Food, Family, and Foodborne Illness-How to Prevent Code Brown This Thanksgiving!

Thanksgiving is time of family, friends, and fellowship.   Most of us are concerned with the massive caloric content of our favorite Thanksgiving foods, however there may be a bigger concern.  The schedule for this beloved American holiday is often food and football, but unfortunately can be followed by a bad case of foodborne illness if food safety is overlooked.  Foodborne illness often manifests itself with moderate to severe gastrointestinal symptoms including nausea, vomiting, and diarrhea, or "Code Brown".   The Centers for Disease Control and Prevention (CDC) estimates that 48 million, or 1 out every 6 of us, will get sick each year from foodborne illness.  Infants, adolescent children, elderly, and those with compromised immune systems are especially at high risk.

According to the CDC, the two leading causes of food borne illnesses are eating raw or undercooked foods such as meat, poultry, seafood, and eggs; and allowing food to remain at unsafe temperatures too long.  It is important to make sure that you keep your food safe this Thanksgiving by remembering a few simple rules. Food safety begins with the purchase of food and continues until the food is discarded.  Proper handling of food is most important and can be summarized by the tips below: 

1)  Purchase foods that have been stored at the appropriate temperatures.  If you are buying frozen food, it should be thoroughly frozen in the store.  If you buying a ready to eat product, make sure it is at the proper temperature. Cold foods should be held at 40 degrees or below and hot foods should be held at 140 degrees or above.  The danger zone for high microbial growth in food is 60 degrees to 120 degrees (where we also find "room temperature".

3)  Check expiration dates on cartons and cans.  Make sure that you are using safe and fresh ingredients.  Old or expired products can taint dishes before the holiday even begans.

3) Avoid buying dented or bulging cans.  These can be signs of foods affected with the toxin, Cl. botulinum, which can be life threatening or deadly.

4)   Plan ahead to thaw raw meats and poultry properly.  It is important to keep in mind that it may take several days to safely thaw a frozen turkey.  It is unsafe to set a turkey or meat out on the counter to thaw, as the  exterior portion of the meat will be exposed to the "Danger Zone" temperatures, while the interior of the meat will remain at freezing for some time.  Thawing the meat in the refrigerator on a bottom shelf is the optimal method to use (bottom shelf is preferred to prevent uncooked poultry drippings from contaminating other ready to eat foods).

5)  Cook meat, poultry, and other dishes to safe internal temperatures.  Properly using a meat thermometer can assure that your food is at a lower risk for contamination.  The thermometer should be inserted in to the middle of the interior to check for doneness.   

6)  Keep cold foods refrigerated below 40 degrees and hot foods at 165 degrees until ready to serve.  This can be done by keeping the food in the oven, using heating elements to keep food warm, and warm or cold packs for insulated casserole dishes.

7) Most families serve Thanksgiving in a buffet style where there are no sneeze guards, hand washing police, or heating and cooling elements to keep foods at their preferred temperature settings.  All of these factors can contribute to your risk.  To maximize food safety, encourage hand washing, help children with their plates to prevent little fingers contaminating entire dishes.  Keep food completely covered to minimize unsafe sampling and to prevent germs from sneezing or coughing to infiltrate the food.  Cover foods quickly after serving and refrigerate as soon as possible. 

8) No double dipping!  Provide serving spoons for each dish.  Never put a "personal" utensil in a "public" dish!

9) Fill your plate with foods that have lower microbial growth potential such as fresh fruit, plain vegetables, whole grains, and appropriately heated meats (as opposed to creamy or protein based casseroles). 

10) Risks for illness increase dramatically when the Thanksgiving feast is left out at room temperature for hours, sometimes until the next meal.  Remember, bacteria thrive at room temperature and many bacteria are introduced during the serving of the holiday dinner.  When in doubt, throw it out.

Following these guidelines can help you have a safe and enjoyable Thanksgiving day and extended weekend.  Do your part to encourage friends and family to prevent having a Code Brown Turkey Day! Happy and Healthy Eating!

For more information on healthy eating, contact Leslie Goudarzi, MS, RD, LD, at the GSMC Institute for Healthy Living at 903-239-1551.

Happy Holiday Eating!

The holidays are full of fun, family, and festivities making it one of the most favorite times of the year.  The holiday season officially begins on Halloween (with ALL of that Trick or Treat candy) and typically ends on the Sunday after New Year's Day.  That is a solid two months of temptation, time constraints, and turmoil, and can have disastrous results on your health, weight, and general feeling of well being.  So how can this year be different?

