Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

The Other Biological Clock

May 2nd, 2012 at 6:58 am by timigustafson
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This year, I have a significant birthday coming up, nothing too dramatic by today’s standards of longevity, but still a good time to take stock. I’ve been reading lately a few books on the difference between chronological and biological age and have even taken some tests online, just out of curiosity (yeah, right).

Of course, I’m supposed to be as old as I feel, but what does that really mean? Am I in some ways younger on days I feel refreshed and energetic after a good night’s sleep. Does time catch up with me when I’m a bit under the weather?

One of the tests I’ve been taking was designed by Dr. Michael F. Roizen. In his book, “RealAge – Are You as Young as You Can Be,” he suggests that shaving off as much as a quarter of a century from your numerical age is a real possibility (so don’t take the test while you’re still in your twenties), provided you have good genes and stick to healthy diet and lifestyle choices. But seriously, taking the “RealAge” (sic) test was an eye-opener for me.

As Dr. Roizen points out, for the longest time aging was considered as a linear process. For example, all sixty-five plus year olds are categorized as seniors and as such, presumably, in a state of decline. This view may be helpful for census bureau statisticians, but it is not an accurate representation of today’s reality. “Not everyone ages equally,” says Dr. Roizen. Some of us continue to live active and fulfilling lives and pursue their goals with the same zest and energy they always had. Others are riddled with debilitating diseases, barely managing to get through the day. In other words, your ‘real age’ is not identical with the number of years you’ve lived according to your birth certificate.

Many people, including doctors, still believe that aging is mostly a matter of genetics. For this reason, everyone’s aging process, and ultimately life expectancy, is supposedly predetermined by his or her genetic makeup. Indeed, there is good scientific evidence that supports this assumption.

One of the symptoms of aging is the slowing of cell division. Cells in the body must continuously divide in order to reproduce and replace damaged tissue. How often cells are able to divide depends on the genetic information (DNA) embedded in them.

Each time a cell divides, its DNA strand, called chromosome, uncoils and genetic information gets copied into the new cell. When the copying process is complete, the strand coils up again and gets capped by a piece at the end called telomere (Greek for “end bodies”). This procedure can be repeated thousands of times over a lifespan, however, every time a DNA strand is replicated, a small portion of telomere gets cut off. Eventually, the telomere become too short (a.k.a. the Hayflick limit) for further DNA replications and cells stop dividing. They enter a period of so-called “cell senescence,” the cellular equivalent of aging, before they finally die. This also means that by measuring the lengths of telomere, we have effectively a way of estimating how far someone’s aging process has advanced. Or so scientists thought for a while.

In 1985, two researchers discovered an enzyme called telomerase. Dr. Elizabeth Blackburn and Dr. Carol Greider found that through telomerase the length of telomere can actually increase. In other words, its shortening is not an irreversible process.

While it is not yet fully understood how exactly telomerase helps telomeres, and in turn the health of cells, there is evidence that lifestyle and diet are important contributing factors. Besides aging, telomeres also seem to be affected by chronic stress, lack of exercise, sleep deprivation, obesity, low intake of essential nutrients and so on – in a nutshell, all the usual suspects that make people sick and wear them out.

On the other hand, if it turns out that positive lifestyle changes can in fact enhance telomerase activity, it may indeed be possible to slow down the aging process on a cellular level, if not reverse it.

Does that mean we can make ourselves biologically younger by eating right, exercising, getting more sleep and managing stress? Perhaps not. But there is ample evidence that diet and lifestyle choices do impact the way people age. I’m not just talking about the dramatic differences between the life expectancy of some villagers in remote places in Japan or the Mediterranean region and the rest of us. Extending longevity for its own sake is not necessarily progress. Maintaining good health and thereby one’s quality of life for as long as possible is the real goal.

So instead of counting my years and comparing myself to other members of my generation, I make sure I give my body what it needs to be well, knowing that when the time comes to let go, I have done my best. I can’t ask for more.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Protecting Children from Developing Weight Problems

April 29th, 2012 at 7:30 am by timigustafson
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You have probably heard by now of Marshall Reid, the sixth grader from Sanford, North Carolina, who managed to change his and his family’s poor eating habits and wrote a book about the experience, titled “Portion Size Me,” which was obviously inspired by the well-known documentary film, “Super Size Me,” by Morgan Spurlock about the negative health effects of fast food.

