Fresh Start! New Year 2018!

Okay! So I know this New Year’s post is a little behind. I am thinking that a good New Year’s resolution for me might be to try and stay on top of things in 2018.

  Looking forward to the road ahead

I hope you can say 2017 was a good year for you or at least a learning experience. ūüôā ¬† 2017 has been both for me. I started a new job (which is partly why I am behind on posts) and I have learned so much in the past 8 months. To give you a brief summary, I made a transition in my career from a hospital setting to private consulting and public health. While I enjoyed the experience I had in the hospital and would not trade it for anything, I discovered that I really like public health. I think the prevention side of healthcare suits me much better. It is much more rewarding for me to help people avoid or at least manage disease and reduce hospitalization than to take care of them once they are very sick.¬† It is heartbreaking to watch someone suffer with diabetes (or the complications of diabetes such as wounds or amputations), stroke, heart disease, dementia or cancer. Sometimes just helping them get through another day is all you can do.
And while I am thankful for the wonderful medical professionals that devote their life to helping people in their darkest hours, I knew it was not what I wanted to do anymore. So now I devote my days to counseling people one-on-one and providing educational classes to empower others with knowledge so they can live their healthiest life possible. That is no easy task! With so much misinformation out there and changes always being made to the guidelines, I have to stay on top of latest research to make sure I am giving good advice. I firmly believe that it should be the practice of all those in healthcare (not just doctors) to “First Do No Harm”.

So, as 2018 gets underway, I hope to share more of what I am learning with you. And maybe I can get back in the kitchen and come up with more recipes. ūüėČ

Weight Loss Do’s and Don’ts

Chart of US population with BMI>30

If you have watched the news or read an article recently related to health, you probably know that¬†more than one-third¬†of the U.S. population is considered obese. Obesity is defined as having a BMI equal to or greater than 30 and is based on your weight¬†relative to your height. About another third of the population are considered overweight and are at risk of obesity. Overweight is defined as having a BMI between 25 and 29. These numbers are concerning due to the increased risk of health problems¬†associated with¬†obesity. The¬†causes of this increase in obesity¬†over the past few decades is multifactorial and no one¬†treatment will solve the problem.¬†My concern is that with any problem there are many people willing to offer a solution for the right price. Due to the high¬†number of people living with obesity, the opportunity to sell weight loss products and services for¬†profit is growing and so are the unscrupulous opportunists eager to make money.¬†While there are some good programs¬†and products offered, I want to focus on some important things to consider when trying to lose weight. Here are my weight loss do’s and don’ts.

 

  1. Not all weight loss is healthy.

    1. Don’t skip meals, starve yourself,¬†exercise obsessively or restrict entire food groups.
    2. Do eat regular balanced meals throughout the day, limit your portion sizes, avoid sugary beverages, avoid junk food and be more active.
  2. Anything that promises a 30 lb. weight loss in 30 days is not realistic.

    1. Don’t set your expectations so high that you set yourself up for failure.
    2. Do plan on seeing a 1-2 lb. weight loss per week with the expectation of losing 4-8 lbs. a month. This translates to 48-96 lbs. in a year. Gradual weight loss is better.
  3.  Weight loss does not have to cost a lot of money or severely restrict calories.

    1. Don’t waste your money on expensive diet programs or pre-packaged food. While pre-portioned meals can be helpful, it may not be the most cost effective solution. Calories do matter but restricting calories too much may backfire and lower your metabolism making it harder to keep the weight off.
    2. Do look for more affordable whole foods to incorporate into your diet and plan your meals ahead of time. Most women will need 1400-1600 calories per day and most men will need 1600-2200 calories per day depending on activity level, age, weight and amount of weight loss needed. A registered dietitian can tell you for certain.
  4.  Exercise is an important part of any weight loss program.

    1. Don’t start an intense exercise program if you have not been exercising before. A gradual increase in activity will help avoid injury while building endurance and strength.
    2. Do begin slow and build up over time. Incorporate cardiovascular exercise such as walking, biking or swimming with strength training such as weight lifting to get the best results. Try to get 30 minutes 5-6 days per week.
  5. Weight loss should be just like your medical treatment – individualized for you.

    1. Don’t compare yourself to others. What may work for one person may not work for another. Also your ideal bodyweight may be very different from someone else.
    2. Do focus on your particular goals and what diet and exercise works best for you.
  6. No pill or injection can take the place of a healthy diet and active lifestyle for weight loss.

    1. Don’t think that a pill or injection will solve all your problems without your effort.
    2. Do work on issues that led to the weight gain and use medications if needed as extra assistance to reach your goals. Talk to your doctor if you have made consistent lifestyle changes but still cannot lose weight.