1.  Plan Ahead
Eat a meal before you go to parties.  Choose low calorie choices, such a fresh vegetables and lean meats.  Watch out for cheeses, chips, crackers, dips, and pastries. These can add up quick.  Remember that alcohol also has calories which can contribute to the post holiday bulge, but more importantly lowers you inhibition to say no to tempting fare.  Spend more time visiting and socializing and less time stuffing yourself!

2.  Don't get tricked!
Halloween is the official start to the season.  If you have Halloween candy staring at you between November 1 and Thanksgiving, there is a good chance that you will be consuming it and thus wearing it in the new year!  Those little candies can contain between 50-150 calories per piece, not to mention the elevated sugar and fat content and general lack of nutrient density!  So how can we outsmart the ghosts and goblins? 

Donate the candy to a worthy cause.  If it is not around, it can't go in your mouth!  Several military support groups collect candy to send to the troops.  Churches also have "Fall Festivals" after traditional Halloween, and these are a great place to donate excess candy.
Buy candy that isn't tempting to you.  If you don't like tootsie roll pops, buy those.  So it doesn't matter how many pops are around, those will not be gobbled up by you!
Put the candy up and out of sight.  If the candy is on your counter or desk, you will constantly be thinking about it and most likely consuming it.

3. Pace yourself!
If you know that you will be attending an event or party that will not be "diet friendly", allocate your calories accordingly throughout the day and avoid splurging all day.  Often, when food choices are not going to be stellar for part of the day, we decide to just go ahead and throw in the towel and eat  high calorie foods throughout the entire day.  If this particular day falls during the latter part of the week, then chances are slim that healthy behaviors will resume until the following Monday!  If you get off track at a meal or event, immediately regain your food composure and reset your behavior.

4.  Keep track of how your clothes are fitting.
Our clothes fall into a category called "external cues".   External cues serve as outside reminders that our goals and behaviors are not consistent.  When pants become tight, that is a very accurate sign that there is more booty in those pants and it is time to make some changes and reel in the high calorie foods and change our behavior.  It is also important to wear clothes that provide some "feedback", meaning that they are fitted, and not loose or baggy such as scrubs or workout wear.

5.  Be aware of how you feel.
Take time to assess yourself.  Are you stressed, happy, or sad?  Are you putting food in your mouth to deal with your emotions?  Ask yourself, on a scale of 1-10, how hungry am I?  Remember, hunger is a physiologic response when the body need calories or energy.  If you are not hungry, but find yourself nibbling, ask yourself what is it that your body really needs.  It could be sleep, a time out, exercise, or stress relief. 

This is in contrast to appetite, which is the psychological need for food, meaning that is satisfies our desire for food to look good, taste good, and smell good.  Hunger can be best described as having a physiological need for food that would be so strong that the flavor or desirability of the food would make little difference.  For example, Jane does not like mayonnaise.  But because she is hungry, she will eat a sandwich that has mayonnaise on it.  If she was responding to appetite, she would not eat the sandwich, unless it met her desired choices.

6.  Bring healthy foods to the holiday table.
From Grandma's homemade pie to the latest Pinterest recipe, there is an abundance of high calorie, indulgent foods at most holiday gatherings.  Make a point to offset these foods by bringing some healthy alternatives such as a fruit salad or vegetable tray.  Fill your plate with unadulterated fruits and vegetables, lean meats, and choose your calorically dense foods carefully and with restraint.. 

7.  Learn from your mistakes.
We all know what it feels like to overeat and feel like a stuffed turkey on Thanksgiving and Christmas.  Most of us would agree that the aftershocks feel pretty miserable leaving us like lifeless slugs on the sofa, not to mention the post holiday pounds that have to be dealt with later.

Even when mistakes happen, there is a lesson to be learned, meaning that even a food mishap can be a positive experience if it sheds insight on a behavior that needs to be modified.  Ask yourself why the mistake occurred, how were you feeling at the time, what could have been done to avoid the mishap, and if given the same opportunity again, how could you change your behavior to prevent mistakes in the future. 

Holidays can be enjoyed in a healthy manner by using self awareness, self restraint, and listening to your body's needs. Choose wisely and make this season the best yet!

For more nutrition information or to make an appointment with Leslie Goudarzi, MS, RD, LD at the GSMC Institute for Healthy Living, call 903-239-1551. 

How to Change Our Wicked Ways!

Have you ever wanted to make a change in your diet or exercise program, but after a few short days, found yourself flustered with your efforts or quitting altogether?  You are not alone!  Many of us attempt to change behaviors such as our diet or exercise program, but struggle to make the changes real.

