Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

World Health Organization Sets New Targets for Reducing Chronic Diseases

May 26th, 2012 at 4:34 pm by timigustafson
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The World Health Organization (WHO) has set a number of targets for reducing so-called non-communicable diseases (NCDs) by 25 percent by 2025. NCDs are chronic illnesses largely caused by dietary and lifestyle factors. They include obesity, heart disease, diabetes, some types of cancers and chronic respiratory illnesses that combined have become the leading causes of death globally, according to the agency.

Chronic diseases account for 36 million deaths annually, over 60 percent of all human mortality. They continue to accelerate globally and are advancing across all regions, affecting all socioeconomic classes. It is expected that almost three-quarters of all deaths will be caused by chronic diseases by 2020.

Chronic diseases are defined as illnesses of long duration and generally slow progression. They are also considered as largely preventable by positive dietary and lifestyle changes.

One of the leading causes is obesity, which has doubled worldwide since 1980. Weight problems are the fifth leading risk factor for all deaths. At least 2.8 million adults die each year as a result from being overweight. In addition, 44 percent of diabetes rates, 23 percent of heart disease rates and up to 41 percent of cancer rates are attributable to weight problems. Obesity is now linked to more deaths worldwide than underweight.

Especially worrisome is the continuing rise of childhood obesity. In 2010, more than 40 million children under the age of five (!) were overweight. Almost 35 million of these live in developing countries. Most impoverished children who have weight problems are also severely malnourished.

Leading causes of unhealthy weight gain are poor diets based on energy-dense foods that are high in fat, salt and sugars but low in nutrients. A worldwide decrease in physical activity due to sedentary lifestyles, increasing urbanization and changing modes of work and transportation also plays a role.

To change the current trends, improvements must take place on several levels, according to WHO recommendations, including individual responsibility, education, social environments as well as quality and affordability of food supply. “Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Supportive environments and communities are fundamental in shaping people’s choices. The food industry can play a significant role in promoting healthy diets by reducing fat, sugar and salt content of processed foods, ensuring that healthy and nutritious choices are available and affordable to all customers and by practicing responsible marketing.”

The “WHO Global Strategy on Diet, Physical Activity and Health,” which was first introduced by the World Health Assembly in 2004, calls for actions needed to support healthy eating habits and regular physical activity. The agency “calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.” For this, an action plan was developed for the prevention and control of NCDs as a roadmap to establish and strengthen more initiatives on local, national and international platforms.

Although the targets set by the WHO are not binding and lack in many ways specificity, similar initiatives have shown some degree of effectiveness in the past. For instance in 1987, the World Health Assembly created the first “World No Tobacco Day” to draw global attention to the health effects of smoking. It is commemorated every year on May 31 as an occasion to help reduce worldwide tobacco use. In 2005, the agency released the “Framework Convention on Tobacco Control” (FCTC) with similar goals.

Tobacco use is still the second most common cause of death in the world, after hypertension, being responsible for killing one in 10 adults every year. Obviously, we have a long way to go, but progress has been made. Hopefully, WHO’s continuing efforts will increase awareness of the seriousness of chronic diseases as well.

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.


Diabetes Dramatically on the Rise Among Teenagers

May 23rd, 2012 at 2:23 pm by timigustafson
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Nearly a quarter of American children and adolescents is developing type 2 diabetes or has already the disease, according to a study by the Centers for Disease Control and Prevention (CDC), published in the journal Pediatrics. Diabetes and other metabolic conditions seem to spread more rapidly among the young and are harder to treat than in adults.

The study also found that over 50 percent of overweight and obese teenagers had at least one risk factor for cardiovascular disease such as high cholesterol and high blood pressure. Prediabetes and diabetes rates rose faster than other lifestyle-related diseases among adolescents. “This was unexpected, especially since obesity has been leveling off,” said Dr. Ashleigh May, a researcher at the CDC and lead author of the study report.

The term “prediabetes” refers to higher than normal blood sugar levels and the possibility of developing type 2 diabetes and other risks factors for heart disease, stroke and kidney disease, according to the CDC.