Like many overweight children, Marshall was bullied and made fun of by his peers. After being called “fat” one too many times, he decided to take action and asked his mother to help him lose weight and eat more healthily. He also took up exercising with his father. Eventually, the family made a video about their lifestyle changes and put it up on YouTube. The book that followed is filled with healthy recipes, easy to understand nutrition facts and a journal describing Marshall’s journey to a new life. “We realized that the amount of weight you drop isn’t the endgame. It’s about how good you feel about yourself, about making healthier choices,” said Alexandra Reid, Marshall’s mother in an interview with the New York Times (4/24/2012).

Marshall is by no means alone in his struggle with weight problems at a young age. According to the Centers for Disease Control and Prevention (CDC), almost 20 percent of American kids ages 6 to 11 are now obese. Childhood obesity is one of the greatest health threats we’re facing today, not just here but around the world. What makes this story so remarkable, however, is that one child’s determination to take control of his life and turn his situation around can make this much difference.

Understanding your child’s nutritional needs
Parents are often confused not only about the kind of foods but also how much their young ones need at different stages of their lives. Children always want more of the foods they like, and often these are not the most nutritious choices.

Moreover, appropriate portion sizes can be difficult to determine. Deciphering serving sizes on Nutrition Facts labels is hard to do for adults. There is virtually no information that can help parents with apportionments for smaller stomachs.

The right amount of food to put on your child’s plate varies with age. Toddlers should eat about a quarter of an adult’s serving in one meal, according to the American Academy of Pediatrics (AAP). Preschoolers and younger school-age kids have greater calorie needs, especially during growth spurts. Between the age of four and eight, appropriate portion sizes are around one third of those of an adult. Older children and teens will eat almost as much as their parents, but this is the time when overeating becomes particularly tempting.

Addressing the issues
For families like the Reids, weight problems can be a sensitive subject to discuss. Parents don’t want to embarrass their children even more than they already are and yet the issue must be addressed before things get further out of control.

“While it may be uncomfortable to discuss weight concerns, the sooner you bring it up and help your child take action, the easier it will be to help him or her achieve a healthy weight. Ignoring it won’t make it go away, and in fact, waiting until your child is older to deal with weight issues may make it harder in the long run,” wrote Constance Matthiessen a freelance writer for WebMD.

She strongly recommends tackling weight problems when a child is still young and more open to lifestyle changes. Parents, she says, must act as their child’s ally, not their critic. When it comes to making better food choices, children should be involved in the decision-making process. It gives them ownership and teaches them to take responsibility for their actions. Most importantly, parents have to be good role models. “If parents go to fast-food restaurants and expose their child to junk food around the house, that child will develop the same habits – and those habits are extremely hard to break.”

That’s also Alexandra Reid’s, Marshall’s mom’s experience. It’s a challenge to keep up the hard-won eating and exercise regimens for the whole family. “We are a work in progress,” she said. Aren’t we all?

If you are interested in learning how to determine healthy portion sizes for children, go to “Food and Health with Timi Gustafson R.D./Kids’ Health.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

The K-E Diet – Quick and Potentially Dangerous

April 25th, 2012 at 2:19 pm by timigustafson
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Shedding pounds in a hurry is never easy and it’s certainly not without health concerns. Yet, the so-called “crash diets” rank among the most popular weight loss programs in America. In our culture of instant gratification, getting fast results is what seems to matter most.

Now a new program is making headlines that elevates the meaning of ‘radical weight loss’ to a whole new level. The K-E diet, abbreviation for Ketogenic Enteral Nutrition, promises astounding short-term success without hunger pangs or the need for exercise.

And it’s radical alright, even by the looks of it. Instead of following a specific meal plan, dieters have a feeding tube inserted through their nose into their stomach to facilitate a constant drip of a protein and fat solution mixed with water that can lower their daily calorie intake to about 800. Although this equals a near-starvation scenario, those who have tried the procedure say they never felt hungry.

“It’s a hunger-free, effective way of dieting,” said Dr. Oliver Di Pietro of Bay Harbor Islands, Florida, who offers the program in his clinic. “Within a few hours, your hunger and appetite go away completely, so patients are actually not hungry at all for the whole 10 days [the program lasts]. That’s what’s so amazing about this diet.”

Although the K-E diet is not entirely new and has been in use in Europe for some time, it has suddenly attracted wide attention over here ever since Jessica Schnaider, a soon-to-be bride, has been wearing the feeding device in public for over a week so she could slim down enough to fit into her wedding gown.

“I don’t have all the time on the planet just to focus an hour and a half a day on exercise, so I came to the doctor, I saw the diet and I said, ‘You know what? Why not? Let me try it. So I decided to go ahead and give it a shot,” she said in an interview with ABC News.

Dr. Di Pietro asserts that his approach is perfectly safe. He says body fat is burned off through a process called ketosis that leaves muscle tissue intact. Although exercise is not required during the short diet period to ensure weight loss, Dr. Di Pietro agrees that exercising to maintain muscles may still be a good idea.