I worked as a Registered Dietitian in an inpatient hospital setting for many years.  As a young and eager dietitian, I was often frustrated and disheartened when my patients did not share my enthusiasm after their "diet instruction" and did not drastically change their behavior that had contributed to their medical condition.  After all, it was for their own good.  As my experience in clinical nutrition and wellness evolved, I was reminded of a behavior model that I learned in college and is certainly worth sharing.

The way we habitually behave is considered to be our lifestyle.  Some of our habits tend to be very positive, while others can definitely use some improvement.  Many times, we are able to easily identify a behavior that needs to be changed.  For example, "I need to exercise" or "I want to eat healthier to improve my cholesterol".  Everyone has probably had the thought cross their mind at one point or another that they would like to change a behavior to improve some aspect of their lifestyle.  So why is not just enough to want to make the change and just simply do it?   Because according to Prochaska's Transtheoretical Model of Change , we must go through certain steps to modify problem behaviors such as not exercising, overeating, smoking, or even problem drinking.  It is important to recognize that each step must be resolved before going to the next step or the change will be ineffective.  Some of the steps can take weeks, even months to accomplish.

The Stages of Change:

The following are the steps of change in the order they must be processed.  In addition, statements or examples of behaviors are included that demonstrate each step (for the changed behavior of beginning an exercise program is demonstrated in this example).

1.  Precontemplation:  This is the stage where the individual is not considering a change.  For example, "I don't exercise and have no intention of starting".

2.  Contemplation:  This the stage where the individual is considering a change.  This usually is sparked by reading something, hearing a speaker, being motivated by a negative outcome, or even a doctor's visit.  Pros and cons of the "changed behavior" must be weighed.  In every changed behavior, there will be something given up and something gained.  It must be decided by the individual that the gained behavior is more attractive than what is being sacrificed.  For example, "I know that I should exercise to lose weight and improve my cholesterol levels, but if I do begin an exercise program, I will have less time to watch television".

3.  Preparation:  In this stage, the individual is getting ready to make the changed behavior.  Let's say that we are getting prepared to start an exercise program, several decisions have to be made before starting the change.  For example, "Which exercise program?   Have I signed up for the program?  Do I have proper clothing and shoes?  Do I need to adjust my schedule to get up earlier or to participate after work?".  All of these questions must be answered to successfully move to the next stage.

4.  Action:  This is the stage where the "changed behavior" is actually occurring.  I think that it is notable that action doesn't occur until the fourth step!  Think about how many times that we have been frustrated with ourselves and others for not immediately going from "nothing" (precontemplation) to "everything" (action).  In this stage, the example would be, "I am at the gym (on time) in the boot camp class (dressed appropriately) doing the class".

5.  Maintenance:  This is the stage of behavior where the action becomes part of our normal or typical behavior. "I exercise everyday and I enjoy it.  I feel better, I have lost weight, and my cholesterol has improved".  We have to go through action in order to get to maintenance. 

6.  Relapse:  Although relapse was not an "original stage" in Procahska's model, I think that it is important to acknowledge that returning to our "wicked ways" or slipping back into a negative behavior sometimes does occur.  Sometimes relapse happens because of triggers such as an emotional responses, temporary time constraints, or travel, to name a few.  For example, "I did not exercise today because I had to be at work early and I could not go to my exercise class".  This does not mean that the exercise is over forever.  Relapse does not have to equate to failure.  In fact, it can be an opportunity to anticipate and resolve barriers to success.  In this example, the exercise time could be changed to the evening, and even alternatives to the exercise class could be found.  Again, this is a great opportunity to learn from a failure and determine feasible alternatives when obstacles occur.  When relapse occurs, it is important to move back to "action" as soon as possible.

Changes in our behavior leads to improvements in health, quality of life, and often even the quantity of life.  I encourage you to think of an area of your life that might benefit from change and work earnestly to accomplish them. 

For more information on Nutrition Counseling and how to incrementally change your eating habits,, please contact Leslie Goudarzi, MS, RD, LD at 903-239-1551.

How To Enjoy the Yamboree Without Blowing Your Pants Out!

Growing up in Gilmer, Texas was a unique experience because of the annual holiday and homecoming called the Yamboree.  The Yamboree is a difficult concept to explain to those not born and raised in Upshur County.  School is out, business are closed or at least have "Yamboree hours", and the whole town is involved in the celebration of the sweet potato from Wednesday through Saturday on the third weekend in October.  The small town of Gilmer transforms into a central hub overnight.  There are actually traffic jams during this week!  Every spot in town is occupied and there are multiple attractions everywhere.  The anticipation of the Yamboree hits a fever pitch as soon as the "Welcome Yamboree Visitors" signs are hung above area business doors and the amusement rides began to trickle into town. 

