Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

Can Following a Vegan Diet Be Appropriate for Children?

April 22nd, 2012 at 2:17 pm by timigustafson
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Going totally vegan is becoming increasingly popular among health-conscious adults and many encourage their children to follow suit. But some parents are unsure whether diet restrictions they find healthful for themselves are also a good choice for their kids.

The idea of bringing up youngsters as vegans is controversial, even among nutrition experts. Critics warn that an exclusively plant-based diet may be inappropriate for young children because of the risk of malnutrition when essential nutrients provided in animal products are missing.

Infants and toddlers have special dietary needs because of their rapid growth and development. For those reasons, no dietary restrictions should be applied under the age of two.

Proponents claim that following the dietary guidelines of vegans is beneficial at every stage in life and in any case preferable to the typical American diet, which offers higher amounts of calories and fat but is of lesser nutritional quality.

Veganism, the strictest form of vegetarian diets, excludes all animal food products, including eggs and dairy products. Less stringent variations are semi-vegetarianism (includes fish, poultry, eggs and dairy products but no beef, lamb or pork), lacto-vegetarianism (includes dairy products) and ovo-vegetarianism (includes eggs).

According to the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), “appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases.” The Academy also stresses that “vegetarian diets in childhood and adolescence can aid in the establishment of lifelong healthful eating patterns.” In other words, early adherence to vegetarian eating styles can lay a good foundation for nutritional health, whether those patterns last or change later in life.

A predominantly vegetarian diet is recommended for both children and adults who have weight problems, diabetes, heart disease, high blood pressure and high cholesterol levels. One in three children living in the United States today is overweight or obese and will likely develop some diet-related health problems over time, according to the Centers of Disease Control and Prevention (CDC). Switching to a vegetarian-style diet, sooner rather than later, can help prevent many of these negative health effects.

While it is true that following a strict vegan diet can have its challenges in terms of nutritional balance, vegans can plan their meals carefully to ensure sufficient access to a full range of important nutrients, including so-called “complete” protein. For children in their growing stages, lack of protein can cause serious health problems, including stunted growth and other developmental setbacks.

Only animal and soy proteins are considered “complete” because they contain all amino acids (the building blocks that make up protein) the human body requires. Plant foods can only offer “incomplete” proteins, lacking one or more amino acids. But vegans can make up for these deficiencies by combining different plant foods, for example by eating grains together with legumes, vegetables with legumes, vegetables with nuts, grains with nuts and so on. Because amino acids stay in the blood stream for several hours, complimentary proteins don’t have to be consumed all at once but can be distributed over several meals.

Calcium and iron are two nutrients more easily derived from animal products than from plant foods. Green leafy and cruciferous vegetables such as kale, spinach, broccoli and Brussels sprouts are good sources of calcium. Iron can be found in greens too. Vitamin C-rich foods like citrus fruits enhance iron absorption.

Harder to come by is vitamin B12, which is essential for the health of both blood and nerves. B12 cannot be found in plant foods at all, but the body’s needs can be met by drinking fortified soymilk, eating fortified breakfast cereals or by taking multivitamin supplements.

Iodine is a trace mineral important for the regulation of thyroid hormones. Dietary sources include iodized salt, seafood, eggs, dairy products and crops grown in iodine-rich soil. If these are excluded, smaller amounts are available in green leafy vegetables, potatoes (with skins), seaweed and kelp.

Vitamin D is a nutrient needed for growth and the formation of healthy bones and teeth. It is also harder to get from plant food than from animal products. Thankfully, some vitamin D can be obtained through sun exposure. If sunlight is limited (e.g. you stay indoors or live in Seattle), dietary sources must make up the difference. Fish and fortified milk are good providers, however, if they are excluded, there are only a few plant-based options, such as cauliflower. A multivitamin supplement may be your best solution.

Omega-3 fatty acids are essential fatty acids. They are not made in the body but are important for many bodily functions, including fighting inflammation. Richly present in fish, omega-3s can be supplemented by taking a daily tablespoon of flaxseed or rapeseed oil.

