Intermittent Fasting: Hype or Hoax?

Recently, I have had several of my clients and patients ask me about "Intermittent Fasting".  It seems to be popular in many dieting circles.  Hopefully, this blog post can answer some of you questions as well.

Intermittent fasting is one of the hottest topics among avid dieters at the "moment".  Intermittent fasting has been around for centuries, primarily practiced in various religions.  It wasn't until the early 1900's that some health benefits were observed among diabetic, obese, and epileptic patients (see previous post on Ketogenic Diets).  Basically, intermittent fasting  is a large term that encompasses an eating behavior where an individual eats very little on some days followed by "cheat" or "feast" days or very liberalized eating.  The question that I get the most is "Does this work?", meaning will I lose weight with this type of eating pattern.

As with all such questions, I like to examine the scientific literature on the subject.  A study published this May in the Journal of the American Medical Association: Internal Medicine examined if intermittent fasting was actually more effective in achieving weight loss than the traditional method of daily calorie restriction. 

Here is the recap:

100 study participants (86 women and 14 men) that were classified as obese (but without metabolic complications like Type 2 Diabetes or metabolic syndrome) were separated into 3 groups: those that were put on an "alternate day fast", (meaning that the participants rotated a day on and off of the fast and the feast days), those that followed a daily calorie restricted diet, and those that received no intervention (the followed their 'normal' diet).  The study lasted for a year and was divided into two 6 month phases.  The first phase emphasized weight loss while the second 6 months emphasized weight maintenance.  It is worth noting that the lead author of the study write a book advocating intermittent fasting.

Both the alternate fasting and the calorie restricted groups lost similar amounts of weight (6 % and 5.3% weight loss respectively).  There was slightly more dropouts in the alternate day fasting group than the calorie restricted group (13 versus 10 dropouts respectively).  The dropout rate is an important factor to consider, as it may be indicative that a plan was difficult to follow or simple produced poor adherence.

In the study, intermittent dieting was defined as consuming 25% of caloric needs on fasting days and 125% of calories on "feast" days.  The calorie restriction meant that the participants were allowed to consume 75% of estimated energy/calorie needs.  Mathematically, both groups consumed on average of 75% of estimated energy needs (meaning they ate 25% less calories than needed daily).

Although the weight loss percentages were very similar, the alternate day diet group had a increase in LDL cholesterol (the bad cholesterol) that the daily caloric restricted die group did not.  This may be indicative that it may not be the best choice for individuals at elevated risk for cardiovascular disease (increased LDL is a risk factor for the development of heart disease).  Remember, heart disease is the number one killer in America.  On in three Americans will die as a result of cardiovascular related conditions.

Other reasons that are concerning to me about the intermittent fasting group is the lack of behavioral change it requires.  In my practice, I have found that many of my clients have unhealthy relationships with food including general overeating with periods of starvation and binge eating. I think that the intermittent day fasting may actually enhance these negative interactions with food and does nothing to help change those behaviors.  Although the data suggests both groups had similar weight outcomes, having a healthy relationship with food psychologically is just as important.

Principles of moderation, including portion control, are important in developing healthy eating habits.  I think this can be best supported with consistent behavior as opposed to being on a varying daily calorie levels.

In addition, the sample size of 100 people is also small and more research should be conducted before coming to any "scientific" conclusion.  However, as a registered dietitian with over 20 years of experience, I would strongly caution in applying any one study with limited participants into one's own lifestyle.

The bottom line:  Don't look for an easy fix-it is simply not there.  Weight management is a highly complex problem that must be addressed in a multifaceted manner by trained professionals in obesity management and nutrition.  Enjoy food in moderation and practice calorie control, while enjoying a healthy dose of exercise.  Stay healthy and EAT RIGHT!

What About the Ketogenic Diet?

They say everything old is new again.  That is certainly true for the Ketogenic Diet. This high fat, adequate protein, extremely low carbohydrate diet, along with calorie restriction, was first developed in the 1920's at John Hopkins University to control seizures in pediatric patients.  Patients with epilepsy and seizure disorder would be admitted to the hospital for medical management of their acute seizure activity.  In the 1920's, there were few medications to control or subdue seizure activity.  Often, it became a waiting game of rest and observation.  Physicians and dietitians began to observe that once patients were admitted and were kept NPO (nothing to eat or drink to decrease risk of aspiration should another seizure occur), that the seizure activity greatly decreased or completely stopped, only to return once food intake was advanced. This phenomenon was hypothesized to be a result of the metabolic process known as ketosis and its relationship to the neurological anomalies causing the seizure.  Ketosis itself is the metabolic pathway used when fat is broken down  for energy as a result of inadequate carbohydrate intake.  However, it can be dangerous to be in ketosis for long periods of time due to potential acid-base imbalances and decreased growth in children, not to mention poor palpability and limited selection of foods; and therefore should only be initiated by a trained Neurologist and Registered Dietitian in ketogenic diets.  In the early years, kids on the ketogenic diet had difficulty (more than now) in maintaining/gaining weight and following growth parameters similar to peers of their age and gender.

