Vitamin D and the ADA

I apologize for not posting in quite some time.  No excuses, just got distracted with life but I'm back now.

So let's get down to business.  If you are a dietitian or healthcare provider, you might have had November 30th circled on your calendar. No , not for a after Thanksgiving day sale.  No, it was the day that the Institute of Medicine (IOM) was going to release their long-awaited recommendations on intake and supplementation of Vitamin D.

Many were eager to hear the recommendations because for some time now, Vitamin D supplementation has been a hot topic.  Aside from it's role in bone health, there have been many studies that have possibly linked low Vitamin D levels to increased risk of having a variety of diseases like some cancers, depression, coronary artery disease and even a possible link to obesity.

It has been speculated that most of the US population is deficient in Vitamin D for a few reasons.  Firstly, there are few good food sources of Vitamin D.  Secondly the recommended intake levels were quite low (400 International Units [IU] / day), so fortification levels and amounts in multivitamins was not high.  Lastly, the best source of Vitamin D is from the sun. When the ultraviolet B rays from the sun hit our skin, we produce the active form of Vitamin D.  But using sun block prevents the ultraviolet B (UVB) rays from hitting the skin thereby preventing the creation of Vitamin D.  Also, most of us lead increasingly sedentary lifestyles which prevent us from being in the sun during the best times for UVB ray absorption.

So many were waiting for November 30th to role around to hear what the report from IOM was going to say.  Many hoped that this report would call for dramatic increases in the recommended intake levels for Vitamin D.  The findings concluded:

Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, however, does not support other benefits for vitamin D or calcium intake. More targeted research should continue. However, the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D. Higher levels have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that "more is better."

The final recommendations were for a slight increase in the Dietary Reference Intake (DRI) from 400 IU/day for adults to 600 IU.  The DRI for adults over 71 increased to 800 IU. You can read the full report here, the brief report here, and see the DRI recommendations here. 

Many, including me were a little shocked by the findings.  There have been a lot of articles since the report was released.  One of the better ones is in the Wall Street Journal that recaps different reactions to the IOM's findings.  Another good read is by Dr. David Katz in the Huffington Post which looks at both pros and cons of the issue. For another perspective you should read the official response from the pro-Vitamin D group,  Vitamin D Council to see just how upset some are.  Needless to say, there is some controversy to the findings.

Personally, what frustrated me more that the IOM findings was what I feel was yet another misstep by the American Dietetic Association (ADA).  Soon after the report was released, the ADA released this press release which basically stood behind the IOM's findings.  I wished my professional organization would have had the courage to take a more critical position.  They could have supported the findings while also saying that we, as a profession, look forward to more research in the area of  how Vitamin D may play a role in other chronic diseases.  I understand the politics involved with not standing behind the IOM but couldn't the ADA have taken a few days to discuss the matter?  Why issue a release just hours after the IOM publishes the findings?  Why not have the conversation with your constituents to see what is best as an organization.  Not well played in my opinion.

Bottom Line: Get your Vitamin D level tested.  If it is below 30 ng/mL, talk to your doctor about supplementation.  Since even the conservative new upper limits for Vitamin D intake by the IOM are 4000 IU/day it is still safe to take a 1000 IU supplement if you do not get 15-20 minutes mid-day sun exposure.  

Fat Talk Free Week

This week is marks the third annual Fat Talk Free Week which was created by the sorority Delta Delta Delta.  The week, "is a public awareness effort born from our award-winning body image education and eating disorders program, Reflections."  The original program, Reflections, was established to help promote a positive body image and prevent eating disorders.

In honor of this week I'm going to share some of my personal history with regards to weight loss because I feel its is important to realize that we all struggle with body issues; even dietitians.

As a preceptor at the VA in Los Angeles, I get the opportunity to work with a lot of interns who are working hard to become dietitians.  They are a motivated group and will be great colleagues one day.  As interns they spend time with me working in our weight management program.  For many it is the first chance that they've had to counsel someone who is struggling with losing weight.  Often after a session they come to me and say, "Wow that wasn't what I expected."  After discussing the session they realize that what I told them at the start of the rotation is really true: losing weight is never just about the food.  It's about almost everything else, but almost never just about the food.

When I weighed over 300 lbs. I don't think I was ever unhappier in my life, but the truth is that even before I started to gain weight during college, I was never really happy with myself.  I had great friends, close relationships with my family, but when I looked in my mirror, I never liked what I saw. 

As I got older, food became my comfort for any and all emotions.  No matter what I was feeling, it could be soothed or celebrated with food.  As the weight came on, my image of myself sagged.  On the outside I was the happy fat guy.  Quick with a joke but inside I was crying; struggling with the reality that I hated the direction my life was going in.  Soon I realized that I had created the perfect downward spiral for myself.  I'd eat, look at myself after and get upset--at my weakness, my lack of control and my ugly body.  To cope with those emotions, I ate and then the emotions came back and so on and so on. 

Eventually I realized that enough was enough and that I had to change.  I knew that if I was ever going to be successful with losing weight I had to tackle the emotions and image of myself to really live a healthier life.  Well as you might suspect, I lost the weight.  That was they easy part.  What has taken much longer to change and what I struggle with every day is the image I have about myself.  I still look at myself in the mirror and I see that fat guy from 10 years ago.  I am still not happy with my body.  I see flaws, imperfections, rolls of fat but what IS different is I am comfortable those flaws.  I like who I am and I know where I've come from and the progress I've made.  Do I still cope with food? Yes but not like before.  But I'm not perfect and at my darkest moments, when I'm at my lowest, food is my friend and punishment.  I won't lie, there are times I eat with anger but I work hard to stop myself 10 steps before I get to this point but to be honest, I'm not perfect.