Looking at all the options, it seems very possible to raise healthy children on a vegan diet, especially as they grow older and become adolescents. As long as parents are aware of potential pitfalls and take proper precautions, they should feel confident that they are doing their kids a good service. “The real issue is not whether a child’s diet is vegan or not, or restricted or not. The important thing is whether it’s healthy,” says Amanda Baker, a media spokesperson for the Vegan Society. There are plenty of kids who are not vegan but lack all sorts of nutrients because of their poor diet. It is actually easier for vegans to meet the government’s dietary recommendations for fruits and vegetables servings than for most people, according to Baker.

Ruby Roth, the author of two books about veganism for children, titled “Why We Don’t Eat Animals” (2009) and “Vegan Is Love” (2012), says that introducing children to vegan-style eating has other benefits besides healthful nutrition as well, including instilling interest in environmental and animal rights issues at a young age.

What matters most is that children don’t feel forced to stay within strict dietary limits that don’t allow for some flexibility. If the parents themselves are new to vegetarianism and are trying to get their youngsters to join in, they should start slowly, let’s say, by having one or two meatless nights a week and then progress from there. It’s the same with all diet and lifestyle changes – if they don’t become natural, they won’t last long.

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

So It Is Possible to Reduce Salt in Our Food

April 17th, 2012 at 5:46 pm by timigustafson
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The salt content of popular fast food items like chicken nuggets can vary considerably, depending where you buy them, according to a study report by an international group of scientists that tested products of leading multinational restaurant chains. What they found were dramatic differences in the amounts of added salt in the same kinds of food, made by the same companies, only in different parts of the world.

For the study, researchers from Australia, Canada, France, New Zealand, the United Kingdom and the United States analyzed fast food items from McDonald’s, Burger King, KFC, Domino’s Pizza, Pizza Hut and Subway in each of their respective countries and compared notes.

Although fast food is known for being notoriously high in salt wherever you go, the study results are nevertheless startling. The U.S. and Canada were reported to have the highest levels of salt compared to other countries – in some cases nearly twice as high.

One reason for the differences could be government guidelines for salt reduction like in the U.K., said Dr. Norman Campbell of the University of Calgary, Canada, one of the authors of the study report. The British government has set voluntary targets for the food industry, although not yet for fast food restaurants. Still, a growing number of food manufacturers and restaurant operators have committed themselves to meeting the proposed levels as soon as possible and are already using their pledges for advertising purposes.

What this study shows is that reducing salt in our food is indeed feasible and that the technology to do so exists despite of the food industry’s long-standing assertions to the contrary. If it can be done in one country by the same manufacturers and with virtually identical items, it can be repeated elsewhere and certainly here in the U.S.

“Consumers should not have to bear all the responsibility for their diet choices,” said Dr. Campbell. 80 percent of most people’s daily salt intake doesn’t come from the saltshaker on the dining room table but is already added to many processed foods, including items that don’t even taste salty.

The best strategy for reducing salt consumption is for governments to intervene and regulate the use of salt in food processing, he said. All other attempts have been proven unsuccessful. Education campaigns like the National Salt Reduction Initiative here in the U.S. may be well-intended, but they can only work if supported by binding regulations for the food industry.

Dr. Campbell doesn’t believe that trying to further educate the public will produce better outcomes. “We have a highly educated population that is aware of the issues. They are trying to eat healthy and a lot of them perceive they are eating healthy.” What persists is widespread confusion because people don’t know how ubiquitous salt is in their food supply. They eat their food as it’s presented to them, trusting that – although it may not always be perfectly healthy – it will do them no harm.

Another frequently made argument by food manufacturers is that Americans love salty foods and would not buy them if they had a bland taste. “That is because they are used to higher salt levels,” said Dr. David Katz, director of the Prevention Research Center at Yale University. In other words, it’s an acquired, not a natural taste.

According to a study in the New England Journal of Medicine, it is estimated that cutting back just 3 grams of salt (1,200 mg sodium) a day could save the lives of almost 100,000 Americans annually. If the industry substantially reduced the levels of salt it currently uses for food processing, it could translate to large gains for the health of the population, wrote the researchers in their concluding summary. How much longer do we have to wait?

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.

What Your Neighborhood Says About Your Health

April 15th, 2012 at 2:55 pm by timigustafson
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Where you live may determine how healthy you are or can hope to be, according to a new study published in the American Journal of Preventive Medicine. Researchers using a geographic information system (GIS) found that access to quality food outlets and opportunities to be physically active can make communities not only more attractive but also more healthy.