My Personal Experience with Ketogenic Diets

When I worked at University Medical Center in Lubbock, I acted as the inpatient dietitian for the initiation of the Ketogenic Diet with Dr. Daniel Hurst, Pediatric Neurologist at Texas Tech Health Sciences Center.  Patients were carefully screened based on medical necessity (patients continuing to have many "breakthrough" seizures despite pharmaceutical management, experiencing developmental delays due to the side effects of the medication), anticipated compliance (parents MUST have the ability to say "NO" and mean it), and the overall  intellectual, social, and emotional ability of the family to adhere to the diet. For example, the child would not be allowed to have Halloween candy (not even one piece) or birthday cake.  For some parents, the emotional aspects of these choices were deal breakers.

The actual diet itself is very simple, but the devil is the details.  It meets the RDA for protein (but no more), a minimal amount of carbohydrate (the carbs in medications and even toothpaste must be accounted for), and the remainder of the calorie needs are met with fat.  At the strictest form, (during initiation), the patient would be kept NPO until they were positive for the appropriate amount of urine ketones (generally 2 days), on day 3 the diet would be initiated at 1/3 strength, and advanced daily until full strength.  The inpatient process generally lasted 5 days.  As the dietitian working with these children and their families, I would educate the families in addition to calculating every single calorie provided from food, medication, and yes, toothpaste.  I even personally measured (on a gram scale) and prepared each meal, as any slight deviation could cause the child to be out of ketosis and the whole hospitalization would have to be repeated, potentially costing thousands of dollars.  After successful initiation, the patient was then followed by the neurologist and the trained outpatient dietitian.   One of the most satisfying and rewarding moments that I have had professionally was observing a 3 year old little girl in which I had initiated the ketogenic diet.  When I first met her, she was extremely developmentally delayed due to her severe seizure disorder, having more that 30 seizures each day.  Between the seizures and medications, her little brain just didn't have the time to grasp the world around her, delaying her speech and gross motor development.  A year later, I saw the little girl who was now having seizures very rarely, walking and talking and had been able to greatly decrease her seizure medication regimen.  For me to date, that is one of the most amazing diet interventions that I have observed.

BUT... What about me?  I don't have a seizure disorder.. I just want to lose some weight...
As I stated before, the ketogenic diet is simple in the ratio...however, the implementation may have some downfalls, particularly if you don't have a medical reason to be so motivated (like eliminating seizures).  The diet allows very little carbohydrate.  This doesn't mean that carbohydrates are bad, it just means that they are limited on this particular diet.  The body (and taste buds) prefers carbohydrate, making it difficult for some adults to go "all in".  Let's say that someone goes on the ketogenic diet for 5 days, but then eats a slice of bread, 1/3 cup of pasta, or a serving of fruit, the biochemical pathway will revert out of ketosis, and would need to be re-initiated to obtain the result.  This process can be very taxing for the body and professionally I do not recommend "going in and out" of ketosis on a regular, planned basis.  Many individuals complain of some bothersome side effect during initiation and duration of the diet including headache, lack of energy, moodiness (usually "bad" moodiness), and discontent due to the limited selection of "allowed" foods. 

In 2009, the New England Journal of Medicine published a study by FM Sacks, "Weight Reducing Diets: Comparison of Weight Loss Diets with Different Macronutrient Compositions", which had several interesting findings. The purpose of the study was to compare 4 diets of differing macronutrient composition after 2 years.  The study had 811 participants that met the criteria for overweight or obese.  The participants were randomly assigned to a diet varying in carbohydrate, protein, and fat composition, but all diets created a 750 calorie deficit a day (regardless of the composition).  They all had to participate in 90 minutes of exercise per week as well.  Interestingly, all participants lost similar amounts of weight despite the macronutrient composition, indicating that the diet that works the best is the one your follow!  Behavior factors (attendance, contact, commitment, and engagement were more important than macronutrient metabolism as influencing weight loss.

BOTTOM LINE:

With reference to weight management, if you like breads and grains more than bacon and heavy cream, then follow a diet with a higher carbohydrate content.  The key is reducing the amount of total calories consumed and compliance to making behavior related changes.  On a health note, high fat diets have been associated with heart disease and increased cardiovascular risk.  Cardiac disease remains the number 1 killer of both men and women in the United States.

Thank you Alyssa Simpson for your question on Facebook.

Are You having a "Crappy" Day? Everything You NEVER Wanted to Know About Diarrhea

In my last post, I discussed ways to alleviate constipation.  So it only makes sense to follow up with a post on it's evil twin diarrhea, or CODE BROWN, as I like to call it.  (In hospital training, we learn that that there is a "code" for every almost every situation; CODE RED for fire, Code BLUE for respiratory arrest, etc...so it is only logical that when a patient has a massive amount of stool output, that should be a worthy of "CODE BROWN" status too-although hospitals don't really recognize that is a legitimate "code).

It seems when it comes to bowel movements, people find themselves in the "Goldilocks Phenomenon", where the bowel movement is either too hard (aka constipation) or it is too loose (aka diarrhea. 

Before looking at some of the common causes of diarrhea. it is important to review how the "Poop" factory works.  The gastrointestinal tract (GI tract) includes everything from the mouth to the anus.  Most of the food we eat (95%) is digested and absorbed by the time it leaves the small intestine.  What remains of the food once it has been digested and absorbed will continue traveling to the colon or the large intestine (these terms are used interchangeably). 

There are three important processes that occur in the large intestine:  1) the absorption of water (to help make the stool a nice, neat, brown package), 2) the absorptions of minerals and 3) the fermentation of fiber.  The colon is very specific to it's job description and really doesn't like when any other job is added.  In fact, when other constituents show up, the colon usually expresses it's unhappiness with the onset of "Code BROWN".

