Reducing the Costs of Our Healthcare System

Lifestyle interventions are required to adequately address the rise in obesity 

Medicare has recently decided to cover Intensive Behavioral Therapy for Obesity (IBTO). This landmark decision is very important because obesity will now be recognized independently from co-morbidities such as diabetes and heart disease. Medicare recipients who are obese without other health problems will be allowed to receive IBTO without co-pay in the hope of preventing the development of chronic diseases associated with obesity. The potential for saving healthcare dollars is great, but there is one caveat of this new coverage: The most qualified professionals to provide IBTO are excluded from directly billing Medicare for this service.



Intensive Behavioral Therapy for Obesity will include:

1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed in kg/m2);

2. Dietary (nutritional) assessment; and

3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.



Patients who meet screening eligibility are entitled to:



• One face-to-face visit every week for the first month;

• One face-to-face visit every other week for months 2-6;

• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement.



Medicare names primary care physicians, clinical nurse specialists, nurse practitioners, and physician assistants as being the only professionals who can bill Medicare for IBTO and the primary care clinic as the only site where IBTO can be provided. This leaves out registered dietitians and clinical psychologists, whose training qualifies them over primary care practitioners to most effectively provide this service. Patients who desire to work intensively with dietitians or psychologists will have to pay for these services on their own.



After reviewing the ruling posted on Medicare’s website and looking over the references that were provided in support of IBTO coverage, I’m stumped by this decision. Many of the references cited had dietary interventions provided by registered dietitians. A 2004 article published in the Annals of Internal Medicine by the Centers for Disease Control and the Primary Prevention Working Group names dietitians among the most qualified providers to administer lifestyle interventions. This same article states, “even the most highly motivated physicians typically have minimal education or training in lifestyle intervention, and they usually have inadequate access in their practice to the resources needed to support lifestyle intervention. Well-intentioned attempts by physicians to practice “lifestyle medicine” with scarce resources can lead to embittered rejection of health promotion.” The article then goes on to state, “No efficacy study had physicians directly involved in delivering interventions.”



Dietitians bill insurance at 85% of the physician rate. It doesn’t make fiscal sense to allow primary care providers to bill at a higher rate for IBTO when they are not trained in this technique and they do not have the time to provide such involved therapy. I hope in the future that Medicare sees the value that registered dietitians and clinical psychologists bring to the treatment of obesity and allows them to bill for this service independently from primary care providers.


Please support the effort to urge Medicare to allow registered dietitians to directly bill for obesity services by signing this White House petition by January 7, 2012.


Reference:
Centers for Disease Control and Prevention Primary Prevention Working Group.
Primary Prevention of Type 2 Diabetes Mellitus by Lifestyle Intervention: Implications for Health Policy. Ann Intern Med. 2004; 140:951-957

Medicare Chooses Inferior Care for Obesity

Preventing dietitians from becoming providers for obesity care is not in the best interest of patients 

I received some good news the other day. Medicare has agreed to cover Intensive Behavioral Counseling for Obesity for eligible Medicare beneficiaries. And then I read the statement released by the Centers for Medicare & Medicaid Services (CMS). Registered dietitians and psychologists will be excluded as obesity care providers. According to CMS obesity counseling must be provided by a “qualified primary care physician or other primary care practitioner and in a primary care setting.” What does this mean? A "qualified primary care physician", according to the Social Security Act is a physician who is a general practitioner, family practice practitioner, general internist or obstetrician or gynecologist. A “primary care practitioner” is defined as a physician with a primary specialty of family medicine, internal medicine, geriatric medicine or pediatric medicine or a nurse practitioner, clinical nurse specialist, or physician assistant." Obesity services must be provided in a primary care setting which CMS defines “as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.”


The bottom-line is that registered dietitians who are highly trained to intensively counsel obese individuals will not be allowed to bill Medicare for obesity intervention and private nutrition practices that are established and operated by dietitians are not considered an appropriate setting by CMS for nutrition education of these individuals.

I cannot say for certain what was really behind the decision to exclude dietitians from becoming Medicare providers for obesity counseling because Medicare's explanations seem lame to me. The American Dietetic Association described CMS's action with regards to the exclusion of dietitians as follows:

  it appears that CMS excluded RDs for two reasons:

1. CMS believes it lacks the statutory authority to include RDs as providers outside of diabetes and end stage renal disease; and

2. CMS believes it is important that preventive services be furnished in a coordinated approach as part of a comprehensive prevention plan within the context of the patient’s total health care. As such, they believe primary care practitioners are best qualified to offer care in this context.

Apparently Congress has not charged dietitians in the fight against obesity but dietitians are allowed to help people with diabetes and end stage renal disease. Many people with diabetes are obese and when I am counseling them for diabetes management, weight management is always a part of the intervention.

As for "preventive services being furnished in a coordinated approach as part of a comprehensive prevention plan within the context of the patient's total health care," what Medicare fails to see is that it doesn't matter how well care is coordinated if it is inadequate. To date primary care intensive obesity intervention consists of MDs and NPs telling patients that they need to lose weight and referring them to a dietitian. Now that MDs and NPs will be able to bill for counseling for obesity they can remove the dietitian from the equation and bill their services at a much higher rate than the RD would bill and provide less than adequate nutrition counseling possibly after attending a weekend course on obesity management to supplement their one medical scool course in nutrition. I don't mean to disparage doctors, but they are not trained to provide comprehensive nutritional intervention. My husband is a physician and he is the first to admit that most doctor's knowledge about nutrition is lacking. Think about it this way, does Medicare require that physical therapy be provided under the primary care physician's watchful gaze in a primary care setting?

I am always dismayed when I read press releases about new scientific discoveries related to obesity in which the final sentence in the release states that this information can be used to develop a drug to combat obesity. Obesity fighting drugs that have already been released are often recalled because they pose a serious risk to health and can cause death. Humans have existed for thousands of years with minimal obesity until now. We know how to combat obesity and it is not a pill. It is inexpensive but labor intensive and it does not make research and drug companies incredibly wealthy.

