Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

Anxiety Disorders Are Sharply on the Rise

October 23rd, 2011 at 11:31 am by timigustafson
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It’s getting harder to feel good about life in America. According to data collected by the Census Bureau, the average income of Americans has fallen by almost 10 percent since the beginning of the recession of 2008. Some experts say the financial crisis has been as traumatic and anxiety-producing for millions of Americans as the events of 9/11/2001. While people back then were fearful of another terrorist attack, they are now experiencing profound existential angst about their future.

More than 40 million people suffer from anxiety disorders in this country, estimates the Anxiety Disorders Association of America (ADAA) based on prescription drug sales. Younger generations seem to be most affected.

“It used to be that if you got a good education, you would get a good job. But today, young people are uncertain about finding a job, they have a lot more debt, they are working while studying, finishing later, more fatigued and some are starting families while still in school, and juggling all of this causes a great deal of stress,” said Dr. Katy Kamkar, a clinical psychologist at the Centre for Addiction and Mental Health in Toronto, Canada.

So, are our times more stressful and anxiety-ridden than, let’s say, the Great Depression era in the 1930s? In a way yes, according to Dr. Jean Twenge, a professor at San Diego State University and author of “Generation Me.” “Anxiety rates have risen steadily over the past seven decades, during good economic times and bad,” she said.

Dr. Twenge sees at least some of the reasons in the deep cultural shifts we as a society have undergone since the 1960s. “Recent generations have been told over and over again: You can be anything you want to be, you can have the big job title, you can have the big bank account, and in the case of women, you can have the perfect body. That puts a lot on a person’s shoulder – and it is also not really true. That disconnect creates a lot of anxiety about how hard you need to work […] and a deep fear of failure.”

And it’s not only that people have impossibly high expectations that are bound to be frustrated at some point in their lives. The world keeps changing so fast that many feel left behind even at a relatively young age.

Reconsidering one’s values and making changes to one’s lifestyle is not easy. It’s hard if not impossible to get off the train once you’re on it. “People feel they should always be on, and that they could be called upon at any moment to do something,” said Dr. Susan Nolen-Hoeksema, a professor of psychology at Yale University who specializes in stress and women’s health. “Our e-mail and iPhones are constantly pinging, which keeps anxiety heightened all the time.”

Experiencing anxiety every now and then is – like stress – a natural phenomenon and not necessarily a bad one. It’s an emotional reaction that helps us recognize actual threats or problems and deal with them. If kept at a healthy level, anxiety can help us to be more focused and perform better. However, if it grows out of proportion, it can become quickly counter-productive and, in extreme cases, even debilitating. “Generally, we say anxiety is not normal when it lasts days beyond a specific stressful event, or when it interferes with a person’s life,” said Dr. Terri Moffit, a professor of psychology and neuroscience at Duke University in North Carolina.

The term “anxiety disorder” refers to anxiety as a chronic condition. It can take on different forms. There is generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder (a.k.a. social phobia) and specific phobias.

Anxiety and fear are often used interchangeably. But in clinical usage, they have clearly distinct meanings. Anxiety is defined as a negative emotional state for which the cause is either not identified or perceived to be beyond a person’s control. Fear, on the other hand, is an emotional and physiological response to a concrete external threat. Phobias, which are responses of fear or discomfort triggered by specific stimuli or situations, are also considered to be anxiety disorders.

Anxiety often goes hand in hand with clinical depression and other mental disorders. It is estimated that about 60 percent of people suffering from chronic depression experience regular bouts of anxiety as well.

Sexual dysfunctions are quite common among men and women with anxiety disorders, although it cannot always be determined whether anxiety causes the dysfunction or whether they both result from a common cause.

Treatment options for anxiety disorders include psychotherapy (e.g. cognitive-behavioral therapy), medication and lifestyle changes.

Exercise has been shown to help with stress management and can have positive effects on anxiety reduction as well. So can dietary changes. “Eating too much of the wrong kind of foods produces an inflammation effect that can cause disease in the brain,” said Dr. David Heber, director of the Center for Human Nutrition at the University of California Los Angeles (UCLA). Sufferers from chronic anxiety have reported that cutting back on starchy foods and eating more fresh fruits and vegetables has made a significant difference not only for their physical- but also their emotional well-being.

Controlling and, if necessary, reducing consumption of caffeine and alcohol is equally as important. Caffeine can increase anxiety and trigger panic attacks. While alcohol may make you feel more relaxed for the moment, it can also contribute to depression.

Relaxation techniques, yoga, meditation, breathing exercises, massage and other soothing treatments are all highly recommended to counterbalance anxiety. They may not always suffice, but they are always helpful. Just by being able to turn off the noise once in a while, both body and mind can relax, heal and rejuvenate.

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.

