Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

Can’t Lose Weight? It Could Be Stress

February 2nd, 2012 at 11:39 am by timigustafson
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People who fail to lose weight, routinely name stress as one of the greatest obstacles they face when trying to diet and eat more healthily. As a health counselor, I’ve heard it a thousand times: When I’m stressed out, I almost automatically reach for food. I can’t resist, I just need something to help me cope.

Excessive snacking and overeating are common responses to stress. When feelings of anxiety and discomfort persist, food can offer much needed relief – especially the kind we call ‘comfort food.’ Scientists believe, however, that there is more to the stress-food connection than a simple inability to stay away from the munchies.

Stress itself is not necessarily the problem. In fact, experiencing stress is a natural response without which we would not have survived as a species for long. Stress is our body’s way to protect us from danger. In emergency situations, the release of stress hormones such as adrenaline and cortisol allow us to focus better, react faster and work harder than we normally would be able to. In extreme cases, stress hormones can enable us to react almost without thinking as if on autopilot, a process also known as “fight-or-flight” response, which can be a lifesaver.

But these mechanisms are only designed to deal effectively with short-term events. If the perception of danger continues unabatedly, our own natural defenses can eventually turn against us. Especially in situations where neither fight nor flight responses are possible, enduring continuously high levels of stress can cause serious damage to our physical and mental well-being in multiple ways. Over time, this can lead to a dangerous form of chronic stress, a condition so widespread and so severe, it has become one of the greatest health threats of our time.

“Stress can mean facing each day ravenously hungry, adding weight gain to [people’s] list of worries,” says Dr. Elissa Epel, a professor of the Department of Psychiatry at the University of California, San Francisco. “While the immediate response to acute stress can be a temporary loss of appetite, […] for some people, chronic stress can be tied to an increase in appetite and stress-induced weight gain. The problem,” she says, “lies within our neuroendocrine system, a brain-to-body connection that harkens to evolutionary times and which helped our distant ancestors to survive. This system still activates a series of hormones whenever we feel threatened.”

For instance, the stress hormone, cortisol, is responsible for replenishing the body with nutrients even after the stress-inducing causes have passed. As cortisol levels rise, our appetite for food increases. While the hormone itself does not make fat, chronically elevated cortisol levels can have a variety of negative health effects, including a decrease in insulin sensitivity, growing insulin resistance, reduced kidney function, hypertension and weakening of the immune system.

“The fuel our muscles need during fight or flight is sugar – one reason we crave carbohydrates when we are stressed,” says Dr. Riccardo Perfetti, an endocrinologist and director of the outpatient diabetes program at Cedars Sinai Medical Center in Los Angeles. “To move the sugar from our blood to our muscles requires insulin, the hormone that opens the gates to the cells and lets the sugar in. And high levels of sugar and insulin set the stage for the body to store fat,” he explains.

To better control these negative effects from stress responses, experts recommend regular exercise, not only to burn calories but also to enhance the body’s production of biochemicals that can counterbalance the concentration of stress hormones.

In times of heightened stress, the worst thing people can do is “sit and stew in frustration and anger without expending any of the calories or food stores that would be used in a physical fight out of stress or danger,” says Dr. Shawn Talbott, professor in the Department of Nutrition at the University of Utah and author of “The Cortisol Connection.”

The best de-stressors are eating a balanced diet, getting sufficient amounts of sleep, taking breaks for relaxation and rejuvenation, avoiding stimulants like caffeine, tobacco and alcohol, and spending time with supportive family members and friends.

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.

School Lunches Will Improve, But More Work Needs to Be Done

January 30th, 2012 at 2:33 pm by timigustafson
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School children will find more fruits, vegetables and whole-grain products on their lunch plates under the new nutritional guidelines for the National School Lunch Program issued by the U.S. Department of Agriculture (USDA). The guidelines also seek to reduce or eliminate high contents of sodium, saturated fat and trans fats. For the first time, food and beverages sold in vending machines on campus will have to meet certain nutritional standards as well.

The newly adopted nutrition standards are largely based on recommendations by the Institute of Medicine (IOM) of the National Academies and are designed to help in the fight against childhood obesity, which is now affecting 17 percent of children living in the U.S.

Under the revised rules, all meals served in school cafeterias will have upper and lower limits of calories, which vary with each age group. Kindergarteners to fifth-graders will receive 550 to 650 calories per meal, 6th to 8th graders about 700 calories, and 12th graders up to 850 calories.