Both children and adults who live in areas that provide supermarkets within reasonable distance, recreational parks and safe sidewalks and bike paths have on average lower rates of obesity, diabetes and heart disease than those living in underserved neighborhoods, including so-called food deserts.

“The biggest difference we found in rates of obesity were in places where the environment was good for both nutrition and physical activity,” said Dr. Brian Saelens, professor of pediatrics at Seattle Children’s Research Institute and co-author of the study report. “The rates [in the best places] were less than 8 percent. But if the nutrition and physical activity were not good, the rates went up to 16 percent.”

Although these findings should not come as a surprise, it is the first time that scientists have used geographic data to specifically investigate the causes of lifestyle-related health problems.

Up to now, most studies on the ever-rising obesity epidemic have been focusing on factors such as lifestyle, income, education and genetic preconditions. Geographic differences should be used more often in the future to assess the connections between nutrition, physical activity and obesity. For instance, if we can count the numbers of grocery stores, convenient stores, fast food restaurants and recreational facilities in a particular area, we may be able to predict better what chances the local population has to live more healthily, the researchers said.

“To address this health crisis, attention must be focused on a key issue that lies at the core of the epidemic: The social inequities of obesity,” said Rear Admiral Susan Blumenthal, MD, MPA, a former U.S. Assistant Surgeon General.

“A significant body of scientific evidence links poverty with higher rates of obesity. Families with limited economic resources turn to food with poor nutritional quality because it is cheaper and more accessible. Low-income families live in neighborhoods where it is dangerous to play outside, reducing opportunities for both children and adults to exercise. Instead of supermarkets, [low-income] neighborhoods may have an abundance of fast-food retailers and corner stores that are stocked with products high in fat and low in nutrients. Families are often targeted by food marketers with advertisements encouraging the consumption of nutrient-poor foods, increasing the likelihood of adopting unhealthy dietary practices.”

Despite of their best efforts to lure more supermarkets to underserved neighborhoods through tax breaks and other incentives, local governments find it hard to overcome the many obstacles they’re facing. The so-called food deserts in many poor urban and rural areas persist because of lack of consumer demand (people don’t have the money to buy nutritious but pricey foods), high crime rates (and insurance costs) and transportation expenses (to remote areas).

An area is officially considered a food desert when it has no supermarkets within 1 mile in an urban setting and within 10 miles in a rural environment. The U.S. Department of Agriculture (USDA) estimates that nearly 25 million Americans live in food deserts.

Social welfare programs such as food stamps bring only limited relief because of geographic hindrances. According to data collected by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS), a quarter of all food stamps recipients do not have easy access to supermarkets. High gas prices and lack of private or public transportation only worsen the situation.

Obviously, not all or even many of these conditions can be changed overnight. However, a few small steps in the right direction can go a long way. Communities have taken initiatives all over the country to facilitate more local farmers markets and sales outlets for urban farms where fresh foods are available at affordable prices. Achieving better “walkability” has become a goal in cities and towns of all sizes. With greater awareness, good will and some imagination, we all can make a difference for ourselves and our neighborhood.

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.

BMI Found Insufficient for Measuring Obesity

April 11th, 2012 at 4:41 pm by timigustafson
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For nearly 200 years, doctors have relied on a formula called the “Body Mass Index” (BMI) to determine whether their patients are within a healthy weight range or beyond. A new study suggests that this approach may be insufficiently accurate for measuring obesity. Researchers found that roughly half of women and a fifth of men who are considered normal-weight according to their BMI numbers should in fact be classified as obese when tested for percentage of body fat in relation to lean muscle mass.

The authors of the study report, Dr. Nirav R. Shah, Commissioner of Public Health in New York City and Dr. Eric Braverman, a professor at Weill Cornell Medical School, said that the common reliance on BMI readings was misleading both the experts and the public about the true proportions of the current obesity crisis.

Over a third of adult Americans are classified as obese based on their BMI measures, according to the Centers for Disease Control and Prevention (CDC). But because BMI does not distinguish between fat and muscle, many people with a normal BMI may carry dangerously high amounts of body fat.

“Fat causes heart disease, cancer, menstrual problems, depression, anxiety and a host of other medical problems,” said Dr. Braverman. “Without an accurate measurement of body fat, millions of people don’t know whether they are at risk for obesity-related diseases.”