Americans Are More Realistic About the Quality of Their Diet

October 19th, 2011 at 1:37 pm by timigustafson
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Over the last 20 years, Americans have become increasingly aware that their diet plays a significant role for their health. They also have become more disillusioned about the nutritional quality of the foods they are actually eating. Despite of these changes in awareness, most people’s eating habits have largely remained unchanged and the obesity crisis has worsened. These are the findings of a study report issued by the Economic Research Service of the U.S. Department of Agriculture (USDA).

The objective of the study was to see how Americans are responding to the stepped-up educational efforts by the government and advocacy groups to improve the nutritional health of the public. For this purpose, researchers compared data from two surveys that were conducted between 1989 to 1991 and 2005 to 2008.

“Although the actual healthfulness of diets has not changed much in the last 15 years, there has been a large and significant decrease in the percentage of Americans who rate their diets as Excellent or Very Good,” said the report. “These changes provide a snapshot of consumers’ increased dietary realism and, perhaps, receptiveness to dietary guidance, and they also suggest the possibility that a changed information environment has affected consumers’ perception.”

The comparison of the two surveys clearly shows that a significantly higher percentage of people who were asked to rate the quality of their diets grew more pessimistic over time. 8.6 percent (down from 13.2) were inclined to call their diet Excellent and 23.3 percent (down from 27.8) thought it was Very Good. The percentage of those who considered their eating habits as Good stayed roughly the same – 40.7 percent (up from 39.3).

The researchers concede that an “optimistic bias” about their diet still prevails among Americans. While nutrition experts have learned a great deal about the nutritional quality (or lack thereof) of the typical American diet, most consumers’ perception remains inaccurate. Our diets continue to be too high in calories, fats (especially saturated fats), sodium and added sugar. They are also too low in fiber, whole grains, fresh vegetables and important micronutrients, according to the report. The reason is not that people willfully ignore the dietary advice they’re given. They just misjudge their own actions.

Still, the overall rise in awareness is encouraging. Especially overweight people seem to realize more that their eating habits wreak havoc on their health. Among overweight people, the percentage of those who rated their diets as Excellent or Very Good declined by 12 points since the first survey.

The researchers also looked at other data connected with diet. For example, they found a significant relationship between household income and diet quality perception. Those who believed their diets to be Excellent or Very Good were on average financially better off than those who considered their diets as Poor. The dramatic rise of food prices in recent years has certainly contributed to this discrepancy, although to what degree has not become altogether clear in this study.

Lack of access to healthy food resources in some rural areas and low-income inner-city neighborhoods seems to be a remarkably insignificant factor. The so-called food deserts, where travel time to a supermarket or grocery store exceeds 15 minutes, did not affect diet choices as much as previously thought.

More important was the fact that consumers eat most of their meals away from home. Home-cooking and eating together as a family are rapidly becoming a thing of the past. Again, the percentage of people recognizing these trends as a potential problem is increasing, but there is little effort or even knowledge of how to make the necessary changes to reverse them. Remarkably, those who rate their eating habits as Poor spend on average a larger fraction of their food budget on restaurant food than those who say they have healthier diets.

Clearly, this report does not unveil any great secrets. Most of its observations are unsurprising. Still, one can take comfort in the thought that the information given to the public seems to register, even if that does not (yet) lead to decisive action. We can only hope there will be a tipping point in the not so distant future.

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 Confusing News About Vitamin Supplements

October 16th, 2011 at 2:59 pm by timigustafson
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Two independent studies suggest that taking a daily dose of vitamin supplements may not be as health-promoting as previously believed and may even be harmful. Their findings are only the latest in a series of clinical study reports that have questioned the benefits of the popular nutrition-enhancers.

In one study, researchers from the University of Minnesota followed over 38,000 women in an still ongoing survey called the “Iowa Women’s Health Study.” The participants were in their early 60s when the project was started in 1986. The focus of this study was on the women’s use of vitamin supplements for about 18 years on average.

As it turns out, the women who took daily doses of supplements had a higher mortality rate by two and a half percent compared to those who didn’t take any.

“Our study, as well as other similar studies, have provided very little evidence that commonly used dietary supplements would help to prevent diseases,” said Dr. Jaako Mursu, an epidemiologist at the University of Minnesota School of Public Health and lead author of the study report, which was published in the Archives of Internal Medicine (10/11/2011). “We would advise people to reconsider whether they need to use supplements, and put more emphasis on a healthy diet instead,” he added.

Dr. Mursu admitted that the study was not designed to determine if there was a specific cause for the increased mortality risk of the supplement users. The study did however distinguish between the different kinds of supplements the participants took. For example, the women who took iron supplements had a four percent higher probability of dying. Others who used multivitamins, folic acid, vitamin B6, magnesium and zinc also showed higher rates. Only calcium seemed to have a positive effect, decreasing the risk for most women who took it.

A second study, sponsored by the National Cancer Institute (NCI), found that men who took daily a high dose of vitamin E ran a 17 percent greater risk of developing prostate cancer. These results, which were published in the Journal of the American Medical Association (JAMA), came as a surprise, considering that vitamin E was believed to be actually helpful in the prevention of prostate cancer.