The extra costs for better nutritional quality come to about $6.8 billion over the next five years, according to government estimates. “Schools are definitely going to be challenged by the additional costs of meeting the new rules,” says Dianne Pratt-Heaver, a spokesperson for the School Nutrition Association (SNA), a non-profit organization that represents school cafeteria vendors and operators. The government will pay schools six cents per meal on top of the current rate, which is not nearly enough to cover expenses, according to the SNA. The school lunch program provides daily meals to about 32 million students, often for free or at a reduced price.

Regardless, Ms. Pratt-Heaver says, her organization approves of the new policies. The Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association) has also signaled its support. “Given the realities of federal, state and local budgets, the Academy of Nutrition and Dietetics is committed to leading the creative collaborations that will be needed to implement changes in the school food program,” said Sylvia A. Escott-Stump, a Registered Dietitian and President of the Academy in an official statement by the organization.

The new regulations mark the first overhaul of the school lunch program since the 1990s and will gradually be phased in over the next three year. It was not an easy task, considering the oftentimes vehement opposition from food manufacturers, which culminated in last year’s controversy over whether pizza (or rather the tomato paste topping) should qualify as a vegetable serving. So far, it does, at least legally.

Also somewhat unresolved remains a dispute over the nutritional benefits of potatoes. The National Potato Council (NPC) has voiced strong objections to any attempts to limit servings of potatoes in school lunches, including French fries. “We still feel like the potato is downplayed in favor of other vegetables in the new guidelines,” said Mark Szymanski, a spokesperson for the NPC. “It seems the department still considers the potato a second-class vegetable.”

There is some reason for that. According to a study by the Harvard School of Public Health, which followed over 120,000 people for up to 20 years to find out what kinds of food affected their weight, potatoes were found to rank among the greatest weight boosters.

There is a very strong hypothesis that potatoes in particular lead to weight gain, says Professor Walter Willett, an Epidemiologist at Harvard and lead author of the study report. The reason is that potatoes are consumed fully cooked and rapidly broken down into sugar. Sugar is quickly absorbed into the bloodstream and eliminated by insulin, which leaves us hungry again after just a few hours. Particularly problematic, Dr. Willett says, are potatoes made into French fries and potato chips, “because they’re designed to make us overeat.”

Fried potatoes are also much higher in calorie and fat content than the steamed or baked varieties because of the oil used in the process. While one baked medium-size potato carries about 110 calories and virtually no fat, a medium-size serving of French fries has about 380 calories and 19 grams of fat.

Calories and fat, of course, are not the only issues. High levels of sodium are of equally great concern. While a medium-size potato contains about 10 mg of sodium (without added salt), a medium-size order of French fries comes with a whopping 270 mg.

Worries about sodium content have also fueled the debate over tomato paste on pizza. While tomatoes in their natural form are almost sodium-free, processed tomatoes like tomato paste, canned tomato sauce and ketchup can have over 1000 mg of sodium per serving (100g). High levels of sodium are known to cause a number of negative health effects, including heart disease and high blood pressure.

As a dietitian and grandmother of kindergarteners and gradeschoolers, I obviously support the changes the new guidelines are trying to achieve. However, much work remains to be done before all school children can receive the quality nutrition they need to grow up healthy and succeed at learning.

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.

Unrealistic Expectations Can Sabotage Weight Loss Goals

January 25th, 2012 at 7:32 am by timigustafson
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Resolution season is in full swing or perhaps already winding down. If you have given up by now on this year’s weight loss efforts and old habits start creeping back in – you’re not alone. About 90 percent of all the promises we make to ourselves are quickly forgotten, according to Tom Connellan, author of the “1 Percent Solution – How to Make Your Next 30 Days the Best Ever.”

“Some people’s New Year’s resolutions are so broad that they’re often unattainable,” says Leslie Fink, a Registered Dietitian and contributing writer for Weight Watchers. “When expectations are set too high, it doesn’t take much to throw a person off.” Instead of aiming for a perfect score, she advises, people should be content with 80 percent of their initial objectives. That by itself would qualify as a great success.

How we manage our aspirations in pursuit of our goals is critical either way. In fact, there are physiological reasons why we feel gratified or disappointed when we succeed or fall short of our expectations. A release of a neurotransmitter, called dopamine, is triggered in our brain when our intentions are fulfilled, causing a pleasant sensation of satisfaction and well-being, according to Dr. David Rock, Director of the NeuroLeadership Institute and author of “Your Brain at Work.”

Unfortunately, this mechanism works also in the other direction, and even more so: “When our expectations are not met, […] our negative feelings are much stronger than the good feelings we get when expectations are exceeded,” says Dr. Rock. “When we don’t hit our expectations, our brain doesn’t just get slightly unhappy, it sends out a message of danger and threat.”

