Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

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.

As Income Declines, So Does Health

September 19th, 2011 at 4:40 pm by timigustafson
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The number of Americans living below the official poverty line has increased to 46.2 million, according to just released statistics by the Census Bureau. It is a record in the 52 years the bureau has surveyed poverty in the United States.

The median household income fell nationally last year back to the levels of 1997. It is the first time since the Great Depression that Americans earned less, adjusted for inflation, than they did over a decade ago.

Predictably, minorities were hit the hardest, with poverty rates twice as high as those of non-Hispanic whites. Southern states had the highest amount of people falling into poverty – almost double the rate of the Northeast, Midwest and West.

The poverty threshold is an annual income of $22,314 for a family of four and $11,344 for a single person.

“This is truly a lost decade,” said Lawrence Katz, an economics professor at Harvard University. “We think of America as a place where every generation is doing better, but we’re looking at a period when the median family is in worse shape than it was in the late 1990s.”

As income declined, the number of people without health insurance coverage rose. Nearly 50 million are now uninsured, almost a million more since 2009. For many working-age Americans, job loss and long-term unemployment lead to loss of employer-provided health insurance or affordable alternatives. And those who are working often struggle to maintain their coverage. In 2010, approximately 55 percent of working Americans were insured by their employers, a 10 percent decrease from 2000, according to the census report.

Studies on the causes of poverty have shown that there are three important components that hold together the social safety net for most people: Income, health and relationships. If one of these fails, the other two are usually still able to bridge the gap, at least for some time. However, if two out of three are diminished, the chances for falling into poverty and even homelessness rise sharply. In other words, if you lose your job but are healthy and have a stable marriage or partnership (especially if there is a second income in a household), you are much better equipped to get through the ordeal of temporary unemployment than if you are sick and/or on your own. That may sound like a no-brainer, but it is exactly the kind of situation that most poor people are dealing with.

The harsh realities of poverty affect the youngest members of society even more. 22 percent of children and adolescents under 18 are now considered poor. Hunger or what is called in bureaucratic terms, “food insecurity,” affects 15 million kids in this country today. Considering the importance of healthy nutrition for normal physical and mental development at a young age, there is a whole generation that is being lost in front of our eyes.

Nutrition-related diseases, such as obesity, diabetes and high blood pressure, are most common among the poor. With healthy foods out of reach because of high prices and lack of outlets in low-income neighborhoods, poor families have little choice but to survive on junk food.

The New York City Department of Health and Mental Hygiene has recently published a report on “Health Disparities in Life Expectancy and Death,” documenting current health disparities in New York City based on differences in race, ethnicity and economics. Other factors included in the study were social and physical environmental conditions, opportunities, stressors that impact health, access to primary and preventive health care and quality of health care received.

Trying to identify how poverty and health are interrelated, the researchers wrote: “Living in poverty makes it difficult to know about, find or access a variety of resources that promote health and prevent illness. For example, people living in poor neighborhoods may have access to fewer opportunities to exercise and buy healthy food. Living with limited resources also increases stress and anxiety, which can, in turn, lead to unhealthy habits, like smoking and drug use. In the other direction, poor health can prevent people from completing their education and obtaining well-paying jobs, which can lead to subsequent poverty.”

In other words, the decline of income, social safety and health are all part of the same vicious cycle. To break it, the Health Department makes a number of recommendations, including setting up “health policies that benefit vulnerable populations,” directing “resources to target communities disproportionately affected by illness and premature death,” and implementing “policies that reduce economic and social disadvantages.”

In the meantime, the White House and Congress continue debating how to cut hundreds of billions of dollars more from entitlements and aid programs. I guess the statistics are not scary enough just yet.

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.

United Nations Vow to Combat Lifestyle-Related Diseases Worldwide

September 18th, 2011 at 2:01 pm by timigustafson
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For only the second time in its history, the General Assembly of the United Nations (UN) gathers this week to discuss an urgent issue of health. The last time was ten years ago when the UN confronted the growing threat of the AIDS pandemic. Common chronic illnesses, a.k.a. non-communicable diseases (NCDs), like obesity, diabetes, heart disease and cancer, many of which are acquired by poor lifestyle choices, are now at the forefront of health concerns in the world. The goal of the meeting is to adopt a concise, action-oriented document that can shape a global agenda for the improvement of people’s health and quality of life.

About 36 million people die every year from NCDs, almost 80 percent of them in poor countries where access to preventive health care measures like early diagnosis, treatment and education is very limited. Campaigns to reduce smoking rates, improving diets, encouraging exercise and making more life-saving drugs available at affordable prices would make a real difference in many of these places.

There is a common story around tobacco, alcohol, diet and exercise. By addressing these issues and finding better solutions to fight their impact on people’s health would be both significant and cost-effective, according to David Kerr, president of the European Society of Medical Oncology.

The focus at the UN meeting will be on fatty foods, sugary drinks and, above all, tobacco use. Cigarette smoking alone will kill more than billion people worldwide in this century if current trends persist, according to estimates by the World Health Organization (WHO).