The vitamin E study, named the “SELECT” trial, began in 2001. It was designed as a double-blind, placebo-controlled research project, the highest standard in scientific testing. The initial goal was to find out how vitamin E and selenium (a mineral mostly found in soil) can reduce the risk of prostate cancer.

“I was surprised by the results of this trial,” said Dr. Eric Klein, an urologist at the Cleveland Clinic and the national coordinator of the study. “There really is not any compelling evidence that taking these dietary supplements above and beyond a normal dietary intake is helpful in any way, and this is evidence that it could be harmful.”

The increase in health risks could be derived from the high concentration of nutritional compounds that many supplements contain. Most of these micronutrients are present in much smaller amounts in regular foods, so they can become toxic when they are consumed over long periods of time and accumulate in the body, according to Dr. Mursu.

While vitamins and minerals are necessary for healthy nutrition, excess intake can create serious problems. It is also important that consumers understand the differences between the supplements they are taking.

For example, overdosing on water-soluble vitamins like vitamin C and B-complex is possible but unlikely. Excessive amounts pass through the system and get eliminated in the urine.

Fat-soluble vitamins like vitamins A, D, E and K, on the other hand, are stored in fat cells and can eventually build up to toxic levels. Minerals like calcium, chloride, chromium, copper, fluoride, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium and zinc are absorbed in the body as well and can become harmful to the liver and kidneys. Some supplements can interfere with medications a person is taking and also negatively affect the metabolism of other nutrients.

For these reasons and others, many nutrition experts warn that supplements should not be considered as a substitute for a well-balanced diet, notwithstanding their enormous popularity. Over half of American adults take at least one supplement a day. It is estimated that vitamin and supplement sales in the U.S. amount to $20 billion plus per year.

It’s tempting to rely on supplements. In our fast-food culture, it may even sound reasonable to take extra vitamins to make up for nutritional deficiencies. Ironically, the people who use the most supplements are the ones who already eat the healthiest. So, they may want to reconsider. But for the millions of Americans who adhere to a less than perfect diet, it makes good sense to keep adding a basic multivitamin a day.

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.

Preventive Care Must Be Included in Essential Health Benefits Package

October 12th, 2011 at 1:51 pm by timigustafson
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The central goal of last year’s health care reform was to provide coverage for tens of millions of Americans who are currently uninsured or uninsurable because of so-called pre-existing conditions. Under the new legislation, insurance companies will be prohibited from denying acceptance to applicants based on their health status or dropping beneficiaries when they get sick. Insurers will also have to cover a number of preventive measures like immunizations, routine medical check-ups and screenings for certain types of cancer.

Most details of the new benefits program remain sketchy to this point, however. The Department for Health and Human Services (HHS) has tasked the Institute of Medicine (IOM) to come up with guidelines to help determine what health benefits should be considered “essential” and should be included in all insurance plans.

In a long-awaited report, the IOM declined to list specific benefits but gave a framework instead by which the importance of services should be determined. In keeping with the current political climate and economic realities, the institute urged the government to consider affordability above all other criteria. “If the benefits are not affordable, fewer individuals will buy insurance. And if health care spending continues to rise so rapidly, the benefits will erode,” warned the 18-member expert panel that authored the report.

There was also concern that the federal government itself could face unsustainable expenditures if it was forced to subsidize millions of insurance premiums for beneficiaries who can’t afford paying for oversized benefits packages.

For all these reasons and others, the panel advised that benefits should be kept within the limits of a typical employer plan for small businesses – not large or medium-size corporations that are able to provide more generous coverage. As it is written now, the reform law has listed 10 categories of essential benefits that must be offered, some of which go well beyond the provisions of many existing employer plans, such as maternity leave, mental health treatment, pediatric dentistry, among others. By contrast, the panel wants regulators to only include services that are “medical in nature and that have been established to be effective using research.” Excluded should be all “treatments that have not been shown to work [and] services that are primarily educational.” Some of those treatments “not been shown to work,” according to the panel, could be common tests like mammograms and screening for prostate cancer.

Preventive measures as part of the final benefit package remain on shaky ground. House Republicans have already announced their plan to block a program called the “Prevention and Public Health Fund,” which is intended to financially support states and communities in their efforts to prevent diseases. It would pay for public health services that help fight obesity, heart disease, diabetes and cancer, increase vaccination and reduce smoking, alcohol and drug abuse, among other things. Many health organizations, including the American Cancer Society and the American Heart Association are in favor of the project, which will cost about $16 billion over ten years.

In any case, keeping Americans healthy will be more cost-effective than curing them. Unlike our traditional health care model, which is almost exclusively designed to treat illnesses and injuries, any new approach should look for strategies that identify and lower risk factors before serious consequences occur.

This thinking is by no means new, of course. Many employers have long recognized that keeping their workforce in good health is a vital part of controlling health care costs. Three out of four larger companies offer free preventive health services to their workers, according to a 2009 survey by Mercer, a benefits consulting firm. These include anti-smoking policies, access to exercise- and fitness facilities, weight management programs and more. “Wellness benefits” like these should be made available for small business employees as well.