As the years have past, many of my hometown friends and family return to celebrate this one of a kind event.  As much as carnival rides, pageants, and parades are a part of the Yamboree, the food of the festival takes center stage.  It is very easy to load up on high calorie foods and break your calorie budget if you're not careful.

To put things in perspective, the "average" American needs about 2000 calories and 65 grams of fat per day.  Take a look at some of the most popular fair foods and their energy values below.

The Corn Dog                                   375 Calories           36 g Fat
Smoked Turkey Leg                       1135 Calories           54 g Fat
Deep Fried Oreo (5)                         890 Calories           108 g Fat
Nachos                                             750 Calories             55 g Fat
Yam Pie                                           300 Calories             15 g Fat
Corn on the Cob (no butter)             200 Calories               1 g Fat
1/3 Pound Burger                             669 Calories             41 g Fat
French Fries                                     560 Calories             79 g Fat
Bratwurst Sausage on a Bun            803 Calories             61 g Fat
Cotton Candy                                   220 Calories             56 g Fat
Baked Sweet Potato (no topping)    120 Calories             <1 g Fat

As you can see from the list above, some of the calorie contents of these foods can set  you up for a post Yamboree buldge if you indulge too much.  Some of these foods contain 50 % of your total daily calories and many of them exceed your allotment of fat for the entire day! 

Here are some tips to enjoy the carnival food in moderation.

1.  If you know that you are going to indulge on a meal at the Yamboree (or any other fair), make sure that you make healthy choices throughout the rest of the day to achieve balance.

2.  Consider splitting an item with a family member or friend.  You can enjoy the taste and experience in a smaller portion and lesser affect on the waistline!

3.  Don't have a buffet!  Choose a few items to enjoy, but don't eat one of everything!

4.  Ask yourself if you are really hungry.  If you are not, share the remainder with a friend or loved one or even throw it away.  I know that some of you will say that is wasteful, but I would argue that carrying around extra calories and fat in your mid section is not a great place to store wasted food!  And it will have a long lasting and costly affect on your health.

I hope that you will enjoy this year's Yamboree and make healthy and thoughtful choices!  Have a Yam good time all of my Gilmer friends!  Hope to see you there!

A Day in the Life of a Successful Loser

What if I told you that I had a tool that could double your weight loss, was relatively cost free, and you weren’t required to sweat?

The food diary has been shown to one of the best predictors of long term weight lost available.  Several studies have highlighted the effectiveness of using the food journal or food diary.  Researchers have found that dieters that keep a food diary or record actually double their chances of being successful at their weight loss endeavors.

Why does it work?

There are several reasons food diaries are effective.  The first is that it requires the user to be accountable and ‘present’ for their food choices.  This means that you are engaged in your meal.  Many times, the consumer walks through life aimlessly looking for whatever tastes the best.  Sometimes eating becomes another thing to multitask.  When food choices and portion management become coupled with driving, working, socializing, or watching television, the chances of overindulging significantly increase.  The food diary can help the consumer slow down, focus on their eating choices, behaviors and responses.

For example, let’s take a look Christy, a former college student of mine.  Christy was unhappy with her weight, complaining that she had gained about 30 pounds in the past 2 years since graduating high school.  She reported the “she really didn’t eat that bad” compared to her friends.  I asked her to tell me in general terms what her food intake was, which she willingly described as follows:

For breakfast, she usually ate nothing because she said that she was not a “morning person” and typically ran late getting to school as she had a 20-30 minute commute depending on traffic.  After 3 hours of back to back classes and labs, she was in another rush to leave school and make it to her part time job.  Because of her late start and lack of highly nutritious food choices, she would evaluate each line at the fast food venues in town and make her decision based on the shortest line with consideration to what “sounded good”.  No doubt, Christy was definitely hungry, but hunger differs greatly from appetite.  Hunger is the physiological need for food.  Few of us actually experience true carnal hunger, generally because we are constantly responding to appetite, or the psychological need for food.  Simply put, appetite can be describe as “it smells good, it looks good, or it tastes good”.  So Christy was basing her lunch decision on her proximity to food, time (or lack of), and what appealed to her appetite.  With this in mind, she found herself at McDonald’s or Taco Bell ordering off of the “Value Meal” because as it turned out she was “watching her spending”.  I asked her to describe her eating experience.  She said that she generally ordered a #1 or #3 off of the McDonald’s menu or a # 1 or #2 off of the Taco Bell’s menu.  (Interestingly, fast food restaurants organize these “Value Meals” in order of popularity, with #1 being the best seller and so on).  After pulling through the drive through, Christy would admit that she would talk on the phone, check her e-mails (only when at a red light), listen to music, and try to plan her homework schedule, work schedule, and social calendar as she drove and ate.  I asked her to tell me at what point did she quit eating.  She responded, “When I am through”.  I continued by asking her how did she determine when she was through.  She thought for a second and said, “You know, when there are no more French fries”.