Not too long ago, type 2 diabetes was known as adult onset diabetes because it was virtually unheard of affecting children. But with the growing childhood obesity epidemic in recent years, more youngsters are being diagnosed with the disease every year.

Even normal-weight children are not completely safe. Of those thinner kids, 37 percent have at least one heart risk factor, said Dr. May. “Anyone who’s eating a diet high in sugar and fat will likely have problems, even if it isn’t apparent in their weight,” said Dr. Dorothy Becker, chief of endocrinology and diabetes at Children’s Hospital of Pittsburgh. “If they don’t make a change, then they’ll carry all of these risk factors into adulthood, and that’s like having a ticking time bomb over your head. You don’t necessarily know when it’s going to go off, but it’s likely that it will,” she added.

Dr. Mark Hyman, chairman of the Institute for Functional Medicine and founder of The UltraWellness Center as well as bestselling author of “The Blood Sugar Solution,” agrees. “One in three children born today will have diabetes in their lifetime. We are raising the first generation of Americans to live sicker and die younger than their parents. Life expectancy is actually declining for the first time in human history,” he warned.

Even the distinction between prediabetes and diabetes he considers as meaningless. “Prediabetes is not ‘pre’ anything,” he said. “It is a deadly disease driving our biggest killers – heart attacks, strokes, cancer, dementia and more. So if your doctor has diagnosed you with prediabetes or metabolic syndrome, don’t think that you are only at risk for something “in the future,” such as diabetes or heart attack. The problem is happening right know.”

In response to study reports like these, the American Academy of Pediatrics (AAP) has recommended that children and adolescents undergo regular check-ups of their blood pressure and cholesterol levels.

The good news is that these developments are largely reversible and avoidable in the future through dietary changes and lifestyle improvements. “The big message here is that children and teenagers need more help with following a healthy diet and staying physically active,” said Dr. May.

Obviously parents are the first line of defense when it comes to their children’s health and well-being. But society has a role to play as well – nutrition and health education in all public schools being one of them.

In all likelihood this latest CDC study will be dismissed (like most others) in the public discourse as just another “doomsday” report that can be ignored. In truth, however, an entire generation’s future is at stake. If we continue on the path we are currently on, we are going to become a nation where being sick is normal and good health is the rare exception. It doesn’t have to come to that.

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 True Cost of Healthy Eating

May 17th, 2012 at 5:10 pm by timigustafson
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A common argument why Americans don’t eat better is that healthy food costs too much. A new study by the U.S. Department of Agriculture (USDA) attempts to dispel this widely held belief by comparing the prices of healthy and less healthy foods. When analyzing costs per calorie, per edible gram and per average portion sizes, some highly nutritious foods such as grains, vegetables, fruits and dairy products turn out to be cheaper than protein foods like meats and processed items, which are typically higher in saturated fat, added sugars and sodium.

For the study, the researchers looked into nearly 4,500 different food items. “Healthy foods” were defined as products containing at least half a serving of one of the major food groups recommended by the Dietary Guidelines for Americans of 2010, including vegetables, fruits, grains, dairy and proteins, as well as only moderate amounts of saturated fats, added sugars and sodium.

The takeaway from the study is that contrary to popular belief, it can actually cost more to eat badly, said Elisa Zied, a Registered Dietitian and regular contributor to MSNBC. “Comparing the costs of commonly available foods is important because, at a time when two-thirds of Americans are overweight or obese and many low-income families struggle to control their grocery bills, the belief that healthier foods are always pricier adds to the problem. Although many variables – personal preferences, convenience and cultural factors – play a role in what we buy at the supermarket, cost may play an even greater role in our food choices,” she said.

While I agree with this assessment, it seems to me that these variables cannot easily be changed. Poor eating habits can only be improved with education. Many people who eat unhealthy foods on a regular basis don’t really know what makes these foods detrimental to their health. They just eat what they like and what they are used to. The same goes for convenience and culture. If a fast food restaurant or a food truck is just around the corner, but the next supermarket is miles away, guess what most folks will go for?

