Shop Smart and Read the Label

Smart Shopping and Label Reading

            These days it seems as if the simple act of shopping for food has become just another task on the busy to-do list.  Add to that the barrage of advertisements (in store and not) and mixed messages that the media is touting and you have some pretty confused folks wondering the supermarket trying to make heads of tails of it all.  I have put together a grocery shopping guide to use when you head out to the store.  Always be sure to avoid shopping on an empty stomach and plan ahead what you are going to buy and prepare for the week ahead.  The best advice overall is to choose whole foods.

1.      When you get into the store be sure to get the size of cart that you are going to need.  If you need a few items from a list be sure to just grab a basket or small cart.  If you are shopping for a large family and buying for one week or more go for the bigger cart.  The reason is that if you have more room to store items you may end up buying more items than you need.

2.      Begin with the perimeter.  The most important foods are found in the perimeter (fruits, vegetables, meats, dairy, etc).  Start by stocking up on the fresh fruits and vegetables that you know you will be able to use within a week or so.  Then head onto meats and diary and buy enough for the week or buy some meats and freeze them for the month.  Try to plan your meals around these food groups.  Keep in mind that juices often are mostly water and sugar (even some of the better brands) so stick to whole fruits and vegetables as much as possible.

3.      Head to the isles after you finish the perimeter.  This is where the packaged items will be found.  These items are more likely to be processed, canned, and have additives that are unnecessary for your body (but necessary for long-term storage).  Choose wisely when shopping in these isles.  Try to avoid foods that are canned and those that are heavily processed (check your ingredient list-the first ingredient is the highest percentage of that food and so on down the list).  Choose whole grain cereals, breads and pastas and whole wheat crackers without added fats.  Grab some mixed, unsalted nuts as a snack.

4.      End with the freezer section where you can choose dairy foods, meats and frozen fruits and vegetables that may remain in your freezer for longer than one week.  This is where you want to check the labels carefully to avoid trans-fats and sugars at greater than 10-12g per serving.  Be sure to check the ingredient list of fruits and vegetables for additives that are unnecessary (for example-frozen broccoli should say broccoli, nothing more).

Label Reading Tips

1.      Start at the top with serving size and servings per container.  If you plan to eat more than one serving you will need to multiply everything else on the list by that number of servings to know how much you are actually eating.

2.      Try to avoid foods with greater than 3g of total fat per serving (unless it is nuts, oils and margarine or avocado).  Packaged foods (even foods such as bread and cereal) may contain added fats (and sugars and salt).

3.      Limit the sugar content.  A breakfast cereal with more than 6-10g of sugar is a dessert, not a breakfast.  Also keep in mind that sugar alcohol and sugar are pretty much the same (in the way that they act in your body) so do not be fooled.  Avoid sugar alcohols the way that you avoid sugar.

4.      Watch out for those fat-free and sugar-free lines on packages.  When a product has the fat taken out, often either sugar or salt is added.  Additionally, when a sugar or salt are removed fat is often added.

5.      Limit salt content.  Sodium is in virtually everything that is processed (as it acts as a great preservative).  In fact recent studies indicate that many Americans are getting most of their daily sodium from the bread that they eat.  Limit sodium (aka salt) to 1,500-2,000mg per day.

Remember that whole foods are foods that can be readily found in nature and/or are minimally processed before you eat them.  A good example is an apple vs. apple juice or carrot sticks vs. cheese flavored crackers.  Choose whole foods first.  Try not to buy items that you may find tempting when in your home.  If you have trouble eating only a few cookies then don’t buy a big package and keep it at home.  Every once and a while you can always stop by a store for a small package and enjoy the smaller portion.

Five Things You Can Do Today for Better Health

Oftentimes life keeps us pretty busy and focusing on healthy behaviors can drop down the priority list.  Stress is a major contributor to unhealthy habits which can lead to poorer health and lower quality of life.  The good news is that oftentimes all that we need is to make a few good choices during the day to accomplish our health goals and get back on track.  Remember that healthy living is made up of every choice that you make throughout the day, every day.  Try making these five choices today to start improving your quality of life.

1.       Eat breakfast.  I know that you hear this often but starting the day out with a solid breakfast will be a key factor in how you feel for the rest of the day.  Skip the bagel and doughnuts though and grab some berries, yogurt, whole grain cereal or an egg white omelet instead. 