As a dietitian, I am ashamed to admit that I don't have the perfect relationship with food but I'm also proud to admit that this is who I am.  I am flawed but I have learned to embrace the things that make me me. 

I am thankful for this career.  I am so happy that I get to work with others who are losing weight.  I know that why and what they eat is not always about the food.  It's about the emotions too.  To successfully lose weight, eat and live healthfully, you need to change the way you think about food.  It's why I'm drawn to the notions of mindful eating and intuitive eating.  Along with changing how you eat, you also need to change how you see yourself. 

So in honor of Fat Talk Free week, I'm pledging to change how I talk to myself.  I'm pleding to be kinder to me and kinder to my emotions.  I am a work in progress.  What are you going to do to stop the Fat Talk and change how you see yourself?

NYC Steps Up AGAIN to Fight Obesity

In Thursday's New York Times, there was an article detailing how Mayor Bloomberg has asked the USDA for permission to ban the use of food stamps for the purchase of sodas in New York City.   The ban would apply to all sodas or other sugary drinks.  If approved, the ban would last for two years while its effectiveness would be studied. 

Why would Mayor Bloomberg and his office propose such a ban?  According to the Times article, there are 1.7 million people in New York City who receive food stamps.  It goes on to say:

City statistics released last month showed that nearly 40 percent of public-school children in kindergarten through eighth grade were overweight or obese, and that obesity rates were substantially higher in poor neighborhoods. City studies show that consumption of sugared beverages is consistently higher in those neighborhoods.

It is statistics like this that have public health officials so concerned about the health of our country. 

What's my take on this issue?  Well, as soon as I heard about this in the news, I was very supportive.  I think that because obesity is such an epidemic in this country (especially in low income neighborhoods), we should explore any possible solution to the issue.  I've said before in other blog posts here, here and here, we need a food revolution in this country.   I've also talked about liquid calories here and how they contribute to obesity.  We need to change how we think about food and I think that in this instance, government can have help us change.

I really don't have a problem with a limit on what can be purchased with food stamps.  Food stamps should be used for food, not for soda which provides absolutely no nutritional value.  Other federal grant programs like WIC limit types of food that can be purchased in the hopes of providing the most nutrtitous food possible.  So there is a precedent within our government that already exists.  No, I don't want to stigmatize low income families but I also don't want them to use my tax dollars to buy sodas.

If you read this blog you know that I'm a fan of Marion Nestle.  I value her opinion and she has already weighed in on this issue.  Read her full thoughts here but to quote one part of her post she says, "...if I were in charge of Food Stamps, I would much prefer incentives: make the benefit worth twice as much when spent for fresh (or single-ingredient frozen) fruits and vegetables."  A valid point and a more of a positive approach.

Another opinion offered in the Times article was from George Hacker, a senior policy advisor from Center for Science in the Public Interest.  He says, “The world would be better, I think, if people limited their purchases of sugared beverages.  However, there are a great many ethical reasons to consider why one would not want to stigmatize people on food stamps.”

A good friend expressed these thoughts to me about the proposed ban, "Paternalistic. . but no more than having to wear helmets when you right a motorcycle . . . or use a seat belt in a car. ."  Well put.  We don't like government getting involved in our rights but sometimes it is needed.  I think this is one of those times.  I'm sure this isn't the last time we'll hear about this and I will be interested to hear more about the debate. 

What do you think?

Issues with Feeding Twins

The following is a cross-post from LittleStomaks.com.  Click here to see the original. 

Question: How can I get my twins to eat well and develop healthy habits?

Answer:

You would think that a dietitian would have an easy time when it comes to feeding their own children right? After all, we do consider ourselves the nutrition experts.  I find it is quite the contrary.  Knowledge does not always equal 100% success when it comes to feeding your kids.  Along with being a dietitian, I am also the proud father of not-quite 3-year-old twins, Reuben and Shira.  Being a father of twins and a registered dietitian, I think I’ve gained some unique perspective on feeding children.

Before being father, I remember sitting in school earning my bachelor’s degree, and learning about Ellyn Satter.  I found out she was a dietitian who had very interesting insights into feeding children.  I knew she wrote many books on the subject I never was motivated to read them until I found out my wife was pregnant.  Until you have children of your own, you never really know what kind of parent you will be or how you will handle any given situation.  You think you will handle it one way but until that actual moment is there, you never really know. Feeding my children was a perfect example of this.
What I loved about Satter’s theory is that focuses on responsibilities.  She believes that a parent’s job is to provide healthy, balanced meals to their children.  Then it is the child’s responsibility to eat the meal.  A parent is not a short order cook and should not run to the kitchen to make a whole new meal just because he/she doesn’t like what is being served.  Sounds simple?  In theory it is but until you experience the five-minute tantrum that your son is having because he doesn’t want pasta with vegetables, you don’t know how hard that is.

Having twins adds another complexity to all of this.  Some think that twins (no matter if they are identical or fraternal) should be similar since they have the same birthday, are raised together and share most of their experiences.  Wrong!  Twins are really just siblings who share a birthday and can be as different as night and day, especially when it comes to food.  My kids eat the same meals as each other but how they react during a meal is totally different.  One is more likely to get upset and the other is more likely to lose attention quickly and eat only one or two bites of food before asking to leave the table.  We learned that there were differences very early on.  Our daughter was colicky for the first four months of her life.  We tried everything to relieve the symptoms.  There was one point when she had different bottles, nipples and formula than our son.  It was our first lesson that what applied to one would not necessarily apply to the other.

If you want some insight into chaos theory, come over for dinner one night.  It is a bit of a circus but despite all of this, my wife and I have two kids that are actually very good eaters.
So how did we do it? They key is that with most things behavioral, there is no quick fix.  It takes time and consistency but pays off in the end.  Here’s what’s worked for us and maybe it can work for you too.