Instead of relying solely on the BMI formula, which is weight divided by height squared in kilograms and centimeters, or weight divided by height squared in pounds and inches multiplied by 703, Shah and Braverman propose to take a test called dual-energy X-ray absorptiometry (DEXA), which is commonly used to evaluate bone density in women to check for signs of osteoporosis. Unfortunately, that kind of test is costly and may not be feasible for use as a routine procedure.

As an alternative, the doctors suggested measuring leptin levels in the body. Leptin is a hormone secreted by fat cells. Testing leptin levels is simpler, less expensive and focuses on the core of weight problems, which is body fat.

Other easy measures that can be done by anyone at home are called waist circumference and waist-to-hip ratio.

“Without knowing how much fat [people] have, you can’t really save them from illness. It is the number one predictor of who’s going to live or die,” said Dr. Braverman.

Based on their findings, Shah and Braverman suggested to lower the BMI markers for obesity from 30 to 24 for women and 28 for men. Under the current standards, BMI classifies millions of Americans as healthy when they actually should be concerned about their weight.

Commenting on the study, Dr. William O’Neill, a professor of cardiology at the University of Miami Miller School of Medicine who was not involved in the research, called the findings “alarming.” “Traditionally, we have used BMI. But this study tells you that BMI really underestimates how many are obese.”

Shah and Braverman agree that this may be a game-changer. “We may be further behind than we thought in addressing the nation’s crisis of obesity,” they said.

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

Adjusting Diet and Exercise to a Slowing Metabolism

April 7th, 2012 at 2:02 pm by timigustafson
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Nothing in your lifestyle has changed, you are eating the same way and exercise as often as you always have, but, as you get older, you are gaining weight. How come? What you may not be aware off is that your body’s metabolism has slowed down, which means that you are burning fewer calories than when you were younger.

Starting at about age 25, the average person’s metabolism declines between 5 and 10 percent per decade, according to Dr. John Berardi, president of Precision Nutrition and author of “The Metabolism Advantage.” This means that the typical American loses between 20 and 40 percent of metabolic power over the course of his or her adult life span.

Typically between 40 and 50 years of age, the body requires fewer calories due to lower expenditure. There can be several reasons for this. You may be less physically active, spend more time working at a desk, endure longer commutes and adopt an all-around more sedentary lifestyle. You may also undergo an increasing amount of muscle loss, partly because of the natural aging process, partly because of physical inactivity. Either way, your calorie needs go down. If you don’t reduce your food intake accordingly, you gain weight from storing fat.

These effects can be more pronounced when someone already has weight problems. The more fat is stored, the less efficiently the body is able to burn calories. Add to this a lesser amount of physical activity and you have a scenario where more weight gain is almost unavoidable.

Genetics and certain medications can also play a role as well as hormonal changes. Women after menopause are especially prone to undergo metabolic shifts.

But it’s not all bad news. A vastly slowed down metabolism isn’t inevitable, said Dr. Berardi. The main problem is that we all tend to become far less physically active over the course of our lives. People who preserve their physical activity levels can expect to see only a 0.3 percent metabolic decline per decade, a 1 to 2 percent total drop over a person’s lifetime, he added in an interview with WebMD.

So what can you do to fight nature every inch of the way? Scientists at Johns Hopkins University have compiled a number of strategies that can give a boost to your aging metabolism.

• Adhere to a healthy diet. If you reduce your calorie intake to avoid weight gain, it is crucial that you make up for the difference by eating more nutritious foods. Whether you are concerned with weight control or not, it is always helpful to cut back on empty calories and go for highly nutrient-dense items instead.

• Eat breakfast. Having a healthy meal at the start of your day gets your metabolism out of its resting state and back into burning mode. Skipping breakfast forces the body to endure longer periods of fasting, which can leave you excessively hungry and tempt you to overeat at the next opportunity.

• Eat frequently. Instead of consuming large meals two or three times a day, try to keep your metabolism consistently on ‘slow burn’ by eating small amounts of food every three or four hours.

• Eat lean protein. Your body burns more calories when digesting proteins rather than carbohydrates and fats. Preferable are low-fat protein sources such as lean meats and poultry, beans and non-fat dairy products.