2.      Drink water.  Summer is officially here and that means that you are much more likely to become dehydrated.  Our bodies need a minimum amount of water daily to function properly and dehydration can make you feel tired and run down all day.

3.      Go for a walk.  Whether it is 15 min during your lunch break, 20min before work or 30min or more after work head outside and go for a stroll.  We often think that exercise means sweating and exerting a lot of energy but all activity throughout the day counts.  Vigorous exercise is definitely recommended at least twice a week but those little walks really add up to better health at the end of the day.

4.      Catch up with someone today.  It can be as simple as a phone call, chatting via the computer or having coffee with a friend but personal relationships add to our quality of life.  Call someone you have been meaning to talk to or have lunch or dinner with your co-worker or significant other to just chat about your day. 

5.      Go to bed early.  Sleeping less than 7-8 hours a night can lead to tiredness the next day and for many people a higher intake of calories.  When our bodies don’t get enough sleep we don’t have enough energy to get through the day.  So have a cup of (non-caffeinated) tea and hit the hay early tonight for a better tomorrow.

Make Exercise More Meaningful

    To be honest I have always been an active person.  I played outside most of the time as a child and was on a little league team by the age of 5.  I swam 3 years in high school and was on the track and field and tennis teams and even swam one year in college.  I have felt that I kind of need to be doing a sport in order to stay active.  Sure sometimes I will go to the gym and take a cycling class or jump on the Arch trainer but that cannot be the only thing I do.  As an adult I have undertaken the sport of triathlon and I have to admit that I really enjoy it.  People look at me like I am a lunatic when I say that I do it because there is the misconception that it’s “hard.”  Honestly as long as you train for it and you at least somewhat enjoy each sport triathlon is great!  I would argue that multi-sports are better than single ones as they get you doing different activities (and since boredom, routine and “regular” exercise are not really my forte it is perfect for me).  I have found that training for my next race is a huge motivator to exercise when I am not feeling up to it.  It also keeps me more focused on my diet as good nutrition is very important for athletic performance.  Whenever I am discussing exercise with someone, this is the advice that I give when deciding what it best for you.

·         Find something that you enjoy.  This seems like a no brainer but you would not believe how many people tell me that they will pick up running only later on to admit that they hate to run.  This is not a wise plan when trying to choose a behavior that fits into your lifestyle FOR LIFE!

·         Try different activities.  This is pretty easy and I highly suggest it to avoid boredom and to find out exactly what it is that you enjoy.  I have tried a number of activities including skiing, ice skating, windsurfing, hiking and dance classes.  The key here is to try new things that at least sound like fun and stick with those that you enjoy the most.

·         Mix it up!  Once you find one thing you like, start looking for others.  Have a plan B activity for those days when you are unable to do your favorite.  Also, mixing up you exercise routine prevents your body from getting too used to the activity.  When we get too used to an activity we need to work harder at it to continue to be challenged.

·         Try out a sport if it is your thing.  Okay so you won’t be joining the high school football team again but look for recreational sports at places like the local YMCA.  You can also train for an upcoming 5K run or 20K bike ride or join a master’s swim class at a local University.

·         Eat like an athlete.  When you decide to become more active it is time to eat more like an athlete.  Starvation dieting will not work if you plan to take on an activity on a regular basis.  Eat enough food and eat plenty of nutrient rich foods (whole grains, fruits, vegetables and legumes) every day.  Time your meals around your exercise/activity to see what works best for you.

·         Challenge yourself.  This is one really big reason why I do cycling classes and train for triathlon.  Moderate exercise is good but vigorous is important too.  In fact you are likely to feel hungry after moderate exercise but less likely to be hungry after vigorous exercise so push yourself!

·         Don’t forget strength training.  This can be as simple as a $10 workout DVD or as much as a class at your gym.  Building muscle is important for strong bones and a faster metabolism.  Resistance training can also decrease the loss of lean muscle mass if you are losing weight (along with eating plenty of food).

The last most important thing is to find other people who are enjoying your activities.  Exercise is always more fun with other people plus you are more likely to push yourself and each other in a group.  Join a running or cycling club or a hiking meetup group.  Take your family or find a workout buddy to go to the gym with .  Having some support and making it a social activity will increase the likelyhood that you will continue to do it longterm. 