1. Everyone sits down at the dining room table with the TV off for dinner. (Unless there is a big football game on!)  This gives us structure at night and allows us to connect with each other
2. Have regular snack times.  If one child doesn’t eat at dinner for any reason (mood or not hungry) my wife and I know that they won’t starve.  They will have a balanced and nutritious snack in a couple hours that will satisfy them
3. As your children get older, involve them in the meals.  I made falafels at home for the first time last month and the kids helped by adding the ingredients in the food processor.  Since they were apart of the process they were more interested in trying this new food.
4. Grow some vegetables with your kids.  They will love watching the plants grow and be excited to see how a cucumber started from a seed to the long green vegetable that is now on their plate.
5. As they get older, give them a choice between two things for dinner.  Every night I ask, “Ok, do you want this or that for dinner tonight,” and that’s it.  I don’t give them more choices and I try not to get into a negotiation.

Thintervention: Definetely Not BVM

Photo courtesy of Bravo TV

I will admit it, I watch and enjoy reality TV.  Since some of my favorite shows (Top Chef and West Wing reruns) are on Bravo TV, I see a lot of their ads for new shows.  Maybe just because I'm a dietitian I was naturally drawn to one of this season's new shows, Thintervention with Jackie Warner.

If you are familiar with Bravo, you might recognize Ms. Warner from her previous series Workout which highlighted the personal and professional drama that comes from a Beverly Hills health club.  Her new show, Thintervention is a less personal drama but more like the Biggest Loser.  It tracks a small group of people who are working with Ms. Warner to lose weight.  Her expertise is as a personal trainer and according to this site holds certifications from the International Sports Science Association (I.S.S.A.), and National Endurance and Strength Association (N.E.S.T.A.) but no nutrition degree or certification of any other kind.  The greatest thing she has to offer is the best six-pack abs on TV.  But abs of steel in no way qualifies her to give sound nutrition advice or help people find a successful weight loss plan.

I watched just enough of Episode 1 to see Ms. Warner literally punish her client for eating 150 calories of cookies. Her basic nutrition advice was to eliminate all sugar from her clients' diet.  When she found that her client did not follow this "order", she made him walk up and down the stairs in his house until he burned the 150 calories from the cookies he ate.   My thought when I saw this was a little shocked.  Working with obese individuals, I never try to demonize a specific food or punish someone for not making a healthy choice.  What message does that send to the client and how does that promote long-term healthy eating?  It doesn't but it does get ratings.  Since I couldn't watch the whole first episode I thought I should give Ms. Warner a chance and try to catch a full episode.

Last night, after putting the kids to bed I figured I would watch Episode 2.  I still have a bad taste in my mouth.  Thankfully, there wasn't much in the way of flawed nutrition information from Ms. Warner during the episode.  Her only really great kernel of "nutritional wisdom" was to talk about her pre-workout shake.  See the recipe here but to summarize, it's protein powder, glutamine powder, branched chain amino acid (BCAA) powder, L-carnatine, flax oil, spinach and fruit.  I'm not an expert in sports nutrition but it seems like a lot of supplementats to me.  Wouldn't teaching her clients how to find some of those ingredients in whole foods that they can find in any market be more useful? 

The most disturbing thing about the episode though was the end.  All but one of the clients lost weight.  Most averaged a few pounds but no, "huge numbers." Jackie's reaction to the weight loss was simple: disappointment.  Not reassurance, not a congratulatory hug.  No, disappointment.  There was no discussion about how the body fights weight loss and that it might not be realistic to lose 5+ pounds every week.  No, there was disappointment.  How does that motivate someone to stay with a program?  Now I know that this is TV and that we are only watching the show for the drama that ensues but with something as personal weight loss, drama is not the name of the game.  Losing two pounds in a week is a big accomplishment for anyone and should be congratulated. 

I'm sure that Ms. Warner's clients get results.  I'm sure that they lose weight while following her exercise and diet plan, but is it sustainable? Is she helping her clients make life-style changes to make the weight loss permanent/ Is she teaching them to change how they think about food?  Is she giving them the tools to have a healthy relationship with food?  From what I've seen so far, the answer is no.  I wish her clients success and good health.  Maybe after they are done filming they can go to the ADA website, find a Registered Dietitian and  see how the nutrition experts do it. 

Relationships and Food

I apologize ahead of time but this is going to be a more personal post than others, but I have been thinking about some things and I wanted to share some thoughts with you all. 

This month I am celebrating my 7 year wedding anniversary with my wife.  I am by no means a marriage or relationship authority but coming up on this milestone has forced me to reflect on my relationship, love and of course how that relates to food.  My wife and I have both, at different times in our lives, struggled with weight and we each have our own issues with food.  I gained weight during and after college by eating too much and not exercising.  As I look back on it now, I was a very unhappy person and food was my best friend.  I didn't like work, I didn't like being single and the only constant was food.  Food was there for me no matter what and it would comfort me late at night when there was no one else around.  I changed my habits before I met my wife.  I quite literally woke up one morning and decided to eat better.  I lost over 100 lbs by being a different person, I ate better, I exercised, but more importantly, as I lost weight I felt better.  After losing the weight I met my wife.  I told her about my relationship with food and she had similar experiences and that helped bring us together. 

So where does this whole story lead me to?  As a dietitian helping individuals lose weight I often hear something like, "When I get skinny, I'll be happier."  I wish it was that simple but it never is.  Weight loss is not a quick fix to happiness.  The problems you had when you were heavy are going to be there when you are thin.   I think it goes back to the old saying, "You have to love yourself before you can love someone else."