As a dietitian I have heard some crazy ideas about how to lose weight. From very restrictive diets that limit calories to the point of starvation or eliminate entire food groups to avoid certain macronutrients (like carbohydrates) to eating only certain foods in combination with other foods and only at certain times of the day. It can be quite amusing at times. But obesity is serious and there is nothing funny about someone being taken advantage of because they are trying to lose weight. And yes, you can lose weight on just about any of these programs but it is not always a healthy weight loss and may contribute to problems later on. For example, some diets advocate a very low fat diet. While this may save calories, it can also set you up for gall bladder issues. Once you reintroduce foods containing some fat (which you need by the way) you may find yourself having gallbladder issues. This is not a good trade off for a little bit of weight loss.

So my professional advice is to start by restricting the portions of foods that you are currently eating. Eating smaller amounts more frequently can help you avoid being too hungry. Then begin to incorporate healthier fruits and vegetables into your meal plan. Next, start eliminating foods or beverages that you know are unhealthy like sweets and soda. Experiment with different foods in order to get variety in your diet. Choosing fruits and vegetables of different colors makes this easy to do. Be careful when eating out and try cooking without adding excess oil, butter, sugar or salt. Add daily exercise to your routine to burn calories. Make sure you are getting adequate sleep at night. Being sleep deprived can make it harder to handle stress and you may be tempted to eat during the day in order to stay awake. A good 7-8 hours of sleep is ideal.

If these tips do not work for you, see a healthcare professional that can help you identify other possible causes for the unwanted weight such as thyroid issues, hormone imbalances or medication side effects. Diet becomes even more important if any of these are an issue. To find a qualified dietitian in your area that may be able to help, click here.  Feel free to share your comments below.

 

Blood Pressure and Salt: What is the Connection?

Digital blood pressure cuffWhen blood pressure begins to rise, the advice always seems to start with reduce salt intake. While this can be good advice, it fails to consider the complexity and possible other causes of elevated blood pressure. Risk factors for high blood pressure, also known as hypertension, includes:

  • Sedentary lifestyle
  • Excessive sodium intake from processed and fatty foods
  • Low potassium intake
  • Being overweight or obese
  • Excessive alcohol intake
  • Smoking
  • Age greater than 60
  • Race – African American adults are at greater risk than Hispanic or Caucasian adults.
  • Certain diseases or medications

If high blood pressure is caused by another disease or condition, it is termed secondary hypertension. If there is no identifiable cause found, it is termed primary hypertension. Primary hypertension is the most common form and can be related to the risk factors above.

To understand the risk for hypertension, we must understand the physiology of blood vessels. The pressure inside the blood vessel is regulated by hormones that control the blood volume and pressure. When the blood volume increases so does the pressure. Coronary artery disease can also increase pressure inside the blood vessel due to constriction. When the diameter of the vessel wall narrows due to hardening of the arteries (loss of elasticity) or plaque build-up, it increases the pressure. Over time this can lead to more damage of the arteries and gradual increase in blood pressure. High blood pressure is a major risk factor for stroke and heart disease. Unfortunately, there are approximately 75 million people in the U.S. living with high blood pressure.

So, how do we treat high blood pressure? Lifestyle factors should be the first consideration unless blood pressure is dangerously high. If this is the case, medications and/or hospitalization may be required. But for slightly elevated blood pressure, making a few lifestyle changes can go a long way. Weight loss will help if you are overweight or obese. Exercise can also improve blood pressure over time. But be cautious about exercising if blood pressure is very elevated as exercise will make it go up. Avoid tobacco and excessive alcohol intake since these will make hypertension worse. Stress reduction can also help. Dietary changes include reducing intake of processed foods that are high in sodium and fat and eating more fruits and vegetables rich in potassium. Potassium seems to be protective against the effects of excess sodium. Diets such as the Mediterranean or DASH diet are known to reduce blood pressure and heart disease risk.  Some studies also found that getting adequate magnesium and calcium can improve blood pressure. Supplements may be beneficial but nutrients from food is always best.

The question remains however, how much sodium is too much? Americans consume 3,400 mg of sodium per day on average. Current guidelines recommend no more than 2,300 mg of sodium per day. The American Heart Association has lowered the guideline to no more than 1,500 mg of sodium per day for those at risk of heart disease. Some researchers argue that¬†recent studies show limiting sodium too much may¬†do more harm than good. According to them, a very low sodium diet increased the risk for heart disease. Several studies confirm reducing sodium intake improves cardiac risk factors, however the question remains how much should sodium be reduced? We know sodium is necessary for the body to work properly. We do not know for certain how much sodium is needed. Until we can determine this for certain, my advice is “sodium in moderation”. And remember, there is no “one-size-fits-all” when it comes to nutrition. You are an individual so listen to your body and stay healthy!

DIABETES: Dealing with a Pandemic

Stop DiabetesDid you know that over 29 million Americans are living with diabetes according to the Center for Disease Control (CDC)? Another 86 million Americans are living with pre-diabetes, a condition where blood sugar is elevated but not to the level needed to be diagnosed as diabetes. The high prevalence of diabetes is not just confined to the United States. Other countries are seeing an increase in cases of diabetes as well. Diabetes is now the 7th leading cause of death in the United States and the leading cause of kidney disease, lower limb amputation and blindness. Diabetes also increases the risk of heart disease and stroke. The cost of diabetes is enormous and makes up over 20% of healthcare spending.