In other words, as humans we generally tend to be optimistic (and oftentimes overoptimistic) about our prospects but are more afflicted when they end up in failure. The trick is not to get stuck in the negative emotions, even if they initially dominate.

Being able to build on the successes you already had is crucial for staying motivated. Take your cues from what worked and what didn’t and find out what made the difference. Then, if you fail or are about to fail, put a plan into action you may call “resolution revival,” suggests Dawn Jackson Blatner, a Registered Dietitian at Northwestern Memorial Wellness Institute. “Evaluate where you’ve been and where you want to go,” she says, “and make sure your initial goal was realistic.”

If you expected too much of yourself, “chop up your resolution into little pieces,” as Blatner puts it. Small steps are much more manageable and they eventually add up to greater achievements. If you are continuously able to meet your (somewhat scaled back) expectations, you will gain more confidence over time and can set the bar higher as you go.

Being realistic about your abilities and limitations also includes to learn from your past mistakes. Don’t make the same resolutions year after year, says Blatner. Rather, ask yourself what you can do differently from hereon in. Also, keep your eye on the larger picture: You are not trying to perform a quick fix (at least, you shouldn’t) but to make lasting lifestyle changes.

Last but not least, do not expect that losing weight, getting back in shape and looking more attractive is going to solve every other issue you may be dealing with in your life. Being thinner does not necessarily turn you into the person you idealize in your fantasies. Don’t listen to all the “testimonials” from people on TV claiming their entire lives have been turned around after they lost weight.

“People expect a lot from weight loss, things that weight loss alone can’t deliver,” warns Dr. Lee Kern, Clinical Director of Structure House, a residential weight management facility in Durham, North Carolina. “And then they learn the hard way that success and happiness aren’t linked to a number on a scale,” he says.

Identifying your real goals and pursuing them in realistic ways will make it much more likely for you to stay on track. If your motives are misguided, the messages you give your body will be equally confusing.

“The first thing I always ask people is why is this the right time for you to lose weight,” says Dr. Madelyn Fernstrom, Professor of Psychiatry and Epidemiology at the University of Pittsburgh School of Medicine and author of “The Real You Diet.” If they say they’re happy with their lives but have hypertension – great. If they’re losing weight just to be happier, then we’ve got to talk. Happiness isn’t a size 2.”

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.

One Out of Five Americans Found to Be Mentally Ill

January 25th, 2012 at 7:28 am by timigustafson
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Nearly 50 million Americans suffered from one or another form of mental illness in 2010, according to a report by the Substance Abuse and Mental Health Service Administration (SAMHSA), a federal government agency founded in 1992 to survey and reduce the impact of substance abuse and mental illness on communities throughout the country.

The survey found that young adults and especially young women were susceptible to mental illness to a degree that it substantially interfered with their lives. SAMHSA defines mental illness as “diagnosable mental, behavioral or emotional disorders.”

For the study, SAMHSA surveyed over 67,500 participants aged 12 and older in all parts of the United States. The results showed that almost 2 million teenagers experienced at least one bout of depression, which is defined as a period lasting at least two weeks. Nearly 9 million adult Americans had serious thoughts of suicide, with 2.5 million making suicide plans and 1.1 million making an actual attempt.

The study results came as a surprise, according to Peter Delany, Director of SAMHSA’s Office of Applied Studies. “We all know people who have had a depression or anxiety disorder,” he said, “but this is a pretty big number.” He said he was somewhat reluctant to speculate on the reasons for these developments, which are not easy to pinpoint. “The recent economic downturn may be a factor for some, but these conditions are multifactorial – there are biological issues, there are social issues and also personal issues.”

Delany thinks that many people who are struggling don’t seek treatment because of the stigma that is often attached to mental illness. Many also lack insurance coverage to pay for their care. According to SAMHSA, less than 40 percent of those with a mental illness receive health services. That’s extremely unfortunate, said Delany. “We know with the appropriate use of medication and with good treatment people can recover and go on to lead very healthy and productive lives,” he said.

Other experts agree. “Mental illness is a treatable problem,” according to Dr. Ihsan Salloum, Director of the Addiction Psychiatry and Psychiatric Comorbidity Programs at the University of Miami School of Medicine. “[But] there is a gap between the need and how many people reach treatment,” he added.

SAMHSA also investigated connections between mental illness and substance abuse such as use of cocaine, hallucinogens, inhalants and heroin. In its report, the agency concluded that people who abused drugs or alcohol showed substantially higher rates of mental illness than those who did not – 20 percent versus 6 percent. Teenagers who suffered from extended periods of depression were twice as likely to develop drug problems than their peers who did not have such experiences.

