Monday, May 31, 2010

Vitamin D, are you deficient?

Before I begin today's post, I just want to inform you of something new I'm going to add to my blog. Every Monday will be "Motivational Monday!" So at the bottom of every Monday post, you will find a phrase or sentence that gives you another reason to lead a healthy life. My hope is that you will find these to be good reasons to exercise and eat better; and use them to help motivate you through your week (and weekend!). I'd love to hear your thoughts if you have any!!

Recently, there has been a lot of research centering around vitamin D deficiency and how it impacts our health. If you’ve been wondering what the deal is, this will give you a general idea of what is going on and what you should do to make sure you’re not missing out on a vital nutrient!

Vitamin D deficiency is real and affects many Americans. According to the NHANES III study, when men, women, white Americans, African Americans, and Hispanics were evaluated and compared, it was found that the prevalence of Vitamin D deficiency was at least 40% for all groups. African Americans in the age group of 20-39 years old had the highest prevalence nearing 100%. White Americans in the same age category had the lowest prevalence of vitamin D deficiency, which was about 40%. (Martins D, et al. Arch Intern Med 2007 June;167:1159-1165)

So why are we having such a problem with vitamin D deficiency? There are many factors to blame. One difference between our culture today and our culture 50 years ago is that we use sunscreen, and a lot of it! I am not saying that is a bad thing! I am no expert on this subject, but I definitely believe that wearing sunscreen is a smart move. Vitamin deficient or not, I want my family’s skin protected! Other factors are air pollution, skin tone, less time spent outside, and poor diet. Many other factors can play into vitamin D deficiency, but they are more specific to some diseases.

Being deficient in vitamin D isn’t just something to fluff off and not worry about. Individuals who are deficient are more likely to die of heart failure or sudden cardiac death. Also, adequate vitamin D is thought to protect against hypertension (high blood pressure).

Ameri P, Ronco D, Casu M, Denegri A, Bovio M, Menoni S, Ferone D, Murialdo G. High prevalence of vitamin D deficiency and its association with left ventricular dilation: An echocardiography study in elderly patients with chronic heart failure. Nutr Metab Cardiovasc Dis. 2010 Apr 14.)

Pilz S, Tomaschitz A, Drechsler C, Dekker JM, März W. Vitamin D deficiency and myocardial diseases. Mol Nutr Food Res. 2010 Mar 29.

Vitamin D deficiency also increases cancer risk, particularly colon, breast, and prostate. Inflammatory and autoimmune diseases, in addition to metabolic disorders are also more likely to occur in those who are deficient. Insulin-dependent diabetes falls into the category of autoimmune diseases.

Peterlik, M., Cross, H.S.. Vitamin D and calcium deficits predispose for multiple chronic diseases. European Jour of Clin Invest, 2005 Apr 28.

Vieth, Bischoff-Ferrari, Boucher, Dawson-Hughes, Garland, Heaney, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J of Clin Nut, 85(3), 643-650: 2007.

The first thing you should do if you have not had your vitamin D level tested is to speak with your doctor. Your serum level of vitamin D can be easily tested and your doctor can then advise you on the next step. Your level may be fine! However, if it is not, you may need to take a supplement in order to achieve a safe level. If your doctor prescribes some time in the sun unprotected, I would encourage you to speak with your dermatologist to get his or her opinion on such a plan. Do not begin taking any kind of supplement without getting your level tested and being advised by a doctor!

Some food sources of vitamin D are wild salmon, canned tuna or mackerel, shitake mushrooms, cod liver oil, and fortified cheeses and milk.

Staying fit gives me the energy I need to play with my children/grandchildren!

Friday, May 28, 2010

Feeding Your Baby.....Jarred or Homemade Food?

To make your baby food at home, or buy it in a jar…that is the question! Both options are ultimately fine choices, but there are pros and cons to both sides. Keep reading for a discussion about your options.