A Dietitian's Top Ten List of Foods to Include in a Heart Healthy Diet

May, which is Older American’s Month, is fast approaching and as an early tribute to Americans over the age of 65 years I wanted to touch on the topic of heart disease.  I don’t want to do this because these Americans are more likely to have or die from the disease but because heart disease is the reason that my father never made to be and “older American.”  Heart disease has been nicknamed the “silent killer” because in many cases it takes someone’s life quickly and without previous warnings.  Heart disease can affect people of younger ages so it is important to know your risk and do your best to prevent this disease.  For the record my father was 36 when he had his first (known) heart attack after which he had a double bypass coronary graph and he was 53 years old when he died.  His father, my paternal grandfather, only lived until age 63 before he succumbed to complications of heart disease.

While heart disease is the most common chronic disease facing Americans right now it is usually accompanied by type 2 diabetes, high blood pressure and obesity.  For many of us, including myself, our genetic background and family history paint a grim picture of a future without proper self care and early detection.  For many others who lack a substantial family history don’t dismiss your risk either.  Just from what I see in my clinic on a monthly basis I encounter patients with absolutely no family history of the disease.  In fact while that can increase your chances of getting the disease that risk factor pales in comparison to diet and lifestyle.  I used to think that having a family history of the disease was a terrible burden to bear but as it turns out it has been pivotal in motivating me to know my numbers (lipid panel and glucose) and maintain a healthy lifestyle.  The good news is that with early detection and lifestyle modification the disease can be prevented, controlled and some cases reversed (for more information on reversal see Dr. Dean Ornish’s work).

Before getting into the important nutrition component I feel compelled to touch upon some of the lifestyle factors that can lead to the disease.  This includes smoking (please quit-my father died with a pack in his pocket), being overweight, uncontrolled diabetes and a sedentary lifestyle.  Basically it means don’t smoke or quit smoking, control your blood sugars if you have diabetes and use exercise as one tool in helping keep your heart strong and maintain a healthy weight.   The other main tool in losing weight is good nutrition.  My favorite handout to give my patients is a top 10 list which highlights the most important foods to add to your diet.  Ideally by adding in healthy foods you will find that less healthy food just doesn’t have as much room in your diet and limiting them feels more natural and less like deprivation.

1.      Considering all of the benefits that we hear about soy it should be no surprise to find it on the list.  However you only get the benefits  by swapping out soy products for meat and dairy choices (such as milk).  So if you have never tried Soy milk or soy beans you may be surprised what you are missing out on.

2.      Nuts and seeds-I can’t count the number of times over the years that I have had to tell the wife of one of my patients to let her husband have his peanut butter and cashews!  Go for unsalted, raw nuts and eat a variety.

3.      Fish Oil-First let me suggest starting out by adding in foods and if you feel compelled to use a supplement I would say that you need to discuss it with your doctor.  You will find high amounts in trout, salmon, mackerel, albacore tuna and herring.

4.      Monounsaturated fats-A typical Western diet provides too much Polyunsaturated and saturated fats without the much needed balance of these oils.  Go Mediterranean by using olive oil as a dressing and throw some walnuts on your salad.

5.      Spices-Especially garlic, are good for your heart.  Try to use a variety of spices (such as turmeric, cinnamon, curry, ginger, etc) and use them whenever possible.  Use them in place of salt when you can.

6.      Whole fruits and vegetables-This seems like a no brainer I know, but it really is important.  Fresh fruits and veggies are best followed by frozen ones.  When you cook them be sure to leave a little crunch in the food which means more fiber.

7.      Water-This is an important nutrient for everyone unless you are on a fluid restriction.  While it may seem counterintuitive, the best way to avoid collecting fluid (especially around the heart and lungs as seen in congestive heart failure) is to drink more water.  You can also benefit your heart by drinking black and green teas (which should be decaffeinated).

8.     Fiber-Fiber is found in fresh fruits, vegetables, legumes and whole grains primarily.  Every meal should be providing fiber.   On average we need 25-30g per day.  One way to get a little extra is to use a fiber supplements such as Metamucil or Benefiber.

9.      Whole grains-How do we know when we are buying whole grains?  Read your ingredient list and look at the first ingredient which should say-whole grain.  If it doesn’t see if there are better options for you.  A rule of thumb; each slice of bread should have at least 2 grams of fiber.