One of my fears as my wife and I started dating and as we settled into our lives together as a couple was would we both gain weight.  I'm sure that we all have stories from friends who talk about how they got comfortable with their partner, stopped exercising, ate differently and started to gain weight.  Well interestingly enough, there's some research on the topic and according to this article from the Mayo Clinic:

Co-habitating increased the odds of becoming obese for women by 63 percent, compared with only 30 percent for men. Marriage doubled the risk of obesity for both men and women — 107 percent for men and 127 percent for women.

The study's findings are echoed in this person's personal story posted on Discovery Health.  She talks about how her weight changed once she moved in with her boyfriend.  It's gives you a glimpse into one person's struggle with weight while also enjoying a new relationship.

Being a dietitian didn't prevent me and my wife from having a similar experience after we got married.  We each "relaxed" just a little and we began to notice some increase in our weights.  But I have I learned after 7 years of marriage.  Just like good eating, love requires some balance, variety and moderation.  We have learned to live together and build a life together and now I couldn't imagine life without her, but building that life took time and patience.  Here's what we do to enjoy each other and stay healthy at the same time:

1. We try to cook at home as much as possible.  The one place we don't get along is in the kitchen so we don't cook together but we have roles in the kitchen.  We plan a week's worth of meals at a time and we make a point to eat together as a family without the TV on.  Since we had kids, we also make sure to have a family Shabbat meal together.
2. We try to find activities that we can do together that keep us active.  Recently we started hiking together and it gives us a great break from our lives to enjoy each others' company while also getting our heart rates pumping
3. We talk about our feelings together instead of using food to soothe us. 

My New Love: A CSA

I have to admit that I have a little bit of a love affair going on right now and I can't hold it in anymore: I love my CSA.  No, I don't have some strange infatuation with a new governmental agency.  CSA stands for Community Supported Agriculture.  If you have never heard of a CSA let me explain the basics.  Simply put, a CSA allows you to purchase a set amount of local produce on a weekly or monthly basis.  When you join a CSA, you agree to pay a subscription fee for fresh, local produce that you can either have delivered to your door or pick up from a designated location.  The fee you pay goes directly to support the farm(s) you buy from, so essentially you are investing in your own food.

Because I get to work with other dietitians, I learned about CSAs from them.  Since I don't live in the same area as my co-workers, I couldn't subscribe to their CSA so they pointed me to Local Harvest.  They have a simple search tool to find a CSA that was convenient for me and I found Abundant Harvest Organics.  I signed up and for the past few months I have been picking up my box every Saturday morning.  I pay for a small box of locally grown, organic vegetables and fruits and it is enough to last my family of four a whole week. You can see one of my most recent box contents on the right.  The great thing about Abundant Harvest is that they also have a ton of add-ons.  Which means I can pay a little extra but along with my regular box I can also buy grass-fed beef, pasture raised chickens, organic nuts and even coffee just to name a few of the products. 

Here's the beauty of a CSA:

• I know that I am supporting a group of small, local farmers who are committed to providing fresh, organic foods. 
• I take my 2 1/2 year old twins with me every Saturday morning while my wife stays at home to relax.  We get to spend some quality time together and they love opening up the box and saying, "Surprise!" and they try little bites of all the produce we get.
• We cook more at home and include more vegetables in everything we make.

CSAs are gaining popularity.  It seems everyone I tell about my CSA says they have heard of other friends getting one.  Someone recently pointed me to Farm Fresh to You.  They are a CSA that delivers your box directly to your house.  Pretty convenient eh?  I also read this week about CSAs being delivered via food trucks to areas that would not normally have access to fresh fruits and vegetables.  Get the whole story here.

There are also some CSAs that provide their members with other benefits aside from fresh produce.  Hazon is a Jewish CSA whose goal is to promote sustainable living and agriculture to the American Jewish community. 

Joining a CSA has been a great experience.  I feel better about where my food comes from and my family has enjoyed trying new recipes to make use of each week's bounty.  My wife and kids will always be my main loves but my CSA has helped develop my love for fresh, locally grown, organic foods.

So Long to Salt

I wrote about the 2010 Dietary Guidelines last month and I thought it would be a good idea to dive a little deeper into one new guideline: "the goal [for sodium] should be 1,500 mg per day."  Sounds like a simple goal but given that our country loves salt, this is a very difficult thing to accomplish.

Salt is 40% sodium and 60% chloride.  The most concerning element is the sodium.  We need sodium in our diet but the problem is we get way too much.   Diets high in sodium are associated with increased risks for high blood pressure which then lead to chronic kidney disease, stroke, heart disease and congestive heart failure.  The Mayo Clinic has a great article for more background. 

Almost all of the sodium we eat comes from processed foods.  There are some foods that naturally contain sodium, but for the most part, anytime we shop for food in the market or go out to eat we are eating sodium.  In an article from the Center for Science in the Public Interest (CSPI) about how to reduce sodium, the physician they interviewed said, 

"...75 to 80 percent of the sodium we consume is added to food before we open a package or walk into a restaurant. So unless you make everything—including breads, crackers, cereals, soup, pizza, spaghetti sauce, salad dressing—from scratch, you can’t easily avoid the salt."

The reality is that we are hardly cooking anything from scratch.  What most people do at home is not generally cooking, we're heating.  We need to learn to cook again.  I wrote about cooking at home earlier but another great resource is from this blog Inspired RD.  She has great recipes that will truly inspire you.

Until we learn to cook we need to do two things:

1. We need to read the food labels when we shop.  When you pick up a food label, start by looking at the serving size of a product.  Next move down to see how many milligrams (mg) of sodium a product has.  Try to find foods that have 300 mg of sodium or less per serving.  
2. We need the government's help to pressure the food industry to use less salt.  Marion Nestle wrote a great piece on this very topic you should read.  In addition to this, read the Institute of Medicine's report on Strategies to Reduce Sodium Intake in the United States. One of the key recommendations is to have the FDA change and regulate how much sodium can be safely added to foods.