A cynical interpretation of this whole debacle is that lobbying from Big Pharma helped to ensure that the practitioners who can prescribe medications would be the only ones whose obesity related services could be covered by Medicare.

It is sad to me that some highly qualified nutrition and behavioral therapists (dietitians and psychologists) will be excluded from treating Medicare recipients. Patients who want to see dietitians and psychologists for nutrition and behavioral counseling will have to pay for these services out of their own pockets (again).

What do you think? Will Medicare provide the most comprehensive treatment for obesity by the most qualified providers?

“Gout” You by the Toe? Kick It with Good Nutrition

Lifestyle contributes to gout 

Gout has long been viewed as a malady suffered by the wealthy, those with means to afford rich foods and wine. Today, gout is the most common form of inflammatory arthritis suffered in men, effecting 3.4 million adult men and an increasing number of postmenopausal women. The incidence of gout is on the rise and lifestyle factors play a significant role in its occurrence.




Gout is characterized by on overproduction of uric acid or a decreased excretion of urate in the kidney. Uric acid is the end product of purine metabolism. Most purines are contained in the human body as DNA. Cells of the body are constantly turning over with the release of genetic material and their consequent breakdown to uric acid. Foods and beverages that we consume can also contribute to the overall uric acid load in the body. When the uric acid level of the body is elevated, crystals can form in the joints. These crystals activate an inflammatory response, which brings on the pain and swelling of gout. The big toe and ankles are common joints affected.



Gout has been shown to be related to the metabolic syndrome, which includes features that increase the risk of heart disease and diabetes such as obesity, elevated cholesterol, high blood pressure, and insulin resistance. Overweight and obesity seem to play a role in both gout and metabolic syndrome. Maintaining a healthy body weight is import in the control of gouty inflammation, however, sensible eating is important. Following a low carbohydrate, high protein diet for weight loss can exacerbate gout.



High protein foods tend to contain more purines with the potential to raise uric acid level, though not all high purine foods have the same ability to cause an attack of gout. Beef, lamb, pork and fish are primary offenders and should be eaten less often and in smaller amounts. A small portion is considered three ounces and is the size of a deck of cards. Most restaurants serve meat in portions of six ounces or greater. Plant foods higher in purines do not seem to bring on gout and do not need to be limited. These include whole grain breads and cereals, oatmeal, wheat germ, wheat bran, mushrooms, green peas, spinach, asparagus and cauliflower. These foods have other health properties that may protect against gout. Low fat dairy products seem to protect against gout and it is recommended to eat at least two servings a day. Dairy products are low in purines and increase the excretion of urate. Vitamin D may also play a role in gout. Many people who have gout are deficient in vitamin D. Urate may prevent the activation of vitamin D, which is believed to have anti-inflammatory properties.



Alcohol has long been known to be a risk factor for gout. Beer is high in purines but alcohol in general may also be implicated. Alcohol is dehydrating and poor hydration increases the risk of gout. Alcohol intake should be controlled; especially beer and special attention should be paid to drinking enough water. This is particularly true when traveling. Many people experience gouty attacks while on vacation. They are dehydrated from their travels and imbibe more than they would at home.



Other diet and lifestyle factors important in the management of gout are:

• Reduced fructose consumption. Fructose is the only sugar that increases urate. Fructose is found most in soft drinks, sweetened juices, apples and oranges.

• Increased fruit and vegetable consumption (except apples and oranges). These foods are known to decrease inflammation with the potential to lower urate.

• Increased vitamin C intake. Vitamin C found in many fruits and vegetables decreases urate. Supplementation of 1500 mg vitamin C daily may be helpful. Vitamin C supplementation should be split throughout the day (500 mg with meals three times a day is suggested).

• Cherries are known for their anti-inflammatory ability. Consumption of cherries and cherry juice decrease gouty attacks.

• Increased physical activity is associated with decreased risk of gout.



As with all diet and lifestyle recommendations, do not undertake dramatic changes in your habits without supervision and advisement from your physician.

How Are We Teaching Our Children to Eat? Some Comments on McDonald's

Unfortunately, eating fast food regularly is a reality for many families 

I'm not quite sure what to think about McDonald's pledge to improve the nutritional offerings of their trademark Happy Meal. By the end of 2012 all Happy Meals will automatically include apple slices and the calorie content will be decreased by 20%. This is good, but will it really make a difference in battling childhood obesity? The bottom line for me is that allowing your kids to grow up eating McDonald's food (or any fast food) is like throwing them in a swimming pool without lessons and expecting them to know what to do. Let me explain.

When my kids were young, I would meet other mothers at a Maryland McDonald's so our kids could play. Our local McD's had a Playplace for the kids to climb and run. After an hour of play, we would buy the children Happy Meals. I noticed that my kids and my friend's kids would eat only a very little bit. We ended up throwing at least half of the meal away. The kids were little (under 5 years) so of course they couldn't eat the whole meal. We did this a few times and there were times that I did this with my kids alone. Despite being in the metropolitan Washington DC area, I was lonely and isolated from my friends because it took at least an hour to get anywhere. Letting my children play at McDonald's got us out of the house.

When I moved to Rochester, NY my two older children were 4 and 2 years old. I began stopping in at the corner McDonald's at lunch time on occasion. As I sat watching my kids barely eat their meals I finally got some sense. By continuing to take my kids to McDonald's I was teaching them to like fast food. In the world of nutrition and health, I was teaching them how to drown.

McDonald's will most likely benefit from all the hoopla surrounding their recent press release. Consumers will view the company as caring and wanting to improve the health of children. I don't believe it! Large companies care about their finances. If they truly cared about childhood obesity, they wouldn't market their foods to children with toys. The toys in Happy Meals will still be offered. McDonald's wants your children to learn how to like their food so that they will continue to eat it as they grow up.