SO WHAT CAUSES CODE BROWN?

Diarrhea can have lots of contributing factors.  Therefore it is important to examine some of the most common culprits (when viruses or gastrointestinal illness have been ruled out).

One factor can be medications, including antibiotics. Antibiotics are useful to treat infectious diseases/conditions in the body, but also disrupt the "good" bacteria that is found in the intestines that helps to digest food and provides anti inflammatory properties. Individuals that are on prolonged antibiotic therapy (commonly seen in patients with Staphylococcal infections can be especially at risk for such issues, even allowing for opportunistic "bad" bacteria, like C. difficile to invade the intestine, resulting in the "Mother of Code Brown" situations.

Other medications that  contain sorbitol (a sugar alcohol the increases the osmolality of the intestines and causes excessive water to be shifted into the intestines) can cause diarrhea.  When possible, it helps to take medications not suspended in sorbitol.  Some sugar free gums can also provide a significant amount of sorbitol (for an avid gum chewer) and may also contribute to unwanted bowel behavior.

A contributing dietary factor to chronic diarrhea in some individuals is the sugar found in milk and milk products known as lactose.  In normal functioning GI tract, lactose is broken down by the enzyme lactase into glucose and galactose in the small intestine and then metabolized and used for energy.  Unfortunately, some people do not have the enzyme lactase (or have inadequate amounts of the enzyme) to break down lactose in the small intestine.  As mentioned earlier, the large intestine has the three major functions (absorb water, absorb minerals, and ferment fibers); note that there is nothing on the list about breaking down lactose.  When lactose reaches the large intestine, there is no system in place to digest or absorb it.  Therefore, the colon does what it can to rid itself of the lactose-it solicits as much water into the colon to flush the lactose out, causing gas, abdominal pain, and loose, watery stools.  Many times, lactose/milk intolerance is self diagnosed when adverse symptoms consistently occur after milk intake, and the food is completely avoided.  Avoidance of any food group can lead to nutrient imbalances and deficiencies.  There are many alternatives to regular lactose-containing cow's milk, such as Lactaid Milk (where the lactose is already broken down into galactose and glucose) or lactase enzymes are taken concurrently when consuming milk/milk products.

Occasionally, individuals may go from a highly refined diet to a diet that is high in fiber over a very short time, decreasing gastrointestinal transit time,  resulting in diarrhea.  Therefore, it is very important to increase fiber intake slowly in order to allow the gastrointestinal tract to adapt to the increased fiber intake.

WHAT TO DO IF THERE IS TOO MUCH NUMBER 2?

Regardless of the cause of diarrhea (including viruses and GI illness), the colon generally has something that need to "get rid of".  I imagine Ray Charles in the colon playing "Hit the Road Jack" as the bouncer swiftly escorts the offending agent out of the large intestine. 

Generally, slowing the process down with anti-motility agents only prolongs the time of gastrointestinal discomfort and a "crappy day".  Remember, there is an offending agent in colon. One of the most effective nutritional management strategies of diarrhea includes consuming more soluble forms of fiber.  I like to think of these as the types of fiber that visually absorb water.  For example, if  a bowl of cherrios and milk was left out all day (perhaps in the sink), the cherrios absorb a great deal of the milk and increase in size and reduce the fluid in the bowl.  Soluble fibers acts in a similar fashion when the colon has a high volume of watery stool.  The soluble fiber will soak up the watery stool, adding bulk to the stool, and slowing down the transit time, so that it may be excreted in a nice, neat, solid brown package.  Foods that are generally well tolerated and help resolve diarrhea, include breads, cereals, apples (not the skins), bananas, and rice.  It is also most important to drink lots of fluids when diarrhea is present to prevent and/or treat dehydration.

Have a HAPPY, not CRAPPY Day! @eatrightleslie

Constipation-Is Number 2 your Number 1 Problem?

Let's face it-No one likes to talk about excretion patterns (or lack there of), especially constipation. As a dietitian, I have the "opportunity" to talk about poop, "Code Brown", or Number 2 often.  After all what goes in, must come out!  Unfortunately, constipation is a BIG problem in America, due to many factors, such as eating the "typical" American diet (low in fruits and vegetables), lack of physical activity, and lack of adequate fluid intake.   Constipation refers to inconsistent, infrequent, or hard to pass stool.  Other symptoms can include abdominal pain, bloating, and the feeling of that there is unpassed stool in the rectum. 

Chronic constipation can be problematic and be a real pain in the backside (literally).   It can result in hemorrhoids, anal fissure, fecal impaction, and even increased risk for colon cancer.

How often should I go Number 2?

Experts agree that there is a wide variance in "normal" bowel patterns.  Typically, normal frequency is considered from 2-3 times per week to 3-4 times per week in adults.  (Please note, individuals that have had bowel surgeries, gastric bypass, etc... will experience vastly different excretion patterns in most cases from their pre-surgery habits).  The most important thing to monitor is what is normal for you.  If you normally go Number 2 daily,  and then you notice that your bathroom time has decreased to 3 times per week, that would definitely indicate a change in normal bowel habits.

What can I do If I am constipated?

There a three things that I recommend to regulate your Number Two!