As alarming as the SAMHSA report sounds, it is also somewhat vague because it compiles a number of different issues that may be connected but are by no means identical. For instance, thoughts of suicide may not always be symptoms of mental illness but can result from deep despair. Hopelessness is not necessarily a mental dysfunction but can be a conceivable reaction in the face of extraordinarily dire situations. Alcohol and drug abuse are far too widespread among the general population to label them as symptoms of actual mental illness. People use them for recreational purposes and often, of course, to numb themselves in times of heightened stress and anxiety.

Still, the report should give us pause and have us ask how dysfunctional our lives must have become to cause so much suffering especially among the young who are supposed to look to the future with optimism and confidence. Hardly a promising picture for all of us.

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.

Fighting Childhood Obesity in a Complex Environment

January 22nd, 2012 at 4:52 pm by timigustafson
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With one in three children in the United States struggling with weight problems, the fight against childhood obesity is becoming ever more desperate. Some of the new health care provisions that are going into effect this year include insurance coverage for screening, counseling and other preventive care measures for obese children.

While the need for more programs for preventing and treating childhood obesity is obvious, experts say that creating them poses considerable challenges. “Few proven models exist for helping children and adolescents to achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years,” writes Reed Abelson in an article for the New York Times, titled “Learning to be Lean” (1/17/2012).

Insurance companies are developing new policies to determine treatment coverage of childhood obesity. One insurer, Wellpoint, is working with pediatricians by offering training in obesity treatment and connecting them with dietitians. And Weight Watchers has announced an upcoming program specifically designed to meet the needs of overweight children and teenagers.
Experts agree that for the fight against childhood obesity to be successful, the focus must be on the greater environment today’s children live in, including families, the media, schools and communities.

Parents
The home is the place where children first learn and develop their eating and lifestyle habits. Parents decide what kind of food is being brought into the house, how it is prepared and how much is served at the dinner table. Parents influence through their own behavior what lifestyles their kids adopt, how physically active they are, how much time they spend watching TV, and how much sleep they get.

For these reasons and others, diet- and lifestyle counseling and education should first be directed towards the parents, according to Dr. Adam P. Knowlden and Dr. Manoj Sharma, both pediatricians at the University of Cincinnati and co-authors of a systematic review of clinical studies of pediatric obesity. Unfortunately, the need for educating parents of overweight children is often difficult to meet. Even those who seek counseling (and by far too few do) don’t always have access to the right resources.

Media
Parents are oftentimes defenseless against outside influences, especially the daily onslaught of advertising by food companies that spend billions on TV ads and product placements geared towards children, according to Dr. Victor Strasburger, a professor of pediatrics at the University of New Mexico School of Medicine and lead author of a study report by the American Academy of Pediatrics (AAP), titled “Children, Adolescents and Advertising.”

“It’s not that easy when you are up against Ronald McDonald,” says Dr. Strasburger, referring to McDonald’s iconic clown character that is popular with many kids. “In fact, it is inherently unfair and deceptive to advertise to children who are too young and too impressionable to distinguish between advertising and factual reporting,” he says.

On average, children watch up to 10,000 food and snack commercials every year, according to the AAP. The best thing parents can hope for is limiting the time their kids are exposed to television and other advertising outlets, which, of course, is easier said than done.

In response to the AAP report, the Federal Trade Commission (FTC) has asked food manufacturers to regulate their marketing efforts to children but has stopped short of asking for any binding policies. Critics say that calling for voluntary self-regulation by the industry is not sufficient to change the existing advertising practices.

Schools
Despite of the government’s more recent efforts to improve the National School Lunch Program with “The Healthy, Hunger-Free Kids Act of 2010,” many schools across the country still don’t have the necessary resources for facilities and personnel to meet the nutritional needs of their students. Due to the downturn of the economy in years past, millions of children depend on the free or subsidized meals they receive at their schools, which in many cases is the only food source available to them. School officials say the increase of federal reimbursement for school lunches by 6 cents per meal does not nearly cover the costs for the growing demand.

So, vending machines filled with sodas and snack foods will not disappear from campuses as long as schools depend on corporate funding for many of their programs and services. And physical Education (PE) is still not available in all schools because of budget limits. The bottom line is that too many schools continue to fail doing their part in the fight against childhood obesity.

Communities
When Michelle Obama started the “Let’s Move” initiative, she put much emphasis on the role of communities. In general, the response was strong and countless grassroots movements have been brought to life all over the country ever since. What is sorely lacking, however, are important changes in our infrastructure. Due to budget crunches, more public parks and playgrounds are being closed than opened. Many cities don’t have bike paths or safe areas to run. Low-income neighborhoods are often too dangerous to let kids play outside or even walk to and from school. In a nutshell: Too many communal environments are not designed to allow kids to be physically active and stay healthy and fit.