I read through several comments at the end of one of the online articles about this topic. One reader suggested that McDonald's trash should be evaluated for all the wasted Happy Meal produce. I'm sure that there are a lot of wasted hamburgers, chicken nuggets and French fries in that trash too. We give up so easily when teaching our children how to eat better. We stop offering vegetables because they won't eat them not knowing that the simple act of consistently offering healthy foods is important.

My question to those who give up trying to feed their kids healthy foods; would you stop teaching them math just because they are having difficulty with subtraction? The way to work towards combating childhood obesity is to feed your children lots of vegetables, not buying them the "healthier" Happy Meal.

I'm giving away the family cookbook No Whine with Dinner by fellow RD's Janice Newell Bissex and Liz Weiss. Comment on this blog post by August 31st, 2011 and you will be entered to win this cookbook to help your kids eat healthier (just in time for the new school year)!

Nutritionists Blog About MyPlate

A more simple model for healthy eating 

MyPlate is barely a week old and the nutrition world is buzzing about it. If you are curious about what this new icon is and what it might might mean to you, read on.

I'm happy to share a link with you that is a collection of blog posts written by dietitians (myself included) on the new MyPlate. Much thanks goes the Janet Helm of Nutrition Unplugged for organizing this list. Enjoy reading the various comments on MyPlate from nutrition professionals and add to the discussion with your own comments if you feel so moved. We'd love to hear your voice!

MyPlate Blog Link

Keeping Your Food Focus in an Attention-Grabbing World

Isn't all yogurt probiotic? 

It seems that almost every month there is some new concept in nutrition that seeks to grab our attention. Many eating styles and food products are developed to help people adopt these "new" eating principles. Some examples of these are the Paleo Diet, Atkin's Diet, glycemic index, raw foods diet, gluten-free diet, juicing and super foods (this list goes on and on). There is a lot to grab our attention and the end result for many people is not better health and vitality, but a short stint following an unmanageable eating pattern, a little weight loss, and more weight gain down the road. All of this is for the privilege of spending a small fortune.

I'm not saying that diet and nutrition principles don't have merit. A gluten-free diet is vital for people with celiac disease and the rest of us could probably stand to consume less refined wheat products. Rather, I think we lose our focus on eating a healthy diet by being drawn into food fetishes that may not make any sense for us. As an example, I've heard many people claim that they won't eat carrots, grapes or watermelon because they contain sugar. To equal the amount of sugar in a 12-oz can of Coca Cola Classic you would need to eat 4 cups of watermelon, 10 large carrots, and 45 grapes. Some people might be able to eat this much, but I'm sure that they would be quite full and not able to eat much for a period thereafter which is not the case when you drink a can of Coke. Also, consider that natural foods such as carrots, grapes and watermelon contain nutrients that promote health.

I was recently asked my opinion about Joe the Juicer who has a website called Fat Sick and Nearly Dead. Joe found "religion" (health) through juicing and now is on a crusade to transform the world. There is some sensible nutrition advise promoted on Joe's website and it is this advise that is responsible for transforming lives. Juicing is the vehicle that is used to promote a more plant-based diet. If you can live on juice, then this is the diet regimen for you. If not, then you better pay attention to adopting healthy lifestyle habits that you can maintain, and forget the juice.

When adopting a healthy lifestyle, ask your self this question: Can I maintain this change over my lifetime? If the answer is no, figure out what you can do to be healthier and establish SMART goals for yourself. A SMART goal is specific, measurable, attainable, realistic and time-lined. A SMART goal will lead you to the healthy lifestyle you are seeking, one goal at a time.

My kids often joke about being distracted by shiny objects. There is a lot of "nutritional glitter" out there vying to take your attention away from more sensible practices. Trust in your common sense and your ability to stay the course. It may not be as dramatic as juicing, buying amped up yogurt or getting your stomach stapled. But it is what works. Slow and steady wins the race, as long as you stay on the course.

MyPlate Introduced. Now What?

The endless junk food aisle 

Yesterday was a big day in the world of nutrition. The 20 year old Food Pyramid was retired by the USDA and the new MyPlate was unveiled. The new food guide shows a plate with four sections for the basic food groups: grains, fruits, vegetables and protein. To the side is a cup of dairy. The new food icon was introduced by USDA Secretary Tom Vilsack, US Surgeon General Regina Benjamin and First Lady Michelle Obama at a press conference yesterday morning. Vilsack commented that the personal health of the nation is as important to the wellbeing of the country as its fiscal and economic health. It is an issue of national security when many youth are too overweight and unfit to protect the country. Dr. Benjamin concurred that childhood obesity is one of the greatest challenges facing our nation. She stated that the goal of the new food icon is to provide clear and simple information based on science to guide the American people to make healthier food choices. First Lady Michelle Obama commented, "What is more simple than a plate?"

Michelle Obama goes on to say that there is still work to be done in leading our nation toward health. I can't agree more! I like the simplicity of the icon and the message to the American people to eat less that is a central tenet of the Dietary Guidelines. But I wonder if this new food guide will have any impact upon the way that Americans eat?

At the Future of Food Conference in Washington, DC last month, Secretary Vilsack commented that the way farm subsidies are appropriated will change with the new Farm Bill. He hopes to empower more small family operated farms which means decreasing (or ending) the subsidies paid to larger agribusinesses. To me, this is a more important step in changing the US food and health environments than the combined efforts of the new MyPlate, Dietary Guidelines and universal health insurance. The endless aisles of junk foods, cereals and beverages are directly related to subsidies paid to grow corn, wheat and soy which allowed the creation of cheap processed foods. Cheap processed foods are bad for health for many reasons, one of which is that they displace healthier foods such as vegetables, fruits and whole grains. When soft drinks and junk foods are more expensive and vegetables and fruits are less expensive, Americans will buy less junk. When we see smaller displays of junk foods at the grocery store, then we'll know that we are moving in the right direction.