Still, many governments will find it hard to implement more draconian measures to reduce smoking in their countries. In Japan, for example, 50 percent of the tobacco industry is owned by the state. In China, where a third of all smokers in the world live, sales from the state-run tobacco industry account for nine percent of fiscal revenues. And here in the U.S., cigarette makers continue to rake in robust profits, if not from the domestic market then certainly from exports.

So it should not come as a surprise that after months of tough negotiations only a much watered-down compromise could be found to which a majority of nations would be willing to commit. Among the surviving intentions are: A pledge to institute a global monitoring framework within the UN that will assess future developments in the spread of diabetes, cardiovascular disease, respiratory disease and various types of cancer. There will also be a catalogue of recommendations for actions to be taken by individual governments to reduce NCDs and related risk factors. If this sounds somewhat vague, it’s because it is.

Yet the UN is lucky to have come this far. Diplomats involved in the preliminary drafting of the agenda reported that negotiations stalled several times because of heavy lobbying efforts by food, tobacco and drug industries, according to the British Medical Journal.

Funding is a major concern. It is still unclear how the planned monitoring- and promotional measures will be financed. The WHO may end up having to ask wealthier governments to raise funds, for example by imposing higher taxes on tobacco and sodas, to support the efforts of poorer nations. At this time, even the most optimistic health advocates don’t dare to hope for funding on par with the resources that were provided for the global fight against AIDS in 2001.

Unlike AIDS, which until recently was an almost certain death sentence for those affected with the disease, NCDs are not commonly seen as an immediate threat to the survival of large parts of the world population. Stopping people from smoking or providing cheap drugs like aspirin or statins to prevent heart attacks and strokes may be easy and cost-effective by comparison, but simple measures like these don’t provide many incentives for governments and private sectors to invest. “The time horizon for the return on that investment is very long and beyond many political horizons,” said Dr. Gordon Tomaselli, president of the American Heart Association (AHA). “So it’s difficult to get people to commit to these kinds of resources.”

Nevertheless, a complete failure to come to some consensus about the seriousness of the NCDs crisis and the necessity for counteraction would be tragic. “A major opportunity to advance global health is in danger of being lost if substantive targets are not set and nations don’t agree to be held accountable for meeting them,” warned the medical journal, “The Lancet,” in a recent editorial (30/16/2011).

If not much else, at the very least, the meeting, which will be attended not only by expert representatives but also heads of state, will help to raise awareness and remove some of the stigma that is often associated with obesity and other lifestyle-related diseases. The world needs to know that this is no longer a matter of personal choices but a menace to public health that would be perfectly preventable if the right policies were put in place.

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.

Harvard Health Experts Offer Their Own Dietary Guidelines

September 16th, 2011 at 2:52 pm by timigustafson
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Just a few months after the government released its newest nutritional guidelines for Americans, called “MyPlate,” researchers at Harvard School of Public Health decided to offer their own modified version.

The “Healthy Eating Plate,” as the alternative plan is called, offers more specific recommendations for following a healthy diet than MyPlate, which was developed by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Service (HHS).

The Harvard plan is “based on the most up-to-date nutrition research, [which] provides consumers with the information they need to make choices that can profoundly affect their health and wellbeing,” said Dr. Walter Willett, a professor of epidemiology and nutrition at Harvard School of Public Health. He went on to say that he and his team tried to address the shortcomings of the government’s guidelines: “The main thing is that MyPlate isn’t specific enough to really give enough guidance.”

Like the MyPlate icon, the Harvard recommendations are conceived in form of a plate. There is a similar division in four sections for fruit, vegetables, grains and protein but with added information on what foods in each category are actually healthier than others. For example, a clear distinction is being made between grains and whole grains. Whole grains are part of a healthy diet, while refined grains such as white bread and white rice are not.

Likewise, not all sources of protein are equally recommended. Fish, beans, nuts and, to a lesser extent, poultry and lean meats are considered good sources, however, red meat, bacon, cold cuts and processed meats are not and should be avoided altogether.

Even vegetables are not all safe. Most are, but potatoes, especially in form of French fries, shouldn’t count as healthy. The reason is that potatoes are full of rapidly digested starch and can have a “roller-coaster effect” on blood sugar levels and insulin secretion – which can lead to overeating with all its well-known consequences.

With regards to oils, the government’s guidelines are mum. But there are healthy fats we can get from olive- and canola oil and they are important to mention, according to Dr. Willet.

He is also critical of the inclusion of milk in every meal, as the MyPlate graphic seems to suggest by adding a separate container for dairy products. “Modest dairy consumption is OK,” he said, “but having a glass of milk with every meal is excessive and does not reduce the risk of osteoporosis and fractures.” The Harvard plate replaces milk with water and recommends only one or two servings of low-fat milk per day. The consumption of fruit juices should be limited, while sugary sodas should be completely avoided.

The Healthy Eating Plate also features a symbol reminding us of the importance of exercise, something that is completely missing from the MyPlate graphic.