When the K-E diet first made the news, many nutrition experts responded with skepticism and a few were downright outraged. “Any extreme low-calorie diet is associated with side effects [such as] kidney stones, dehydration, headaches,” said Dr. Louis Aronne, director of the Comprehensive Weight Control Program at New York Presbyterian/Weill Cornell Medical Center. “Nutrition should probably be included in that. If you lose muscle mass and water, what’s the point of that.”

That is a problem with most crash diets. The quick success in weight loss rarely lasts. As soon as people go back to their normal eating habits, they regain their lost pounds and sometimes add even more. This can result in the notorious ‘yo-yo’ effect when body weight fluctuates considerably within relatively short periods of time.

Another potential danger is the development of eating disorders in connection with crash dieting, warns Dr. David L. Katz, director of the Prevention Research Center at Yale University and founder of the Integrative Medicine Center at Griffin Hospital in Derby, Connecticut. He has little patience with concepts like the K-E diet and compares them to disorders like bulimia. “This ‘diet’ is little short of lunacy,” he wrote in a recent article published in the Huffington Post. “If self-induced vomiting after meals constitutes an eating disorder, what exactly is infusing a liquid formula through a tube into the duodenum without medical indication? It has nothing at all to do with health and basically endorses the notion that weight loss by any means is acceptable.”

Dr. Di Pietro argues that his method applies mostly to people who are in need of a quick fix and not to those who have large amounts of weight to lose or deal with weight-related illnesses, such as diabetes or heart problems. “I get a lot of brides, nervous eaters,” he said. But that may not be enough justification for resorting to such radical measures, according to Dr. Jodi Krumholz, director of Nutrition at the Renfew Center in Philadelphia, who specializes in the treatment of eating disorders. “Even though they might do this one time for the wedding, I think there can be addictive qualities to these diets, and I think that someone might continue to do something like this. And it could put them in a really dangerous low weight place,” she said.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Can Following a Vegan Diet Be Appropriate for Children?

April 22nd, 2012 at 2:17 pm by timigustafson
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Going totally vegan is becoming increasingly popular among health-conscious adults and many encourage their children to follow suit. But some parents are unsure whether diet restrictions they find healthful for themselves are also a good choice for their kids.

The idea of bringing up youngsters as vegans is controversial, even among nutrition experts. Critics warn that an exclusively plant-based diet may be inappropriate for young children because of the risk of malnutrition when essential nutrients provided in animal products are missing.

Infants and toddlers have special dietary needs because of their rapid growth and development. For those reasons, no dietary restrictions should be applied under the age of two.

Proponents claim that following the dietary guidelines of vegans is beneficial at every stage in life and in any case preferable to the typical American diet, which offers higher amounts of calories and fat but is of lesser nutritional quality.

Veganism, the strictest form of vegetarian diets, excludes all animal food products, including eggs and dairy products. Less stringent variations are semi-vegetarianism (includes fish, poultry, eggs and dairy products but no beef, lamb or pork), lacto-vegetarianism (includes dairy products) and ovo-vegetarianism (includes eggs).

According to the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), “appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases.” The Academy also stresses that “vegetarian diets in childhood and adolescence can aid in the establishment of lifelong healthful eating patterns.” In other words, early adherence to vegetarian eating styles can lay a good foundation for nutritional health, whether those patterns last or change later in life.

A predominantly vegetarian diet is recommended for both children and adults who have weight problems, diabetes, heart disease, high blood pressure and high cholesterol levels. One in three children living in the United States today is overweight or obese and will likely develop some diet-related health problems over time, according to the Centers of Disease Control and Prevention (CDC). Switching to a vegetarian-style diet, sooner rather than later, can help prevent many of these negative health effects.

While it is true that following a strict vegan diet can have its challenges in terms of nutritional balance, vegans can plan their meals carefully to ensure sufficient access to a full range of important nutrients, including so-called “complete” protein. For children in their growing stages, lack of protein can cause serious health problems, including stunted growth and other developmental setbacks.

Only animal and soy proteins are considered “complete” because they contain all amino acids (the building blocks that make up protein) the human body requires. Plant foods can only offer “incomplete” proteins, lacking one or more amino acids. But vegans can make up for these deficiencies by combining different plant foods, for example by eating grains together with legumes, vegetables with legumes, vegetables with nuts, grains with nuts and so on. Because amino acids stay in the blood stream for several hours, complimentary proteins don’t have to be consumed all at once but can be distributed over several meals.