Vilsack goes on to say at the MyPlate press conference yesterday that you have to walk the talk. He tells a story of how the new icon influenced him recently at a dinner where he was served a piece of steak that covered more than half his plate. He purposefully didn't eat it all. I hope Congress has the same good sense when it comes to passing a Farm Bill that will change the US food and health environments. Congress will have to turn a deaf ear to the wealthy and powerful food lobbies and do the right thing for the American people by voting to reduce subsidies to large agribusiness. Our national security depends upon it.

Moving Beyond SAD: Embrace the Mediterranean Lifestyle

The Mediterranean Diet Pyramid

The standard American diet is often referred to as the acronym SAD. The SAD is indeed sad when we consider the impact that it has upon the health and wellbeing of Americans. The increase in chronic diseases such as heart disease, cancer and diabetes is of great concern. Lifestyle choices have a large impact on the development of chronic illnesses. In 2005, one of every two adults had at least one chronic illness. With the current increasing trend in obesity, this number is expected to rise with serious social and economic outcomes.

The SAD is a result of US farm and economic policies. Laws were created throughout our history that gave advantage to companies. These companies in turn controlled what crops farmers would grow and how food was developed from them. High fructose corn syrup and soy protein isolate are two examples of food additives cheaply created from subsidized corn and soy crops. Processed foods flooded the markets and Americans responded by buying them up. It appears that now the devil is collecting what is due. What is truly sad is that our children won't even have a chance. Obesity rates in children have skyrocketed with a concomitant increase in chronic diseases. Many healthcare professional are expecting children born today to have shorter lifespans than their parents.

Across the globe, people developed eating patterns that were consistent with their natural environments. This way of eating offered people the greatest advantage for survival. The Mediterranean diet is a prime example of this. I can wax poetic on the benefits of following a Mediterranean diet pattern, but there are wonderful resources that already exist. Instead, I'd like to focus on a few of the Mediterranean eating and lifestyle habits that Americans can easily follow in their natural environments.

1. Tend a garden: This is not a foreign concept in American history. Most families used to have to grow their own food. Gardening has become almost quaint with our busy lifestyles and the greater availability of convenience foods. If gardening is too challenging you can frequent farmer's markets weekly or join a Community Supported Agriculture group. Either way, you'll be connected to the land and the life-giving foods that come from it.

2. Plants, plants and more plants: Place focus on eating more plant-based foods. We certainly aren't lacking for protein in the US. What we are lacking is eating more plants. Every meal and snack of the day should contain plant food. We can explore eating a wide variety of fruits, vegetables and whole grains that offer a bounty of nutrients.

3. Go fishing: I mean this metaphorically, but if you actually can go fishing more power to you! Replace eating beef and pork with fish. The fish in the market today is fresher than ever and there are many wonderful options that come from our lakes, rivers and oceans.

4. Be a little nutty: Nuts are a plant-based source of protein and healthy fats. Many nuts such as almonds, pistachios, walnuts, pecans and peanuts are cultivated in the US. Nuts can be used to enhanced the flavor of recipes or they can be a satisfying and nutritious snack when paired with a fruit or vegetable.

5. Cook and eat together: Nurturing is an innate human instinct, although some are more in tune with it than others. Our convenience-oriented environment has made it more difficult to become in tune with our more natural nurturing instincts. Cooking food to share with your family and friends is a great bonding activity. It is part of being human. Get everyone involved and enjoy the experience!

6. Get on your feet: Gardening, cooking, and walking to the market are all activities that support health. Life used to be very physical and now we have to exercise to replicate what we used to do on a daily basis for survival. An interesting thing is that all the exercise in the world won't save you if you sit for hours on end in a day.

A new US Food Guide will be unveiled June 2nd, 2011. Word has it that it will be very different from the Food Guide Pyramid of the last decade. A new icon was developed to more simply help Americans adopt the Dietary Guidelines into their lives. Whether or not the Food Guide is wonderful, all Americans can make little changes to move them to a healthier and closer relationship with the land that they live on.

How to Mindlessly Eat Better



Arrange your home and work environments
 to help you to make healthy food choices 


The food industry knows what we like. Sugar, fat, and salt have incredible power over us, and for a very good reason—survival. I recently had an opportunity to interview and attend a lecture by Brian Wansink, PhD, behavioral psychologist and author of Mindless Eating: Why We Eat More Than We Think. We are programmed to love the taste of sugar, salt and fat according to Wansink. Our ancestors knew that sweet berries were safer to eat than bitter ones, and that they supplied us with much needed quick energy to help us build civilizations and flee danger. Fatty foods provided energy reserves to help us through periods of famine. Salt helped our active forbearers to retain water and prevent dehydration. Finding convenient food was also important for survival. The less time prehistoric humans spent in the pursuit of food, the less risk they had of encountering something that would pursue them as food. The concerns that our ancient ancestors had for survival are not as relevant to us today, but our preferences for sugar, fat, salt and convenience persist. Do not blame the food industry for the overabundance of convenient foods loaded with sugar, salt and fat. Dr. Wansink contends that the food industry’s only concern is to sell you the foods that you want. “They could care less if you eat it” he claims.

Our desire for sugar, salt, fat and convenience paired with a very marketing savvy food industry are a part of the reason we have become the fattest nation on earth. We make over 200 food decisions in a day, and many of those decisions are mindless. Dr. Wansink’s research shows that calorie consumption is greater when we are cued to eat mindlessly. He also discovered that no one is immune to it. Wansink studied graduate students who were trained to understand the concept of mindless eating, and found that they were just as likely to engage in eating mindlessly as anyone else. Education and intelligence do not prevent mindless eating.

It seems the answer to mindless eating would be to become more mindful of what we put into our mouths. However, Wansink believes that mindfulness requires too much energy to maintain. Instead he believes that we should adjust our environment to allow us to mindlessly eat better.

Eating Cues

There are many cues that promote mindless eating and they very often trump hunger. The cues around us suggest when it is time for us to eat; we may habitually eat at a certain time or take a specific amount of food because that is what we are used to doing. We develop unhealthy habits that we engage in frequently simply because they have become normal. Wansink has discovered that we can eat on average 20% more or less without being aware of it. He calls this the mindless eating margin. Big portion sizes and giant-sized packages have helped us to become accustomed to eating more. Making a few small changes can help us to eat less. The following is a list of cues that promote mindless eating with suggestions how we can re-engineer our environment to mindlessly eat better.