Jarred baby food bought at the store is not overly inferior to homemade baby food, although it is probably not quite as rich in some vitamins and minerals. This is due to the heating of jars, possible over-cooking and sitting on a shelf for some time. So, your baby may not get quite as much nutrition from the jarred food, but there isn’t a detrimental difference in homemade food and jarred. You shouldn’t feel that your baby is being deprived if you don’t have the time to cook your own food at home. If you do have time to steam fruits/veggies and puree them, which is not as time consuming as it seems, you may feel good about the fact that you are probably putting a more nutrient dense food on your child’s spoon.

Often times, making baby food is significantly cheaper than buying food in a jar. You can buy an inexpensive sweet potato and make a couple of weeks worth of baby food, freeze it, and pull it out, as you need it. When I did this, I always liked to calculate exactly how much I was saving because that always made me happy! However, I recently realized that you could also purchase baby food at very cheap prices, sometimes free! If you purchase baby food when it is on sale and use coupons, you’ll be amazed at the deals you get.

A definite con when it comes to store-bought baby food happens when you start your baby on stage 2 and 3 foods. I was really disappointed when I saw things like “Turkey and Green Beans”; however, I found something very different on the ingredient label. I would often see “sweet potatoes” as the first and most abundant ingredient. Sometimes the vegetable listed on the front of the jar, was the very last ingredient on the list! If I see the words “turkey” and “green beans” on a label, I expect those to be the prime ingredients. Instead, the mixture is sweetened so that we can continue to teach our children to only enjoy sweet foods. It is important for children to get a taste of vegetables and meat so that they can learn to enjoy those flavors as well.

On another note, while I found it very easy to turn fruits and vegetables into yummy foods for my baby, I didn’t have the same luck with meats. Whenever I made chicken, it turned into a crumb that my child wasn’t ready for. He really needed something smoother that he didn’t have to chew.

With all of these pros and cons, what should you do? It is really up to you! However, I'll tell you what I did. For my child, I served a mix of homemade baby food and some store-bought. I really enjoyed and felt good about cooking his foods fresh in my own kitchen. However, when I was able to get jarred food at a great price, I stocked up on meats that were mixed with whole grains. I typically stayed away from the meats mixed with a conglomerate of fruits and vegetables, unless I saw that the vegetable that I was looking for was at the top of the ingredient list. I found that when we were out and about, sometimes the jarred food was very convenient. However, I also put my homemade food in a little container and brought it with us on occasions.

If you’re wanting to start making your own baby food, but are unsure of where to begin, I recommend “Cooking For Baby” published by William Sonoma. It has great recipes for babies and toddlers. The toddler recipes are great for the whole family too! Just beware that you should follow your pediatrician or registered dietitian’s advice about when to introduce foods. Do not go by the advice of any cookbook or book that is not written by an appropriate health professional!

Wednesday, May 26, 2010

Exercising with Diabetes

If you are one of the many Americans with diabetes choosing to exercise, good for you! This can benefit you in many ways including reducing your hemoglobin A1c (an indicator that gives insight to blood sugar levels over a three month period), increase insulin sensitivity, and decrease risk for heart disease. Here are some recommendations from the American College of Sports Medicine for diabetics to keep in mind while exercising.

Check your blood sugar before exercise. If blood sugar is above 250 mg/dL, do not exercise until the level comes below 250 mg/dL. If blood sugar is less than 100 mg/dL, have a snack containing 10 to 20 grams of carbohydrate.

Keep an exercise log. On this log, record your pre-exercise blood sugar level, the time of day, medication/insulin administered, type of exercise, duration of exercise, and intensity level. Over time, this will help you to gain a better understanding of how certain types of exercise impact your blood sugar level.

Plan ahead. Knowing what type of exercise and how much you will do can help you to adjust any medications and insulin. Also, carry a 10 to 15 gram carbohydrate snack with you to eat/drink approximately every 30 minutes.

Adjust insulin dosages. Short- or rapid-acting insulin can be reduced by 50% to avoid hypoglycemic episodes. Be sure to get your doctor’s approval for this.

Exercise with a friend. This is especially important when beginning an exercise routine until blood sugar response is better known.

Wear a diabetic identification tag. Hopefully this would never be needed, but you wouldn’t drive a car without insurance, so don’t exercise without your tag! If something were to happen, this would help you to receive better care by anyone attending to your needs.