Also, the reputation of health food stores to be overly pricey is well deserved. Why, for example, is Whole Foods Market often called “Whole Paycheck Market”? Even if not every item in the store is excessively expensive, perception matters, and price-conscious consumers won’t even try shopping there.

The USDA study is a laudable attempt to shed more light on the true costs of food and, consequently, the affordability of healthy eating. But it’s a theoretical exercise with few practical implications. People don’t calculate like this. They buy the kind of food they can afford and they don’t want to drive long distances to find it. Those who have to get by on a limited budget have to consider expenses for gasoline and electricity as well. Even home-cooking is not cheap when you include energy costs. Plus it’s time consuming and adds to the daily workload (not to mention that you have to learn a few skills with the skillet).

Having said that, it should be pointed out more often to consumers that the costs of fast food, pizza and TV dinners are by no means negligible. A family dinner for four from the drive-through can easily set you back 30 bucks or more. For a similar amount, you could get, for example, a green salad, a whole chicken with some vegetable side dishes, and fruit for dessert. The difference is that a whole lot more preparation goes into a meal made from scratch, and it may be less fun than digging into a pizza that has just been delivered to your door. But those are the real calculations we have to consider before America’s eating habits can change for the better.

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.

Stigmatization Makes It Harder to Overcome Obesity

May 16th, 2012 at 11:46 am by timigustafson
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Obesity rates may be on the rise worldwide, but thinness continues to be the standard for physical beauty and attractiveness. Conversely, obesity is often linked with poor body image and low self-esteem, which only adds to the struggle with weight and weight-related health problems.

“Modern Western culture emphasizes thinness, denigrates excess weight and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about their physical presence that brands them,” said Dr. Kelly D. Brownell and Dr. Marlene B. Schwartz of the Rudd Center for Food Policy and Obesity at Yale University in a study report on obesity and body image.

Prejudices against the overweight seem to develop early. One study found that children as young as three years of age believed fat people were “mean, stupid, ugly, and had few friends.” A majority of adults responded similarly, associating obesity with self-indulgence, laziness and lack of discipline. One poll conducted by Reuters found that over 60 percent of respondents believed the current obesity epidemic was caused by personal diet and lifestyle choices alone. Half supported the idea of charging obese patients higher health care premiums.

Views like these are also reflected in the job market, where obese candidates on average fare much poorer than their slender peers, according to a report on the subject by Reuters (5/11/2012). Statistically, obese workers receive lower wages, are more often passed over for promotions, and are less perceived to have leadership potential than their slimmer colleagues.

The effects of stigmatizing obesity have not yet received wide attention in our society. Unlike discrimination based on race, gender, religion or sexual orientation, exhibiting bias against the overweight is not illegal and would in any case be difficult to prove. One of the reasons for this discrepancy may be cultural. Many of us like to think that hard work leads to success and that failure results from weakness. The same applies to our standards of health and beauty. We each are responsible for our own well-being, so the thinking goes, and if we don’t manage, we have only ourselves to blame. So it shouldn’t come as a surprise that obesity, especially when it’s seen as a self-inflicted disorder, is judged so harshly, even in moral terms.

Fat people are increasingly becoming scapegoats for all sorts of cultural ills, said Dr. Linda Bacon, a nutrition researcher and author of “Health at Every Size: The Surprising Truth About Your Weight.” “There is an atmosphere now where it’s O.K. to blame everything on weight. We have this strong believe that it’s their fault, that it’s all about gluttony,” she said.

Even health care professionals are sometimes found to have prejudicial attitudes towards heavier patients, as studies have shown. In one survey, more than half of the interviewed doctors said obese people were “less likely to comply with treatment.” Consequently, they tend to spend less time with them and, as a result of feeling embarrassed and disrespected, the patients themselves avoid seeking the care they need.

In sharp contrast to many popular views on the causes of obesity, the Institute of Medicine (IOM) has recently published a report that identified the increasingly “obesogenic” environment we live in as the root of the crisis, rather than individual behavior.