One of the reasons for publishing an alternative and arguably improved version of the just released USDA guidelines is the growing frustration among health- and nutrition experts over the domineering influence of the food industry on government policy-making. “Unfortunately, like the earlier USDA [Food] Pyramids, MyPlate mixes science with the influence of powerful agricultural interests, which is not a recipe for healthy eating,” said Dr. Willett.

Other nutrition experts voiced criticism with regards to some aspects of the Harvard approach. For example, some noted that dairy products like milk and yogurt should not be limited for children because of the importance of sufficient calcium supply during growth. Others worried that the new graphic was too detailed and too hard for many consumers to follow. Defenders of the MyPlate say that the strength of the USDA icon is its simplicity, while it is also much more intuitive and self-explanatory than the Food Pyramid variations of the past. It would not be helpful to give up on that advantage by adding on more information.

I think that both the USDA and the Harvard concept are a step in the right direction. Considering how much consumers are already confused about eating right and staying healthy, user-friendliness is certainly a virtue. Those who are ready and willing to embark on a regimen of good nutrition and regular exercise learn very quickly that it’s not a one-step process but a life-long journey that has many ups and downs. So it makes sense to begin with a few essentials and go from there as one progresses. In the end, success will only come with stick-to-itiveness and the willingness to keep learning – I’m sure the Harvard professors can appreciate that.

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

Health Educators Should Learn from the Entertainment Industry

September 15th, 2011 at 12:42 pm by timigustafson
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The information age has made the public extremely knowledgeable on almost every topic there is. Whether it’s about politics, business, science, technology or health, most of us have easy access to the information that exists on any given subject.

Before the Internet – if you are old enough to remember that there once was such a time – things were different. You had to go to a bookstore or a library and study up if you wanted to know about something in greater detail. Now, it’s all literally at your fingertips. We are all experts now.

While there is nothing wrong with a better-informed society – to the contrary – these changes have certain consequences we need to be aware of. Expertise and authority are being much more questioned now than they used to be. Not long ago, if you went to the doctor, he told you what to do to cure your ailment – and that was that. Today, it’s more the other way around. My own clients bring me stacks of printouts from websites they’ve browsed through before scheduling their next consulting session.

At the same time, it seems, we are not able to translate this dramatic increase of knowledge into action. We have the data, we receive the instructions, but incorporating them in our daily lives is still another matter.

Take, for example, the government’s “Dietary Guidelines.” Never before in history were we given so much detailed information about our nutritional health. At the same time, the obesity crisis keeps getting worse. Why the disconnect? Obviously the messages are not getting through despite of the fact that they’re being conveyed in the most user-friendly ways.

Communication experts have long known that what they call the “entertainment factor” plays an important role in the learning process. To absorb information – any information ¬– our attention must first be aroused. Then it must be kept stimulated, so our attention span extends long enough for the message to be delivered. The news industry knows that, the advertising industry knows that, the entertainment industry knows that – they all live and die by how well they perform this fine art of keeping us, the audience, interested.

ABC News/Health has recently published a survey of how popular TV shows influence viewers’ behavior in terms of their health. They listed programs that played in a hospital or health care environment, like “Grey’s Anatomy,” a hospital drama. Of course, the “Biggest Loser” on NBC, which is about to start its 12th season, has to be mentioned. A new reality show, titled “Extreme Makeover: Weight Loss Edition,” follows a similar format. “The Last Heart Attack,” an episode of CNN’s health series “Dr. Sanjay Gupta Reports” that included an interview with former President Bill Clinton on his heart condition, made a big splash. Analysts involved in these surveys say these shows do have an impact on the audience beyond viewing time.

When viewers follow a person’s struggle to lose weight and regain their health, they eventually come to think about themselves. “It’s about changing your mindset, [which] is going to be life-changing and personality-changing,” said Dr. Keith Ayoob, professor of pediatrics at the Albert Einstein College of Medicine in New York City, referring to the participants in “Extreme Makeover.” Some of these effects inevitably rub off on the audience, which, of course, is the point.

Undoubtedly, we are visual creatures. What we see influences us perhaps more than any other factor in our daily learning processes. Often that takes place in a subconscious manner. Here is an example: A few days ago, I saw the movie “Contagion,” a thriller about the outbreak of a lethal virus that ends up killing millions around the globe. As the title indicates, the infection is highly contagious and can be transmitted by coughing, touching and even by indirect contact, like holding on to a railing or pressing an elevator button. The initial symptoms are similar to a severe cold or flu before it gets much worse.

Although the movie theater was quite full, there was not a single cough to be heard throughout the performance – which is unusual, because hearing someone else cough can often result in similar reactions around that person; it’s psychologically contagious, too, if you will. I think it’s not far fetched to think that nobody in that audience dared to cough because of the drama that was unfolding in front of our eyes. And after the film, guess what? That’s right. Bathrooms filled up fast with people wanting to wash their hands as quickly as possible. They don’t do this normally, not to that extent.