Her day went on from there to her work schedule.  She liked her job, but some of the other employees (also students), didn’t always do their part which caused a lot of the self-reported stress to Christy.  Because she was seen as the responsible one, her supervisor often asked her to work more hours and close.  After 6-7 hours of working with her stressful coworkers, she left work and headed for the next meal which was often times chosen in a similar fashion to lunch.  Because now, she was truly physiologically hungry, she would eat all of her fast food meal, and then head home for whatever convenient foods were there (like chips and ice cream), as she began studying or unwinding.  On nights that she didn’t work, she would go out with friends and indulge in alcoholic beverages, go to a bar or dance club, and then found herself at Whataburger in the wee hours of the morning with her friends eating another high calorie fast food concoction.

As you can probably see, the 30 pounds that had accumulated were no metabolic mystery.  They were the result of poor planning, poor recognition of the high calorie, low nutrient density food that she was putting into her body, and the lack of accountability for her choices.

After discussing the cause and effects of Christy’s food choices with her, Christy agreed to keep a food diary for 2 weeks and report back to me.  When she returned, food diary in hand, she told me that she was shocked to have learned some very troubling news about her food choices.  For example, she had no idea that the quarter pounder and fries, plus the large drink she was consuming as she left her classes for the day contained a whopping 1330 calories and 51 grams of fat!  (Christy’s estimated caloric needs for the day were 1900-2000 calories and 60-65 grams of fat).  She also said that having to write down everything that went in her mouth, made her more aware of caloric expenditures and more mindful of making better choices.  Somehow being accountable and mindful of what we are consuming and evaluating the costs, make us more judicious in our culinary choices,

How to keep a food diary

There are many effective strategies for keeping a food journal.  It can be as simple as using pen and paper, then recording every food and quantity, along with caloric content, time of day, and feelings surrounding the eating experience.  By recording this data, individuals can identify where the “potholes” are in their eating plan, possible triggers for bad choices, and times of the day that are at the highest vulnerability, and as a result, improve their diet, improve their overall health, and lose weight.

Other, equally effective strategies, include using the apps on a smart phone such as my fitness pal, See How You Eat, or Just Food Diary to name a few (not endorsed by this page and used for example purposes only).

The most important factor is finding the food journal format that is best suited for you. The pay off is well worth the effort.  Food recorders lose twice as much weight in the same time period as non food recorders!

And remember, if it goes in your mouth, then it goes down on the food diary!

For more assistance with keeping track of your own food diary and improving your diet, contact Leslie Goudarzi, MS, RD, LD at the Institute for Healthy Living or call 903-239-1551.

Help! My Kid Makes Me Want To Scream! How to Grow Healthy Habits

I had a friend that called me the other day, wanting some advice about her 14 year old daughter and food. “She only will eat a few certain things…she picks the unhealthiest foods when we go out, she won’t try anything healthy at home, she is gaining weight (but is not overweight), and I am scared these behaviors are going to follow her throughout life”.

While obesity is at epidemic proportions in the United States, with 2/3 of American adults and 1/3 of American children classified as overweight or obese, it is not unreasonable to be concerned. However, I think that I have some good news for my friend and all of the other anxious parents concerned about their kids food choices.

The Bad Years

Although I am a registered dietitian, a marathon runner, and a health advocate, “EatRightLeslie” didn’t always have the best nutritional patterns. Let me regress to my freshman year in high school. I was an extremely picky eater (and had always been), but it went to a new level when I was fourteen. There were several reasons for my food quirks that year. Looking back, I remember going to high school and feeling the pressure to fit in. That includes what you eat and drink. Eating the federally mandated and “balanced” school lunch was the equivalent to wearing nerd glasses, plus then as it is now, was not the most tasty or appealing meal (partly because it is a mass produced meal having to meet certain federal nutritional requirements at a very low cost). So no school lunch for me. Instead, growing up in the 80’s, we had free access to vending machines and snack lines. My lunch which was based on my picky behavior, budget of $1.50 per day, taste, and what was perceived to be socially acceptable. Based on these strict criteria, I ate (hold onto your carrot stick) three (3) Blue Bell cookies and cream ice cream sandwiches chased by a diet coke. This was not a sentinel event. This was an everyday occurrence. Surprisingly, I was not overweight and remained active, participating in gymnastics, cheerleading, all while maintaining an “A” average.