Wear comfortable shoes appropriate for activity. This helps to prevent injury.

Check your feet! Always do this whether you exercise or not. However, it is probably even more pertinent after exercise. You need to look for sores or any irritated spots and show them to your doctor if they occur.

American College of Sports Medicine. Guidelines for exercise testing and prescription, 5th edition. Baltimore: Williams & Wilkins: 2006.

Monday, May 24, 2010

Go ahead, eat the chocolate!

You liked that title, didn’t you? Sometimes we all get a craving for something less than healthy. If you think about it for days in and days out, aren’t you going to go crazy? You’re human and you shouldn’t be deprived of all of the things you love! In fact, I believe that when we deprive ourselves and feel deprived, we go overboard at some point eating more than “just a nibble” of our favorite, unhealthy foods.

If you are eating healthy 90% of the time, there is no reason that you can’t partake in a little indulgence here and there. Maybe if you let yourself have a little nibble of what you really enjoy, you won’t feel the need to go overboard because you know you can have it again soon. It all goes back to the old saying “everything in moderation”.

I just want to be clear that I’m not saying that is okay to eat a huge bowl of ice cream, quarter pounder cheese burger, French fries, and a bag of chips all in one day. This would be considered "going overboard". I’m just talking about small indulgences that satisfy your cravings. So, go ahead and enjoy!

Friday, May 21, 2010

A More In-Depth Explanation of Why Eating Often is Beneficial

Recently, a question came up from a reader on another website (go here to read the full post) about the validity that you should eat 3-6 meals daily. This individual referred to an article written in The New York Times touting that there is really no benefit to eating frequently. Instead of responding, knowing full well that some people just have their minds made up, I decided to post on my blog giving information to back up the reasoning behind frequent meals.

1. To be clear, I stated in my post that a minimum of 3 meals should be eating each day. The studies mentioned by The NY Times compared 3 meals to 6 meals. I do not believe that eating only 3 meals is detrimental; however, less than 3 meals is damaging. Not only for the reasons of increased fat storage and depletion of glycogen, but also because people overeat when they are deprived for long periods during the day. I have seen this in practice over and over again. I have had hundreds of patients who go all day without eating, and then tell me that they are so ravenous by the end of the day that they eat everything they can find. I have had some patients find that they are consuming several thousand calories in the evening. So yes, while the end result is calories in versus calories out, a) you are more likely to metabolize more calories per day with more frequent meals; and b) people who eat less than three times per day, typically eat more calories than they need in a day in one or two sittings.

2. Magazines, Newspapers, and other media present the research how they would like to present it. There is always a way to take portions of a study out of context and bend it to appear how you would like it. The people who write these articles are not always qualified to interpret research and advise others on it. Sometimes, the articles are written simply for “interesting reading”. To decide whether or not to take heed, check their credentials.

2. I did take a look at The NY Times article and the research that it was referring to. Notice that the author also mentioned a scientific study that did, in fact, show a metabolic advantage to eating small frequent meals. ( Jenkins, Wolever, Vuksan, Brighenti, Cunnane, Rao, Jenkins, Bucklye, Patten, Singer, et al. Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med. 1989 Oct 5;321(14):929-34.) Part of the story is that, in science, many studies will be conflicting, so it takes a lot of analysis and MANY scientific studies before conclusions can really be drawn. To be honest, after looking at all three of the studies mentioned in the article, I don’t believe any of them were well designed. They all include an extremely small amount of subjects and they all look at different outcomes. Unfortunately, I was also unable to pull up the entire studies; however, looking at the abstract is much more telling than a line or two in The NY Times. However, I have a few more comments on the two studies that “disproved” the need for small frequent meals. One of the studies gave every subject the same amount of calories. Everyone surely does not have the same caloric needs; therefore, you will have some people consuming more than necessary and others consuming less. How can you conclude anything from that? The other study was only conducted for two weeks and it did, in fact, show a decrease in fat oxidation. Overall, it looks like better studies need to be completed.

