Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

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.

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.

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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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