• Dish and Utensil Size: Larger plates, bowls and serving spoons can encourage us to eat about 25-30% more food.
Mindlessly Eat Better: Use smaller plates, bowls and spoons when serving and eating food.

• Glass Shape: We pour a greater volume of beverage in short wide glasses than in tall narrow ones. A study conducted on bartenders showed that they over poured beverages an average of 37% in short wide glasses.
Mindlessly Eat Better: Drink only from tall thin glasses.

• Food Package Size: The larger the food package, the more we tend to eat.
Mindlessly Eat Better: When buying larger packages for value repackage the food into smaller portions at home right away and hide the extras.

• Variety: When presented with a greater variety of food we will eat more total food than when we are given fewer food choices.
Mindlessly Eat Better: Provide a greater variety of healthy foods during meals such as offering two vegetables and/or a piece of fruit every time you eat.

• Visibility: If we see food we will most likely eat it. In one study, participants ate 71% more candy when the candy in the dish was visible.
Mindlessly Eat Better: Place healthier foods in visible locations and less healthy foods in less visible locations in your workplace and home.

• Family-Style Meals: We tend to take more food per serving and take additional servings of food when it is offered family-style.
Mindlessly Eat Better: Serve foods such as vegetables and fruits family style and serve entrées and bread, rice or pasta from the counter. Having to get up from the table to serve more food provides enough pause for us to determine if we are still hungry.

• Distractions: Eating while doing other activities such as reading, working on the computer, watching TV or eating with other people promotes mindless eating.
Mindlessly Eat Better: Eat only fruits and vegetables when doing other activities. When eating with other people, pace yourself to be the last one to start eating and the last one to finish eating to avoid taking extra food.

Wansink says that, “it is easier to change your environment than to change your mind.” He is currently involved in a program called The Smarter Lunchroom Initiative whose mission is “to design sustainable research-based lunchrooms that subtly guide smarter choices.” Most lunchroom changes cost less than $50. By making healthy foods more visible (serving fruit in a nice bowl in a well-lit area) and offering a greater variety of healthy choices (two vegetables instead of one) schools can significantly promote healthier eating among students.

These strategies can also be used in home and work environments. Anyone can make two easy changes to eat better. You will hardly notice that you are hungry with a daily decrease of about 100-200 calories, but you will be establishing new eating patterns that will lead to significant weight loss and improved health over time. Don’t let another day, month or year go by without making a consistent change. Think about it, in a year you could be ten pounds heavier if you do nothing or ten pounds lighter if you change your environment.

This article will be published in Rochester Healthy Living.

Note to Americans: Celebrate National Nutrition Month All Year Long

Define yourself as a healthy eater 

March is National Nutrition Month. This is a big deal to dietitians and those who work in the field of nutrition and aspire to help Americans to adopt healthier eating and lifestyle habits. I wonder, has the rest of America received the memo?

Nutrition impacts so many aspects of health. What we eat deserves the greatest of care and attention the whole year, not just on one designated month of the year. What is it going to take to finally get Americans moving in the right direction to make healthy food decisions most of the time?

Eating healthy is not an all or nothing proposition and perhaps dispelling this myth is the first place to start. Let's embrace food for its nourishing properties and celebrate its flavors, textures and aromas for what they are, delicious! Eating healthfully does not mean that you can never eat pepperoni pizza (or cake or whatever your favorite food might be). In fact, including your less healthy favorite foods in your diet from time to time may be helpful in actually adopting a healthier diet overall.

This brings me to my next point; our skewed taste perception. Many of the foods that are sold in grocery stores and restaurants in America are loaded with fat, sugar and salt. Our tastes veer naturally toward these compounds in foods, but what we taste most often are not the naturally occurring elements in foods, rather the concocted flavors created by food engineers. The politics behind this is enmeshed in our agricultural system (farm subsidies), and food industry (food lobbies) and presents a huge hurdle for Americans to jump over in order to make healthy eating easier. I don't have a clear solution for this problem, other than to encourage Americans to go back to what is natural (unfortunately, the definition of natural is meaningless on food packages) and naked, food in its natural state prepared with ingredients that were not created in a lab. There is hope that we can regain our taste for real food. Taste perception is not static, it changes over time. I can attest to this myself as I have worked to wean my taste away from sweet and salty foods. I can now barely tolerate these flavors in most manufactured foods. I would much rather add my own sweetness to oatmeal with raisins than eat sweetened packaged oatmeal and I notice how salty most foods taste in restaurants.

Nutrition should be on our mind every day as we choose what we eat. The nutritious foods that we eat are also delicious, from the whole wheat cinnamon toast with butter and a full bowl of berries that I ate for breakfast this morning; the homemade pea soup I'm having for lunch with an over-sized red delicious apple; to the red beans and brown rice, pecan cornbread (from a package with ingredients that are foods, not chemicals) and roasted asparagus that I am making for dinner tonight.

Upon learning that I was a dietitian, a gentleman once commented that he felt sorry for my husband. I replied back, "My husband is the luckiest man in the world. He gets to eat the most delicious and nutritious food!" Our perception of healthy foods should stress how wonderfully delicious they truly are so that we celebrate National Nutrition Month all year long!

Facebook Moratorium

The social network connection

I often wonder why I spend so much time creating my online presence using social media tools such as Facebook. There are a few reasons that I use Facebook professionally. It is a great tool for staying connected with my colleagues and keeping on top of cutting edge news in my field. It also serves as a valuable resource for getting my message out to my clients, although I question if I'm really reaching my ideal client. It's difficult to tell the impact that I'm having without getting feedback in the form of comments. I carefully look for information to post to help others make positive diet and fitness changes and have only once been made aware of the value of this work to my audience. It is important to me to stay connected with my audience but difficult to to so when I wonder if I even have an audience.