Of course, there are many more factors to be considered if we are to deal with the childhood obesity crisis effectively. But these are some of the central issues in this complex task. Education of the public, regulation of industry, funding of school lunch programs and other health services for the young as well as building community support systems and infrastructure are all crucial elements in this fight. Addressing all of them in a comprehensive manner might get us somewhere, hopefully sooner rather than later.

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.

Paula Deen – Part of the Obesity Problem?

January 18th, 2012 at 5:11 pm by timigustafson
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Unless you have spent the last week stuck in the snow somewhere remote or vacationing on a deserted island, you must have heard the news: Paula Deen, the celebrity chef and self-proclaimed “queen of Southern cuisine,” has been diagnosed with type 2 diabetes.

Ms. Deen, who is widely known for her unapologetic preferences for heavy cooking styles, says she knew of her medical condition for about three years but decided to keep it private. Critics have been quick to question her motives, suspecting she didn’t come forward out of fear of losing her lucrative show on the Food Network, which has millions of followers.

Despite of her diagnosis, Ms. Deen, 64, doesn’t blame herself for causing her illness through unhealthy eating habits. In an interview with The New York Times (1/18/2012), she said she did not plan on changing her lifestyle or cooking but will consider reducing portion sizes of the unhealthful foods. “I’ve always preached moderation,” she said.

Others disagree with that assertion. In a widely publicized interview with TV Guide, one of her fellow-celebrity chefs, Anthony Bourdain, called her “the worst, most dangerous person” on the Food Network. “There is no denying that Paula’s food has a lot of what we call the deadly triangle: fat, sugar and salt,” said Geralyn Spollett, Director of Education at the American Diabetes Association in an interview with the Times.

Ms. Deen has long defended herself against such criticism. “I cook for regular families who worry about feeding their kids and paying the bills, she said in an interview with The New York Post. Her supporters concur. “She feels like she cooks for ‘real people,’ and for better or worse, that is how many people in this country choose to eat,” writes Virginia Willis, a food writer in Atlanta, Georgia.

All of this may be true. Still, it is one thing to acknowledge people’s budget limits, but it is another matter entirely to promote cooking styles and eating habits that are known to be outright unhealthy.

Health problems such as obesity, diabetes, high blood pressure and heart disease are most widespread among those with low incomes and less education. These are the men, women and children who would greatly benefit from being offered better alternatives to their existing diet choices. Instead, Ms. Deen promotes a message that willfully disregards the warnings of health experts and in fact sabotages efforts to reverse the worst public health crisis in our history. As such, she is part of the problem.

Even more disturbing is Ms. Deen’s newest endeavor. As reported in the Times, she has now accepted the role of a paid spokesperson for Novo Nordisk, a Danish pharmaceutical company and the maker of a drug named “Victoza,” a diabetes medication. In this position, she will spearhead an advertising campaign titled “Diabetes in a New Light.” It is quite ironic to see someone who has long decried her critics as “elitists” advertise a drug that costs about $500 a month.

One might argue that Ms. Deen knows how to make lemonade out of lemons. But before you say, “good for her,” let’s think for a moment about the implication of the message she’s giving out now: Don’t let anyone tell you what to eat and how to live your life – and if it makes you sick, well, there is always Victoza (if you can afford it). It would be more commendable if she were honest with her fans and use her clout to promote healthier diet- and lifestyle choices that make these kinds of drugs less necessary in the first place.

For Ms. Deen herself this could be a teachable moment. Why not open the next show with a line like this: “My dear viewers – for years I have promoted cooking techniques and eating styles I thought were tasty and affordable. Now I know that eating this way has made me seriously ill. I’ve learned from my mistakes. That is why, from hereon in, I want to invite you to join me in my new efforts to cook lighter and eat healthier, so that you don’t have to suffer the same consequences.”

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.

Treating Dry Skin from the Inside Out

January 18th, 2012 at 2:57 pm by timigustafson
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One of the misgivings of winter is dry skin or xerosis, as it is known in medical terms. Having problems with dry skin can be quite uncomfortable. Your skin feels tight, even painful, and it looks unattractively red and flaky. It can maddeningly itch, making you want to scratch all day.

Dry skin is extremely common, especially in the cold season, according to Dr. Barney Kenet, a dermatologist at Presbyterian Hospital and Weill Cornell Medical Center in New York. There are probably close to 100 million Americans who go through the experience every year. Dry skin problems are usually easy to treat, but they can become more than a skin-deep health issue if you don’t pay attention.