3. Regardless of the fact that the above-mentioned studies were really not conducted well, classic studies do show that resting energy expenditure is, in fact, decreased during prolonged periods of not eating. In the first 24 hours of starvation, glycogen stores are depleted, so there is no “fat melting away”. Glycogen is stored with water, so when glycogen is used up, water loss occurs. This leads to…….weight loss! But not fat loss! Fat loss occurs in the later stages of starvation. In the early stages of starvation, fat is preserved. (Barton. Nutrition support in critical illness. Nutr Clin Pract 9: 127. 1994) Another study shows that resting metabolic rate does drop by as much as 15% within 2 weeks of inadequate food intake. (Ravussin, Swinburn. Effect of caloric restriction and weight loss on energy expenditure. In: Wadden TA, Van Ittalie TB (eds.) Treatment of the Seriously Obese Patient. New York: Guilford Press, 1992.)

4. When you are not eating often, you can think of insulin release like hills and valleys. This is unfortunate because it causes large fluctuations in blood sugar, which is not healthy for organs. Also, when insulin is peaking due to a large influx of food after fasting, fat storage is promoted.

Hopefully this post helped to clear up any possible confusion!

Wednesday, May 19, 2010

Cross-training is important....

1. To prevent boredom. Let’s face it; sometimes you need a little change! By switching up your workout often, hopefully you can keep interesting.

2. To prevent injuries. Because your body is moving in different ways with various types of exercise, so do your joints and muscles. Variation gives certain parts of your body a little rest and; therefore, decreases your risk for injury.

3. To make you a better athlete and make you more fit. Working muscles differently allows you to strengthen your “weakest link”, if you will. Always exercising the same way will only strengthen certain muscles, and only in a particular way. Changing up your routine allows you to challenge your muscles.

4. To possibly get you through a weight-loss plateau. When you exercise in one mode, whether it is running, walking, or riding your bike, your body becomes very efficient at that task. Challenging your body to a different type of exercise may allow you to burn more calories.

5. To find your favorite types of exercise. You never know if you’ll like something until you try it. You may just find out that you like biking better than running. However, you’ll never know if you only run!

Monday, May 17, 2010

Sensible Eating

There are so many factors that contribute to our overweight nation that it is really complex and no one aspect can be completely to blame. However, I do feel that one of the complex issues is that we don’t listen to our body to tell us how much and when to eat. We’ve all been there! We’re at a party; the chips and dip look awesome even though we’re not hungry. After dinner, we’re full, but the chocolate cake looks amazing, so we manage to find some room in our bellies.

I think everyone can relate to this at one time or another. I know I have certainly been in those situations myself. In order to lose or maintain weight, the above situations need to happen infrequently. Your body knows when and how much fuel you need; and it doesn’t cost anything for that special feature! Going from ignoring your body’s signals to being very aware may take some time. Here are some ideas to get you started.

1. Consider keeping a food journal. Not only should you write down what you’re eating, but also write down how hungry you were before you started and how satisfied, full, overstuffed, or still hungry you are when you finish. It is helpful to jot down your mood too. After a while, you’ll really start to see a pattern, which may be helpful in making a change.

2. Every 15 minutes, or sooner if you’re a fast eater, stop and ask yourself how full you are. If you’re not sure, give yourself a little break from eating so that your body has a chance to get the signal of whether you’re satisfied or still hungry.

3. Remember that getting that “satisfied” or “full” signal may take up to 20 minutes. If you’re eating very fast, it is a great idea to slow down so that your body can “talk” to you before you overstuff yourself.

4. Forget about reaching your “full” mark and aim for “satisfied”. In other words, think about eating until you are no longer hungry, but not until you need to unbutton your jeans or become uncomfortable. When you have reached that point, you have consumed more food than you need.

5. Don’t ignore hunger signals. Just like you shouldn’t over eat, you should also not avoid eating when you are truly hungry.

Friday, May 14, 2010

Surviving the heat without ditching your exercise routine this summer...

If you have access to an air-conditioned gym, or have equipment in your home, you are set this summer! If not, you may need to be a little bit more creative to beat the heat. One way to stay in-doors and get some exercise is to visit your local mall, or other large building that you have access to, and walk there. If all else fails, here is a list of tips for surviving your exercise outside this summer.

