most common in children than young adults like Bao Bao. In fact, an estimated 10-32% of kids aged 1-6 eat dirt. Pica can also occur in pregnant women or adults who crave a certain texture that they apparently can't get from food.

Aside from the obvious issues with eating non-fresh dirt, people with pica often have iron deficiency anemia and zinc deficiency. If you or someone you know has pica, it's time to visit a doctor and get tested for blood levels of iron and zinc and also check for other medical problems such as lead exposure.

Munching on dirt is a cheap habit but could be a sign of other medical issues and of course, it may result shame or at the least, odd stares from your friends and family.

Pregnant? Are you Consuming Enough Iron?

2010-04-08T10:12:00.000-07:00

Anemia can increase the risk of preterm delivery. Yet many women don’t consume enough iron while pregnant. In fact, the National Institutes of Health indicates that up to 50% of pregnant women do not have enough iron in their body. That’s why prenatal multivitamins are so important. They contain more iron (and other nutrients) than regular multivitamins. Pregnant women should also get their iron levels tested at least twice while they are pregnant (more often if necessary). However, you still need to be aware of the signs of iron deficiency (though some people have few or no symptoms from iron deficiency). They include:

• Fatigue
• Weakness
• Feeling cold, low body temperature
• Feeling out of breath easily
• Irritability
• Headache

Many women complain of side effects related to their prenatal supplement. You can minimize some of these side effects by consuming your supplement with food. If you are still having problems, talk to your physician about switching brands. Some women do better on name brand versus generic. And finally, consuming a prenatal multivitamin with heme iron will decrease the likelihood that your supplement will make you constipated (because you need less heme iron in comparison to non-heme, to raise your iron stores).

References
J of Nutr 2000;130:443S-447S.
NIH: http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm

Anemia - There are Several Kinds!

2010-04-07T05:33:00.000-07:00

The word anemia typically makes people think of iron. However, there are actually over 400 kinds of anemia. Anemia is a condition characterized by a lack of healthy red blood cells. Because red blood cells transport iron to your body’s tissues, anemia will often lead to fatigue. The most common types of anemia related to dietary deficiencies are:

Iron deficiency – over time, inadequate iron intake will hamper the body’s production of hemoglobin, a protein in red blood cells that carries oxygen. Iron deficiency can result from inadequate dietary intake (especially in vegetarians, children and teenagers), increased demand for iron (pregnancy and breastfeeding), heavy menstrual periods and digestive diseases such as Crohn’s and ulcerative colitis.

B-12 or folate (folic acid) deficiency – both of these vitamins play an important role in the production of red blood cells. Folate is found in food and folic acid is the syntheic form of this vitamin. Megaloblastic anemia is due to a deficiency in vitamin B12 or folate or both. Pernicious anemia results from inadequate B12 absorption.

Vitamin E deficiency – hemolytic anemia, from a vitamin E deficiency, is rare but can occur in newborns and people who have problems absorbing fat.

Iron for the Over 65 Crowd

2010-03-29T07:55:00.000-07:00

I’ve seen two diametrically opposite personality types in the over 65 crowd. The first type focuses on their aches and pains and believes that age is slowing them down so there’s really no use in trying to figure out why they feel sub-par. People that fall into the second personality type believe they can overcome aches and pains, age doesn’t matter and they are enthusiastic about all that life has to offer. As a dietitian and exercise physiologist, I think everyone will feel better if they are physically active and eat a healthy diet. And oftentimes, elderly people fall short on several nutrients, making their diet, and not necessarily age, the root cause of some of their health issues.

The elderly often take in fewer total calories, protein, vitamins B6 and B12, folic acid, iron and zinc than they need. All of these play critical roles in good health. Iron deficiency anemia, the second most common cause of anemia in the elderly, can make you feel tired, breathless and decrease your ability to focus. Iron deficiency anemia can also decrease immunity leaving you susceptible to infections and illness.

If you feel fatigued or you’re having trouble concentrating, get checked for anemia. There are many causes of anemia in the elderly so your physician will likely run a few different tests to find out what is ailing you. Talk to your physician about all of your symptoms, what medicines (prescription and over the counter) and dietary supplements you are taking. After all, you deserve to feel energetic every day!

References:
Am J Clin Nutr. 2004 Mar;79(3):516-21.
J Nutr Health Aging. 2004;8(1):2-6.
J Am Geriatr Soc 1992;40:489-96.

Iron and Your Heart

2010-03-24T07:15:00.000-07:00

Are iron supplements bad for your heart? According to media reports from years ago, the answer is yes. In fact, they suggested that taking iron might increase a person’s risk of heart attack based on a study conducted in Finnish males. But, in reality, this study was blown out of proportion. No studies conducted in other populations have come to this conclusion. In fact, some studies have tested this hypothesis by examining iron stores (ferritin) in those with coronary heart disease, comparing them to age and gender matched controls and they found no differences in iron status in those with compared to those without coronary heart disease.

There is however, a relationship between iron and heart functioning. Iron deficiency anemia decreases oxygen delivery to the heart, causing the heart to work harder to pump oxygen to the body. By working harder this increases the likelihood of abnormal heart rhythm (arrhythmia), which can increase heart attack risk. In addition, a significant percentage of patients with heart failure are anemic. However, IV treatment for iron deficiency in these patients improves symptoms, functional capacity and quality of life.

If you have coronary heart disease, don’t lower the iron in your diet but, if you have questions talk to your physician. Always talk to your physician about all supplements you are taking, the dosage and frequency. Never take any vitamin or mineral in excess of your needs.

References
J Nutr 2008;138:2436-2441.
Ann Epidemiol. 2000 Oct;10(7):441-8.

How Much Iron do You Get from Cooking in a Cast Iron Skillet?

2010-03-17T19:11:00.000-07:00

For years I’ve heard that cooking in a cast iron skillet can increase the iron content of your food. And then I realized all the work involved in maintaining an iron skillet. Storing one would be cumbersome, I’d have to season it with some sort of grease (after all, if you aren’t using non-stick pans you have to make the stuff not stick somehow) and it could rust. That’s just a little to high maintenance for a skillet in my opinion. However, I still wondered about the iron content. Does it really make a dent in a person’s diet?

In an effort to find the truth about the iron content in cast iron cooking utensils, I turned to my partner in research, google scholar. Luckily, a typewritten and scanned thesis from 1984 appeared that examined this very topic! After reading through this study I came to a chart that outlined how much the iron content increased if a particular meal was cooked in an iron utensil versus a non-iron utensil.

A few items on this list were not a surprise to me. Stew, chili with meat, applesauce and spaghetti sauce (all of which contained some acidic ingredients) gained a significant amount of iron if cooked in an iron versus non-iron utensil (applesauce was the all time leader in iron gained). However, there were also many surprises to me: scrambled eggs, rice and a white sauce. In fact, eighteen of the twenty foods cooked in iron and non-iron skillets absorbed significantly more iron than when cooked in the non-iron skillet. This study found that foods with a higher moisture content, more acidity and a longer cooking time take up more iron from the iron cookware.

I have to thank Cheryl Eileen Nossaman’s work for finally answering that question I’ve always wondered about. I’m still not going to use iron cookware because I prefer using oil versus grease in my pans. But at least I now know that iron utensils can in fact add iron to one’s diet!