1) Make sure that you are eating plenty of fiber.  The recommended amount of fiber is 25-30 grams of fiber per day.  Fiber content is listed on our food labels of packaged foods under the "Carbohydrate" heading.  Some packaged foods, such as fiber rich cereal, bars, and canned legumes can actually have a significant amount of fiber.  Whole fruits and vegetables (with the skin) are rich sources of fiber.  Dried beans and peas are also excellent sources, with a 1/2 cup of beans containing 6-8 grams of fiber. 

A Word of Caution about Fiber:

If you have not been consuming much fiber, (let's say 10 grams per day), and suddenly increase your intake (to 30 grams the next day), then you are very likely to experience some not so pleasant side effects such as gas, foul smelling flatulence, loose stools, or as I like to call it, "Code Brown".  Instead, if you recognize that you need to increase your daily fiber intake, proceed slowly, adding 2-3 grams per day, to avoid the nasty side effects.

2) If you increase your fiber intake, then it is very important to increase your fluids.  I like to use the swimming pool slide analogy.  When I was a little girl, I used to go to a public swimming pool that had a small slide with two water spickets that were supposed to wet the slide.  However, the slide was old and the water spickets did not adequately wet the slide.  I would climb to the top of the slide, and about half way down, I would hit the dry area of the slide and literally get stuck midway on the slide.  This is exactly what happens in the bowel when someone eats a lot of fiber, without consuming adequate fluid.  The stool sticks in the bowel, resulting in abdominal pain and distention, which can be quite uncomfortable.

3) Make sure that you are being active.  This means that you are moving around throughout the day, engaging in physical activity, and reducing the time spent sitting.  The movement in the gastrointestinal tract, known as peristalsis, is more active when the whole body is active.  This is why physicians encourage their patients to sit up in bed as soon as possible, followed by getting to a chair, and then to walking the halls.  The movement facilitates peristalsis, increased blood flow, and reduced risk of constipation.

The Ounce of Prevention is Worth the Pound of Cure!

Number 2 can be managed by remembering 3 things:  Fiber, Fluid, and Activity! 

The Almond (Math) Problem

Recently, I was visiting with a client regarding her food diary.  Although my client had been keeping a food diary, it was incomplete, lacking serving sizes and macronutrient information.  As we began discussing her record keeping, I noticed that she had recorded "almonds" several times per day, over the course of the week in question.  I asked her to tell me exactly how many almonds was in each serving on her food record.  Her response was something like, "I'm not exactly sure, but probably a handful each time" (which was occurring 4-6 times day). 

So what is the BIG deal about eating almonds?  The package even says that they are "smart eating" and an "irresistible snack", and they are also whole and natural.  The package also highlights that they have no cholesterol, they are a good source of fiber, and contain no artificial ingredients.  It is true that most of the fatty acid content of almonds comes from monounsaturated fatty acids (~61% of the fat content) and polyunsaturated fatty acids (~25% of the fat content).  These are considered to be the "good" fats as compared to saturated fatty acids which are more prevalent in high fat animal products, such as whole milk, standard beef products, and chicken with skin.  These buzz words had been a selling point on her choice of "snack".

After some "investigating", it was clear that my client was eating more than the serving size of almond that we had discussed in her nutrition counseling session.  (Please note that portion sizes and serving sizes are inconsistent depending on which entity is being used).  For example, I had provided my client with serving sizes based on the Exchange System, developed by the American Diabetes Association and the Academy of Nutrition and Dietetics, which classifies foods into groups based solely on their calorie content.  In the Exchange System, 6 almonds is a serving of fat and contains 45 calories per serving.  On the label of her bag of almonds, a serving was defined as 24 nuts and contains 160 calories per serving.  Although my client could not exactly tell me how many almonds she was consuming per day, she could tell me that she was consuming one 12 ounce bag every week, as she was having to re-purchase them routinely in her weekly trip to the store. (This is the small bag up from the canister, but not the largest bag generally found at most grocery stores).

Here comes the "almond (math) problem"....If I look at the label on the almonds she is purchasing, it indicates that there are 12 servings in a bag, each containing 160 calories, with 130 calories derived from fat.  If she eats the entire bag in 1 week, the caloric cost of those almonds is 1920 calories per week (or 275 calories per day on average) of primarily fat. 

Based on her past and current behavior, let's pretend that my client eats one 12 ounce bag of almonds every week for the next calendar year.  That would be a total of 99,840 calories from almonds.  Just for the fun, I am going to apply the Wishnotsky (1958) model of 1 pound of fat = 3500 calories (which by the way has been recently deemed mathematically inaccurate and over simplified manner of estimating weight loss, but at risk of putting you sleep with mathematical formulas, I am going to use this method to illustrate my point). 

If my client consumes an extra 99, 840 calories from almonds in a year (from consuming one 12 ounce bag per week), the math would be calculated as follows:

99, 840 calories/year       = ~ 28 pounds expected weight GAIN/year
3500 calories/lb of fat

As I mentioned before, every pound of fat does not contain exactly 3500 calories and multiple regression analysis have shown this to be true, I am using this method to illustrate a point. 

My client certainly does NOT want to gain 28 pounds in a year from almonds.  And as she replied. "There not even that good!  I thought that I was making a healthy choice".  Generally, we think it is the "BIG" things in our diet that are causing our "BIG" butts and bellies, but more often than not, it is the "little" snacks and bites that we enjoy that are the culprits!  As I mentioned previously, almonds are a great source of monounsaturated fats, however, it is most important to watch the serving size and the calories respectively!  Happy Eating!