Dr. Rebecca Puhl, a psychologist at Yale’s Rudd Center, agrees with the IOM’s conclusions, but she warns that “as long as we have this belief that obese people are lazy and lacking in discipline, it will be hard to get support for policies that change the environment, which are likely to have a much larger impact than trying to change individuals.”

People suffering from emotional distress in connection with weight problems are much less likely to succeed in their efforts to improve their health. Dissatisfaction with one’s size or body type can produce great amounts of stress. The results can be eating disorders like binge eating or bulimia, social isolation, depression and other psychological dysfunctions. Comprehensive counseling and support from family members, friends and people with similar experiences can be lifesaving. For our society in general, a shift in attitude would help as well.

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.

More Americans Suffer from Asthma

May 13th, 2012 at 2:06 pm by timigustafson
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Asthma rates in the United States have been on the rise over the past decade and are now at an all-time high, according to the Centers for Disease Control and Prevention (CDC). Almost 26 million Americans had asthma in 2010, the last time data on the disease were reported. Seven million of those were children and adolescents.

According to the CDC, asthma ranks among the leading chronic illnesses affecting young people. It is one of the most frequent causes of school absenteeism. About 10 percent of school children miss classes because of asthma at least once a year.

Especially low-income populations are at an increased risk. 11.2 percent of Americans living below the poverty line are reportedly affected. Females seem more prone to developing the disease than males.

Asthma is a chronic inflammatory disorder of the airways. This can include narrowing of the bronchial tubes, swelling of the bronchial tube lining and an increase of mucus secretion to the point where the airways become blocked. In case of a so-called asthma attack, a person’s airways are so obstructed that it becomes difficult to breath, which can lead to a life-threatening situation. Thanks to faster intervention and preventive treatments, death rates in connection with asthma have dropped by a third compared to 10 years ago.

Asthma is often misdiagnosed as allergies. Not all people who experience allergy symptoms have asthma. Like allergies, asthma is associated with exposure to allergens and also smoking, chemicals and air pollution.

Identifying and controlling potential triggers of asthma attacks is crucial for effective treatment. Although there is no known cure or even prevention of asthma, multiple steps can be taken to limit exposure to allergens and other irritants.

The CDC recommends the creation of more asthma-friendly environments such as schools by implementing policies and procedures that allow students to successfully manage their asthma. These can include providing access to asthma care clinicians and school nurses, educational and awareness-building programs, training of teachers and school staff, community outreach and so forth.

In the home, it is recommended to keep dust and dirt from accumulating. Dust mites are notorious asthma attack triggers. Ventilation and air filtering is equally as important. Pet animals can be a significant source of allergens and should be kept away from asthma sufferers. Exposure to a whole range of potential irritants, including tobacco smoke, wood and coal fire smoke, strong odors from cooking, household chemicals, paint fumes and cosmetic products should be avoided as well.

Even dietary precautions may be necessary. Some food-borne allergens can become triggers and it is crucial to identify and eliminate them as much as possible. Some people may be able to tolerate smaller amounts of foods they are allergic to. Only experience can determine the limits.

There is no medication that can cure asthma. But medications are available to control asthma symptoms. There are different types and they come in different forms such as pills, aerosol inhalers, powder inhalers, liquids and injections.

The two main types of medications are anti-inflammatories and bronchodilators. Anti-inflammatories reduce swelling and mucus production in the airways. They can lower the intensity of asthma symptoms and allow for better airflow. Bronchodilators relax the muscles around the airways, thereby easing breathing. Bronchodilators are especially effective during asthma attacks.

The primary purpose of taking asthma medications is to control and relieve. Most asthma medications must be taken regularly, often daily. So-called reliever or rescue medicines are only to be used during acute attacks.

How often an asthma patient has to take medications depends on the severity of his or her symptoms. Some are affected only during certain times of the year, e.g. in the spring. However, no one should experiment with asthma medication dosages without prior consultation with a doctor.