Don’t take dry skin lightly, warns Dr. Claude Burton, professor of dermatology at Duke University School of Medicine. “Your intact, healthy skin is your body’s primary defense against infections. If you let your skin get dried out and cracked, you could be giving all sorts of bacteria a way in. That can lead to more serious problems.”

Healthy skin is coated with a thin layer of natural molecules of fat, keeping it moist and smooth. Dry, cold air, harsh soaps, chlorinated water, itchy fabrics and misused cosmetics can strip away these fatty oils, leaving the skin unprotected. In many cases, the causes can also be internal such as a genetic predisposition or other medical conditions, including diabetes, psoriasis, hypothyroidism or malnutrition. If untreated, dry skin can lead to dermatitis – a form of inflammation.

“Dry air is probably the most common cause of dry skin,” says Dr. Kenet. “It draws the moisture right out of the skin. Another big problem lies indoors – the dry heat churned out by your furnace. To counteract dry heat, turn down the thermostat and use a humidifier,” he recommends.

As good as they may feel, you should also limit your hot showers to a few minutes per day. “Prolonged exposure to water, especially hot water, can wash away the natural oils that protect your skin. If you get out of the bath or shower and your skin feels tight, it’s dried out,” says Dr. Kenet. “Also, wash with a mild, fragrance-free soap. The best choice is a mild skin cleanser rather than soap,” he advises.

Certain medications can impact the health of your skin as well. For instance, some drugs for high blood pressure can have diuretic side effects. Age is another factor. Dry skin problems can especially plague older women because of hormonal changes. “As many as 75 percent of people over 65 have dry skin, according to Dr. Vesna Petronic-Rosic, professor of medicine and director of the Dermatology Outpatient Clinic at the University of Chicago Medical School.

Besides lathering on moisturizers, you can also take a number of dietary measures to fight skin dryness. The simplest and best way to keep your skin from drying out is to stay hydrated. Besides drinking lots of water, you should add more fruits and vegetables to your diet. Preferably choose items with high-water content such as melons, apples, oranges, celery and cucumbers. Some experts say that drinking large amounts of water alone does not affect the skin all that much. “The water we drink is processed internally and does not impact the look and feel of the skin. It’s the skin’s outer layer that is essential for keeping moisture in – not the other way around,” says Michele Murphy, a Registered Dietitian at New York Presbyterian-Weill Cornell Medical Center. On the other hand, diuretic drinks like tea, coffee and alcoholic beverages promote drying of the skin.

Foods high in omega-3 fatty acids offer great benefits for your skin, too. They are richly present in cold-water fish like salmon, tuna and trout. If you are not much of a fish eater, you can substitute with flaxseed oil, avocado and walnuts.

Make sure you get plenty of vitamin C throughout the winter months. Besides strengthening your immune system, vitamin C is essential for the formation of collagen in the body. Collagen allows the skin to absorb moisture.

Vitamin A, found in dark green leafy vegetables like spinach and kale, can help to repair skin damage. Foods rich in carotene – carrots, sweet potatoes, butternut squash and pumpkin – are also useful in this regard.

Vitamin E does not only boost the healing of skin tissue but also enhances moisturizing and bolsters defense against UV damage. Good sources for vitamin E include nuts, seeds, avocado, wheat germ, flaxseed oil and broccoli.

Oysters, crab, lean turkey, beef and beans are rich providers of zinc, a mineral that is especially useful for healing wounds and cracked skin.

There are lots of good reasons to keep your skin from drying – not just your looks but also your health. Your skin is your body’s largest organ and it deserves great care and protection.

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.

Gourmet Dining on a Slowing Metabolism

January 18th, 2012 at 2:43 pm by timigustafson
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Today’s retirees have many more options how to spend their golden years than any generation before them. Baby boomers, especially those who are well off, can satisfy their curiosity and adventurous spirit by exploring new business endeavors, continuing their education or traveling around the world. Some discover new passions and acquire new skills they never had time for while working.

One of those late pursuits that is rapidly gaining in popularity is gourmet dining, both at home and at restaurants. Interest in advanced cooking classes has never been greater, not to mention the high ratings for food shows and competitions between celebrity chefs on TV. The auditoria of culinary institutes around the world are filled with students in their sixties, seventies and beyond, eager to familiarize themselves with the latest trends and techniques in the world of haute cuisine.

Fine wining and dining has always been a prerogative of those who like (and can afford) to indulge in the better things life has to offer, but today it’s a whole different ballgame. In an article for the New York Times (12/28/2011), Charles Isherwood, a food writer, describes his parents (both retired) as “foodies” for whom eating well has become their lives’ mission. “My parents practically live to eat,” he writes. “At home [they] eat out three or so times a week. But when they come to New York, we sample the city’s restaurants in five-day, two-big-meals-a-day binges that have become something of a legend.”