• Do aerobic exercise and strength training. Regular age-appropriate exercise and resistance training are highly recommended. As we age, we are at greater risk of losing lean body mass, which can initiate a vicious cycle of change in body composition, according to Dr. Andrew Weil, author of “Healthy Aging.” To control weight, you may, in addition to eating less and exercising more, try to increase lean body mass – by weight training, for example – in order to keep the metabolic furnace burning.

• Get enough sleep. Our busy lifestyles keep too many of us chronically sleep-deprived. Among other effects, not getting enough sleep can interfere with your appetite-regulating hormones. Studies have shown that lack of sleep can lead to unhealthy eating habits, similar to stress.

• Avoid supplements. Taking metabolism-boosting supplements such as caffeine, kola nut, bitter orange and others, all of which are stimulants to raise your metabolism by boosting your heart rate, is not a good idea because of many potentially serious side effects. One of the most popular stimulants, ephedra (Ma-huang), was banned by the U.S. Food and Drug Administration (FDA) after its use was linked to several deaths.

The body has many ways to adjust to its changing needs. The best thing you can do is to be aware of these changes and respond accordingly.

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

How Can Education Make You Live Longer? It’s Complicated

April 4th, 2012 at 4:39 pm by timigustafson
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The average life expectancy of all Americans has continuously increased over the past few generations for a number of reasons, including advances in nutrition, hygiene and medical care. But there are significant disparities within the population, which seem to be linked to social, economic and – as it turns out – educational differences.

According to a new study by the University of Wisconsin Population Health Institute, sponsored by the Robert Wood Johnson Foundation, there could be a direct correlation between a person’s education and the number of years he or she can hope to live.

For this study, researchers analyzed over 3,000 counties nationwide and ranked them within their respective states by a number of diverse measures, including access to quality healthcare, obesity rates, tobacco sales, unemployment, environmental pollution, crime rates, even the density of fast food outlets. The significance of education levels stood out.

“If you have a community with a high number of high school dropouts, with a high unemployment rate and with children living in poverty, you can absolutely predict that poor health outcomes will be coming down the road,” said Dr. Pat Remington, associate dean at the University of Wisconsin School of Medicine and Public Health and director of the study.

Unemployment and poverty do not only lead to deprivation of essential resources such as good nutrition and basic health care but often also to self-destructive behaviors like smoking and alcohol- and drug abuse. “All these things are part of a web of health,” Dr. Remington added.

The Wisconsin study is not the first that has found a link between education and longevity. A study from Harvard University, published in 2008, described “a stunning correlation between the longer lifespan of people with at least one year of college compared to people with a high school education or less,” according to Dr. David Cutler, dean of social sciences at Harvard. Better educated adults gained on average 1.5 years of life expectancy over 10 years and an additional 1.6 years over 20 years compared to those with a high school diploma or less.

Going to college by itself, of course, does not automatically make you live longer. But the study does suggest that better education often leads to better lifestyle choices. “It turns out that across the board, if you look at any health behavior, better educated people do better than less educated, said Dr. Cutler. “Anything from smoking, obesity, wearing seat belts, having a smoke detector in your house, not using illegal drugs, not drinking heavily, better educated people do better,” he said.

Conversely, the average life expectancy of obese people, smokers and those without access to preventive health care has begun to plateau. Due to growing childhood obesity, some experts predict that the lifespan of significant parts of the population will likely decline in the future.

Needless to say that none of these findings are clear-cut. There are plenty of folks with PhDs and beyond who are overweight and smoke and drink heavily. “Sometimes, even a good education can’t keep smart people from doing dumb things,” said Lee Dye, a science writer for the Los Angeles Times who reported on the Harvard study.

And even centenarians have bad habits. Researchers at the Albert Einstein College of Medicine found that the 100 plus crowd does generally not adhere to dramatically healthier lifestyle choices than the rest of us. There seems to be no particular formula that allows some people to live exceptionally long lives. Even genetic factors have turned out to be less important than some have suggested, as demonstrated in studies that followed identical twins who were separated at birth, lived under vastly different circumstances and died at different ages.

Besides reasonably healthy diet and lifestyle choices, one thing, however, seems to matter greatly. People who remain free of debilitating illnesses at old age, physically as well as mentally, are typically very active. They enjoy a vibrant social life, pursue multiple interests, maintain a positive attitude and know how to take care of their needs. They may be well educated, but not always in terms of formal education. An open mind and an insatiable curiosity may have gotten them just as far.