Calcium and iron are two nutrients more easily derived from animal products than from plant foods. Green leafy and cruciferous vegetables such as kale, spinach, broccoli and Brussels sprouts are good sources of calcium. Iron can be found in greens too. Vitamin C-rich foods like citrus fruits enhance iron absorption.

Harder to come by is vitamin B12, which is essential for the health of both blood and nerves. B12 cannot be found in plant foods at all, but the body’s needs can be met by drinking fortified soymilk, eating fortified breakfast cereals or by taking multivitamin supplements.

Iodine is a trace mineral important for the regulation of thyroid hormones. Dietary sources include iodized salt, seafood, eggs, dairy products and crops grown in iodine-rich soil. If these are excluded, smaller amounts are available in green leafy vegetables, potatoes (with skins), seaweed and kelp.

Vitamin D is a nutrient needed for growth and the formation of healthy bones and teeth. It is also harder to get from plant food than from animal products. Thankfully, some vitamin D can be obtained through sun exposure. If sunlight is limited (e.g. you stay indoors or live in Seattle), dietary sources must make up the difference. Fish and fortified milk are good providers, however, if they are excluded, there are only a few plant-based options, such as cauliflower. A multivitamin supplement may be your best solution.

Omega-3 fatty acids are essential fatty acids. They are not made in the body but are important for many bodily functions, including fighting inflammation. Richly present in fish, omega-3s can be supplemented by taking a daily tablespoon of flaxseed or rapeseed oil.

Looking at all the options, it seems very possible to raise healthy children on a vegan diet, especially as they grow older and become adolescents. As long as parents are aware of potential pitfalls and take proper precautions, they should feel confident that they are doing their kids a good service. “The real issue is not whether a child’s diet is vegan or not, or restricted or not. The important thing is whether it’s healthy,” says Amanda Baker, a media spokesperson for the Vegan Society. There are plenty of kids who are not vegan but lack all sorts of nutrients because of their poor diet. It is actually easier for vegans to meet the government’s dietary recommendations for fruits and vegetables servings than for most people, according to Baker.

Ruby Roth, the author of two books about veganism for children, titled “Why We Don’t Eat Animals” (2009) and “Vegan Is Love” (2012), says that introducing children to vegan-style eating has other benefits besides healthful nutrition as well, including instilling interest in environmental and animal rights issues at a young age.

What matters most is that children don’t feel forced to stay within strict dietary limits that don’t allow for some flexibility. If the parents themselves are new to vegetarianism and are trying to get their youngsters to join in, they should start slowly, let’s say, by having one or two meatless nights a week and then progress from there. It’s the same with all diet and lifestyle changes – if they don’t become natural, they won’t last long.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

So It Is Possible to Reduce Salt in Our Food

April 17th, 2012 at 5:46 pm by timigustafson
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The salt content of popular fast food items like chicken nuggets can vary considerably, depending where you buy them, according to a study report by an international group of scientists that tested products of leading multinational restaurant chains. What they found were dramatic differences in the amounts of added salt in the same kinds of food, made by the same companies, only in different parts of the world.

For the study, researchers from Australia, Canada, France, New Zealand, the United Kingdom and the United States analyzed fast food items from McDonald’s, Burger King, KFC, Domino’s Pizza, Pizza Hut and Subway in each of their respective countries and compared notes.

Although fast food is known for being notoriously high in salt wherever you go, the study results are nevertheless startling. The U.S. and Canada were reported to have the highest levels of salt compared to other countries – in some cases nearly twice as high.

One reason for the differences could be government guidelines for salt reduction like in the U.K., said Dr. Norman Campbell of the University of Calgary, Canada, one of the authors of the study report. The British government has set voluntary targets for the food industry, although not yet for fast food restaurants. Still, a growing number of food manufacturers and restaurant operators have committed themselves to meeting the proposed levels as soon as possible and are already using their pledges for advertising purposes.

What this study shows is that reducing salt in our food is indeed feasible and that the technology to do so exists despite of the food industry’s long-standing assertions to the contrary. If it can be done in one country by the same manufacturers and with virtually identical items, it can be repeated elsewhere and certainly here in the U.S.

“Consumers should not have to bear all the responsibility for their diet choices,” said Dr. Campbell. 80 percent of most people’s daily salt intake doesn’t come from the saltshaker on the dining room table but is already added to many processed foods, including items that don’t even taste salty.

The best strategy for reducing salt consumption is for governments to intervene and regulate the use of salt in food processing, he said. All other attempts have been proven unsuccessful. Education campaigns like the National Salt Reduction Initiative here in the U.S. may be well-intended, but they can only work if supported by binding regulations for the food industry.