So what can health care providers, like myself, learn from all this? For starters, we should certainly not dismiss the value of good entertainment. Despite of increased efforts to make health education more palatable, especially for younger generations, criticism persists that it remains impractical, elitist and out of touch with the real world. Many comments in the press on the newest version of the government’s nutritional guidelines for Americans, “Myplate,” reflect this continuing sentiment. Maybe, we experts should get out of the proverbial ivory tower more often and go the movies instead.

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.

In Terms of Health Benefits and Versatility, Tomatoes Reign Supreme

September 13th, 2011 at 11:12 am by timigustafson
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Tomatoes rank among the most popular and versatile foods we know. They are loaded with important nutrients and are believed to have heart-health-promoting and even cancer-preventing properties. Tomatoes are low in calories and fats but rich in dietary fiber, minerals and vitamins.

Antioxidants, which are present in high amounts in tomatoes, have been found to be protective against many cancers, including colon-, prostate-, breast-, endometrial- (the lining tissue of the uterus), lung- and pancreatic cancers.

Phytochemicals like lycopene and carotenoids protect cells from so-called “free radicals,” molecules known to wreak havoc in the body and accelerate the aging process.

Lycopene has also cardiovascular benefits. Studies have found that a high dietary intake of tomato products significantly reduces total and LDL (“bad”) cholesterol levels.

Vitamin A, also richly present in tomatoes, is essential for the preservation of good vision. In addition, Vitamin A is required for maintaining healthy mucus membranes and skin.

Vitamin C strengthens the immune system and helps building resistance against infections.

Vitamin K helps maintaining bone density because of its ability to activate osteocalcin, a chemical that anchors calcium molecules inside the bones.

Potassium is an important component of cell- and body fluids and also helps to control heart rate and blood pressure.

Especially the red varieties are filled with flavonoids, which can protect against certain cancers, including lung cancer.

All tomatoes are a good source of folate, iron, calcium, manganese and other important minerals the body needs to function properly.

A colorful history
Botanically, tomatoes are actually not vegetables but fruits. Known by the scientific name, “Solanum lycopersicum,” they are members of the “Nightshade” (Solanaceae) plant family, which also includes bell peppers, eggplants and white potatoes.

The name reflects some mystery that has surrounded the tomato plant for centuries. “Lycopersicon” is the Latin word for “wolf peach,” which was probably chosen because of a long-held belief that this fruit was dangerous – as dangerous as a wolf.

The French seemed less fearful and called it “pomme d’amour,” meaning “apple of love.” They believed that eating tomatoes had an aphrodisiacal effect, comparable to Viagra or Cialis today. And in Italy, where tomatoes are arguably the most popular, they call them “pomodoro,” the “golden apple.”

Originally, tomatoes were native only to South America’s west coast, including the Galapagos Islands. The early types cultivated by humans resembled today’s cherry tomatoes. At that time, they were usually not eaten but rather displayed for decoration, like flowers.

The use of tomatoes as food became eventually popular in Mexico, perhaps because the people there were already familiar with a fruit called “tomatillo,” a type of small green tomato (in Spanish: “Tomate verde”) that was a staple in their cuisine. When the conquistadores invaded the country in the 16th century, they took seeds of tomato plants back to Spain. Soon thereafter, tomatoes were introduced all over Europe. The early colonists brought tomato seeds with them to North America. Today, farmers in the United States rank among the top producers of tomatoes worldwide.

Many varieties to choose from
Tomatoes come in many sizes, shapes and colors. In fact, there are thousands of varieties, including hybrids and genetically modified versions. The so-called “heirloom” tomatoes are becoming increasingly popular, especially among organic producers and their clientele.

Heirlooms, a.k.a. “heritage tomatoes,” are open-pollinated, non-hybrid cultivars. Many have been passed down through several generations of growers and are highly valued for their unique flavors, coloring and other characteristics. They too come in all sizes, from beefsteak to cherry. Some have names as colorful as their looks, like “Big Rainbow,” “Cherokee Purple,” “Red Brandywine,” “Green Zebra,” “Red Zebra” – or, how about “Mortgage Lifter”?

Tomatoes taste best when they are freshly harvested during the summer and early fall. The flavors typically change as the season progresses, with most varieties becoming more acidic over time. Unfortunately, tomatoes are subject to a number of diseases, including fungal and bacterial infections, especially in cool rainy weather. Still, I would always recommend choosing the organic kind to avoid exposure to pesticides.

Select only tomatoes with rich, deep colors. The skin should be smooth with no wrinkles, cracks, bruises or soft spots. Ripe tomatoes will yield to a slight squeeze. When buying canned tomatoes, make sure you get a reputable brand. Not all imports follow strict standards for lead content in cans. This is especially important for tomatoes because their high acidity can cause corrosion, which may result in poisoning.

Tomatoes continue to ripen after they are picked. You can keep them at room temperature or put them in the fridge if they are close to becoming overripe. Whole tomatoes and tomato sauce freeze well for future use in cooked dishes. Sundried tomatoes should be stored in airtight containers at a cool temperature.