10.  Chocolate-I bet you didn’t expect to see this on my list-did you?  That’s right dark chocolate and baker’s cocoa are very good for the heart.  The best way to get it into your diet is by cooking or baking with cocoa or dipping fresh fruit into melted dark chocolate as a treat.

Probiotics: The "Good Bugs"

Probiotics (also called "good bugs") are defined by the World Health Organization as live micro organisms that, when administered in adequate amounts, confer a health benefit on the host. One of these benefits is changing or reintroducing bacteria in the intestine. Many foods contain probiotics, but the first one a person is likely to receive is breast milk, which protects a baby from infection.

Yogurt contains two common probiotics -- lactobacilli and bifidobacteria -- but there are many more. Other fermented dairy, such as kefir and some nondairy foods, also have these live cultures. Certain nondairy fermented foods are also rich in probiotics. They include sauerkraut (fermented cabbage), kimchi (Korean spicy cabbage), tempeh (a fermented soybean product), miso (fermented soybean paste) and soy sauce. While research is still new in this area, it suggests probiotic cultures may help keep your immune system healthy and help maintain the good bacteria in your intestine. However, you don't necessarily need probiotics to be healthy. These micro organisms may simply aid with digestion and offer protection from harmful bacteria, just as the existing good bacteria in your body already do.

"Prebiotics" are plant fibers that are food for probiotics. While probiotics are found in foods like yogurt, prebiotics are found in whole grains, bananas, onions, garlic, honey and arti chokes. In addition, probiotics and prebiotics are added to some foods and are available as dietary supplements. Inulin and chicory root fiber are two common prebiotics you may see on an ingredient label. Prebiotics may help with irritable bowel syndrome, Crohn's disease, colon polyps and leaky gut syndrome. Although more research is needed in the area of probiotics, there's emerging evidence suggesting that probiotics may help:

·         Treat diarrhea, especially after treatment with antibiotics.

·         Prevent and treat vaginal yeast infections and urinary tract infections.

·         Treat irritable bowel syndrome.

·         Reduce bladder cancer recurrence.

·         Speed treatment of certain intestinal infections.

·         Prevent and treat eczema in children.

·         Prevent or reduce the severity of colds and flu.

It's believed that a balancing act within the human body can be thrown off in two ways. The first is by antibiotics, which can kill friendly bacteria in the gut, along with the unfriendly bacteria it's targeting. People may use probiotics to try to offset aintibiotics' side effects like gas, cramping or diarrhea. Similarly, some use them to ease symptoms of lactose intolerance, which is a condition in which the gut lacks the enzyme needed to digest significant amounts of lactose, the sugar found in milk. Lactose intolerance can cause constipation and gas in some people and diarrhea in others, and is thought to be linked to irritable bowel syndrome in some people. The second way that the balance can be offset is through "unfriendly" micro organisms, such as disease-causing bacteria, yeasts, fungi and parasites. Researchers are exploring whether probiotics could stop these unfriendly agents or at least suppress their growth and activity.

Side effects of probiotics are rare, and most healthy adults can safely add foods that contain prebiotics and probiotics to their diet. If you're considering taking supplements, check with your doctor to be sure that they're right for you. It is important to remember that most supplements are not regulated by the FDA or any other governing body. This means they may not actually contain what they say they do. Eating foods that contain probiotics and prebiotics is the safest way to get them in your diet. It is important to eat a varied diet, including foods that contain prebiotic fibers and those with live cultures such as yogurt. Yogurt is a great way to help fulfill your "three a day" of dairy recommended by MyPlate, the USDA's new food tool that replaced MyPyramid.

It is also important to do some research on the use of complementary and alternative medicine and to discuss the use of such things with your physician. The National Center for Complementary and Alternative Medicine Clearinghouse provides publications and searches of federal databases of scientific and medical literature. The clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. Information: nccam.nih.gov

March 14, 2012 is National Registered Dietitian Day

Every second Wednesday in March is Registered Dietitian Day in the United States.  This is a day to commemorate and celebrate those individuals working in the field of dietetics as nutrition professionals.  But what exactly is a Registered Dietitian and how is it different from a Nutritionist? 