Dr. Campbell doesn’t believe that trying to further educate the public will produce better outcomes. “We have a highly educated population that is aware of the issues. They are trying to eat healthy and a lot of them perceive they are eating healthy.” What persists is widespread confusion because people don’t know how ubiquitous salt is in their food supply. They eat their food as it’s presented to them, trusting that – although it may not always be perfectly healthy – it will do them no harm.

Another frequently made argument by food manufacturers is that Americans love salty foods and would not buy them if they had a bland taste. “That is because they are used to higher salt levels,” said Dr. David Katz, director of the Prevention Research Center at Yale University. In other words, it’s an acquired, not a natural taste.

According to a study in the New England Journal of Medicine, it is estimated that cutting back just 3 grams of salt (1,200 mg sodium) a day could save the lives of almost 100,000 Americans annually. If the industry substantially reduced the levels of salt it currently uses for food processing, it could translate to large gains for the health of the population, wrote the researchers in their concluding summary. How much longer do we have to wait?

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

What Your Neighborhood Says About Your Health

April 15th, 2012 at 2:55 pm by timigustafson
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Where you live may determine how healthy you are or can hope to be, according to a new study published in the American Journal of Preventive Medicine. Researchers using a geographic information system (GIS) found that access to quality food outlets and opportunities to be physically active can make communities not only more attractive but also more healthy.

Both children and adults who live in areas that provide supermarkets within reasonable distance, recreational parks and safe sidewalks and bike paths have on average lower rates of obesity, diabetes and heart disease than those living in underserved neighborhoods, including so-called food deserts.

“The biggest difference we found in rates of obesity were in places where the environment was good for both nutrition and physical activity,” said Dr. Brian Saelens, professor of pediatrics at Seattle Children’s Research Institute and co-author of the study report. “The rates [in the best places] were less than 8 percent. But if the nutrition and physical activity were not good, the rates went up to 16 percent.”

Although these findings should not come as a surprise, it is the first time that scientists have used geographic data to specifically investigate the causes of lifestyle-related health problems.

Up to now, most studies on the ever-rising obesity epidemic have been focusing on factors such as lifestyle, income, education and genetic preconditions. Geographic differences should be used more often in the future to assess the connections between nutrition, physical activity and obesity. For instance, if we can count the numbers of grocery stores, convenient stores, fast food restaurants and recreational facilities in a particular area, we may be able to predict better what chances the local population has to live more healthily, the researchers said.

“To address this health crisis, attention must be focused on a key issue that lies at the core of the epidemic: The social inequities of obesity,” said Rear Admiral Susan Blumenthal, MD, MPA, a former U.S. Assistant Surgeon General.

“A significant body of scientific evidence links poverty with higher rates of obesity. Families with limited economic resources turn to food with poor nutritional quality because it is cheaper and more accessible. Low-income families live in neighborhoods where it is dangerous to play outside, reducing opportunities for both children and adults to exercise. Instead of supermarkets, [low-income] neighborhoods may have an abundance of fast-food retailers and corner stores that are stocked with products high in fat and low in nutrients. Families are often targeted by food marketers with advertisements encouraging the consumption of nutrient-poor foods, increasing the likelihood of adopting unhealthy dietary practices.”

Despite of their best efforts to lure more supermarkets to underserved neighborhoods through tax breaks and other incentives, local governments find it hard to overcome the many obstacles they’re facing. The so-called food deserts in many poor urban and rural areas persist because of lack of consumer demand (people don’t have the money to buy nutritious but pricey foods), high crime rates (and insurance costs) and transportation expenses (to remote areas).

An area is officially considered a food desert when it has no supermarkets within 1 mile in an urban setting and within 10 miles in a rural environment. The U.S. Department of Agriculture (USDA) estimates that nearly 25 million Americans live in food deserts.

Social welfare programs such as food stamps bring only limited relief because of geographic hindrances. According to data collected by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS), a quarter of all food stamps recipients do not have easy access to supermarkets. High gas prices and lack of private or public transportation only worsen the situation.

Obviously, not all or even many of these conditions can be changed overnight. However, a few small steps in the right direction can go a long way. Communities have taken initiatives all over the country to facilitate more local farmers markets and sales outlets for urban farms where fresh foods are available at affordable prices. Achieving better “walkability” has become a goal in cities and towns of all sizes. With greater awareness, good will and some imagination, we all can make a difference for ourselves and our neighborhood.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

BMI Found Insufficient for Measuring Obesity

April 11th, 2012 at 4:41 pm by timigustafson
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For nearly 200 years, doctors have relied on a formula called the “Body Mass Index” (BMI) to determine whether their patients are within a healthy weight range or beyond. A new study suggests that this approach may be insufficiently accurate for measuring obesity. Researchers found that roughly half of women and a fifth of men who are considered normal-weight according to their BMI numbers should in fact be classified as obese when tested for percentage of body fat in relation to lean muscle mass.