Ultimately, it comes down to this simple question: Should we continue to invest almost exclusively in medical treatment or should we change the system in favor of prevention. On face value, I think, it’s a no-brainer. Even folk wisdom has it that an ounce of prevention is worth a pound of cure.

Preventive health care essentially means helping people to maintain good health. This includes getting them to exercise, manage their weight, eat right, quit or avoid smoking, abstain from drug-and alcohol abuse and keep blood pressure, diabetes and cholesterol levels under control. Health education and counseling can be instrumental to prevent most lifestyle-related illnesses.

Annual physicals and regular screenings matter greatly as well. Especially after a certain age, they should include monitoring blood pressure, cholesterol screening, pap smear tests, mammograms, PSA testing, colon cancer screening and CT scans for lung cancer.

Most diseases can be effectively treated as long as they are detected early enough. It shouldn’t be a question whether we can afford to offer preventive services to everyone. The truth is, we can’t afford not to. All alternatives will turn out to be much costlier.

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.

Don’t Grow Old Alone

October 9th, 2011 at 3:23 pm by timigustafson
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People who are lonely and isolated in their senior years tend to be in poorer physical and mental health than their contemporaries who are in loving relationships. These are the findings of a recent study published in the Journal of Health and Social Behavior that investigated links between social connections and health in older adults.

“Feelings of loneliness and isolation can affect older adults’ health in a number of ways. They can, for example, create stress, lower self-esteem or contribute to depression, all of which can have physical health consequences – either by affecting a person’s lifestyle choices or through direct effects on the body,” said Dr. Erin York Cornwell, a sociology professor at Cornell University and lead author of the study report.

Social isolation may even shorten your life expectancy, according to Dr. James Lynch, author of “The Broken Heart: The Medical Consequences of Loneliness.” Human beings are social creatures throughout their lives. As people grow older, their need for social interaction remains the same, but their ability to satisfy this need may become diminished: They retire and lose contact with former co-workers; their children grow up and move away; they become widowed or divorced; their circle of friends shrinks. As a result, many elders find themselves increasingly deprived of the important benefits of companionship. Life becomes less satisfying and loses its meaning. Consequences are often severe depression and lack of will to live.

“Suicide is more common among older Americans than any other age group,” according to Jane E. Brody, a columnist for the New York Times who writes on issues of personal health. “While people 65 and older account for 12 percent of the population, they represent 16 percent to 25 percent of the suicides. Four out of five suicides in older adults are men. And among white men over 85, the suicide rate – 50 per 100,000 men – is six times that of the general population.

Older widowers and divorcees are at the highest risk. When wives die or move away, their husbands’ social connections often cease as well, especially when the women did most of the social networking. “Men are poorly prepared for retirement and don’t know how to fill in the hours and maintain a sense of usefulness when they stop working,” said Dr. Martha L. Bruce, a professor of sociology and psychiatry at Weill Medical College of Cornell University.

“Many older people despair over the quality of their lives at the end of life. [We] think that sadness is a hallmark of depression. But more often in older people it’s anhedonia – they’re not enjoying life,” Dr. Bruce added.

Conversely, having loved ones to spend time with, making new friends and sharing experiences and interests with others can help decrease the susceptibility to loneliness, depression and illness. Nurturing new relationships and even falling in love again can bring back a renewed zest for life. Research has shown that seniors who remain sexually active enjoy better physical and emotional health than those who do not, according to Dr. Andrew Weil, professor of medicine and director of the Program for Integrative Medicine at the University of Arizona and best-selling author of numerous books on health and wellness, including “Healthy Aging – A Lifelong Guide to Your Physical and Spiritual Well-being.” “The youth culture would have us believe that sexual pleasure is the birthright of the young, that old people shouldn’t be thinking about sex, and that imagining old people having sex is distasteful. None of this is true. [Physical contact] is a basic requirement for optimum health,” he added. “This need does not diminish with age.”

Thankfully, the baby boomers are less inhibited in this regard than previous generations may have been. Today’s 55-plus crowd definitely does not think the party is over any time soon. And they know where to look for love in all the right places – via the Internet, of course. Memberships of dating sites are booming, and the older demographics are growing the fastest. “With so many older Americans unattached, living independently into their later years, and increasingly comfortable using the Internet, they too are logging on for love,” observed Stephanie Rosenbloom in an article for the New York Times (10/6/2011), titled “Second Love at First Click.” Not everyone is looking for true love, let alone marriage. But companionship and romance are in high demand and the dating industry is happy to help.

Living longer and healthier as we grow older through sound nutrition, physical exercise and mental activity is very important, but it’s only a worthy goal if the experience is enjoyable and gratifying – and that includes love.

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.

