An Action Plan for a New Year and New You

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

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

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

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?

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

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

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?

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

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

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?

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?

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

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?

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

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

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

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

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

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

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.