Iron Deficiency is the MOST Common Deficiency-Are YOU at Risk?

Iron deficiency is the most common deficiency in the United States and world-wide, with approximately 10% of Americans and 30% of the world's population exhibiting iron deficiency anemia.  Although anyone can be diagnosed with iron deficiency, certain populations are at a very high risk.

Heme in blood cells contain iron; and hemoglobin carries oxygen to our cells and helps excrete carbon dioxide.  When hemoglobin levels become decreased, deficiency symptoms began to present.

Symptoms of iron deficiency include fatigue (despite adequate sleep), poor temperature regulation, decreased appetite, and pale skin.  In populations with darker skin tones, clinical paleness can be observed in the gum tissue.  Side effects as a result of iron deficiency anemia include low attention span, difficulty concentrating,and low immune response resulting in opportunistic infections and illness.

1.  Women of Childbearing Age: 

Females that experience menses have increased blood losses each month, making them at higher risk for low serum iron levels, particularly if periods are extremely heavy or long in duration.

2.  Infants, Children, and Adolescents:

The common denominator in infants, children, and adolescent iron deficiency is an expanding blood supply due to high periods of growth.  Infancy is the most rapid period of growth demonstrated from birth to 1 year of age.  Ideally, a term infant should triple their birth weight by their first birthday. As adults, it would be most frightening if our weight tripled in a year!  It is recommended by the American Academy of Pediatrics that infants from 9-12 months be screened for iron deficiency, as it can cause growth and developmental issues, as well as, decreased immune system. Infants at the highest risk are those that are breast fed without the inclusion of iron fortified cereal or good sources of iron from age appropriate foods.

Growth in children continues at a steady rate, and the blood supply increases accordingly.  Children should be monitored to insure iron needs are adequately met.  Like infancy, adolescence represents another period of high growth and expanding blood supply.  In addition, females have the onset of menses, further increasing iron needs.

Interestingly, the USDA school Lunch and Breakfast Programs are in place to minimize iron deficiency in at risk populations.  Adequate iron intake has been shown to improve attention span, concentration, and learning ability.  This is why parents often receive a friendly reminder encouraging breakfast during standardized testing periods and low income school often offer free breakfast to all students.

3.  Pregnancy: 

During pregnancy, women also have another period of rapidly increasing blood supply.  Not only does this increase in blood volume affect the iron status of the expectant mother, it also affects the iron store of the growing fetus.  Babies born with low hemoglobin levels can have low APGAR score and difficulty breathing after birth.  Iron stores are best maintained during pregnancy by choosing a diet rich in iron and vitamin C, in addition to taking prescribed prenatal vitamins.

4.  Athletes:

Iron depletion is a relatively common occurrence among athletes, ranging between 30% and 50%, especially among female athletes and both male and female athletes who participate in endurance sports.  Because female athletes often do not consume proper amounts of dietary iron ( as a result of lower calorie consumption and/or reduction in meat in the diet), coupled with increased iron losses in sweat, gastrointestinal bleeding, muscle stress/trauma, and menstruation, health and optimal performance may be compromised.  Decreased exercise performance is related not only to anemia, and decreased aerobic capacity, but also to tissue iron depletion and diminished exercise endurance.

The Best Foods to Prevent Iron Deficiency:

Iron is found in a variety of foods including:
-Oysters
-Liver
-Lean red meats
-Iron fortified cereals
-Peanuts
-Almonds
-Barley

Consuming vitamin C rich foods in the presence of iron rich foods (particularly meat sources) will help increase the absorption of the iron.  An example of a meal might be to have a steak (great source of heme iron) with broccoli (excellent source of Vitamin C).

Calcium and antacids can reduce iron absorption and should be taken at opposite times to prevent decreased iron absorption.  If iron deficiency persists, iron supplementation should be considered.  Taking supplements with heme or animal sources of iron and vitamin C will also enhance iron absorption.

If you are in a high risk group, you should consider asking your health care provider to check your iron status at your annual exam.  Iron deficiency is easily prevented and treated and can have a great impact on your health, physical performance, and cognitive ability.

Now, go pump some iron!

For more information, please contact Leslie Goudarzi, MS, RD, LD, Wellness Dietitian at the Institute for Healthy Living, at 903-239-1551.

Febuary is Heart Health Month! Are You at Risk?

February highlights heart health focusing on the prevention of heart disease.  Heart disease continues to be the number 1 killer of both men and women in the United States, accounting for about 28% of total deaths per year.

No one single factor "causes" heart disease, however,  predictive risk factors that can help identify individuals at the highest risk for a cardiac event, including heart attack, stroke, or atherosclerosis.  Some of our risk factors are inherited or can result from aging, however, the majority of risk factors are a result of our lifestyle choices.

There are some risk factors that are inherited.  These include being male at age 45 and greater (Being male doesn't cause heart disease, but increase cardiac risk at an earlier age than females.  Females have an elevated risk after age 55), being African American increases risk for hypertension and stroke, while Caucasians are at a higher risk for myocardial infarction.  Family history is also important in assessing heart disease risk. 

The good news is that most of our risk factors are daily choices that we make!

What Are The Risk Factors for Heart Disease That I Can Control?

1.  Tobacco Use:  Smoking cigarettes or using smokeless tobacco products cause vasoconstriction of blood vessels, contributing to hypertension or high blood pressure.  It also lowers the levels of oxygen that reach our cells and also contributes to lung disease.  Smoking is a choice that definitely increases heart disease risk.