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.

Weight Loss Surgery for Diabetes Patients – A Problematic Choice

April 1st, 2012 at 3:19 pm by timigustafson
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With obesity rates in the United States and around the world continuously rising, surgery for weight loss is becoming an ever more acceptable option. Now, two clinical studies suggest that diabetics can benefit from operations as well. Type 2 (or adult-onset) diabetes is mostly linked to weight problems and has reached similarly epidemic proportions. According to the Centers for Disease Control and Prevention, the number of diabetes cases has nearly tripled over the last three decades and affects today more than 20 million Americans.

Both study reports – one from Italy, the other from the United States – concluded that surgical procedures, a.k.a. bariatric surgery, by which the size of the stomach is considerably reduced, enabled patients not only to lose weight but also manage their blood sugar levels more effectively than traditional measures like dieting and medication. Bariatric Surgery Can Carry Great Risks, Including Malnutrition

The findings, which were published in the New England Journal of Medicine, may change how many diabetes cases will be treated in the future. Proponents of bariatric surgery say the studies confirmed that stomach size reduction should no longer be seen as a last resort but should be considered earlier in the treatment of obese patients with type 2 diabetes. Others warned that more studies are needed and that the risks in connection with the procedures available today remain high.

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), about 200,000 surgical procedures for weight loss are performed annually in the U.S. The National Institute of Health (NIH) says that surgery should only be recommended for people with a body mass index (B.M.I.) of over 40, or over 35 for those with diabetes and other serious illnesses related to weight problems.

For the studies, the researchers limited themselves to three types of weight loss surgery: Roux-en-Y, biliopancreatic diversion and sleeve gastrectomy. Roux-en-Y is the most commonly applied method of gastric bypass surgery, by which a small part of the stomach is sealed off and then directly connected to the small intestine. Biliopancreatic diversion removes large parts of the stomach and bypasses the majority of the small intestine as well, which limits both food intake and absorption of nutrients. Sleeve gastrectomy reshapes the stomach into a smaller tube but does not alter the way food enters or leaves it.

Needless to say, these are all very drastic steps to prevent weight gain and a host of diseases that often go with it, including diabetes, heart disease, hypertension, high cholesterol and so forth.

As a dietitian, my greatest concern is how the anatomical changes affect the metabolism of patients. Because bariatric surgery limits food intake so dramatically and also diminishes the absorption of nutrients, there is a great risk of malnutrition. Especially a sufficient supply of protein, which is extremely important during rapid weight loss for overall health and to allow for proper healing from the surgery, can become hard to obtain. Part of the reason for this is that the initial digestion of proteins takes place in the stomach, which after surgery is not only reduced in size but also in capacity. Even more problematic is the hindered absorption of essential nutrients in the small intestine because some or much of it is bypassed. This affects the absorption of carbohydrates, proteins and fats but also vitamins and minerals. Potential complications, not only from the surgical procedure itself but also from the nutritional deficiencies, are multiple.

Bariatric surgery should never be considered as a quick fix, on par with cosmetic surgery. It is a profound alteration of the digestive system that is risky and requires permanent changes in diet and lifestyle choices. Intensive post-operational counseling and strict observation of nutritional guidelines are an absolute must.

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.

Widespread Chronic Sleep Deprivation Seen as a Cause for Concern

March 28th, 2012 at 7:23 am by timigustafson
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There are multiple causes for the so-called lifestyle-related diseases that plague us today. Obesity, diabetes, heart disease and hypertension can mostly be blamed on poor nutrition, lack of exercise, stress and, as scientists increasingly find out, sleep deprivation.

Over the last few decades, Americans have kept cutting back on their sleep as their lives have become busier. Long hours spent on work, commutes, kids’ activities and household chores leave less and less time for rest. While a few generations ago people slept for eight hours or more, most Americans have to get by on six hours or less today.

And it’s not only the difference in the amount of time but also the quality of the rest we get that has turned us into a nation of chronically sleep-deprived zombies.

“Sleep deprivation is reaching epidemic proportions and may soon be our nation’s number one health problem,” says Cindy Heroux, a Registered Dietitian and author of “The Manual That Should Have Come With Your Body.”