1. Exercise in a pool.

2. Take advantage of the cool air in the mornings by exercising before work or school.

3. Always be sure to hydrate. If you will be out for a while, find places to hide water bottles so that you can grab them on your way. Personally, I prefer to wear one of those running belts that you can store several small water bottles in. These can be purchased at running stores and some athletic stores.

4. Know that it takes about 1 week of daily exposure to heat before your body adapts. This doesn’t mean you won’t mind the heat, but you’ll cope with it better. Losing this adaptation takes a very short time, so you have to continue exercising in the heat often in order to maintain your adaptations.

5. Be smart and follow heat advisories. Do not go out in the middle of the afternoon for a nice little run when it is 100 degrees. Listen to your weatherman (and your body!) and either go out during the coolest part of the day, or find an in-door place for walking or running.

6. Wear appropriate clothing for the weather and your sport. Do not overdress!

7. Use sunscreen. Just because you’re not laying by the pool doesn’t mean you can’t get a burn. Be good to your skin!

Have a great and fit summer!

Wednesday, May 12, 2010

Tempo Training For Better Fitness

If you are looking for another way to improve your fitness, you visited on the right day! Tempo training is most often referred to as a tempo run, but you can apply it to any type of cardiovascular exercise. Tempo training is great when you only have 20 or 30 minutes for a workout, and you want to get the most out of that time.

In order to complete a tempo training session, you should be running (or whatever your sport) at a pace that is pretty strenuous and doesn’t allow you to carry on much of a conversation. You should be able to speak, but not in complete sentences. Although you should be working hard, this is not “race speed” or the fastest you can possibly run. When you finish, you should feel some relief, be proud, and feel that you got a great workout. You should not be passing out, vomiting, or feeling like you won’t get off the couch for the remainder of the day. I hope that description helps to shed some light on the proper intensity at which this workout should be completed.

So how does this tempo training work? Well, you should be working at an intensity that forces your body to breakdown nutrients for energy anaerobically, or without oxygen. When this is happening, the byproduct of this particular energy pathway is called lactic acid or lactate. Everyone has a threshold at which they can no longer process energy aerobically, so they must move to this other anaerobic pathway (anaerobic glycolysis for those of you who want the exact terms!). This threshold is called the anaerobic threshold or lactate threshold. So, theoretically, when you are tempo training your body should be working at its lactate threshold.

The results of training in this manner are a higher lactate threshold and better running economy. In simple terms, you can run faster and more efficiently. This type of training can be done about once each week.


Monday, May 10, 2010

Sweet Rewards

We all love that sweet reward; whether it is for weight loss, exercise compliance, a promotion at work, or an A+ on a test. The tricky part is, what we use to reward ourselves. Rewards are wonderful; however, using food for this purpose may be detrimental. In our American culture, we have learned to eat “emotionally”, which over time leads to a negative relationship with food. Training us to expect food as a reward can certainly add to a growing waistline.

To change the way we reward our children and ourselves, it takes some brainstorming. First of all, think about the fact that your reward for some achievements, may just be the positive consequence that naturally occurs. For instance, my reward for exercising five days this week will be feeling better, weight loss, better sleep, and more energy. If I choose to reward myself with a whole pizza and 2 regular beers, I’ll likely undo all of the progress I made.

Here are some suggestions for ways to reward yourself:

1. A new workout outfit, or any kind of outfit
2. A massage
3. An hour of relaxing by the pool without worrying about things you need to do (you may need your spouse to be in on this reward by watching the kids!)
4. Rent a movie you’ve been wanting to see
5. Get a manicure or pedicure

Suggestions for rewarding children:

1. An extra story before bedtime
2. Rent a short movie for them
3. Take them to the zoo
4. Go for an afternoon at the pool
5. Take them to the park

I would love to hear how you use non-food items to reward yourself or your children! Please post a comment with your ideas!