My bad habits were further enhanced by external influences, particularly my freshman US History teacher. He was an eccentric fellow and often incited debates in the class (“Prove that we have gone to the moon”), incited a complete boycott of the high school cafeteria (demanding better food), along with other items that are highly unlikely to be in the traditional curriculum for an US History teacher. For months, he read excerpts from a book called The Jungle by Upton Sinclair, which featured horrific stories about the meat packing industry during the early 1900’s. He strongly associated these meat packing plants with the school lunch. One of his favorite passages, although inspired by the book, had been tweaked to make it personal to our school and went something like this:

“Mary had a little lamb

And when she found it sickened

She sold it to GHS

And now it is sold as ……..CHICKEN”

Ironically, he was most fond of this passage on the day that we were served some form of chicken. I am became fearful and completely repulsed by the thought of ALL meat and avoided it at all costs. My mother was worried by my new eating habits and I even remember her pleading with me to eat meat and trying to convince me that the “meat was safe” that she had prepared. This just fueled my fire. As a teenager, I like all teenagers before me and since, experienced a “yen and yang” of sorts with authority including my own mother. I wanted to be the center of her universe, but only when I wanted it. I also was trying to pull away from her to express my own sense of self and independence. All of this, now, I recognize to be age appropriate and age specific behavior.

The Good News

Eventually, I (on my own) began to gradually eat certain meats again, partly I think because my mom backed off of the issue after a routine check-up by my regular doctor. As I continued to journey through high school, my interests shifted into fitness, and then to nutrition. As I began to study nutrition, I realized that fueling my body with ice cream sandwiches was not only affecting my abilities and performance, but was not well balanced or healthy. It is not that I had never heard this information, I had. Many times. But I had to “get it” myself and it had to be my idea. This again is age appropriate behavior. Keep in mind that “age appropriate” does not make it an easier pill to swallow for parents. (Remember, it is age appropriate behavior for 2 year olds to “NO” to everything).

After graduating high school and beginning college, I realized that nutrition and eating right not just a passing interest for me, but a life long passion. Please keep in mind, as I share this with you, that I am still not a perfect eater, nor do I strive to be. My goal is to be healthy, not perfect. That means following the researched and evidenced based health guidelines that keep my body healthy and functioning optimally. It also means that I don’t believe in restricting foods or food groups. This epiphany often is unsettling to clients and patients. When I ask clients or students, they assume that I eat grilled chicken, green beans, and brown rice for the meals when I am not eating a salad. They are often shocked to learn that I occasionally enjoy a steak or pizza.

So to my friend with the 14 year old daughter, here is my advice. Tread lightly. Remember that the pediatric feeding guidelines also can still apply to adolescents:

1. Parents decide what, when, and where. This means mom (or dad) decides what food come in the house, when meals are served (or when eating time is done), and where (Preferably at the table as a family, as studies have shown that families that eat together have better nutritional habits, share more information, and increased cohesiveness in the family).
2. Kids decide how much or whether. The worst thing you can do with a child of any age is get into a “food fight”. The kid will ALWAYS win. You cannot make a human being eat and keep it down. Even if you are able to conquer the physical aspects of force feeding (which is highly unlikely), the kid will always associate the food with a negative feeding experience and likely avoid that food for the duration. If certain foods are withheld, they will binge or hoard these foods when they do have access to them, creating a very unhealthy and distorted view of eating.
3. Be patient. Adolescents are spreading their wings and trying to find their independence. Try to remember when you were that age. Very few teens think their parents are “cool” or know anything (even if your mom is a registered dietitian). Thankfully, this stage ends too. Providing a secure and supportive eating environment will allow them to grow through these changes, and decrease the chances of problematic eating behaviors and body dysmorphia. Remember, there are hormone fluctuations, mood swings, peer involvement, and changing appetites. Model the behavior that you want your teen to adapt.
4. And the worse thing I think parents can do is to assess their teen’s weight in a negative manner. Although they are pulling away, teens still value your opinion. Telling your child that they are fat or making them feel as if they should be restricting food is no better than feeding them ice cream sandwiches for lunch. In fact, it can be a gateway for disordered feeding and a lifelong struggle. Focus on improving instead of critiquing. Allow your teen to trust their own hunger, appetites, and their own bodies. A little positivity goes a long way!
5. Seek professional help when need. And then allow the professional to help. I have had several parents bring their kid to see me for various disordered eating concerns. After listening to their concerns, then the well meaning parents will tell me exactly what I need to do to treat their child. Remember, the professional has lots of experience in treating these problems and uses evidence based research to provide the best possible options for diet improvement.