2.  Uncontrolled Hypertension:  High blood pressure is associated with increased occurrence of cardiac events.  The good news is that hypertension can be controlled with one or more of the following treatments, including lowering sodium intake to 1500 mg per day, weight management, exercise, stress management techniques, and sometimes prescription medications.  As a Registered Dietitian, I recommend the least invasive strategies first such as a therapeutic nutrition program as well as an exercise regimen.  If elevated blood pressure continues to persist, it may be time to consider a more aggressive approach, such as medication.  The most important factor to consider with your health care professional is the most effective way to control your blood pressure. 

3.  Elevated Blood Cholesterol:  Like the other risk factors, high cholesterol does not cause heart disease, but it is a significant risk factor and predictor of future disease.  More that 100 million Americans have increased cholesterol, or roughly half of the US population.  Cholesterol can only be assessed by obtaining a blood sample, typically at your doctor's office or clinic.  Total blood cholesterol levels should be less that 200 mg/dL.  Individuals with cholesterol levels more that 240 mg/dL are at twice the risk of a heart attack.  The most effective ways to lower blood cholesterol levels is by maintaining calorie control (not consuming more calories than you need to maintain a healthy weight), decreasing sugar consumption, and controlling fat intake. It is important to note that we make cholesterol in the body.  In fact, approximately one third of our serum cholesterol is contributed to our liver's ability to produce it's own cholesterol from fatty acids.  Some individuals are highly "efficient" cholesterol producers and actually produce more cholesterol  in the liver than what is normally expected.  Like hypertension, it is important to control hyperlipidemia and sometimes it is necessary to include the use of statin medications to help lower cholesterol.  Your best option to decrease your cholesterol should be discussed with your health care provider.  Generally, a combination of treatments is most effective.

4.  Physical Inactivity:  It has been said that "Sitting is the new smoking",  Exercise is very important to the prevention of heart disease.  It has been shown to be a vasodilator (opens up blood vessels), lowers blood pressure, lowers stress levels, lowers cholesterol, and contributes to the maintenance of a healthy weight.  All types of exercise are beneficial and should be included in a healthy regimen including aerobic activity, strength training, and flexibility and stretching.  There is really no downside to exercise. 

5.  Being overweight or obese:  Having an elevated BMI (greater than 25) is indicative of being overweight or obese.  Excess body weight is also a risk factor for the development of heart disease, especially if it is centered around the trunk of the body (imagine an "apple" shape versus a "pear" shaped individual).  Typically, individuals with a "big belly" are at higher risk than those with a "big bottom.  Exercise, diet, and stress management can all be helpful in achieving a healthy weight.

6.  Having Diabetes:  Diabetes mellitus also increases the chances of having a cardiac event.  Type 2 Diabetes Mellitus (adult onset) is typically associated with high BMI, obesity, low levels of physical activity, increased insulin resistance, and poor carbohydrate metabolism.  Controlling blood sugar levels, exercise, and weight management are all priorities in helping to manage this risk factor.

7.  Uncontrolled Stress: Stress is a factor in everyone's life.  Some people handle stress better than others.  There are many effective strategies to deal with stress including yoga, meditation, and exercise.  Poor ways of dealing with stress including "eating your feelings", internalizing feelings, and self medicating with drugs or alcohol.  Sometimes counseling or therapy may be helpful.

8.  Alcohol Usage:  Alcohol intake above a moderate level (one drink for a female and two for a male) increases cardiac risk, particularly increased hypertension leading to higher risk for stroke.  Alcohol also is a significant calorie source and can increase body weight and body fat.

Managing your risk factors for heart disease is the most important thing you can do to prevent this devastating disease.  The best part is that your heart health can be managed by your daily choices!

For more information regarding Heart Healthy Nutrition, please contact Leslie Goudarzi, Wellness Dietitian at the Institute for Healthy Living, at 903-239-1551.

Are These Yoga Pants Making Me FAT?

Weight gain happens slowly, creeping up, like a monster in a horror movie.  Sometimes, it is barely noticeable until you have hit a new 5-10 pound increase.  How does this happen?  Our yoga pants (or other comfortable clothes) may be to blame. 

When it comes to food intake, there are 2 basic factors that regulate our consumption.  These are our internal and external cues.  Internal cues, are those signs that your body is physically no longer hungry and you can continue on with your daily activities.  Our external cues, however, can positively (meaning encouraging you to eat more) or negatively (meaning you eat less) influence your intake greatly. 

Internal cues, in my opinion, is how our relationship with food was "meant to be",  The best example of a human following their internal cues is a typical 4 year old.  The child is presented with a full meal, including dessert.  He is allowed to eat how much of each item he wants (not forced or coerced).  Lunch time is over and he is done.  Now as adults, we may look at his plate, and think, "Hmm, I don't think he ate enough".  Or maybe, "There are children starving in Africa and he is so wasteful" (By the way, I have never understood how someone eating excess calories in America solves world hunger on another continent).  Or perhaps, a million other things that our brains have been programmed to tell our gastrointestinal tract in order to manipulate it into consuming more.  Simply put, internal cues are noticing when your body is hungry and eating until it is comfortably satisified.