Breakfast – The Most Important Meal of the Day

October 5th, 2011 at 12:48 pm by timigustafson
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My grandmother used to say: Never start your day before you had breakfast – and if you have to, at least eat something.” Granny knew nothing about the intricacies of modern-day dietetics, but her folksy philosophy was right on the money. Yes, you should not leave home in the morning on an empty stomach. So at least eat something, or even better, get a highly nutritious boost that fuels your body for the day ahead.

Breakfast cultures can differ tremendously, not only between countries and ethnicities but also within families. Having been brought up in England, I have maintained some of my early habits and preferences throughout my life. I don’t eat kippers (smoked herring) anymore, but I still like my cup of tea with a biscuit as soon as I get out of bed, as I did as a kid. My own children, both born and raised in America, would never dream of having anything else than coffee and cereal, and perhaps pancakes on weekends. For them, as for many Americans, convenience and efficiency matter most.

That wasn’t always the case. In the early 1800s, our forbearers ate their main meal at midday and a lighter supper in the evening, as it’s still the case in many European countries. Breakfast was not a separately prepared meal but consisted mostly of leftovers and was served cold so as to not require making a fire, describes Elizabeth Giddens in an article for the New York Times Magazine (10/2/2011), titled “How Has Breakfast Evolved.”

By the mid 19th century, working men no longer had the time to go home for lunch, so having a hearty breakfast became important. To endure long hours of hard labor until dinner – mostly of the physical kind like construction, manufacturing and agriculture – they needed to consume as many calories as possible.

Only in the early 20th century, certain foods like eggs, sausages, bacon and pancakes became distinguished breakfast staples. It was also around that time that the breakfast cereal was invented. “Few foods have transformed the American table quite so significantly as cereal,” said Giddens. And with more and more women entering the workforce in the 1950s and 1960s, cereal became the breakfast of choice for many families because it required almost no preparation.

Today, breakfast as a regular meal has almost ceased to exist. More and more people skip breakfast for a variety of reasons. They say they are too pressed for time, don’t like breakfast food or are not hungry in the morning. The problem is that going without food between dinner and next day’s lunchtime means eighteen hours of fasting, which leads to a state of semistarvation that can eventually create a number of serious health risks.

Research has shown that taking time for breakfast is more valuable for your health than a few extra minutes of sleep. A nutritious morning meal will refresh you and recharge your body better than your snooze can.

Choosing the right kind of food for breakfast matters greatly. You don’t have to stick to “traditional” breakfast items. During my many travels, I’ve encountered all sorts of breakfast styles, many of which I never heard of before but found absolutely delicious.

Fruit for breakfast is always a good choice. It provides many important vitamins and other essential nutrients. Cereal can be a good source of fiber. Hot cereal like oatmeal is preferable. Make sure you’re getting a brand that contains only whole grains and no added sugar. For protein, have some eggs (egg white only), yogurt or milk (both non-fat or low-fat). Vegetables are great, but they are not to everyone’s taste. I sometimes like tomatoes or beets as a side dish.

If you are not used to eating an elaborate breakfast, start small. Not being hungry in the morning may be the result of a heavy meal for dinner or a late snack the night before. When that happens, your stomach keeps digesting while you’re asleep. When you wake up, your blood sugar level is at the lowest and you feel sluggish and irritable, which also affects your appetite. So, instead of forcing down food you are not used to and don’t enjoy, have a piece of whole-wheat toast and some fruit and gradually add more items over time.

Some people skip breakfast to lose weight. It’s a bad idea! Research has shown time and again that skipping meals, especially breakfast, can make weight control more difficult. Avoiding regular meals makes the temptation of unhealthy snacking harder to resist, which, of course, defeats the purpose of dieting. “Eating breakfast prevents you from bottoming out and getting too hungry,” said Susan Kraus Ms, RD, a registered dietitian at Hackensack University Medical Center in New Jersey. “Without eating breakfast, you’re more vulnerable to cravings and less likely to make healthy choices in the morning and throughout the day. That’s a disaster – whether you’re on a diet or just eating for good health.”

By contrast, eating a healthy meal before you start your day keeps you satisfied and your metabolism running smoothly. It also helps you to stay focused and perform at your best. It prevents you from running out of energy and making poor eating decisions.

If this is true for adults, it matters even more for growing children. Numerous studies have shown that kids who skip breakfast regularly do less well at school than those who don’t. Pediatricians and nutrition experts urge parents who are unable to feed their kids a wholesome breakfast at home to enroll them in a school breakfast program. It’s one of the best investments they can make in their future.

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.

Listeria Outbreak Reminds Us of the Importance of Food Safety

October 2nd, 2011 at 5:39 pm by timigustafson
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The recent listeria outbreak in cantaloupe is the deadliest of its kind in more than 10 years in the United States, according to the Food and Drug Administration (FDA). At least 16 deaths and over 80 infections have been associated with cantaloupes from Jensen Farms in Colorado, which so far has been identified as the single source. A few days ago, California-based True Leaf Farms, a processing plant of Church Brothers LLC, has announced a recall of chopped romaine lettuce that also may be contaminated with listeria bacteria.