Many Americans know tomatoes best in form of ketchup. Although it’s not as beneficial as the real thing, tomato ketchup is not completely void of nutrients. Much of the lycopene content remains intact after processing. However, it is worth buying organic ketchup because it contains up to three times more lycopene than regular brands.

Many ways to prepare and enjoy
Eating tomatoes raw and unaltered is the quickest (and perhaps best) way to get all the nutritional benefits. However, cooked tomatoes, which can be used in sauces, purées or soups, contain even higher amounts of lycopene. Tests have shown that chopping and heating makes phytonutrients and other health-promoting components in tomatoes more potent. And tomato paste, especially when the skin is included in the making, has a high concentration of carotenoids.

In addition to enjoying tomatoes just as nature made them, you can dry, bake, roast, sauté, blenderize or utilize them in countless other ways. On a hot summer day, there is nothing better tasting than chilled gazpacho made from scratch. When it gets cooler outside, maybe it’s time for a hearty tomato-based soup with lots of vegetables to be added. Any good vegetarian cookbook will give you plenty of ideas – or you just find out for yourself how versatile tomatoes truly can be.

For great ideas to use tomatoes in different dishes, go to our recipe section. Try our home-made Bruschetta, Tomato Soup or Baked Penne Pasta Italiano.

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.

President Proclaims September as Childhood Obesity Awareness Month

September 11th, 2011 at 3:37 pm by timigustafson
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President Obama has marked September 2011 as the first “National Childhood Obesity Awareness Month,” calling on all Americans to “promote healthy eating and greater physical activity by all our nation’s children.”

“By taking action to address the issue of childhood obesity,” the president went on, “we can help America’s next generation reach their full potential.”

As an example for the kind of action the president had in mind, he named his wife’s initiative, called “Let’s Move!” – a program that encourages government agencies, corporations and advocacy groups to unite in the fight against the growing obesity crisis that afflicts America’s youngest generation today.

His call for action couldn’t have come too soon. According to the Centers for Disease Control and Prevention (CDC), childhood obesity has more than tripled over the past 30 years. One if five children age six to 11 is now being considered obese. The numbers are similar for adolescents age 12 to 19. And the trend continues. “Childhood obesity statistics and facts are more and more pessimistic and should be an alarm sign for all those who don’t take it seriously,” warns the latest CDC report on obesity trends in America of 2010.

The reasons why we are facing a childhood obesity epidemic today are multi-faceted, which makes it hard to pinpoint particular causes. Lifestyle is certainly a factor, but so are genetics, socio-economic factors, exposure to marketing and advertising, education and culture. “Most factors of overweight and obesity do not work in isolation, and solely targeting one factor may not make a significant impact on the growing problem,” concludes a report on childhood obesity by U.S. Department of Health and Human Services (HHS).

One particularly decisive factor for the rise in obesity can probably be found in the major lifestyle shifts that took place in the 1960s, according Dr. Tracy Deutsch, a history professor at the University of Minnesota who specializes in women studies and consumer culture. It was a time when more women entered the work force, partly to have their own professional careers but also to add a much-needed second income to their households. “Women working outside the home doesn’t cause obesity,” she said, “but it exacerbates the problem. They have less time to cook and plan meals, but they still need to feed their families. Processed and fast food is often the easiest and most affordable option.”

Today, we see the consequences of these changes much more clearly. According to Dr. Deutsch, today’s young adults are the first generation that has basically been brought up on junk food. “The tastes they developed as children continue to inform their eating choices,” she said. And as young parents, they pass these preferences on to their kids, one might add.

Families eat half of their meals outside the home, mostly at pizza parlors and fast food joints. Not only is restaurant food often loaded with fat, salt and sugar, the portion sizes have also grown dramatically. When restaurant owners discovered that offering larger portions wouldn’t add much in costs but would attract more customers seeking the biggest bang for their buck, they went for supersizing as a lucrative business model.

According to Dr. Lisa Young, professor for nutrition at New York University and author of the “Portion Teller,” the trend towards larger portion sizes began in the 1970s, increased sharply in the 1980s and continues to rise today.

Physical inactivity and sedentary lifestyles are often named as major causes for the obesity crisis for both children and adults. As the HHS notes, schools are still decreasing the amount of physical activity they offer during school hours. Only about one-third of elementary school children receive physical education (PE) and less than one fifth have extracurricular sports programs at their schools. PE classes at high school level have been reduced to a mere 25 percent. Many school districts have all but eliminated PE because of financial constraints or strictly test-oriented curricula.

In his announcement, President Obama emphasized that childhood obesity is a national problem. It cuts across all cultural and demographic lines, he said. That is true to a degree. But, as the HHS report points out, socio-economic status – e.g. parental income, parental education, occupation status, etc. – have an enormous impact on a child’s nutritional health. African Americans, Latinos and Native Americans are disproportionately more affected by obesity. Low-income neighborhoods notoriously suffer from lack of access to healthy foods. Children who grow up in less than safe environments are much more likely to stay indoors. The absence of sidewalks, bike paths, public parks and sports facilities leave families few options to maintain a regular exercise routine.