Of course, besides being tremendously pleasurable, fine dining also conveys an aura of culture and sophistication (not to mention exclusiveness due to oftentimes ridiculous pricing). However, many food lovers also seem to think that eating at the best restaurants or cooking with the most expensive ingredients automatically means their diet is healthy. But this is not necessarily true.

Gourmet chefs typically focus on taste and presentation. Calorie counts and fat contents are not their primary concern. The individual portions may look small compared to lower-end eateries with their “all-you-can-eat” value offers, but if you order three, four or more courses, you end up with a similarly large amount of food in your stomach.

You may say, well, it’s only on rare occasions that you go all out like that. But what about eating out three times a day when you travel? What about a cruise where limitless access to great food is one of the perks?

The unfortunate truth is that as you get older and have more time and funds to indulge a little more than you used to, your metabolism begins to slow down. In fact, it slows down about 5% to 10% every decade or so, beginning in your mid-twenties. This means that the typical American loses between 20% and 40% of metabolic power over the course of his or her lifespan, according to Dr. John Berardi, best-selling author of “The Metabolism Advantage.”

The reasons are easy to understand: Your metabolism converts calories into energy. When your calorie intake is higher than your energy expenditure, weight gain occurs. As you grow older, it becomes harder to maintain a healthy calorie-energy balance because your lifestyle probably becomes more sedentary and your physical activities get less strenuous. Another result is age-related muscle loss. Diminishing muscle mass means that fewer calories are being burned off and your metabolism slows down. While this is an inevitable, natural process, there are things you can do to prevent it from happening too fast.

The best way to counteract muscle loss is weight training. Lifting weights does not only add muscle, it also burns off calories even while you rest afterwards. Doing aerobics, of course, also helps with calorie burn. People who are said to have a faster metabolism are probably just more physically active all day.

Not surprisingly, adherence to healthy eating habits also matters more with age. Your calorie requirements may go down, but your need for high-quality nutrients remains the same throughout your life. Simple but nutrient-dense foods are the best choices for a healthy, age-appropriate diet – such as fresh fruits and vegetables rich in antioxidants, whole grains, fish, lean meats and low-fat dairy products.

So, before you try out your next culinary sensation downtown or at home, keep in mind that your health is too important to throw all caution to the wind, just because you can.

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 Long Will You Live? A New Set of Assessment Tools May Be Able to Tell

January 15th, 2012 at 4:54 pm by timigustafson
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Researchers at the University of California, San Francisco (UCSF) have come up with new assessment tools to determine the likelihood of death within a certain period of time.

For this, they established a number of prognostic indices to predict the life expectancy in older and terminally ill patients. The main purpose of this project is to provide doctors, care givers as well as patients and their family members with information that can help prevent overtesting and overtreatment.

The UCSF team has also posted an interactive website online, called “ePrognosis.org,” which can be used to calculate a person’s mortality risk based on specific data, including age, health conditions, cognitive status, functional ability, etc.

“This is the first time such tools have been assembled for physicians in a single online location,” wrote Paula Span of the New York Times who reported on the project (1/11/2012) after a review was published in The Journal of the American Medical Association last week.

Among experts, responses have so far been mostly positive. “This kind of synthesis is very helpful for [health care] providers, researchers and some patients,” said Dr. Susan L. Mitchell, a geriatrician at Harvard University and researcher at Hebrew SeniorLife in Boston who was quoted in the Times article.

“A more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at UCSF and one of the authors of the review. A more accurate assessment of a patient’s life expectancy could help doctors and families evaluate, for example, whether an older person with a terminal disease should continue receiving treatments that may cause more pain and discomfort than relief, according to Dr. Lee. It may also be useful in determining how vigilant a patient has to be in observing and maintaining certain treatment- and lifestyle measures.

Since no calculation of life expectancy – other than based on data collected by U.S. Census Bureau – has so far existed, there is now hope that relatively easily accessible assessment tools like ePrognosis will be able to better assist health care providers with their decision making process.

In fact, many clinical decisions for older and terminally ill patients include considerations of life expectancy. But “at present, physicians are often shooting in the dark when they recommend tests, treatments and medications for older patients. […] Even when interventions do work, the benefits can be years away. Doctors have no easy way to know whether their elderly patients will live long enough to experience them. The potential for complications and side effects, however, is immediate,” wrote Ms. Span.