Social media is a time sink. Facebook and Twitter eat up time that I should spend doing other things to grow my business. There already is enough to keep us tethered to our computers without the addition of Facebook and Twitter. In the back of my mind I think that I should spend more time in endeavors that will make money rather than posting free information for an invisible audience.

To make matters worse, I have been gaining weight lately despite exercising regularly. I can't help but think that all this sitting behind a computer is a bad thing for humans in general. My recent weight gain has spurred me into action. I have decided to impose a moratorium on Facebook and Twitter for the next week. Every time that I think about checking my social media accounts I will do ten jumping jacks and ten push-ups instead. One of the purposes of my social media existence is to inspire others to improve their lifestyle. I can think of no better place to start doing this than with myself. The calories we burn when we exercise are a small fraction of what we burn in a whole day. Our goal should be to pursue activity all day long. So whenever I have the urge to post an article, picture of food, recipe or any other tidbit that I find interesting, I will be active instead. I wonder how many jumping jacks and push-ups I will complete in a week. I'm sure that I will be doing quite a few of them. Social media has become a big part of my professional life in the past couple of years.

I will return to sharing information on Facebook and Twitter after a week, but I will incorporate my new habit of activity before every interaction. I encourage everyone else to attach some form of physical activity to your more sedentary pursuits.

To Health!

What are some of your impressions about social media?

What Do Box Tops for Education Really Promote?

I collect Box Tops for Education for my daughter's elementary school. One or two products that I buy are involved in the program and I dutifully clip the box tops for the school. I recently noticed a commercial for Pillsbury® Toaster Strudel® Pastries promoting their affiliation with the Box Tops for Education Program. It got me thinking: How healthy are the food products that are involved the program?

"Box Tops for Education is a program created by General Mills to provide funding for education." This is the description of the program on the eHOW website. The official Box Tops for Education website claims to have raised over $320 million for schools since 1996 (each box top collected is worth ten cents). Compare this with the annual cost of obesity which was recently stated as $147 billion per year, and the benefit of the Box Tops program pales in comparison! With increasing rates of overweight and obesity in kids, it's pretty important that programs designed for schools promote healthy eating habits.

I surveyed the food products involved with the program and created three categories: healthy, pseudo-healthy, and refined. I classified each food in a category for each division of food products (refrigerated, frozen, beverages, etc.). This is by no means a scientific study and my criteria for healthy vs. pseudo healthy foods is perhaps a bit blurred (I classified Juicy Juice as a pseudo-healthy food. Consumed in small amounts, it is fine, but even 100% juice can contribute to weight gain when over-consumed). If a food contained a majority of whole grains, was in its natural state, contained lower amounts of sodium, and had limited added sugars, I considered it a healthy food. Food products close to their natural state, but with some added sugars (or high natural sugar content) and added ingredients to bump up their dietary fiber were considered pseudo-healthy. Foods with a high amount of refined grains and sugars (including artificial sweeteners) and higher in sodium were classified as refined foods (notice how I didn't call them unhealthy, although it is implied).

As you can image, most of the food products promoted by the Box Tops for Education program are processed. You can view the participating products for yourself. The list changes often as new products are added and limited products are deleted. Of the one hundred and eighty-eight products that I looked at, 14.3% were healthy, 14.8% were pseudo-healthy, and 70.7% were refined. These results are not so impressive, especially when it comes to feeding our kids!

Ehow suggests using the program only for products that you normally buy. But we all know that this is not really how promotions and coupons are intended to be used by their creators. They want us to buy their products and the more we buy the better. It behooves manufacturers to offer promotions to encourage us to buy; if we think that they are socially minded in the process, all the better for them. I wish they would just donate money to the schools without pushing us to buy products, but that's not how America works.

Fortunately, there are non-food products that are involved in this program, so you don't have to worry about contributing to childhood obesity because you want to clip a few box tops. Even better is the online program. There are many participating stores selling many non-food products that will provide a multiple of box tops per every $10 spent.

I'll continue to clip the box tops for the three food products that I regularly purchase and resist the urge to buy more because I think that I'm helping my daughter's school by doing so.

How Food Can Help You Score in Love

Set the stage for love by following a healthy diet 

The connection between food and love goes much deeper than eating certain foods to increase arousal. The right foods convey vitality, endurance and improved blood circulation; all very important for a special night with that special person. There is no mystery; a healthy diet sets the stage for a fulfilling romantic experience. We’ve all heard it before; eat more whole grains, fruits, vegetables, nuts, seeds, and fish. Not eating this way yet? Well you should, and here is another good reason why: what’s good for your health is also good for your mojo. We are just beginning to understand how the array of nutrients we get from unprocessed foods impact our bodies; from the phyto (plant) chemicals in blueberries that help relax your blood vessels, allowing blood to flow through them more freely, to boosting your libido by eating enough zinc from meat, whole grains, legumes, and seafood (oysters, a famed aphrodisiac, are high in zinc). If you abuse your body with foods high in saturated fat and refined carbohydrates, over time you’ll increase your risk for heart disease and diabetes, two chronic diseases with serious negative ramifications in the love department.




A little foresight is required to set the tone for a romantic evening. Follow a few simple guidelines to help you get ready for that perfect encounter.

1. Eat Breakfast: Eating breakfast is the best way to assure that you have the energy to make it through the day and into the night. Breakfast foods such as oatmeal, fortified cereals, milk, and eggs provide a good dose of B-vitamins, which will keep your libido soaring and the stress of courting under control. One of the B-vitamins, niacin, is important for the secretion of histamine, a chemical that your body needs for arousal.

2. Limit Caffeine and Alcohol: In moderation, both are fine, but tip the scale in the direction of excess and your night of romance could be railroaded. More than three cups of coffee can act as a diuretic and cathartic; where a little caffeine and alcohol may help keep you alert and relaxed, too much and you could spend most of the night in the bathroom rather than with your love interest.