External cues, in contrast, are all of the outside influences that affect our food choices, including how much we eat.  These can vary from time of day, how many people we are eating with, mood, portion sizes, cost of the food, and even what we are wearing!

In his book Mindless Eating by Brian Wansick, Ph. D., he cites an observation that occurred in county jails:

"The food served in county jails is not typically awarded any Michelin Stars.  In fact, complaining about the food is one of the great inmate pastimes.  This is why a sheriff at one Midwestern jail was puzzled when he noticed an odd trend:  The inmates, with an average sentence of six moths, were mysteriously gaining 20-25 'prison pounds' during the course of their 'visit'.  It wasn't because the food was great.  Nor did it seem to be because they hadn't exercised or because they were lonely or bored.  They generally had access to exercise facilities and to daily visitors.

In fact, upon release, no inmate blamed the food, the exercise machines, or the visitation hours for their weight gain.  They blamed their jailhouse fat on the baggy orange jumpsuits they had to wear for six months.  Because these orange coveralls were so loose-fitting, most of them didn't realize they had progressively gained weight-about a pound a week-until they were release and had to try and squeeze back into their own clothes".

Hopefully, you are not in county jail and wearing orange coveralls.  However, we can all benefit from these jail house subjects because we practice similar behaviors, such as wearing stretchy yoga pants in lieu of jeans or fitted pants, pull on shorts, or loose dresses.  All of these types of clothing are known for their comfort value, however, when our calorie intake starts increasing and affecting our waist line, it may go unnoticed if our pants aren't talking back! 

Our clothes do communicate with us if we tune in and listen.  The notch in the belt is let out or taken in.  Our pants only zip half way or are too loose entirely.  Researches in Dr. Wansick's lab reported  these 8 signals that indicated weight loss to them more often than just the number on the scale. 

-"When my jeans feel comfortable again."
-"When I have to start wearing a belt".
-"When I suck in my stomach, and I can see some definition, like a four pack".
-"When my belt notch moves back to where it used to be".
-"When I don't get tired walking up two flights of stairs to my office".
-"When I can see my cheekbones".
-"When I don't have to inhale to button my pants".
-"When friends or colleagues ask me if I've lost weight".

So, a few take home messages:
1) Wear some "fitted clothing", at least some of the time for a REAL gut check!
2) Be mindful of your eating, when your actually hungry and when you are actually satisfied.  I like to encourage my clients to close their eyes, take a deep breath and exhale, and ask themselves to rate their hunger before a meal on a scale of 1-10.  After assessing their hunger, make sure that the food intake matches their hunger level.  During their meal, eat slowly, noticing what the foods taste like, how their body feels.  About half way through the meal, reassess the hunger and respond accordingly until satiety is achieved, and get back to your four year old self!

Happy and healthy eating!

For more information on nutrition or counseling services, please contact Leslie Goudarzi, MS, RD, LD at 903-239-1551.

Cheers! The Ups and Downs of Alcohol Intake

The average American consumes 6-10% of their calories as alcohol.  The average represents those who never drink, those that drink socially (those who prefer an alcoholic beverage over water, tea, milk, etc.. with a meal or social engagement), binge drinkers (those who drink 4 or more drinks in a short period), and problem drinkers (those who prefer to become intoxicated as often as possible; may be due to psychological and physiological issues).

Moderate drinking is defined by one drink per day for a woman and two drinks per day for men.  This does not mean that a female can abstain from alcohol for 6 days, and on day 7 enjoy seven alcoholic beverages (this would be considered binge drinking as describe above). 

An alcoholic drink is defined as 1 ounce of hard liquor, 12 ounce beer, or 3.5 ounces of wine.  The amount of calories in alcoholic beverages can be significant ranging from 90-600 calories per beverage, depending on the mixers in which the alcohol is combined.

We have all heard that we should not drink on an empty stomach (and some of my readers may have actually participated in their own "scientific experiment" with regard to this).  When alcohol is consumed without food, the alcohol can be absorbed directly from the stomach into the blood stream, where it travels quickly to the brain, lowering inhibitions and limiting judgement ability.  The alcohol in the blood will eventually make it's way to the liver for metabolism or break down.  The liver views alcohol as a toxin and the main goal of to dismantle the alcohol and excrete it from the body.  When alcohol is consume with or after food intake, alcohol absorption is slowed and the intoxication effects are lessened. 

An enzyme, alcohol dehydrogenase (ADH), is secreted n the liver when alcohol is present.  A nondrinker will have a smaller amount of ADH available as compared to a binge drinker or a problem drinker.  Alcohol dehydrogenase is the enzyme that is typically associated with what the average person refers to as "tolerance", meaning the more an individual drinks, the more alcohol dehydrogenase the individual will produce in anticipation of needing it to break down future alcoholic beverages.  This explains why some people can be 'drunk' on 2 drinks, while others can tolerate a case of beer or a fifth of hard liquor in a single day. 

Once alcohol dehydrogenase has been activated, it will begin a cascade of physiological processes to rid the body of the toxin.  First, antidiuretic hormone (controls fluid balance in the body by regulating urine output) is deactivated resulting in increased urine output in order to rid the body of the alcohol .  This explains why it is much easier to find an empty bathroom stall at a school that in it is at a concert or bar.  This excessive urine output will dehydrate the body, leading to increased thirst, and if followed up with additional alcohol intake, will further dehydrate the body.  The eventual result of this dehydration will cause many of the symptoms associated with the hangover including headache, nausea, and muscle weakness and lack of coordination.  if the alcohol consumption continues to an excessive amount, vomiting is likely to occur, furthering the dehydration.