By choosing lower sodium foods and food companies reducing the amount of salt in processed foods, we can start to make a difference.  To quote the movie Food Inc. "You vote with your fork three times a day."  Make each vote count and you'll be surprised about how well you can do if you just make a little effort.

Updates to Recent Posts

CLEANSE UPDATE:

Last week I wrote a post about cleanses.  Just days later First Lady Michelle Obama (who I praised here) was interviewed by Ladies' Home Journal.  In the interview she admits that occasionally she  does her own "cleanse" every now and then.  In the article she says,

The cleanses are good for a short period of time. I can't live my life on a cleanse. But they help me clean out my palate. Because when you start adding things like sugars into your diet, you start craving them. And the more you eat, the more you crave. . . . So maybe I'll do a cleanse for two days. It isn't a way of life, because I like food too much. But it is good to break your mind-set.

I was a little shocked by the First Lady's comments about her cleanse mostly because she's been doing such a great job of promoting healthy eating habits.  I recently found a great blog that recapped some opinions about Mrs. Obama's comments.  You can read the whole post here but to summarize I think the article  does a great job of presenting arguments from Marion Nestle and Jeff Stier, associate director for the American Council on Science and Health discussing the First Lady's cleanse as well as her press release for clarification.

While I agree with eating less sugar, a better way to break that cycle is not by going on a cleanse.  Cleanses are temporary solutions to a long-term problem.  If you continually eat a lot of high sugar foods what is more important is helping change the behavior that is driving you to choose these foods. 

At least the First Lady is not doing a cleanse to lose weight.  With all the talk of cleanses, I was so pleased to read this story about John Goodman.  He's lost 100 lbs. by doing something amazing: eating right and exercising!  Bravo, Mr. Goodman.


EXTREME EATING UPDATE:

I've written about extreme eating already here and here.  Well there's a new extreme food to talk about.  Denny's jumped into the fray with their Fried Cheese Melt.  It's a grilled cheese filled with fried mozzarella sticks.  A lovely mix of appetizer and and entree to clog your arteries and expand your waist.  The estimated nutrition information from this CBS article: 845 calories and 34 grams of fat. Oy vey!

Another Celebrity Cleanse

Detox and cleanses are all the rage these days.  In our constant craving for the quick fix, many turn to a cleanse or detox for that instant gratification to shed some quick pounds or remove those "harmful toxins" from our body.  I was not surprised to hear that yet another celebrity was promoting their latest detox/cleanse plan.  This time it was Demi Moore via The Huffington Post who was defending her new regime The Clean Program.  I guess her and her husband were on the Master Cleanse for some time but then switched to the Clean Program.  Naturally this article caught my attention and I felt it needed further explanation.

So what's the theory behind cleanses?  Basically they are selling you the idea that our bodies build up toxins from an unhealthy lifestyle.  You start a cleanse by fasting and/or taking a laxative to help you "eliminate" waste.  Depending on the program, you slowly add some food back but continue to restrict most foods while on the program.  The theory is by taking a 21 or 14 day cleanse, we are helping clean out our systems and promoting better health.   This article and this blog post will offer you some good background on detox/cleanses as well as highlight some of the potential dangers.

So after reading the article previously mentioned, I headed over to The Clean Program to see what it this detox/cleanse was all about.  According to the site:

The Clean Program is a 21 day detox program that is specifically designed for the person on the move. Unlike traditional cleanses, you need not stay at home while you detox on the Clean Program. This cleanse is designed for those who want to live their life and still get Clean

The program (which costs $350!) consists of two detox shakes and supplements taken twice a day plus one regular meal (they suggest lunch)  from their "elimination" diet plus more supplements.  I was pleased that they provided some scientific research to support their program.  When I read their articles though I was not surprised they they were simply analysis of other research and not randomized, double-blind placebo controlled studies.  Neither article really showed their program as effective but instead were general articles about the role of detoxes related to chronic diseases.  The Clean Program is just another in a series of very slick marketed products to try to help you be healthy.  That $350 could probably be better spent on a couple months worth of fresh fruits and vegetables.

So what is the bottom line?  A cleanse is a short-term solution to a long-term problem.  You might lose weight from a detox but that will likely be water weight and possibly a loss of muscle mass and more importantly as soon as you are off your detox/cleanse you'll probably just gain all that weight back.  Want to hear the easiest way to keep your system clean?  A diet rich in fiber.  How about eating plenty of fresh fruits and vegetables, less meat, exercise and drink plenty of water?  But what of these pesky toxins in our body?  Well we have organs (the liver and kidneys) in our bodies whose function is to remove toxins from our body. 

With all due respect to Ms. Moore and all future celebrities and sales people trying to promote a detox,  don't believe the hype.  There is no quick fix to good health.  Focus on a healthy lifestyle and live a life of balance, variety and moderation.

Liquid Calories

When I start talking to someone about losing weight I often start with one big change, avoid as many liquid calories as possible.  It doesn't sound like something that would make a big impact but the fact is it does.

To lose weight, you need to cut calories and one simple way to cut a lot of calories from your diet is to avoid all high calorie beverages.  The typical culprits are sodas, energy drinks and juice.  These beverages can put a serious dent in your calorie budget.  Let's just say you drink a 20 oz. soda, 1 regular Monster Energy drink, and 16 oz of Tropicana orange juice in one day.  Well all of those beverages make up 1/3 of your 1800 calorie budget (which is on the low end of what most men need to lose weight).