“When you don’t get enough sleep, you are more likely to suffer from certain chronic illnesses, including diabetes and heart disease. You are also more likely to gain weight or become obese,” she says.

What is the connection? Sleep deprivation can lead to disruption of your metabolism, which in turn can make the cells in your body more insulin resistant. Insulin resistance causes the cells to think they are being starved and, as a result, urgent hunger signals are dispatched to the brain, making you want to eat. That is one of the reasons why people reach for food when they are overtired or stressed out.

A recent study published in the “Journal of Clinical Endocrinology and Metabolism” concluded that even short-term sleep deprivation can activate the appetite-controlling part of the brain, increasing hunger levels. Researchers have calculated that for each hour a person cuts back on sleep, he or she consumes an average of 360 additional calories. If extra calories are not burned off, they are stored as fat and insulin resistance increases even further. It’s a vicious cycle and the negative health effects can be multiple.

Some experts say that it’s not just the perpetual lack of sleep that makes Americans sick but also the ways we are trying to cope with being chronically sleep deprived. Too many people just muddle through their tiredness, says Dr. Matthew Edlund, author of “The Power of Rest.” He believes that the widespread reliance on energy drinks like “Red Bull,” “Monster” and “5-Hour Energy” does potentially more harm than users realize.

“We don’t use our bodies the way they’re built to be used,” he says. “We guzzle energy drinks and then can’t sleep at night. We sit all day and then read e-mails at 3 a.m. It’s no wonder we walk around like zombies and treat these drinks like liquid life support. It’s a good time to question these trends and find healthier ways to power up.”

Instead of using energy boosters that work short-term but eventually only add to the exhaustion resulting from sleep deprivation, nutrition experts recommend protein-rich snacks like low-fat yogurt or cheese or peanut butter. In the end, however, there is only one solution and that is getting regularly a good night’s sleep.

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.

Following a Heart-Healthy Lifestyle Can Add Years to Your Life

March 25th, 2012 at 3:48 pm by timigustafson
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Do you observe a healthy diet, abstain from smoking, watch your cholesterol, blood pressure, blood glucose levels and do you exercise at least for 30 minutes three times a week? If so, your chances of dying from a heart attack are much lower than those of your contemporaries with less health-promoting lifestyles.

Researchers found that taking a few simple, commonsense steps to protect your heart can reduce the risk of cardiovascular disease more substantially than previously thought.

For a recently completed study that followed almost 45,000 adult Americans, scientists looked into data collected by the U.S. National Health and Nutrition Examination Survey and linked them with a database of deaths over three time periods, starting in 1988 and ending in 2010. After almost 15 years of follow-up, the survey showed that participants who adhered most closely to the diet and lifestyle recommendations of the American Heart Health Association (AHA) had a 76 percent lower risk of dying from heart disease and a 51 percent lower risk of all-cause deaths than those who complied less. The details of the study were published in the Journal of the American Medical Association (JAMA – 3/23/2012).

Unfortunately, the researchers also found that only a small minority of Americans follows all or most of the AHA guidelines for heart health.

“Everyone knows that the heart health of Americans is dismal. Yet, despite of trying hard (really hard), I fail more than 90 percent of the time to get patients to change their heart-healthy behaviors,” laments Dr. John Mandrola, a cardiologist. “Nine in ten patients return just as fat and sedentary as they were at the time of my previous lecture on heart health.”

The problem is not that Americans lack access to information that prevents them from taking better care of their heart health. “Getting people to know [the facts] is not the issue, rather the issue is the implementation of the plan, says Dr. Mandrola.

Heart disease is the most common cause of deaths in the U.S. today, ahead of cancer and stroke. One and a half million Americans die every year from the disease or complications connected to it. While it is true that heart disease can be caused by inherent risk factors such as family history or simply by aging, poor lifestyle choices are to be blamed in most cases. Excess weight, diabetes, high cholesterol levels, high blood pressure, smoking, alcohol abuse and insufficient physical activity are all commonly known culprits. Most heart patients have several of these risk factors to deal with – and they tend to “gang up” and aggravate each other’s effects.