The authors of the study report, Dr. Nirav R. Shah, Commissioner of Public Health in New York City and Dr. Eric Braverman, a professor at Weill Cornell Medical School, said that the common reliance on BMI readings was misleading both the experts and the public about the true proportions of the current obesity crisis.

Over a third of adult Americans are classified as obese based on their BMI measures, according to the Centers for Disease Control and Prevention (CDC). But because BMI does not distinguish between fat and muscle, many people with a normal BMI may carry dangerously high amounts of body fat.

“Fat causes heart disease, cancer, menstrual problems, depression, anxiety and a host of other medical problems,” said Dr. Braverman. “Without an accurate measurement of body fat, millions of people don’t know whether they are at risk for obesity-related diseases.”

Instead of relying solely on the BMI formula, which is weight divided by height squared in kilograms and centimeters, or weight divided by height squared in pounds and inches multiplied by 703, Shah and Braverman propose to take a test called dual-energy X-ray absorptiometry (DEXA), which is commonly used to evaluate bone density in women to check for signs of osteoporosis. Unfortunately, that kind of test is costly and may not be feasible for use as a routine procedure.

As an alternative, the doctors suggested measuring leptin levels in the body. Leptin is a hormone secreted by fat cells. Testing leptin levels is simpler, less expensive and focuses on the core of weight problems, which is body fat.

Other easy measures that can be done by anyone at home are called waist circumference and waist-to-hip ratio.

“Without knowing how much fat [people] have, you can’t really save them from illness. It is the number one predictor of who’s going to live or die,” said Dr. Braverman.

Based on their findings, Shah and Braverman suggested to lower the BMI markers for obesity from 30 to 24 for women and 28 for men. Under the current standards, BMI classifies millions of Americans as healthy when they actually should be concerned about their weight.

Commenting on the study, Dr. William O’Neill, a professor of cardiology at the University of Miami Miller School of Medicine who was not involved in the research, called the findings “alarming.” “Traditionally, we have used BMI. But this study tells you that BMI really underestimates how many are obese.”

Shah and Braverman agree that this may be a game-changer. “We may be further behind than we thought in addressing the nation’s crisis of obesity,” they said.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Adjusting Diet and Exercise to a Slowing Metabolism

April 7th, 2012 at 2:02 pm by timigustafson
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Nothing in your lifestyle has changed, you are eating the same way and exercise as often as you always have, but, as you get older, you are gaining weight. How come? What you may not be aware off is that your body’s metabolism has slowed down, which means that you are burning fewer calories than when you were younger.

Starting at about age 25, the average person’s metabolism declines between 5 and 10 percent per decade, according to Dr. John Berardi, president of Precision Nutrition and author of “The Metabolism Advantage.” This means that the typical American loses between 20 and 40 percent of metabolic power over the course of his or her adult life span.

Typically between 40 and 50 years of age, the body requires fewer calories due to lower expenditure. There can be several reasons for this. You may be less physically active, spend more time working at a desk, endure longer commutes and adopt an all-around more sedentary lifestyle. You may also undergo an increasing amount of muscle loss, partly because of the natural aging process, partly because of physical inactivity. Either way, your calorie needs go down. If you don’t reduce your food intake accordingly, you gain weight from storing fat.

These effects can be more pronounced when someone already has weight problems. The more fat is stored, the less efficiently the body is able to burn calories. Add to this a lesser amount of physical activity and you have a scenario where more weight gain is almost unavoidable.

Genetics and certain medications can also play a role as well as hormonal changes. Women after menopause are especially prone to undergo metabolic shifts.

But it’s not all bad news. A vastly slowed down metabolism isn’t inevitable, said Dr. Berardi. The main problem is that we all tend to become far less physically active over the course of our lives. People who preserve their physical activity levels can expect to see only a 0.3 percent metabolic decline per decade, a 1 to 2 percent total drop over a person’s lifetime, he added in an interview with WebMD.

So what can you do to fight nature every inch of the way? Scientists at Johns Hopkins University have compiled a number of strategies that can give a boost to your aging metabolism.

• Adhere to a healthy diet. If you reduce your calorie intake to avoid weight gain, it is crucial that you make up for the difference by eating more nutritious foods. Whether you are concerned with weight control or not, it is always helpful to cut back on empty calories and go for highly nutrient-dense items instead.