Last but not least, it deserves to be mentioned that the food industry is not necessarily on the same side as health advocates. Food and beverage companies collectively spend tens of billions of dollars annually to reach young consumers, mostly through TV ads. Researchers have clearly established a direct link between exposure to food advertising and increasing rates of obesity among children, according to the HHS. As far back as in the 1970s and 1980s, experimental studies have shown that children under the age of eight were much more likely than older kids to believe that TV ads were telling the truth and that exposure to TV ads influenced their food choices and requests from their parents. A review by the Kaiser Family Foundation found that the amount of time spent watching TV correlated significantly to children’s calorie intake as well as to specific food preferences.

I personally think the president is overly optimistic if he truly believes that together as a nation we can stop childhood obesity in its track. There are too many diverse interests at stake here. Several measures that could be taken right now are not being implemented on any level, federal, state or local. How about imposing significantly higher taxes on sodas and fast foods to curb consumption? How about outlawing advertising snacks and sodas to kids the way we outlawed tobacco ads to minors? These are baby steps by comparison to what’s needed to reverse this epidemic. But even they can’t get off the ground.

I applaud both the president and the first lady for bringing childhood obesity to the forefront of their agenda. But raising awareness can only be a first step and good will alone won’t save an entire generation that is now in peril.

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

The Many Health Benefits of Yoga

September 9th, 2011 at 7:35 am by timigustafson
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Yoga has been practiced around the world for thousands of years. Between 12 and 15 million Americans do it regularly and swear by its numerous benefits for their health and well-being. Followers practice at home or join classes for pure relaxation.

Most yoga styles focus on physical poses, called “asanas.” They also include breathing techniques and forms of meditation. There are other versions that teach you to move your body in unfamiliar ways. These are meant to build greater flexibility, strength and balance.

Now, researchers are finding that there may be many more health benefits in connection with yoga than previously thought. One small study involving 123 middle-aged and older adults concluded that diabetic yoga practitioners might be able to control their blood sugar levels better than their non-practicing counterparts. The study results were published in the journal “Diabetes Care.”

The researchers said they did not mean to suggest that yoga should be considered as an alternative to traditional treatments of diabetes, such as weight loss and medical blood sugar control. “To really lose weight and rein in blood sugar, more vigorous exercise would work better,” wrote Dr. Shreelaxmi V. Hedge of the Shrinivas Institute of Medical Science and Research Center in Mangalore, India and leader of the study. Still, she said, “it should be noted that yoga controlled the blood sugar levels, which otherwise rose in the [non-yoga-practicing] control group.”

The yoga style her research was based on is a relatively “gentle” version among yoga practices. It was chosen because it is easy to get into. Some more vigorous styles involving complicated poses would not be appropriate for older adults and those with chronic health conditions, according to Dr. Hedge.

In fact, a lot of people shy away from taking up yoga because they consider themselves as too old, too stiff and too unfit to perform even the most basic poses. Yoga instructors generally disagree with such preconceptions. The consensus is that nobody is ever too old or too out of shape to improve flexibility.

Stretching releases the lactic acid built up in the muscles, which can cause stiffness, tension, pain and fatigue. It also increases the range of motion in the joints and promotes their lubrication. This results in more ease and fluidity throughout the body. Yoga stretches do not only benefit the muscles and joints but all tissues in the body, including ligaments, tendons and the fascia sheath that surround the muscles.

More rigorous yoga styles are focused on building muscle mass. They are called “ashtanga” or “power yoga.” But even tamer versions, such as “Iyengar” or “hatha,” which are designed to achieve optimal alignments in their poses, can help improve strength and endurance. Poses that strengthen the lower back and abdominal muscles are especially helpful for people who spend many hours sitting. More strength and flexibility afford better posture, which counterbalances the potential damages from extended immobility.

Perhaps the most studies on the benefits of yoga have been conducted with regards to its effect on heart health. Practicing yoga is highly recommended as a non-medical tool to help lower blood pressure and slow the heart rate. Again, it is not to be taken as an alternative to other forms of hypertension- or heart disease treatment but as a useful support element.

The same goes for measures to control cholesterol and triglyceride levels. Studies have shown that yoga helped lower LDL (bad) cholesterol levels and improve blood circulation in patients with cardiovascular disease. Some hospitals have incorporated yoga into their post-cardiac rehabilitation program.

There is also evidence that yoga helps to release antioxidant agents into the blood stream. In Dr. Hedge’s study, participants who practiced yoga suffered significantly less from what is called “oxidative stress,” a condition that is caused by molecules, also know as “free radicals,” that damage cells and contribute to a host of diseases. “Yoga may curb oxidative stress because it stimulates the parasympathetic nervous system – the part of the nervous system that acts as a brake against the gas pedal of the sympathetic nervous system,” said Dr. Hedge.