The good news is¬†the risk of developing diabetes can be reduced by up to 58% in people with pre-diabetes or¬†at risk of diabetes when following a healthy diet and lifestyle.¬†¬†Many people believe they are doomed to develop diabetes at some point in their life because they have a family history of the disease. According to the Joslin’s Center for Diabetes and the Juvenile Diabetes Research Foundation (JDRF), there seems to be a genetic predisposition to developing diabetes. However, not everyone with a family history of diabetes will develop diabetes and not everyone without a family history of diabetes is exempt from diabetes. It seems that some people may be more susceptible to developing diabetes but following a healthy diet and lifestyle is protective and can prevent the “diabetes gene” from expressing itself as diabetes in the person. (And by the way, researchers are not yet sure which gene or genes¬†are affected). Even if someone has a gene that makes them more susceptible to diabetes, there must be an environmental trigger to turn the “diabetes gene” on. Eating a healthy diet, exercising, maintaining a healthy weight and reducing stress can empower the body to function properly and avoid disease. Major risk factors for type 2 diabetes includes obesity, being 45 years of age or older, sedentary lifestyle, history of gestational diabetes or delivering a baby weighing over 9 lbs. or having a family history of diabetes. Consuming excessive amounts of sugar does not cause diabetes but it does overwork the pancreas and causes an increased amount of insulin production which can fatigue the pancreas, lead to weight gain and cause other harmful effects in the body.

So the question is – how do I prevent diabetes in the first place? Knowledge is power so know your risk and learn what you can do to reduce your risk. Maintain a healthy weight, exercise at least 5 days a week for 30 minutes, watch your diet and reduce your stress. A healthy diet includes plenty of fresh fruits and vegetables, whole grains, nuts, seeds and lean meats. Avoid refined carbohydrates such as in sweets, candy, doughnuts or sugar-sweetened beverages. Also avoid unhealthy fats (trans fats specifically) that can increase insulin resistance. A moderate amount of exercise and maintaining an active lifestyle can make a big difference. If your body mass index (BMI) is over 25, consider losing at least 5-10% of your current bodyweight. Even a little weight loss can improve your body’s ability to metabolize glucose. Calculate your BMI here. If you have been diagnosed with diabetes, there is hope. Type 2 diabetes can be treated with diet and lifestyle changes. Even people who start medication for diabetes may be able to reduce the dose or eliminate it altogether once lifestyle changes are made, assuming the pancreas is still making enough insulin. Find a qualified certified diabetes educator here to give you the support you need.

IRRITABLE BOWEL SYNDROME: Handling Your Gut Feelings

Band Aid on Belly

   When Your Gut Hurts

Did you know that April is Irritable Bowel Syndrome Awareness Month? The International Foundation for Functional Gastrointestinal Disorders (IFFGD) has recognized April as IBS Awareness Month since 1997. IBS affects between 25 and 45 million people in the United States with two-thirds of those being female. It is estimated that 10-15% of the world’s population suffers from Irritable Bowel Syndrome (IBS). So what exactly is it? IBS is a disorder characterized by abdominal pain accompanied with diarrhea, constipation or alternating episodes of both. Other symptoms such as gas or bloating may be present as well. There is no cure for IBS but there are ways to manage it.

IBS is considered a¬†brain-gut disorder since the brain controls the functions of the gut and IBS involves changes in gut motility and sensation. When motility is affected, the bowels can move too much or not enough (diarrhea or constipation). The nerves are more sensitive to movement or stretching of the intestines which causes pain. Symptoms can change over time and there may be periods of remission followed by flare ups. The cause of IBS is unknown but may¬†occur in those with a¬†genetic predisposition (family history) or following an intestinal infection or a¬†long-term stressful¬†life event. Getting a diagnosis of IBS usually involves ruling out other possible disorders and will be based on your symptoms. If you are experiencing diarrhea or constipation with abdominal pain, your doctor¬†may test for Celiac’s disease (gluten allergy) before making a diagnosis. Keeping a symptom diary and noting when your symptoms are worse (such as after eating or when stressed) can help you and your doctor better understand how to treat IBS. If it seems there may be a bacterial overgrowth or infection in the intestines, antibiotics may be prescribed. Probiotics have also been studied and found to be helpful in some people, especially when using the strain Bifidobacterium infantis 35624. Other medications may also be prescribed to help manage symptoms. Other treatment may involve¬†learning stress reduction techniques, changing the diet or making lifestyle changes. If you are experiencing symptoms and are not sure what is causing it, talk to your doctor. Getting a proper diagnosis is of first importance. Once you have confirmed a diagnosis, consider seeing a registered dietitian/nutritionist that specializes in gastrointestinal disorders. To find one in your area, visit the Academy of Nutrition and Dietetics. Don’t let those gut feelings get you down. Learn more about IBS here and improve your quality of life.

Feel free to share your struggles with IBS in the comments section so that others may benefit. If you found this article helpful, please share.