Aside from the excess calories, most of these beverages are a huge source of added sugar.  According to the American Heart Association (AHA),

In 2001 to 2004, the usual intake of added sugars for Americans was 22.2 teaspoons per day (355 calories per day). Between 1970 and 2005, average annual availability of sugars/added sugars increased by 19%, which added 76 calories to Americans’ average daily energy intake. Soft drinks and other sugar-sweetened beverages are the primary source of added sugars in Americans’ diets.

The AHA new recommendations for sugar intake is not to exceed 100 calories for women and 150 calories for men.  You can read their full recommendations and findings here.

Other high calorie beverages include coffee beverages like lattes and cappuccinos,  sweetened iced tea, whole-fat dairy, lemonade, fruit punch and of course alcohol.

If weight loss is your goal, try to limit your calories from beverages to less than 100 calories per day.  The Center for Disease Control (CDC) put out a great promotion Rethink Your Drink which will give you some great tips for limiting your liquid calories. 

Remember, you are drinking to hydrate yourself, then nothing does that better than plain, simple water.  But if you must add some flavor, try a squeeze a lemon, using Crystal Light, or choosing diet beverages.  Just be cautious with the amount of artificial sweeteners you use.  Some research has shown that those who drink more diet sodas tend to gain weight rather than lose weight.  Take a look at this great blog post to learn more about artificial sweeteners.

So if weight loss is your goal, take a close look at the liquid calories you are taking in and try to make some healthier choices.

More Extreme Eating

Extreme eating has really taken off.  First there was the Double Down from KFC and not to be left out of the fun, Friendly's has announced their new offering, the Grilled Cheese Burger Melt.  What makes this melt so extreme?  Try starting off with a not-so friendly burger patty.  Then surround it with not one but TWO grilled cheese sandwiches.  But that might get a little dry right? So why not add some mayo to that just to make sure it can slides down easy.  Missing some veggies, well the friendly people at Friendly's decided to add a tomato slice and some lettuce.  How nice of them!   So what is the nutritional damage?  Try 1500 calories (over half from fat),  97grams of fat (38g saturated),  and 2090mg of sodium.  Not a very friendly choice at all.

Just like I mentioned before here, we are amazed and disgusted by these new crazy foods, but we will still eat it.  Right now someone is just hearing out about the Grilled Cheese Burger Melt and trying to figure out where the closest Friendly's is and how soon can he/she get there. 

Where will it all stop?  My guess is that it won't.  Wait another month and there will be yet another announcement from some fast-food chain about their latest "extreme" meal.  Stay tuned.

Weighing In on the 2010 Dietary Guidelines

This week the UDSA-DHHS Dietary Guidelines Advisory Committee released their report for the 2010 Dietary Guidelines.  For RDs there is always excitement and interest in the Dietary Guidelines because they set the national framework for much of our nutrition education for the next 5 years. 

This year's report does not offer huge revelations in terms of overall nutrition. Check out the graphic on the right that I got from Marion Nestle's post.  These are the guidelines from 1980!  Not big shock that a lot of similar recommendations are in this years report. 

What is interesting is that some of the more subtle wording in recommendations might make some waves (my emphasis added):

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  "Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds."
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  "the goal [for sodium] should be 1,500 mg per day for the general population."
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  "Improve nutrition literacy and cooking skills, including safe food handling skills, and empower and motivate the population, especially families with children, to prepare and consume healthy foods at home."

Changing to a mostly plant-based diet, reducing sodium and improving cooking skills so that we can cook more meals at home would be a huge shift for this country.  As mentioned briefly in my previous post, we might need a food revolution to help reverse the current obesity epidemic. Well all three of these subtle changes, sound pretty revolutionary to me.  We are a nation of convenience especially when it comes to food.  We want the easiest, simplest, meals to eat.  We complain we don't have enough time to cook when in reality I think we just don't make it a priority.  

But let's be honest with ourselves.  How much change will these 2010 Dietary Guidelines really bring?  Just to give you a little Government 101, this report is from the Advisory Committee. The report is open for public comment from now until July 15th.  After July 15th,

.. [the] USDA and HHS will consider these and other comments as they translate the Advisory Report of the Committee into the 2010 Dietary Guidelines for Americans. Secretary Vilsack and Secretary Sebelius will release the 2010 Dietary Guidelines policy document jointly at the end of 2010.

In lay mans terms, the Dietary Guidelines are not set in stone yet.  There is going to be some changes so stay tuned!

Regardless of what changes are made to the final guidelines, it's clear to me that more and more people are understanding the importance to making real food at home. I think Michael Pollan says it quite well when he writes, "“Eat food. Mostly plants. Not too much.”

The questions remains, will this country do it?  I think we can! 

Issues with the ADA

Spring is a time for renewal, and not just in the garden.  It is also the time of year when RDs are asked to renew our membership to the American Dietetic Association (ADA).  As many of my colleagues will attest, I have struggled with my membership to this organization recently. 

In comparison to other professional organizations, the ADA is relatively small. We don't have the power (aka money) compared to other food corporations and food lobbyists to meet our vision which according to the website is:

Optimize the nation's health through food and nutrition

Like any organization, ADA gets donations to help accomplish its goals. Go to the ADA Corporate Sponsors page here and you'll see for yourself who has been donating money to the ADA. The list includes companies like Unilever, Mars Inc, The Coca-Cola Company, General Mills, and PepsiCo to name a few.  So what's wrong with taking a few bucks from some corporate sponsors?

My issue is that some of these companies are a big reason why RDs are so busy these days.  Added sugar in cereals and beverages, highly processed foods and candy bars just some of the many reasons for the growing obesity epidemic in this country.  And like I highlighted in a previous post here, some of these companies are even trying to convince us that their high sugar foods are healthy choices! What message does it send to our community when as a profession we say, "Drink less soda, eat more high fiber/low sugar cereals and choose healthy snacks," but then the ADA takes contributions from the companies that profit from these same foods.  To me, it undermines our credibility and without credibility can we really accept the title of "nutrition experts"?