I think that Ellyn Satter, RD, author of How to Get You Kid to Eat Right…But Not Too Much… sums up “Normal Eating” in the following passage:

“Normal eating is being able to eat when you are hungry and continue eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it-not just stop eating because you think you should. Normal eating is being able to use some moderate constraint in your food selection to get the right food, but not being so restrictive that you miss out on pleasurable foods. Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored, or just because it feels good. Normal eating is three meals a day, most of the time, but it can also be choosing to munch along. It is leaving some cookies on the plate because you know that you can have some again tomorrow, or it is eating more now because they taste so wonderful when they are fresh. Normal eating is overeating at times: fueling stuffed and uncomfortable. It is also under eating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important are of your life.

In short, normal eating is flexible. It varies in response to your emotions, your schedule, your hunger, and your proximity to food”.

For more information on pediatric nutrition or nutrition therapy for kids and families, please contact Leslie Goudarzi, MS, RD, LD, Wellness Dietitian at the Good Shepherd Medical Center’s Institute for Healthy Living at 903-239-1551.

Why Is Water the Most Important Nutrient?

Water constitutes 55-60 % of the body’s weight. Interestingly, we can go weeks without eating adequate calories, vitamins, and minerals, but only a few days without water. From athletes to the average individual, most people wonder how much water is needed. Although there are several methods for estimating fluid needs, there is not a one size fits all.

The Ins and Outs of Water

We ingest water in only 2ways (excluding IV fluids). The water in our body comes from the beverages and food consumed. Whereas fluid losses can be contributed directly to urine losses (which are measurable) and insensible losses (not easily measured) such as respiration losses (think of blowing on a cold window and watching the condensation collect), perspiration, and water lost in stool output. These insensible losses account for about 1/3 of the total fluid output.

What’s water do anyway??

Water has many functions in the body. The functions include: being a solvent for the biochemical reactions that take place in the body, maintaining acid and base balance (pH) in the body, releasing calories or energy from the foods consumed in the diet, regulation of body temperature, and growth of new tissue.

The body controls the amount of water that is retained or excreted depending on the concentrations of electrolytes, particularly salt.

How Much Water Do I Need?

There are several ways of calculating water needs in the body. One of the simplest calculations is using 1 ml/calorie consumed. This is fairly simple if you know that 30 ml=1 fluid ounce. So let’s look at an example of a person consuming 2000 calories/day (to meet their estimated energy expenditure). Based on the formula of 1 ml/calorie consumed, we could evaluate that this person needs 2000 ml/d. Most Americans however are more comfortable using ounces, so we must do a tiny bit of mathematical conversion as follows:

2000ml = 66.6 ounces AND 66.6 ounces = 8.2 cups water/day

30 ml/oz 8 ounces/cup

So, we see where the 8 cups of water per day rule comes into play. However, water needs can sometimes be more, particularly if you are exercising, traveling, visiting a higher elevation, living/working in a hot environment, or having a bout of diarrhea. More fluid is needed during exercise and in a hot environment primarily because of increased perspiration or sweating. Flying on an airplane or visiting a higher elevation can increase respiratory water losses. In fact, for every hour of air flight, 2 cups of water is lost! And the water loss from increased stool output can also be significant.

One of the best rules of thumb for monitoring hydration levels is to observe your urine output and color. When adequately hydrated, urine color should be light yellow and frequent (ever 2-3 hours). Dehydration will result in dark yellow to brown, concentrated urine in small amounts that occur infrequently. Over hydration is seen with large amounts of clear urine occurring often. Both dehydration and over hydration can be significant and detrimental.

Help! I’m Parched!

Dehydration occurs when there is inadequate fluid intake, often combined with increased fluid expenditure such as sweating or from increased elevation. Symptoms of dehydration often appear similar to other symptoms and may be missed even by a health care professional if a complete history is not taken. It is important to remember that the average human body is 55-60% water and the body become symptomatic with even small fluctuations and signals the brain to try to correct the imbalances. The table below describes the symptoms associate with the negative percentage change of the body’s water weight:

Homeostasis (The body is 55-60% water)	No symptoms
1-2% Loss	Thirst becomes increased
4% Loss	Muscles lose strength and endurance, fatigue
10-12% Loss	Heat intolerance, increase core temperature, weakness
20% loss	Coma and Death

It is always surprising to hear of someone that dies of dehydration. How could this happen? It happens because human beings are the only mammal to ignore their own thirst. For example, let’s look at the family dog. Let’s pretend that the dog’s water bowl has been depleted and not refilled. The dog is thirsty. But the dog is unable to verbalize to his owner that he is thirsty and becoming dehydrated. The dog will seek out alternatives, such as drinking from the toilet.