3. Minimize Foods that Create Unpleasant Odors: Many foods that create odors, such as garlic, onions, curried dishes, broccoli and cauliflower are good for you. You still want to eat these foods, but not on date night. The alternative is to persuade your date to eat them with you, that way you will both be blissfully ignorant about how you smell to the world.



The best aphrodisiac is to feel good about yourself. The confidence that you exude because you feel good about the way that you look and feel can make you irresistible to others. A few types of foods can help add to your appeal. If you want to be assured of a “sure-thing”, try one or more of the following:



Celery: Celery doesn’t come to mind when you think about passion, but this unsuspecting vegetable releases pheromones—chemicals that naturally turn us on—with every bite. Munch a few stalks, and you could give another meaning to the term “rabbit food”.

Chocolate: Chocolate contains chemicals that heighten the love experience. One is phenyethylamine—called the “love molecule” because it is suspected to cause the feeling of bliss lovers experience. The other, methylxanthine, is a stimulant responsible for increasing skin sensitivity. Chocolate rightly earns its reputation as a treat for lovers.

Vanilla: The scent of vanilla has been shown to be relaxing, putting people in the mood for intimacy. Light a few vanilla candles and serve vanilla ice cream with a chocolate dessert and you and your intended will soon be in the mood for love.

Adventures in Soup Making

Delicious and easy red lentil soup 

We love soup in my house. I began making soup a more regular part of our meals a few years ago. I started by using prepared organic broths. There are many easy recipes out there making soups with prepared broths. The only problem is that they are high in sodium. Yes, I know that you can buy low sodium broths and this is a good option, but I have flavor fatigue from most commercially prepared broths. As my husband and I are pushing the second half century of our lives, I think that it is better to prepare more homemade soups with homemade stock.

This may seem like a daunting task, but really, it isn't. You can prepare your soup or broth when you have more time. Once you get familiar with what tastes good to you, you'll be able to "wing it" without a recipe. I still like to find a great soup recipe like Red Lentil Soup from The Best of Bloodroot, Volume Two, but most of my soup adventures are flying by the seat of my pants. I throw all kinds of combinations of food into a pot and typically the results are great.

I'll share the recipe for Red Lentil Soup as this one is really out of this world and it can teach you some soup-making skills. After the recipe, I'll include some guidelines for mixing up your own creations.

Red Lentil Soup

2 cups red lentils
2 large onions, sliced
8 cloves garlic, sliced
3 T. fresh ginger, sliced
2 T. grapeseed oil
2 tsp. ground cumin
2 tsp. ground coriander
8 cups water
1/3 c. low sodium tamari
2 cups canned diced tomatoes (low sodium is best)
pepper to taste (only add salt if you really have to after you serve the soup)

Spiced Oil Garnish

4 T. grapeseed oil
1/2 tsp. dried red pepper flakes
1/2 tsp. whole cumin
1/2 tsp. turmeric
1-2 sliced green onions

1. Pick over and rinse lentils (I admit that I usually skip this step-I rarely find rocks in my legumes).
2. In a large stock pot heat oil and saute ginger, garlic and onions with cumin and coriander for about 2 minutes.
3. Add lentils, water, and low sodium tamari. Add tomatoes (the original recipe says to drain the tomatoes. I add the whole can, including the liquid. I use a 28 oz. can of organic diced tomatoes. It is not low sodium and I do not add any extra salt). Cover and bring to a boil. Simmer until lentils are tender, about half an hour (I find that red lentils cook quickly since they are so small).
4. Puree soup until smooth. You can use a blender, but this is a big task. The soup is hot and you have to blend it in batches. I can't tell you how many times I've had hot soup going everywhere. It is definitely not fun and enough of an annoyance to prevent future blended soup adventures. I suggest using a hand held immersion blender. It will make this step much easier.
5. Season with pepper.
6. To make spiced oil garnish, heat grapeseed oil in a small pan and add red pepper flakes, cumin and turmeric, stirring for a few seconds.
7. To serve, ladle hot soup into bowls and drizzle a spoonful of spiced oil on top. Sprinkle with sliced green onions (the recipe calls for cilantro. I much prefer green onions).

Serves 6 to 8 people

Hints for Creating Your Own Soups

1. Begin by making soup a few times following a recipe. I tend to make vegetarian soups so I look for vegetarian recipes. Bloodroot is my new favorite cookbook and if you're looking for amazing vegetarian recipes, I highly recommend it. I've learned a lot about flavor combinations by following recipes.

2. Choose healthy ingredients. I encourage you to make soup the main part of your meal. To get the nutrition you need you should include healthy sources of protein, carbohydrate, fat, vitamins, minerals and antioxidants. In food lingo that means lean meats, legumes, whole grains (barley, brown rice, wild rice, quinoa, millet, etc.), and lots and lots of vegetables (don't forget the greens. Soup is a great way to eat greens)!

3. Season for flavor and that doesn't mean salt! You can use a little salt or salt containing foods such as canned legumes or tomatoes, but experiment with a variety of flavors from spices, herbs and flavorful foods (garlic, onion, lean meats, citrus peel, dried mushrooms, etc.).



Add a variety of vegetables, herbs and spices to your soup 


4. Go for color. Colorful foods have antioxidants and add to the appeal of food. I'll add onion skins to my stock because I like the color that it gives the broth. I'll also add beets. Nothing looks prettier than a red vegetable soup in a white bowl.



Colorful foods add nutrition, flavor, and eye appeal 


5. Be daring. When you've made soup a few times you'll begin to improve upon what you've made. Perhaps you may decide that a stalk of lemon grass would enhance your recipe. Or you might like to add a bit of lime zest or some coconut milk. Get out of your comfort zone and explore new flavors.

Soup can be served as part of a larger meal or it can be the main dish. I often serve it as the main dish. I'll round out the meal with crusty whole grain bread and a salad containing a variety of interesting greens.

One of the benefits of eating soup is that it promotes a feeling of fullness that can help decrease calorie intake. If you've stuck around long enough to read this statement, it should motivate you to experiment more with homemade soups.