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.

Nearly Half of All Americans Will Be Obese Within Two Decades, Study Projects

May 9th, 2012 at 6:24 am by timigustafson
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A study by the Centers for Disease Control and Prevention (CDC) predicts that obesity rates in the United States will reach up to 42 percent of the population by the year 2030. More than 10 percent will be classified as “morbidly obese,” which is 100 pounds plus over a healthy weight range. If these predictions come true, health care costs in the U.S. will increase by well over half a trillion dollars.

The study report was presented at a conference sponsored by the CDC, titled “Weight of the Nation” (May 7 to 8, 2012) in Washington D.C. and simultaneously published in the American Journal for Preventive Medicine.

While it is difficult to make these kinds of forecasts, it is clear that obesity trends that started in the 1980s and 1990s continue on their paths. Currently, over 60 percent of Americans have weight problems and over 30 percent are diagnosed as obese. Even more worrisome are the growing rates among young people. Over 20 percent of children and adolescents are obese today.

Obesity can cause a host of chronic health problems such as cardiovascular disease, diabetes and also certain forms of cancer. Many people who develop weight-related illnesses during childhood are likely to face at least some of the consequences throughout their adult-lives.

“The prospect of such increasing rates, particularly those of severely obese Americans, is alarming, especially since efforts aimed at helping people to lose weight have so far proven relatively ineffective,” said Dr. Eric Finkelstein, one of the authors of the CDC report.

For a long time, the causes of obesity have been in dispute. One popular explanation is that people just eat too much and exercise too little. Some health experts say it’s not that simple. In a separate report on America’s obesity epidemic that was also released at the “Weight of the Nation” conference, the Institute of Medicine (IOM) concluded that the crisis is deeply rooted in the environment we live in, which is, as the report called it, “obesogenic.” According to the IOM, it is not so much people’s behavior that has changed over the past few decades but rather a number of factors that are beyond any individual’s control, including agricultural policies and food manufacturing.

“When you see the increase in obesity, you ask, what changed? The answer is, the environment,” said Dr. Shiriki Kumanyika, a professor at the University of Pennsylvania of Medicine and IOM committee member in an interview with Reuters. “The average person cannot maintain a healthy weight in this obesity-promoting environment.”

Instead of appealing to “personal responsibility,” the report suggests for policy makers to pursue structural changes like shifting subsidies from corn and wheat farms to fruit and vegetable growers, creating more pedestrian-friendly infrastructure, and limiting the number of fast food outlets near schools and residential areas and so on. The hot-button-issue of imposing surtaxes on sodas to curb consumption was also mentioned.

The Center for Consumer Freedom, an advocacy group for the food manufacturing and restaurant industry, rejected the IOM report and argued that Americans should be free in making their own food choices but should act responsibly. It accused the IOM of joining forces with the nation’s “food nannies,” according to a Reuters report (5/8/2012).

By contrast, the IOM panel said that blaming obesity on a failure of personal responsibility and individual willpower has long been used by the industry as the basis for resisting legislative and regulatory efforts to address the problem.

The costs for treating obesity and obesity-related diseases are responsible for about 20 percent of all spending on healthcare today, about $190 billion annually, not counting rising insurance premiums, lost productivity and missed work days due to illness. The IOM urges employers and insurance companies to participate more aggressively in the fight against obesity, if for no other reason than their own bottom line.

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 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.

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About timigustafson

Timi Gustafson, RD, LDN, FAND is a registered dietitian, health counselor, book author, syndicated newspaper columnist and blogger. She lectures on nutrition and healthy living to audiences worldwide. She is the founder and president of Solstice Publications LLC, a publishing company specializing in health and lifestyle education. Timi completed her Clinical Dietetic Internship at the University of California Medical Center, San Francisco. She is a Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Dietetic Association, a member of the Diabetes Care and Education, Healthy Aging, Vegetarian Nutrition and the Sports, Cardiovascular and Wellness Nutrition practice groups. For more information, please visit http://www.timigustafson.com

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