I follow Marion Nestle on Twitter and always find some interesting new tweets from her.  Last month this tweet popped up.  I followed the link to Michele Simon's blog Appetite for Profit.  Her post detailed how a RD from Canada, Sybil Hebert, had similar concerns with her professional organization, the Dietitians of Canada.   Ms. Hebert's original post is here.  In writing about the exact same moral dilemma she says,

How does this affect DC's [Dietitians of Canada] message? How does this make dietitians look? Do you think they can be unbiased and critique the food industry, if they're getting money from it? 

She wrote a great letter that she sent to the DC and I applaud her efforts! 

So where did that leave me as the June 1st deadline approached?  After a lot of thinking, I decided to renew my membership for another year.  A friend said, "Maybe you can make more change from within an organization rather than just dropping out?" So that is my personal challenge. I'm not going to be a silent observer.  I plan to write a similar letter to the ADA that Ms. Hebert wrote to the DC.   I'm going to make my voice heard for the next year and I encourage other RDs to do the same if they agree.

Extreme Eating

Every year the Center for Science in the Public Interest (CSPI) publishes a list of most extreme over-indulgent restaurant foods.  This year's list just came out yesterday and you can read it here.  As always, CSPI opens our eyes to even more high calorie, high salt and high fat gut busters from some of the nations most popular restaurants.

Each year they do this I am surprised by how truly "extreme" some of these meals are.  One item that shocked me were the burgers from Five Guys.  According to the article, the hamburger,"...700 calories (with no toppings) makes a Big Mac (540 calories) or a Quarter Pounder (410 calories) look like kids food. And the McDonald’s numbers include the burgers’ fixin’s. A Five Guys Bacon Cheeseburger has 920 calories and 30 grams of saturated fat (1½ days’ worth) without toppings. Think two Quarter Pounders."  It's not just the burger that was shocking but the fact a large fries will add an extra 1460 calories was just draw jopping.  

The other standout is the Double Pan Fried Noodle Combo from P.F. Chang's.  Sure the 1820 calorie dish is extreme but the most disgusting part is that the dish has 7690 gm of sodium.  Seriously?  Come on, that's nearly 3x the amount recommended for a healthy adult. 

Since reading and writing about The End of Overeating, I continue to think differently about eating out.  These foods have an affect on us.  We crave them and even though we are repulsed when we find out whats in them, they are on the menu for one simple reason, they sell!  Take the Double Down from KFC for example, we laugh about how gross it is but KFC just decided this week to continue selling the item because the demand was there.

CSPI's article is another reminder about how challenging eating out can be.  I'm sure they did not have a hard time finding "extreme" meals.  I bet the real problem was cutting down the choices to just nine that were described in the article.  We love the sensationalism of "extreme" eating but it's what we do with the information that is important.  We vote with our pocket books and if we stop buying 1800 calorie entrees the restaurants will stop selling them.  Menu labeling in restaurats is coming soon and let's hope that will help us make healthier choices rather than enjoying the shock of seeing something that is 1800 calories on the menu. 

The Power of the Pedometer

Any successful weight loss program has some physical activity component.  Exercise has many benefits including: helping burn calories, building muscle and reducing stress, to name a few.  From my experience, both personal and professional, exercise is one of the more difficult behavior changes to make.  For some reason it is a little easier to choose the salad or brown rice than it is to sweat and be active.

The key with any life-style change is to make it a part of your daily life.  If you like to play a sport, find a local gymnasium that might have an adult league you can join.  If you like to be outdoors, plan weekly hikes or walks.  The point is, think about your favorite activity and try to incorporate some exercise around it.

Maybe you're like me and you find that you like to set goals for yourself and like to set small challenges to motivate you.  That is where a simple tool like a pedometer can help.  A pedometer is a device you wear on your belt or waist and it counts your steps.  The goal is to try to walk 10,000 steps in one day.  How far is that you might ask?  That depends on your stride length but in general, 10,000 steps is usually 5 miles.

Do you have to walk 5 miles at one time?  No.  Getting 10,000 steps in a day requires you to be creative in how you spend your day.  Most people average 3,000-5,000 steps per day just in normal daily activities.  So let's assume you are on the low end of that range, you need to find another 7,000 steps to meet your goal.  Think about your day and when you can take a short walk.  Walking for 30 minutes at work might help you get 2,000 steps depending on your pace.  Go for a walk after dinner with your family instead of turning on the TV.

I am a firm believer in the power of the pedometer.  I got one from work and I wear it every day.  I look at it multiple times during my day to see how many steps I am at.  Do I get to 10,000 every day? No, but I do come close.  I love getting up from my desk, walking to the printer and knowing I just added another 125 steps to my total.  I know I'll get an additional 200 steps by taking the stairs instead of the elevator.  It all adds up.  The research shows that a simple $10 pedometer can help you increase your physical activity level and therefore help you manage your weight.

If you challenge yourself you will find ways to get those extra steps in your day.  Challenge yourself to be more active, especially if you want to help manage your weight.

Our Champion for Change

I don't care how you feel about her husband or his politics, First Lady Michelle Obama is doing amazing work with respect to changing how this country eats.  Not only did she plant a garden on the White House lawn but she has now set her sights on fighting childhood obesity.  She doesn't want to just make a dent in the problem either, she wants to solve it, and within one generation.

In February, she launched the Let's Move campaign and soon after, President Obama appointed a task force to give recommendations on how to solve the problem of childhood obesity.  This week, that task force submitted their recommendations to the President.  You can read the brief summary here or the whole 124-page report here.