Heart disease usually shows no specific warning signs. You have to look at the numbers to find out about your heart’s health condition. “You can and should make a difference in your heart health by understanding and addressing your personal risks,” says Dr. Susan B. Shurin, director at the National Heart, Lung and Blood Institute of the National Institute of Health (NIH). For any successful treatment of heart disease as well as for prevention it is crucial to regularly monitor cholesterol levels – LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides –blood pressure and, of course, body weight.

Americans tend to rely too quickly on medications when they encounter heart health problems. In many cases that may be a necessary first step, but the goal should always be to achieve risk reduction by better diet and lifestyle choices. “Good Nutrition and lifestyle are the cornerstones of health,” says Dr. Leslie Cho, director of the Women’s Cardiovascular Center at the Cleveland Clinic. “Pills are supplements. They’re not a substitute for a healthy lifestyle.”

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.

Nutrition Can Greatly Impact Your Child’s Learning Ability

March 21st, 2012 at 12:08 pm by timigustafson
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The nutritional quality of our diet affects our wellbeing throughout our lives, but it has an even greater impact on children whose bodies and minds are still growing. Nutritional deficiencies can seriously damage a child’s neural development, possibly leading to lower IQ and learning disabilities.

Studies by neuroscientists have found that low-quality nutrition during childhood can be detrimental to the development of cognitive capabilities, such as learning, problem solving and memorizing. Early malnourishment can lead to deficiencies in vision, fine motors skills, language and social skills as well as an array of chronic illnesses lasting well into adulthood.

Unfortunately, the crucial role nutrition plays for developmental, cognitive and behavioral outcomes in life’s early stages is often not well understood and appropriately acted upon by schools and parents.

Some scientists see a direct link between high saturated fat intake and mental performance. Tests have shown that many items popular in school cafeterias such as hamburgers, chicken nuggets, pizza and French fries actually lower students’ ability to stay awake and concentrate. A dramatic drop in energy due to digestion of heavy foods leaves kids feeling lethargic, irritable and unable to focus.

According to a study by the American School Health Association (ASHA), students who had consistently insufficient protein intake scored lower on achievement tests than their classmates who had adequate nutrition. Students with chronic iron deficiency were more likely to suffer from attention deficit hyperactivity disorder (ADHD). Under- or malnourished children were found more prone to infections and illnesses, causing them to miss school and fall behind in their education.

Pediatricians and pediatric dietitians have long emphasized that giving kids a healthy breakfast plays an especially important role for their nutritional wellbeing. Without a boost at the start of their day, young brains cannot function well. To do its work, the brain needs a sufficient supply of healthy fats, proteins, carbohydrates, vitamins, minerals and water. Sugary cereals or white-flour pancakes with syrup don’t offer many essential nutrients. Eggs (preferably egg whites only), whole grain breads, fruits and low-fat milk are better choices.

By lunchtime, most children’s bodies are depleted and in dire need of another energy provider. Highly caloric and fatty foods with little or no nutritional value only worsen the situation. Soups, salads, fruits, vegetables, lean protein sources and whole grains can do the job much better. If your child’s school cafeteria does not offer healthy lunch choices, prepare a box lunch for him or her to take along.

An afternoon snack before play or study time is recommended, but, again, sugary items like candy, pastries and sodas should be avoided. Instead, you can serve a fruit salad or a tray of raw veggies and yogurt dips.

Dinner should help your child to wind down and relax before bedtime. Fatty foods like pizza or cheeseburgers are not a good idea. Items that contain high amounts of sugar late in the day can lead to sleep disruptions. Age-appropriate portions of pasta topped with a hearty vegetable sauce (preferably made from scratch), fish, chicken and other lean meats combined with healthy side dishes complete your child’s nutritional needs for the day.

Eating habits develop early. Most children acquire them from their parents and older siblings. Kids don’t develop food preferences on their own, not even for candy. They learn what to like or dislike by observing others. What you as the parent buy and bring in the house is what they will have access to. How you treat your own body in terms of diet, exercise and lifestyle choices will influence their own behavior.

Considering the potentially grave consequences of malnutrition during childhood, parents have a great responsibility to invest in their offspring’s nutritional health. Unfortunately, budgetary limitations and lack of knowledge about basic dietary facts prevent many parents from making better choices. They should not be expected to do it all on their own. A concerted effort involving families, schools, government agencies and community services is necessary to improve the nutritional welfare of all members of society, and especially the young.

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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