Registered Dietitian (RD) is a legally protected professional title only able to be used by individuals who are registered the Commission on Dietetic Registration (CDR).  In order to achieve this registration there are several prerequisites.  A person seeking to become an RD must first complete a minimum of a bachelor’s degree in Food and Nutrition/Dietetics; however many will hold master’s degrees as well.  Either during or upon completion of required coursework an internship encompassing 1200 hours must be completed.  All of this must be done via a college or university with a CADE accreditated (Commission on Accreditation of Dietetic Education) academic and internship program.  Once all college courses and the internship are passed and completed a registration examination must be passed in order to become a Registered Dietitian.  In order to maintain registration 75 hours of continuing education must be completed every 5 years.  Many states also have and require licensure of RD’s.

What is a Nutritionist then?  That is not as easy to explain.  Maybe a Nutritionist is an RD, but probably not.  Maybe they hold a degree in nutrition, maybe not.  Perhaps they have a certificate from an online certificate giving company that says they are a Nutritionist.  You just never know.  There are people who are pretending to be professionals everywhere and they are looking to make a quick buck off of you.  It is crucial when choosing a nutrition professional to help you manage your health that you choose one who is educated in the field and is held accountable for their actions.  You would do that for a nurse, physician, physical therapist or hair stylist, wouldn’t you?

Where can you find an RD?  Well dietitians work in many areas including hospitals, school systems, private practice, WIC and dialysis clinics and nursing homes.  You can also find them writing books, speaking at health conferences and doing research.  Be sure to check the credential of any and all health professionals before seeking information or counseling from them.  If you are looking for an RD visit www.eatright.org and click on the “Find a Registered Dietitian” tab to find one practicing near you.

Get your plate in shape!

March is National Nutrition Month and that means promoting a healthy lifestyle with good nutrition. As a Registered Dietitian this is something I do everyday anyway but this month it is especially important.  This year The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is teaming up with the USDA's nutrition message and use of the new MyPlate (formerly MyPyramid).  There are six key nutrition messages for National Nutrition Month and Choose My Plate: Make half your plate fruits and vegetables, Make at least half your grains whole, Vary your protein choices, Switch to low fat or fat free milk, Cut back on sodium and empty calories from solid fats and added sugars, and Enjoy your foods but eat less.  There is also a message to include physical activity daily-your way!

Using the new MyPlate picture you can see that half of your plate should be fruits and vegetables (with a little more vegetables than fruit).  It is important to eat a variety of fruits and vegetables, especially dark leafy greens and vibrant red, yellow and purple colors.  Color matters when it comes to fruits and vegetables as each color indicates different nutritients available in that food.  Be sure to buy only fresh and frozen and try to eat them raw, steamed or grilled.  One fourth of the plate should be grains and at least of half of the time choose whole grains.  Be sure to check the ingredient list for whole grains as the first ingredient. Whole grains include brown rice, bulgur, oatmeal, whole grain pastas and cereals. The rest of the plate should have lean or non-animal protein such as chicken, fish or legumes. It is important to vary protein sources and try to have on non animal sources such as pinto beans, chickpeas, tofu and tempeh at least one day during the week.

When eating dairy foods it is important to choose low fat/fat free dairy or non-animal dairy products such as fortified rice, almond, hemp and soy milk and yogurt.  Choosing low fat and fat free cheese, milk and yogurt is on one way to help cut calories and reduce your total fat intake.  You can also cut back excess calories by drinking water instead of sugary sodas and juices.  Watch for salt in processed foods and try to limit your intake of these foods.  The best way to limit your salt intake is by focusing on eating whole and fresh foods and limiting the packaged items such as crackers, canned soups and white breads.  Other sources of unwanted calories are high fat foods such as hot dogs, pizza and french fries.  Choose lean, un-breaded protein foods and starches that are not fried to reduced the saturated fat in your diet.  Also remember that you should enjoy your food but eat less.  Choose to eat off of smaller plates to help reduce portions and make sure that you measure your foods so that you know how much you are eating.

Be physically active as well but do it your way.  So you are not an athlete or gym rat, that's okay.  Go for a family walk or swim in the pool at the YWCA for example.  Maybe you could join a recreational league sport for fun or go to your local park and play tennis with a friend.  Make physical activity fun and enjoyable and you will be more likely to stick to it.  For more ideas and helpful hints visit www.choosemyplate.org or www.eatright.org.