In short, the task force made recommendations within five major areas, early childhood, empowering parents and caregivers, healthier food choices in school, improving access to healthy foods and increasing physical activity.  Marion Nestle did a great job of summarizing some of the key recommendations on her recent blog post. 

Reading the recommendations I'm impressed with two things. First, this report mobilizes a group of federal and local agencies.  The problem of obesity is a complex problem with no simple answer.  Smartly, Obama knew that she needed the help of the FTC, USDA, DHHS, EPA and HUD (to name a few) to help solve the problem. 

Secondly, the report has recommendations in many different areas. The recommendations deal with everything from breastfeeding promotion, helping increase the availability of healthy foods in poor urban and rural areas, encouraging food companies to standardize nutrition labeling on the front of packaged food, helping schools upgrade their equipment to give them the availability to actually cook more food, and asking restaurants to decrease portions and improve children menus.

The truth is that there are many factors that have caused our nation's children to gain weight and it will require a broad, far-reaching change to find a solution.  It's been said we need a food revolution in this country.  Mrs. Obama and her Let's Move campaign just handed us the blueprint.  I am proud to have the First Lady as our champion for change and I'm behind her all the way!

Cooking at Home

Huffingtonpost.com recently added a Food section to their site. One of the first articles was written by food writer Micheal Ruhlman. I’ll let you read the article here, but the basic gist of it was that we ALL have time to cook at home!

I’m the father of 2 1/2 year old twins and since my wife gets home from work later than I do, I’m responsible for making dinner for the family. We sit down and eat together as a family every night but I have to admit that I too cut corners and often complain, “I don’t have time to cook”, especially since the kids were born. Over the past few years we’ve resorted to more simple meals where we are heating food more than actually cooking it.

So there I am sitting at my desk, reading Mr. Ruhlman’s article and it dawned on me. ‘I do have time to cook.’ I remembered seeing a recent episode of No Reservations (a must watch show for any foodie) where Thomas Keller showed how to make his favorite recipe, roasted chicken. I found the recipe online at Epicurious.com and decided that THIS is what I was going to cook. Was it organic, farm-raised chicken? No! We are on a budget after all! But regardless, this simple roasted chicken which was served with quinoa and fresh corn was probably one of the best meals I’ve ever had and not only because it tasted great but because what happened during the meal. We got eat on the patio since the weather just started warming up. Sitting outside in the evening sun with my wife, watching our kids eat every morsel of food on their plate and licking their fingers with a smile was a priceless memory I will hold on to forever.

So take the time to cook. Make it a priority, even if it’s just once a week. Not only will you feel a great sense of accomplishment, but by cooking whole foods and choosing less processed or ready-prepared foods is a great way to start to limit your sodium intake. And who knows, you might create your own priceless memory.

A Bizarre Food Month

Since I’ve become a RD I don’t know if I’ve seen a stranger month with regards to bizarre food trends. It seems like we take one step forward and two steps back.

First, KFC decides to release the Double Down! A bacon and cheese sandwich with two fried chicken breasts instead of buns. It says it has only 500 calories but when I added the ingredients up using Sparkpeople, I got something closer to 740 calories.

Next, I see that Mead-Johnson has released chocolate flavored toddler formula.

Then I receive the mother of all propaganda on the "Benefits of Cereal" from General Mills. My favorite part is on page six where they compare Trix to Cheerios. They argue that both are good, healthy breakfast choices. They write, “From a calorie and nutrient standpoint, are both products a good breakfast choice? Yes, they are.”

News comes in that Santa Clara county has banned toys from kids meals if they have more than 485 calories, 600 mg of sodium or high amounts of sugar and salt.

Also this week, 16 companies agreed to begin reducing their salt intake by 25% over the next five years.

Finally, IHOP announced their new menu item, pancake stackers. This “sandwich” is two pancakes with a layer of cheesecake in the middle.

Such a random group of news bites about food. To me it shows the disconnect in most peoples thinking. We want to be healthy with balanced diets, but we love the absurd (like the double down or pancake stackers), but then we are disgusted about what it does to our waistline.

There are those that argue, the government has no business making laws that limit our food choices. But the problem is, we are not choosing what is best for us. We continue to choose high fat, high sugar and high salt foods and then wonder why nearly 68% of the population is either overweight or obese. At some point, enough is enough! The only reason that companies are starting to reduce salt intake is because of government initiatives by Mayor Bloomberg, for example, and recent reports from theIOH that say, they only way we will reduce the intake of sodium is through government regulation.

What ever you believe, this month has certainly given us food for thought!

The End of Overeating

I recently finished The End of Overeating by David Kessler, MD. This book has changed the way I think about food and overeating. Dr. Kessler does a fantastic job of highlighting the complex chemical reaction that occurs in our brain when we eat foods that have salt, fat and sugar. Not only does he use research studies but the personal stories from real-life people drive home how eating can take control of us.

Dr. Kessler goes on to write about how the food industry, especially food scientists, manipulate food to hit our “bliss point.” They purposefully create foods that drive us to crave more of similar types of foods. They are making food with sugar, fat and salt to make us eat more sugar, fat and salt. The result of this type of diet is literally growing all around us. Rates of obesity continue to rise and unless we change how we think about food, there may be no end in sight.

Finally, Dr. Kessler talks about “food rehab” and how we break this cycle. It is the first time that I’ve read a book, written by a doctor, that says everything that would make a dietitian proud. He emphasizes eating balanced meals that have lean protein and high fiber foods that help satisfy our hunger. He also talks about creating structure in our eating patterns to prevent us from making unconscious decisions about food.

Take the time to read this book. It will open your eyes to how our brains are affected by our high fat, sugar and salt diets. It made me realize that changing eating habits is not about will power, it’s about understanding how food can control our decisions the same way cocaine does for drug addicts. This is a must read for anyone struggling with overeating.