Although there is no connection between the lettuce recall and the outbreak tied to the cantaloupes from Jensen Farms, according to the FDA, the growing frequency at which these incidents keep occurring is alarming. As reported by Reuters (9/30/2011), there have been four listeria-related food recalls during the month of September alone. “Any time we find listeria in food, we would consider that food adulterated and ask for a recall,” said Douglas Karas, a spokesperson for the FDA.

The finding of listeria in the romaine lettuce was a result of an FDA research program designed to better understand the prevalence of listeria in fresh produce like lettuce and other leafy greens. Listeria outbreaks are usually associated with deli meats, unpasteurized cheese and seafood, rather than with fresh produce.

Investigators at the Centers for Disease Control and Prevention (CDC) continue to search for the causes of the outbreaks by examining possibilities of water contamination and improper farming practices. In the meantime, the number of people infected must be expected to rise because it can take weeks and months before listeria bacteria develop into potentially life-threatening listeriosis.

“Whether listeria causes illness depends on a combination of three things: A person’s susceptibility, how much listeria a person has been infected with, and the virulence of the particular listeria strain,” said Dr. Patricia Griffin, chief of the Enteric Disease Epidemiology Department at the CDC.

Listeria bacteria are commonly found in soil, animal feed, groundwater and sewage. They can also be carried in livestock. When listeria enters the human body, however, it turns into a bacterial parasite that lives and feeds on cells, which eventually can become a deadly threat.

Young children, the elderly and people with a compromised immune system are at the greatest risk of falling seriously ill due to infection. The disease is especially dangerous for pregnant women because it can adversely affect the unborn and lead to premature delivery, miscarriage or stillbirth.

Dr. William Schaffner, a specialist for infectious diseases and preventive medicine at Vanderbilt University School of Medicine in Tennessee, said that people should pay close attention to flu-like symptoms such as fever, diarrhea, vomiting, muscle aches, stomach cramps and headaches. Caregivers, too, should be on alert because of the contagious nature of the disease.

Listeria bacteria can be eliminated by cooking or pasteurizing but not by freezing or refrigeration. Unlike other pathogens, listeria bacteria can continue to grow at low temperatures and can linger long after the original source of the contamination is gone. For this reason, it is extremely important to thoroughly clean and sanitize all areas where contaminated food items may have been handled or stored, like kitchen counters and refrigerators.

Health experts strongly recommend to dispose of all foods suspected of contamination, not just those affected by the recent recalls. Washing alone will not suffice because you can’t be sure that the bacteria are only present on the surface. Listeria in particular is impossible to identify by sight, taste or smell. Before you dispose of suspicious foods, wrap them in plastic before throwing them out to prevent further contamination.

Better yet would be taking more pro-active measures. In an op-ed article, the New York Times (10/1/2011) called for the immediate passing of new food safety regulations by Congress to prevent these kinds of outbreaks in the first place. Food producers everywhere in the country see their sales plummeting whenever there is a new crisis reported in the media. “For its own good, the food industry needs to increase its cleansing and monitoring efforts. Big grocery chains and box stores ought to demand that their suppliers test their fruits and vegetables for pathogens before shipping them… Even legislators who vehemently oppose regulation ought to recognize that food safety is an area where government oversight is vitally important.”

I’m sure the victims of the recent disasters would all agree with these demands. It shouldn’t take a second thought to make them a reality.

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.

Too Busy, Too Lazy, Too Tired to Cook

September 29th, 2011 at 1:37 pm by timigustafson
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For the majority of American families, homemade meals are a thing of the past. The reasons are multiple: Too inconvenient, too time consuming, too challenging, too expensive.

Nutrition experts have long identified the lack of home cooking as one of the factors contributing to the ongoing obesity crisis, including childhood obesity. There is also general agreement that this is not an easy problem so solve. Here are a few obstacles that keep people from returning to the kitchen.

The traditional household where one spouse – usually the wife – stayed at home is no longer feasible or even desirable for most families. Women commonly have their own careers and bring in badly needed second incomes. Long work hours, commutes, school and afternoon activities make it harder if not impossible to set meal times that fit in everybody’s schedule. Picking up something on the way home that is (almost) ready to eat seems the only reasonable option on most days.

“People really are stressed out with all that they have to do, and they don’t want to cook. It’s one of the few things that even less well-off people have: They don’t have to cook,” said Julie Guthman, professor of community studies at the University of California, Santa Cruz.

Time, or the lack of it, is certainly a factor. However, it is also true that even people who claim to be way too busy to think of cooking a meal once in a while do still have enough time to watch TV – at least 1 ½ hours every night on average. And while cooking shows like “Rachael Ray” and “Iron Chef” are highly popular, they don’t seem to have much effect on viewers in terms of motivation to take up the task themselves.