While it is true that with declining life expectancy some treatments may do more harm than good, it is not altogether clear whether accurate predictions can ever be made for an individual patient, cautioned Dr. Kenneth Covinsky, professor at the Department of Medicine, Division of Geriatrics at UCSF. “The accuracy of prognostic indices is often tested under ideal and controlled conditions,” he said. “When you see a research report of a prognostic index, you see how well it did in a group of patients specified by the researchers. But how accurate will the index be in your patient? […] Your patients are never quite the same as the patients in the research study.”

As a prognostic aid, programs like ePrognosis may turn out to be quite valuable, “if used to supplement clinical judgment,” said Dr. Covinsky. “Clinicians (and patients too) now have easy access to these prognostic indices. […] But perhaps the danger of ePrognosis is that it is too easy. In a matter of minutes, you can input a few elements of patient data and the calculator will spit out a probability of survival,” he added.

Some critics have pointed out that the very idea of basing decisions in medical care on calculations such as these may be a slippery slope. They say that assessing a patient’s life expectancy should never be the starting point of any form of treatment. Dr. Lee freely admitted there are potential problems. Because it is not clear whether calculating prognostic indices will ultimately improve patient care in clinical settings, he said, the researchers stopped short of urging widespread use at this time, according to the Times.

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.

Gourmet Dining on a Slowing Metabolism

January 11th, 2012 at 1:08 pm by timigustafson
  • Comments

Today’s retirees have many more options how to spend their golden years than any generation before them. Baby boomers, especially those who are well off, can satisfy their curiosity and adventurous spirit by exploring new business endeavors, continuing their education or traveling around the world. Some discover new passions and acquire new skills they never had time for while working.

One of those late pursuits that is rapidly gaining in popularity is gourmet dining, both at home and at restaurants. Interest in advanced cooking classes has never been greater, not to mention the high ratings for food shows and competitions between celebrity chefs on TV. The auditoria of culinary institutes around the world are filled with students in their sixties, seventies and beyond, eager to familiarize themselves with the latest trends and techniques in the world of haute cuisine.

Fine wining and dining has always been a prerogative of those who like (and can afford) to indulge in the better things life has to offer, but today it’s a whole different ballgame. In an article for the New York Times (12/28/2011), Charles Isherwood, a food writer, describes his parents (both retired) as “foodies” for whom eating well has become their lives’ mission. “My parents practically live to eat,” he writes. “At home [they] eat out three or so times a week. But when they come to New York, we sample the city’s restaurants in five-day, two-big-meals-a-day binges that have become something of a legend.”

Of course, besides being tremendously pleasurable, fine dining also conveys an aura of culture and sophistication (not to mention exclusiveness due to oftentimes ridiculous pricing). However, many food lovers also seem to think that eating at the best restaurants or cooking with the most expensive ingredients automatically means their diet is healthy. But this is not necessarily true.

Gourmet chefs typically focus on taste and presentation. Calorie counts and fat contents are not their primary concern. The individual portions may look small compared to lower-end eateries with their “all-you-can-eat” value offers, but if you order three, four or more courses, you end up with a similarly large amount of food in your stomach.

You may say, well, it’s only on rare occasions that you go all out like that. But what about eating out three times a day when you travel? What about a cruise where limitless access to great food is one of the perks?

The unfortunate truth is that as you get older and have more time and funds to indulge a little more than you used to, your metabolism begins to slow down. In fact, it slows down about 5% to 10% every decade or so, beginning in your mid-twenties. This means that the typical American loses between 20% and 40% of metabolic power over the course of his or her lifespan, according to Dr. John Berardi, best-selling author of “The Metabolism Advantage.”

The reasons are easy to understand: Your metabolism converts calories into energy. When your calorie intake is higher than your energy expenditure, weight gain occurs. As you grow older, it becomes harder to maintain a healthy calorie-energy balance because your lifestyle probably becomes more sedentary and your physical activities get less strenuous. Another result is age-related muscle loss. Diminishing muscle mass means that fewer calories are being burned off and your metabolism slows down. While this is an inevitable, natural process, there are things you can do to prevent it from happening too fast.

The best way to counteract muscle loss is weight training. Lifting weights does not only add muscle, it also burns off calories even while you rest afterwards. Doing aerobics, of course, also helps with calorie burn. People who are said to have a faster metabolism are probably just more physically active all day.

Not surprisingly, adherence to healthy eating habits also matters more with age. Your calorie requirements may go down, but your need for high-quality nutrients remains the same throughout your life. Simple but nutrient-dense foods are the best choices for a healthy, age-appropriate diet – such as fresh fruits and vegetables rich in antioxidants, whole grains, fish, lean meats and low-fat dairy products.

So, before you try out your next culinary sensation downtown or at home, keep in mind that your health is too important to throw all caution to the wind, just because you can.

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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