• Eat breakfast. Having a healthy meal at the start of your day gets your metabolism out of its resting state and back into burning mode. Skipping breakfast forces the body to endure longer periods of fasting, which can leave you excessively hungry and tempt you to overeat at the next opportunity.

• Eat frequently. Instead of consuming large meals two or three times a day, try to keep your metabolism consistently on ‘slow burn’ by eating small amounts of food every three or four hours.

• Eat lean protein. Your body burns more calories when digesting proteins rather than carbohydrates and fats. Preferable are low-fat protein sources such as lean meats and poultry, beans and non-fat dairy products.

• Do aerobic exercise and strength training. Regular age-appropriate exercise and resistance training are highly recommended. As we age, we are at greater risk of losing lean body mass, which can initiate a vicious cycle of change in body composition, according to Dr. Andrew Weil, author of “Healthy Aging.” To control weight, you may, in addition to eating less and exercising more, try to increase lean body mass – by weight training, for example – in order to keep the metabolic furnace burning.

• Get enough sleep. Our busy lifestyles keep too many of us chronically sleep-deprived. Among other effects, not getting enough sleep can interfere with your appetite-regulating hormones. Studies have shown that lack of sleep can lead to unhealthy eating habits, similar to stress.

• Avoid supplements. Taking metabolism-boosting supplements such as caffeine, kola nut, bitter orange and others, all of which are stimulants to raise your metabolism by boosting your heart rate, is not a good idea because of many potentially serious side effects. One of the most popular stimulants, ephedra (Ma-huang), was banned by the U.S. Food and Drug Administration (FDA) after its use was linked to several deaths.

The body has many ways to adjust to its changing needs. The best thing you can do is to be aware of these changes and respond accordingly.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

How Can Education Make You Live Longer? It’s Complicated

April 4th, 2012 at 4:39 pm by timigustafson
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The average life expectancy of all Americans has continuously increased over the past few generations for a number of reasons, including advances in nutrition, hygiene and medical care. But there are significant disparities within the population, which seem to be linked to social, economic and – as it turns out – educational differences.

According to a new study by the University of Wisconsin Population Health Institute, sponsored by the Robert Wood Johnson Foundation, there could be a direct correlation between a person’s education and the number of years he or she can hope to live.

For this study, researchers analyzed over 3,000 counties nationwide and ranked them within their respective states by a number of diverse measures, including access to quality healthcare, obesity rates, tobacco sales, unemployment, environmental pollution, crime rates, even the density of fast food outlets. The significance of education levels stood out.

“If you have a community with a high number of high school dropouts, with a high unemployment rate and with children living in poverty, you can absolutely predict that poor health outcomes will be coming down the road,” said Dr. Pat Remington, associate dean at the University of Wisconsin School of Medicine and Public Health and director of the study.

Unemployment and poverty do not only lead to deprivation of essential resources such as good nutrition and basic health care but often also to self-destructive behaviors like smoking and alcohol- and drug abuse. “All these things are part of a web of health,” Dr. Remington added.

The Wisconsin study is not the first that has found a link between education and longevity. A study from Harvard University, published in 2008, described “a stunning correlation between the longer lifespan of people with at least one year of college compared to people with a high school education or less,” according to Dr. David Cutler, dean of social sciences at Harvard. Better educated adults gained on average 1.5 years of life expectancy over 10 years and an additional 1.6 years over 20 years compared to those with a high school diploma or less.

Going to college by itself, of course, does not automatically make you live longer. But the study does suggest that better education often leads to better lifestyle choices. “It turns out that across the board, if you look at any health behavior, better educated people do better than less educated, said Dr. Cutler. “Anything from smoking, obesity, wearing seat belts, having a smoke detector in your house, not using illegal drugs, not drinking heavily, better educated people do better,” he said.

Conversely, the average life expectancy of obese people, smokers and those without access to preventive health care has begun to plateau. Due to growing childhood obesity, some experts predict that the lifespan of significant parts of the population will likely decline in the future.

Needless to say that none of these findings are clear-cut. There are plenty of folks with PhDs and beyond who are overweight and smoke and drink heavily. “Sometimes, even a good education can’t keep smart people from doing dumb things,” said Lee Dye, a science writer for the Los Angeles Times who reported on the Harvard study.

And even centenarians have bad habits. Researchers at the Albert Einstein College of Medicine found that the 100 plus crowd does generally not adhere to dramatically healthier lifestyle choices than the rest of us. There seems to be no particular formula that allows some people to live exceptionally long lives. Even genetic factors have turned out to be less important than some have suggested, as demonstrated in studies that followed identical twins who were separated at birth, lived under vastly different circumstances and died at different ages.