“The core problem is that cooking is defined as work,” wrote Mark Bittman in a recent op-ed article in the New York Times (9/25/2011), titled “Is Junk Food Really Cheaper?”
Bittman disputes the widely accepted argument that fast food is so popular because it’s the cheapest kind of food available. “This is just plain wrong,” he wrote, “it isn’t cheaper to eat highly processed food.” For example, a meal at McDonald’s for a family of four, consisting of 2 “Big Macs”®, 1 cheeseburger, 1 6-piece “Chicken McNuggets”®, 2 medium fries, 2 small fries, 2 medium sodas and 2 small sodas, comes to a total of almost 28 dollars. For this amount, and actually much less, a home-cooked meal could include a whole chicken, potatoes, green vegetables and a simple salad on the side.

So, it’s not so much the money but the convenience, ubiquity and the habit-forming appeal that really helped processed foods to drown out all other alternatives. Now there are about five fast-food restaurants for every supermarket in the U.S., according to Bittman.

“Our addiction to processed food is the result of decades of vision and hard work by the industry,” said David A. Kessler, a former commissioner of the Food and Drug Administration (FDA) and author of “The End of Overeating.” “Companies strove to create food that was energy-dense, highly stimulating, and went down easy. They put it on every street corner and made it mobile, and they made it socially acceptable to eat anytime and anyplace. They created a food carnival, and that’s where we live. And if you’re used to self-stimulation every 15 minutes, well, you can’t run into the kitchen to satisfy that urge,” he was quoted saying in the Bittman article.

Pointing fingers only at food manufacturers and restaurant chains won’t bring about the necessary changes that will make Americans (and people around the world for that matter) reconsider their eating habits. “Real cultural changes are needed to turn this around,” wrote Bittman. “The smart campaign is not to get McDonald’s to serve better food but to get people to see cooking as a joy rather than a burden, or at least as part of a normal life.”

So, what can you do to get your groove back as a hobby chef or discover your talent for the first time?

For starters, you need to “turn on your kitchen mojo,” according to Keri Heron, a Dubai-based journalist and photographer of the food blog “chefandsteward.com.” She advises to take a fun approach that avoids a sense of drudgery right from the beginning. Before you put on the apron and heat up the oven, pick your favorite music and set the right mood. Then, if you are so inclined, pour yourself a glass of wine or another favorite drink to stimulate your taste buds and get those gastric juices flowing. Don’t be shy: Dance and sing along with the music while you cut, slice and dice your ingredients. Think of your cooking not as a chore but an act of love for your family and friends who will enjoy the fruits of your labor and hopefully express their appreciation.

If you are a little rusty or have yet to gain more experience in the kitchen, buy an easy-to-follow cookbook that fits both your abilities and amenities. Don’t be intimidated or get discouraged when things don’t work out right away. One of the greatest chefs of our time, Thomas Keller (owner of “The French Laundry” in Napa Valley and “Per Se” in New York City), named the willingness to repeat and refine his recipes over and over again as the single most important element of his success.

Cooking is not an exact science, so allow yourself to be led by your imagination and curiosity, Heron recommends. There should be genuine joy and playfulness in the kitchen. Only then it will be a place you want to return to night after night (well, almost).

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.

New Study Confirms: Diabetes Increases the Risk of Alzheimer’s Disease

September 25th, 2011 at 4:48 pm by timigustafson
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A new study has confirmed a long-held suspicion that people with diabetes are at a higher risk of developing age-related dementia and Alzheimer’s disease. The latest findings are based on research in Japan that followed over 1,000 men and women, age 60 and older. 27 percent of the participants who were diabetic at the outset of the study eventually developed dementia, compared to 20 percent of those with normal blood sugar levels.

“We have clearly demonstrated that diabetes is a significant risk factor for the development of dementia, especially Alzheimer’s disease,” said Dr. Yutaka Kiyohara, professor at the Kyushu University in Fukuoka in Japan and lead author of the study report.

The researchers began studying residents of the town of Hisayama in the early 1960s. The original focus was on cardiovascular disease. In the mid-1980s, they started to observe the development of dementia. Each participant was monitored for an average time period of 11 years. The results were recently published in the journal, “Neurology.”

“Diabetes is a common disorder, and the number of people with [the disease] has been growing in recent years all over the world. Controlling diabetes is now more important than ever,” said Dr. Kiyohara.

Indeed, diabetes is dramatically on the rise worldwide. 230 million now suffer from the disease, up from 30 million 20 years ago. According to the American Diabetes Association (ADA), almost 26 million adults and children have been diagnosed in the United States alone. Another 80 million are considered pre-diabetic, meaning their blood sugar levels are routinely elevated, which can turn into a chronic condition over time if no countermeasures are taken.

The link between diabetes and dementia is not yet fully understood. Diabetes may lead to a particular type of dementia, called “vascular dementia,” in which damage to the blood vessels in the brain inhibits the flow of oxygen. There is also the possibility that the brain’s response to high levels of insulin in the body increases the risk of developing dementia. “There is some evidence that the brain is very sensitive to fuels like sugar and hormones like insulin,” said Dr. Joel Zonszein, professor of clinical medicine at the Albert Einstein College of Medicine. “How exactly it happens is really speculation, we really don’t know,” he added.