The calming effects of yoga are certainly among its best-known qualities. Even beginners and infrequent practitioners appreciate the anti-stress benefits. Some say that doing yoga exercises in the morning improves their mood and ability to concentrate for the rest of the day. Others claim that they have been able to overcome addictions and improve their lives in countless more aspects, including in the bedroom.

Needless to say, there is little chance to scientifically prove the validity of all these assertions. What matters more is that people experience a sense of well-being when they engage in the practice. “Yoga helps reduce stress. That can impact your overall health,” said Dr. Deepak Chopra, world-renowned author of wellness books and advocate of alternative medicine. “While yoga won’t cure everything that ails you – or make your boss nicer – it will help you deal with stress better. And that could make a big difference,” he added.

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 at http://twitter.com/TimiGustafsonRD

“MyPlate” – The First 100 Days

September 7th, 2011 at 12:14 pm by timigustafson
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It’s been almost a hundred days since the government released the latest update of its Dietary Guidelines. For the last thirty years, the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) have jointly given their recommendations for healthy eating to the American public – obviously without much success.

Today, weight problems are affecting two thirds of the American population. Obesity rates have skyrocketed from 15 percent to well over 30 percent. Just by looking at these numbers, it is obvious that the government’s efforts to improve our eating habits have been a dismal failure.

In June 2011, the traditional “Food Pyramid” was replaced with a new icon, named “MyPlate,” which supposedly resembles a dinner plate divided in four segments of various sizes. Each part is dedicated to a different food group: Vegetables, fruits, grains and protein as well as a serving of dairy products on the side.

So far, reactions have been mixed. Many nutrition experts have praised the simplicity of the graphic, which they believe will make the guidelines more intelligible and user-friendly than its predecessors. Others have criticized it as too simplistic to explain the intricacies of important dietetic principles. All of this may be true, however, the main question should be: Are consumers better off than they were with the older versions – or without following any of the government’s guidelines for that matter?

A great deal of attention was given this time to the “primary suspects” that most likely cause Americans to get fatter and fatter. Added sugars in sodas and processed foods belong to this group of offenders. So do fats, solid (butter) or liquid (oils). Sodium (salt) is seen as a major culprit, not only for weight gain but more so for high blood pressure and heart problems. Portion sizes are also of great concern. Americans do not only eat badly, they also eat way too much, the guidelines conclude.

So, the “MyPlate” recommendations call for a radical departure from all that. Forget the meat and potato diet of generations past. Instead, we are urged to eat at least five servings of vegetables, four servings of fruit, three cups of low-fat dairy products and six ounces of whole grains every day. Besides cutting back on fat, salt and sugar, we also better not indulge too much in alcohol and caffeine. Exercise, on the other hand, is something we can never get enough of: A minimum of 30 minutes daily is a must (60 to 90 minutes would be ideal).

Sounds good. But is it realistic? Considering our busy lifestyles and – with food prices constantly rising – our budget constraints, can the government seriously expect that people are willing or even able to follow its advice?

“I think there’s a risk of these guidelines setting people up for failure,” said Dr. Annette Dickinson, president of the Council for Responsible Nutrition, a trade association of dietary supplement manufacturers. “We know that people already aren’t doing what the last guidelines said. Yet these are more stringent. It is good to have a goal to shoot for. But this is just not a real-life solution.”

People don’t change their eating habits because somebody tells them to. For most of us, it takes a heart attack to get us thinking about our diet, according to Mark Bittman, a New York Times columnist and author of the book “How to Cook Everything.” “I couldn’t follow those guidelines. I look at [them] and I’m going to adapt to as many of them as I can. But am I going to let this stuff scare me and run my life? Not unless I have to,” said Bittman.

Someone who famously changed his diet in radical ways is former president Bill Clinton. As he stated himself in a highly publicized interview with neurosurgeon and part-time CNN anchor/commentator Dr. Sanjay Gupta, Clinton decided to become a strict vegetarian to better control his heart disease. For people like him, eating right is a matter of life and death. But that’s an extreme situation. For the rest of us, there must be room for some flexibility, according to Kathleen Zelman, MPH, RD, LD, director of nutrition for WebMD Health.

“Start where you are today and look toward guidelines as goals. If you are eating one serving of vegetables, eat two or three. If you are not exercising, 90 minutes a day is too much. Take baby steps. Make the changes in your lifestyle that help you incorporate some of these recommendations a little at a time,” said Zelman.

Bittman recommends a similar strategy. Seeing the larger picture of your nutritional needs is more important than following the recommendations to the letter, he said. “Set a rough limit for yourself. Be aware of the calories in different kinds of food, but don’t get obsessed counting them. Say, I’m going to try to eat two cups each of vegetables and fruit every day and a cup or two of whole grains every day. Even if you get 600 calories from a Big Mac and 450 calories from a medium order of fries, if the rest of your day’s diet were broccoli and apples and bulgur, you wouldn’t be that bad off.”