The dehydration process will continue until the alcohol is completely metabolized.  The body will also attempt to use the excessive calories from alcohol for energy.  If more calories are consumed than can be utilized, those excessive calories will be converted into fat.  In fact, drinkers have increased body fat compositions compared to nondrinkers.  Excessive body fat and dehydration may be especially contraindicated for athletic performance, decreasing cardiac output, lessen ability to perform for long durations, and fatigue more quickly.

Over the long term, drinkers are more likely to suffer from more conditions than nondrinkers including
`cirrhosis and liver disease
`bladder, kidney, pancreas, and prostate damage,
`bone deterioration and osteoporosis
`brain disease, central nervous system damage, and stroke
`deterioration of the testicles
`type 2 diabetes
`heart disease
sexual impotence in men
`impaired immune response
`impaired memory and balance
`malnutrition
`nonviral hepatitis
`severe psychological  depression
`skin rashes and sores
`ulcers and inflammation of the stomach and intestines

It should be noted that there are populations that SHOULD NOT consume alcohol including:
`children and adolescents
`individuals that cannot restrict intake
`women who may become pregnant, women that are pregnant or breastfeeding
`people that are driving
`people that are taking medication that can interact with alcohol
`people with medical conditions worsened by alcohol, such as liver disease

So is there an upside to drinking?  Yes, in some situations.

1.  Drinking alcohol (in moderation) decreases inhibitions.  This can be a particularly positive for individuals that experience social anxiety or generalized anxiety disorder.

2. Drinking alcohol increases appetite.  Appetite is the psychological need for food, meaning that food looks good, sounds good, and smells good.  In fact, we generally eat about 15-20% more after consuming 1 cocktail before dinner.  In addition, the cocktail drinkers rank the food quality and enjoyment of the meal higher than nondrinkers at the same meal.  For individuals with decreased appetite, such as cancer patients, HIV/AIDS patients, and nursing home residents, alcohol may be helpful in increasing oral intake.  However, if you are trying to lose weight, it is important to remember that alcohol intake will likely result in eating more calories as well as drinking them. 

3.  In individuals over 65 (that have been moderate drinkers during adulthood), switching their alcohol choice to red wine may be cardio-protective.

So when evaluating your food and beverage choices, be sure to include your alcohol intake.  It may be beneficial in moderation for you, however, it could increase your body fatness, negatively impact you athletic performance, or even harm your health.  Remember, like all of our dietary choices, moderation is key with alcohol intake!

Happy eating (and drinking)!

For more information or to schedule an appointment with Leslie Goudarzi, MS, RD, LD, call 903-239-1551.

The Upside of Making SMARTER New Years Resolutions

Millions of us have made lofty "New Year's Resolutions" as part of the tradition of self improvement that occurs each January.  The most popular proclamations include losing weight, quitting smoking, or to cut out junk food.  Although these are all great aspirations, our approach may need some improvement. Stating the goal in a positive manner may actually help achieve those desired positive results.  For example, instead of  a goal of losing weight, perhaps we should focus on improving eating habits or increasing our fitness abilities.  Psychologically, we are in a happier place to think of our goals as gaining something instead of giving something up. 

Once you have goal in mind (aka resolution), increase your success rate by following the SMARTER method.

S-Specific: 
Be clear about what you want as you set a positive specific goal.  Instead of saying "I am going to eat better, state specifically how you are going to improve your eating habits.  For example, "I am going to follow a 1400 Calorie balanced eating plan to improve my nutrition habits and promote weight.

M-Measurable: 
The goal should be measurable.  Using the example above, you could track the number of clories you consume to know whether you are meeting your goal.

A-Achievable:
Focus on behaviors that you can control.  For instance, you can't directly control how much weight  you will lose this week, because you may retain fluid one day or hit a plateau one month.  However, you can control the behaviors that lead to weight loss, such as eating a set number of calories and doing physical activity.  So, instead of setting a goal of "losing 2 pounds this week", phrase your goal to "this week I will consume 1400 calories per day".

R-Realistic:
I see advertisements, especially this time of year, promising quick, rapid weight loss, such as "Lose 10 pounds in 2 weeks".  These types of unrealistic expectations can be incredibly devastating emotionally and sabotage your goals.  Being realistic means setting a goal that is challenging but not overwhelming, so you can experience success and build confidence in your ability to conquer bigger challenges.

T-Time bound:
Setting specific start and end times for your goal will help you commit to a time frame and to avoid restarting each Monday!

E-Evaluated:
It is important to look at your goals and see how you are progressing. In the example above, did you consume the 1400 calories per day?  If not, what happened?  Were there certain challenges or problems with meals or certain days?  Evaluation of your own behavior can help you to plan for possible diversions and learn how to have a positive plan when problems occur.

R-Rewarded:
Celebrate your success!!  Acknowledge your progress by rewarding your achievements with non-food treats!  We are more likely to achieve goals when there are both intrinsic and extrinsic rewards.

Making a positive goal and following through with these steps can help turn those resolutions into a reality!  Wishing you all a happy and healthy New Year!

For more information on healthy eating, weight management, or to make an appointment with Leslie Goudarzi,  Wellness Dietitian at the GSMC Institute for Healthy Living, call 903-239-1551.