To be sure, not everyone with diabetes develops dementia and not everyone who has dementia is diabetic. But still, studies have shown time and again that those with Type-2 diabetes are twice as likely to develop a type of dementia like Alzheimer’s disease. Type-2 diabetes patients often develop insulin resistance, a condition in which their cells can’t properly use insulin to absorb glucose in the bloodstream. To compensate, the pancreas releases additional insulin. The resulting higher insulin levels in the blood can lead to inflammation, which may cause, among other effects, damage to the brain cells. In addition, abnormalities in glucose metabolism and insulin levels in the brain itself may be harmful. Some researchers have therefore suggested that Alzheimer’s disease may actually be “Type-3 diabetes.” Obviously, more studies are needed to prove the existence of these connections.

Currently available measures to prevent or control diabetes may or may not lower the risk of dementia. Some diabetes drugs have been tested for the effectiveness in the treatment of Alzheimer’s. So far, none of these tests have shown more than modest improvement with regards to the symptoms of the disease. They have not stopped progression, which, of course, would be the ultimate goal.

Based on what we know today, preventing or managing diabetes is the best strategy to avoid further complications, one of which may be dementia. This will also reduce the risk of other potentially debilitating effects, including heart- and kidney disease and damage to the optical nerves and nerve endings in the extremities.

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.

Preventive Home Care Reduces the Need for Emergency Calls

September 22nd, 2011 at 12:19 pm by timigustafson
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If the promise of “Obamacare” was to bring universal health care to America, we are bound to be disappointed once more. In terms of access to affordable medical services, the future looks as bleak as ever for most Americans.

Employer-based health insurance is quickly becoming a thing of the past, tens of millions are insufficiently or not at all covered, Medicare and Medicaid are under increasing financial and political pressure, more hospitals and emergency rooms are being closed than opened, rural areas and low-income neighborhoods are severely underserved, and there is a fast-growing shortage of general practitioners in the medical profession. These are just a few examples of many alarming issues that continue to make health care a menacing problem in this country.

Many Americans rely on calling 911 as their only option when catastrophe strikes. Catastrophe can mean anything from injuries suffered in an accident, heart attack, stroke, asthma attack, to adverse reactions to foods or medications. 30 to 40 million emergency calls are places every year in the U.S., according to federal record keeping.

The costs for responding to emergency calls are high. Most will never be repaid because the heaviest users of the system are uninsured and too poor to pay out of pocket. So, more and more cash-strapped communities are looking for ways to reduce the number of calls for help.

Especially in rural areas where medical services are harder to come by, local governments have been experimenting with alternatives to the traditional doctor’s office. One idea in particular seems to have gotten some traction. It’s called the “community paramedic.”

As reported in the New York Times (9/19/2011), the town of Eagle in Colorado, for example, has begun to retrain former first-responders to provide preventive care for seniors to keep them out of hospitals and nursing homes for as long as possible. Visits at senior centers to teach classes in nutrition, regular exercise and accident prevention are all part of the job description of this new brand of paramedics, which proponents say will improve the quality of people’s lives and save communities millions of dollars in health care costs.

Big cities like San Francisco, San Diego and Washington, D.C. have already begun to send paramedics pro-actively into low-income neighborhoods and to the homeless population to reduce the amounts of 911 calls.

The federal Health Resources and Services Administration, which collects data on access to health care nationwide, is expected to implement this year a new system for measuring the performance of community paramedics, according to the Times. “What we have had is a patchwork of different cities trying different things, and different paramedics reinventing the wheel each time,” said Niels Tangherlini, a paramedic captain at the fire department of San Francisco who helped create the city’s preventive health care program for homeless people. As a next step he hopes for a much broader implementation of the concept, which he sees as a better approach because it’s “pro-active rather than just reactive.”

Pro-active measures often come down to the most basic and simple things in health care, such as human contact and interaction. Kevin Creek, a community paramedic in Colorado, works primarily with seniors. He makes house calls, organizes medications, checks on blood sugar levels and blood pressure and countless other day-to-day chores. For many of his patients he is nothing less than a lifeline.

No matter how successful and popular programs like these may be, their survival is by no means guaranteed. Under federal law, emergency medical responders get only reimbursed for their services if they transport a patient to a medical facility. Cutting down on 911 calls is not necessarily in their best interest in terms of their bottom line. When the homeless outreach program at the San Francisco Fire Department lead to a 75 percent reduction in emergency calls, which saved the city an estimated $12 million, it was still discontinued because of concerns that resources would be diverted from traditional emergency response funds, which are already dangerously low due to ongoing budget cuts.

Even staunch supporters of preventive health care admit that success is hard to measure. How do you know what exactly is being prevented? If saving money is the only objective, then you may never truly appreciate the benefits of such programs. But if you consider the increase of quality of life for the elderly, the chronically sick and the poor who are given at least a minimum amount of care they otherwise wouldn’t have, then you know it’s worth the effort and the expense.

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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