Besides reasonably healthy diet and lifestyle choices, one thing, however, seems to matter greatly. People who remain free of debilitating illnesses at old age, physically as well as mentally, are typically very active. They enjoy a vibrant social life, pursue multiple interests, maintain a positive attitude and know how to take care of their needs. They may be well educated, but not always in terms of formal education. An open mind and an insatiable curiosity may have gotten them just as far.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Weight Loss Surgery for Diabetes Patients – A Problematic Choice

April 1st, 2012 at 3:19 pm by timigustafson
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With obesity rates in the United States and around the world continuously rising, surgery for weight loss is becoming an ever more acceptable option. Now, two clinical studies suggest that diabetics can benefit from operations as well. Type 2 (or adult-onset) diabetes is mostly linked to weight problems and has reached similarly epidemic proportions. According to the Centers for Disease Control and Prevention, the number of diabetes cases has nearly tripled over the last three decades and affects today more than 20 million Americans.

Both study reports – one from Italy, the other from the United States – concluded that surgical procedures, a.k.a. bariatric surgery, by which the size of the stomach is considerably reduced, enabled patients not only to lose weight but also manage their blood sugar levels more effectively than traditional measures like dieting and medication. Bariatric Surgery Can Carry Great Risks, Including Malnutrition

The findings, which were published in the New England Journal of Medicine, may change how many diabetes cases will be treated in the future. Proponents of bariatric surgery say the studies confirmed that stomach size reduction should no longer be seen as a last resort but should be considered earlier in the treatment of obese patients with type 2 diabetes. Others warned that more studies are needed and that the risks in connection with the procedures available today remain high.

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), about 200,000 surgical procedures for weight loss are performed annually in the U.S. The National Institute of Health (NIH) says that surgery should only be recommended for people with a body mass index (B.M.I.) of over 40, or over 35 for those with diabetes and other serious illnesses related to weight problems.

For the studies, the researchers limited themselves to three types of weight loss surgery: Roux-en-Y, biliopancreatic diversion and sleeve gastrectomy. Roux-en-Y is the most commonly applied method of gastric bypass surgery, by which a small part of the stomach is sealed off and then directly connected to the small intestine. Biliopancreatic diversion removes large parts of the stomach and bypasses the majority of the small intestine as well, which limits both food intake and absorption of nutrients. Sleeve gastrectomy reshapes the stomach into a smaller tube but does not alter the way food enters or leaves it.

Needless to say, these are all very drastic steps to prevent weight gain and a host of diseases that often go with it, including diabetes, heart disease, hypertension, high cholesterol and so forth.

As a dietitian, my greatest concern is how the anatomical changes affect the metabolism of patients. Because bariatric surgery limits food intake so dramatically and also diminishes the absorption of nutrients, there is a great risk of malnutrition. Especially a sufficient supply of protein, which is extremely important during rapid weight loss for overall health and to allow for proper healing from the surgery, can become hard to obtain. Part of the reason for this is that the initial digestion of proteins takes place in the stomach, which after surgery is not only reduced in size but also in capacity. Even more problematic is the hindered absorption of essential nutrients in the small intestine because some or much of it is bypassed. This affects the absorption of carbohydrates, proteins and fats but also vitamins and minerals. Potential complications, not only from the surgical procedure itself but also from the nutritional deficiencies, are multiple.

Bariatric surgery should never be considered as a quick fix, on par with cosmetic surgery. It is a profound alteration of the digestive system that is risky and requires permanent changes in diet and lifestyle choices. Intensive post-operational counseling and strict observation of nutritional guidelines are an absolute must.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

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About timigustafson

About Timi Gustafson, R.D. As a clinical dietitian, health counselor, book author, syndicated newspaper columnist and, as of late, blogger, she has been able to reach millions of people, addressing their concerns about issues of health, lifestyle and nutrition. As Co-founder and Director of Nutrition Services for Cyberdiet.com (now Mediconsult.com), she created the first nutrition-related interactive website on the Internet in 1995. Many of the features you find on her blog, www.timigustafson.com, are based on the pioneering work of those days. Today, her goals remain the same: Helping people to achieve optimal health of body and mind. She received a Bachelor of Science degree in Clinical Nutrition and Dietetics from San José State University in California and completed a Clinical Dietetic Internship at the University of California Medical Center in San Francisco. She is a registered dietitian and Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Academy of Nutrition and Dietetics, a member of the Diabetes Care and Education, Dietitians in Business and Communications, Healthy Aging, Sports, Cardiovascular and Wellness Nutrition, and the Vegetarian Nutrition Practice Groups. For more information about Timi Gustafson R.D. please visit: www.timigustafson.com

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