Friday, May 7, 2010

Hand Washing for Champions

You may be thinking that hand washing has nothing to do with nutrition and fitness, so why did it earn a spot on this blog. Well, it is certainly an important part of both topics! Food safety is always a nutritional concern and avoiding viruses and bacteria at the gym is just as important. You should always practice good hand washing skills before and after handling food, after using the bathroom, and before and after using gym equipment just to name a few. This post was inspired after seeing way too many people using poor hand washing techniques at the gym. Gyms are crawling with all kinds of disgusting germs that you don’t want! Always wash your hands thoroughly before heading out the door! Anything less than the description below means that you are wasting your time at the sink because it is ineffective! The following steps are required of employees in food establishments for a reason! You should follow them also!

1. Make sure you have paper towels handy before starting to wash your hands.

2. Turn the water on to a warm temperature.

3. Put soap in your hands and then scrub for 20 seconds. You can count to 20 or sing happy birthday to yourself twice. You should be scrubbing between your fingers, the backs and palms of your hands, your wrists, and your nails. Friction is important!

4. Rinse your hands.

5. Grab a paper towel and thoroughly dry your hands. Now, using the paper towel, turn off the water. Do not touch the faucet again because you will just pick up all of the germs you left there when you turned it on, and when everyone else before you turned it on.

Happy Hand Washing!!

Wednesday, May 5, 2010

Fueling for endurance exercise. Part III: Nutrition for recovery

During your workout, you fueled your body. After that long training session or event the fueling isn’t over! It is important to give your body fuel to recover. Here are some guidelines for a good recovery

Within 15 minutes of stopping your exercise, you need to consume carbohydrate. After a long workout, you have surely depleted your glycogen stores. (Glycogen is simply the storage from of glucose found mostly in the muscle, which is a sugar that gives your body energy.) Eating a snack high in carbohydrate post workout helps to replenish those glycogen stores. This is the time when your muscles can store glycogen most easily, so take advantage of it. Use this formula to decide how many grams of carbohydrate you need.

Body weight in pounds x 0.5 = grams of carb needed (Clark, N. Sports Nutrition Guidebook. Human Kinetics, Brookline, MA. 2003.)

Example: 150 lbs x 0.5 = 75 grams of carb

If you are still feeling hungry in 30 minutes, you should eat this amount again. Continue fueling until you are satisfied.

Research is somewhat conflicting about whether or not consuming protein post- endurance training is needed or not. Regardless, you probably need some fat and protein to make you more satisfied, so I would suggest a small amount. A tablespoon or two of peanut butter could be used to top a bagel; or you could have a handful of almonds with an orange.

Just as electrolytes were important throughout your long journey, they are also important post-endurance exercise. Any of the suggestions on last week’s post are good, but just make sure that you are having some snack that provides sodium and potassium.

Electrolytes go hand-in-hand with fluids so don’t forget that! Be sure to drink fluids as needed to continue rehydrating. Monitor your body weight and urine if you’re not sure if you have rehydrated enough.

Happy training!

Monday, May 3, 2010


You have probably heard some hype about fiber being an important part of your diet. This is certainly true, and adults should be aiming for 25 to 35 grams of fiber daily. That said, you should not transition from eating 10 grams of fiber daily to 25 grams daily. You will not like me if you do that!! It is important to slowly increase by about 2 to 3 grams, and then increase again once you are comfortable with that (about 1 week). Also, fiber acts like a sponge, if you will, that soaks up water. You must be sure to drink plenty of water as you are increasing your fiber intake, or again, you won’t like me! It will most likely make you constipated.

Something to keep in mind, in addition to the fact that you need 25 to 35 grams of fiber daily is that half of your fiber intake should be soluble fiber, and the other have should be insoluble. Soluble fiber is instrumental in lowering cholesterol and managing blood sugar levels. Prevention of constipation, possible prevention of some cancers, and contributing to satiety can be attributed to insoluble fiber. Both types of fibers can be helpful with weight control as well!

So where can you get your fiber? Here is a list of suggestions, but keep in mind that most foods on this list contain a little bit of both types of fiber. However, I’m separating foods by which fiber they predominately contain.

Soluble Fiber

Fruits (especially the skins)
Vegetables (especially the skins)

Insoluble Fiber

Whole Grains (cereals, bread, rice, pasta, granola bars)