Human beings on the other hand, are very good at ignoring body cues, particularly thirst. Let’s look at another example of a sixteen year old boy. The boy is playing his first year of high school varsity football. It is August in Texas. The heat and the practice are both more intense than the boy has anticipated. He is thirsty, but the coach has already announced that water breaks will only be allowed at his discretion. The boy continues to ignore his thirst. Soon his body is moving slower and with less power. If the player does not rehydrate soon, his core temperature will continue to increase, causing heat intolerance, and full body weakness. After the 20% loss, the player will be comatose or dead. It becomes imperative to respond to thirst and drink until that thirst is quenched, particularly in these types of conditions.

My Cup Floweth Over…

Over hydration can be just as critical of a situation. However, most of us don’t think of this being too big of an issue and thankfully it is not, except in certain specialized populations. Over hydration is also known as water intoxication. When too much fluid is consumed in a short period, it can overwhelm the kidneys, even fill the lungs, and cause a severe sodium balance called hyponatremia, which literally means low salt in the blood.

Hyponatremia implies that there is too little salt in the blood, but this would be a misnomer. Imagine three equal size clear containers (that represent the human body). Each container is filled with 9 particles of sodium chloride (table salt). One container is filled half way and this first container represents normal hydration. There is an adequate amount of sodium in the body, not too much or too little. In the next container, the same 9 particles of sodium are present, but this time, the container is only filled ¼ of the way. Here we have the same amount of salt, but it is more concentrated because it has less water or fluid. This represents dehydration or the condition known as hypernatremia. This does not mean that too much salt has been consumed, there are still 9 particles of salt in the solution. Instead, there is simply not enough fluid. Finally, in the last container, the same 9 particles of salt are present. This time, the container is filled to the brim. This solution is very diluted. It does not mean that the individual is salt deficient, but that there is too much fluid in the body, creating the condition hyponatremia.

Back to the original question…who is at risk for “over filling their container”? In reviewing popular periodicals, newspapers, and journal articles, there are a couple of groups that stand out. The first is marathon/endurance athletes. Many of these athletes, even elite or highly trained nonprofessional athletes, such as Boston marathoners have fallen victim of the fluid trap. Why? They are afraid that they will become dehydrated so they drink extra fluid to try to offset their anticipated losses, and end up drinking too much. In addition, they don’t want to stop and use the bathroom as this might increase their finish time, so they hold it. Extremely thin runners are at a higher risk because of limited fluid volume in the body. In one study from the New England Journal of Medicine, some 488 Boston Marathoners were measured, weighed, and labs drawn pre and post race. Researchers found that 1 in 8 had serious fluid and salt imbalances. They found that in this population, some runners gained between 4.5 to 11 pounds from drinking water along the route. (For those not familiar with the marathon, it is 26.2 miles). To give you an idea of what it would fill like to “carry” that much fluid, imagine running with a gallon of milk (approximately 7 pound of fluid)!

Another group that was reported by The Dallas Morning News to have been overhydrated were fraternity students involved in a hazing incident at Southern Methodist University. According to reports, these students of Alpha Phi Alpha fraternity were forced to drink hot sauce, followed by gallons of water, and then struck by wooden paddles at an off campus apartment. After the students were found to be unconscious, the men tried to get them to vomit. Medical personal found them to be severely overhydrated, demonstrated by hyponatremia and pulmonary edema (water in the lungs).

Lastly, another reported group to have some self-induced over hydration were contestants on a radio game show trying to win a game system. They were forced to drink and not urinate. The outcome resulted in kidney failure and death.

Obviously, drinking is important in adequate and balanced amounts. Again, fluid intake should be dispersed throughout the day. More fluid may be needed during special times such as exercising in a hot environment, but it also important to be aware of the risks of over hydration and equally important to pay attention to urination cues.

Hydration is vital to maintaining optimal health and performance. For the an individualized nutrition assessment, including fluid requirements, contact Leslie Goudarzi, MS, RD, LD, Wellness Dietitian at Good Shepherd Medical Center’s Institute for Healthy Living at 903-239-1551.