So, here are your more workable guidelines: Eat your burger or steak once in a while, if you must. But then make sure you’re getting plenty of the healthy stuff for balance. And that workout schedule? Stop putting it off.

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 at http://twitter.com/TimiGustafsonRD

Anti-Soda Campaigns Make Progress Despite of Pushback from Beverage Industry

September 2nd, 2011 at 12:47 pm by timigustafson
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Sodas add hundreds of calories a day to the typical American diet, according to a new government investigation. Over half of all Americans drink varying amounts of sugary beverages on most days. Adults consume daily an average of 336 calories from sodas and kids are not far behind.

These are the findings of a study conducted by the Centers for Disease Control and Prevention (CDC) as part of its National Health and Nutrition Examination Survey, which is widely acknowledged among experts as the gold standard for evaluating food- and beverage-related consumer habits. The results are based on over 17,000 interviews between 2005 and 2008.

“Sugar-sweetened beverages are the number one single source of calories in the American diet and account for about half of all added sugars that people consume,” said Dr. Rachel Johnson, a nutrition expert at the University of Vermont, speaking on behalf of the American Heart Association (AHA). The association advises that people should consume not more than 36 ounces or about 450 calories from sugary drinks – a week.

The CDC study has been released less than two weeks after the U.S. Department of Agriculture (USDA) withheld its support for a proposal to exclude soda drinks from New York City’s food stamp program, which was championed by Mayor Michael Bloomberg, who is also known for his strong anti-smoking advocacy.

With anti-soda legislation still facing a rough road ahead, consumer advocacy groups like the Center for Science in the Public Interest (CSPI) say it’s time to think of more effective strategies to increase awareness of the health risks from excessive soda consumption. “Reducing the consumption of sodas and other sugary drinks would be a major public health victory and would help reduce health care costs for all levels of government,” the group wrote in a statement. CSPI announced a new campaign called “Life’s Sweeter With Fewer Sugary Drinks.”

What’s required in this ongoing battle against the health hazards from sodas is an involvement of health experts, civic organizations, youth groups, civil rights groups and many others, according to CSPI director Michael F. Jacobson. He pointed out that the worst health problems caused by excessive soda consumption occur among minorities, the poor and the young. “Not since the anti-tobacco campaigns has there been a product so worthy of a national health campaign,” he said.

Despite of New York City’s recent setback, there are signs that the anti-soda movement is catching on in many more parts of the country. In Boston, soda sales have recently been banned from city property. Public schools are no longer allowed to sell sugary beverages on campus. An extensive media campaign against soda consumption that specifically targets parents of young children is in the works. Later this month, the Los Angeles County Health Department plans to implement a host of similar policies.

In the meantime, there has been considerable pushback coming from the beverage industry. Soda makers have sued health departments from New York to California. The industry, which insists that it only defends itself against baseless attacks, has filed numerous requests for scientific proof of the claims made by government agencies.

Anti-soda advocates say that these requests for documentation, which often require hundreds of staff hours from cash-strapped governments on the local and state level, are only made to sabotage new health policies before they can get off the ground. They come directly from the tobacco industry’s playbook, according to Ian McLaughlin, an attorney at the National Policy & Legal Analysis Network to Prevent Childhood Obesity in Oakland, California. “It is, in our opinion, an effort to overwhelm or smother government employees, who already have too much to do,” he said.

Santa Clara County in California received subpoena letters asking for records relating to its “Rethink Your Drink” education program. Similar notifications were sent to Chicago and Seattle county governments for their publications connected to beverage education efforts, according to Reuters (“Soda Makers Escalate Attacks Over Obesity,” 7/29/2011).

The American Beverage Association (ABA) says that food and beverage makers are being unfairly singled out. “Sugar-sweetened beverages are not driving health issues like obesity and diabetes. In fact, recently published data from CDC researchers show that sugar-sweetened beverages play a declining role in the American diet, even as obesity is increasing,” said Christopher Gindlesperger, director of communications for the ABA.

From 2009 to 2010, the ABA, Coke and Pepsi, two of the largest producers of sodas, have collectively spent $60 million on lobbying efforts against raising taxes on sugary beverages to cover obesity-related health care costs, according to data collected by the Center for Responsive Politics (Reuters ibid.).

In going after public health campaigns, the ABA is taking its cues from the tobacco wars of the 1990s. Back then, tobacco companies embarked on a Freedom of Information effort, targeting government agencies for their anti-smoking legislation, according to a report by the National Cancer Institute.

“For beverage manufacturers, the issue of obesity is kind of Armageddon,” said Tom Pirko, an industry consultant. He may have hit the nail on the head. Once the evidence that tobacco use causes cancer became overwhelming, people finally started paying attention and smoking went down dramatically. When the connection between sugary drinks and obesity becomes similarly clear, a large-scale change of consumer behavior will likely follow. In other words, if it’s no longer considered cool to smoke today, it may no longer be cool to guzzle sodas tomorrow. Obviously, there is a long way to go.

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 at http://twitter.com/TimiGustafsonRD

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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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