Please share your adventures in soup making. I'm always looking for interesting combinations of flavors to add to the pot!

To your health!

PS: When my son was 18 months old he commented on his grandfather eating soup. As he couldn't pronounce his "s" it sounded like, "Papa eating poop." Papa replied, "I hope not!"

Porcini and Quinoa Stuffed Peppers

Porcini and Quinoa Stuffed Peppers served with Tamari Roasted Cauliflower and Sauteed Escarole  

Talk about making half of your plate vegetables, this meal does more than that! I was looking for a good recipe to serve as a substitute for meat stuffed peppers. I came upon a quinoa stuffed pepper recipe, but I didn't love the flavor. So, I made my own. I love the flavor that the dried mushrooms add to the quinoa. I also added diced potatoes for a couple reasons. My kids love potatoes and their flavor really enhances this recipe. Also, my teenagers are athletes and they need a lot of carbohydrates, especially my son who has type 1 diabetes. I'm always looking for a balance of healthy high fiber carbohydrates and protein to feed my son to prevent the blood sugar crashes that can happen about 8 hours after his training. 

Along with the healthy protein and carbohydrate from the quinoa, there is an abundance of antioxidants and nutrients from all the other ingredients in this meal. I hope you enjoy these recipes!

Porcini and Quinoa Stuffed Peppers

1/2 oz. dried porcini mushrooms

1 garlic clove, minced

1 small onion, diced

1 small leek,  cleaned and sliced

1 c. quinoa (I used red)

2 T. grapeseed oil

5 red bell peppers

1 stalk celery, diced

1 large carrot, diced

1 medium potato, diced

scant 1/2 tsp. salt

pepper to taste

2 1/2 tsp. low sodium tamari

If you are unfamiliar with how to clean a leek, follow the link for directions.

1. Preheat oven to 375 degrees F.
2. Soak porcini mushrooms in 1 c. hot water for about 15 minutes. When soft, drain through a cheese cloth, saving mushroom broth. Dice the mushrooms.
2. Cook quinoa in 1 1/4 cup water or vegetable broth.
3. Core and wash peppers, removing seeds.
4. Heat grapeseed oil in a pan over medium-high heat. Saute onion and garlic for 1 min. Add leeks and saute another minute. Add celery, carrot, mushrooms and potato and cook for another 5 minutes or until potato starts to brown.
5. Reduce heat to low. Add cooked quinoa and mushroom broth. Season with salt and pepper. Cook until liquid is absorbed.
6. Stuff peppers with quinoa mixture, dividing the mixture equally among the peppers and filling them to the top.
7. Place stuffed peppers in a baking pan. Drizzle 1/2 tsp. low sodium tamari on top of each pepper. Add about 1/2 c. water to the bottom of the pan and bake the peppers 30 minutes or until cooked through.

Serves 5

Tamari Roasted Cauliflower

1 small head cauliflower split into florets
1 T. grapeseed oil
1 T. low sodium tamari

1. Mix all ingredients together on a rimmed cookie sheet.
2. Roast at 375 degrees F for about 20 minutes or until browned and tender. Stir half way through cooking.
3. Serve and enjoy! It couldn't be any easier!

Sauteed Escarole with Spiced Oil

The spiced oil in this recipe comes from a vegan cookbook that I have been using a lot lately. The Best of Bloodroot, Volume Two has many wonderful recipes. I highly recommend it!

4 T. grapeseed oil
1/2 tsp. dried red pepper flakes
1/2 tsp. whole cumin
1/2 tsp. turmeric
1 T. low sodium tamari
8 c. chopped escarole

1. Make the spiced oil. Add grapeseed oil, red pepper flakes, cumin and turmeric to a small pan and heat over medium heat until aromatic. This will take only a few seconds once the oil gets hot.
2. Add 2 T. of the spiced oil to a wok. Heat over medium-high temperature. Add escarole and saute for a couple minutes, until escarole is half wilted.
3. Add tamari and serve.

Save the extra oil to use in other dishes. It provides the nutritional benefit of capsaicin and curcumin, two plant chemicals with health properties. It also tastes out of this world!

My 500-Calorie Lunch

Koshari with a side of Sugar Snap Peas 

It started as dinner a couple of nights ago. I made a recipe of Koshari, Egyptian lentils and rice, from my new vegan cookbook, The Best of Bloodroot, Volume Two. It was a simple recipe to make. Dinner was ready in less than an hour. The flavor was delicious and my 13 year old daughter took second helpings, a rare event in my house!

Fortunately, the recipe made enough servings to eat as leftovers for lunch! I love eating leftovers for lunch! This particular recipe fares well served as a leftover. The flavor is enhanced with time and the texture stands up well to "fridge time." I describe the flavor and method of making this recipe similar to a healthy version of Rice a Roni. Recipes like this prove that we don't need to rely on convenience items for a quick (and much more delicious) meal or side dish.

Koshari
Egyptian lentils and rice

1 1/4 c. basmati rice
1 1/4 c. French (green) lentils
2 large Spanish onions, thinly sliced
1/3 c. olive oil
1/2 tsp. red pepper flakes
3 cloves garlic, sliced
2 c. very fine vermicelli noodles, crumbled
Kosher salt to taste
1 1/2 c. fresh tomatoes, diced

1. Rinse rice. Cover with water in a bowl and let soak while preparing other ingredients.
2. Pick over and wash lentils. Cover with 2 1/2 c. water and cook until tender (I added additional water as they cooked. I didn't use a lid and some of the water evaporated. I suggest using a lid).
3. Heat olive oil in a pan being careful not to overheat it to avoid smoking. Add onions (I chopped my onions. I don't enjoy eating long strings of onions). When onions are transparent, add red pepper flakes (you may use less depending on your tolerance to spicy foods) and garlic. Continue cooking, stirring occasionally, until onions just begin to caramelize. Remove onions to a bowl using a slotted spoon.
4. Add crumbled noodles to the frying pan (I used very thin Japanese wheat noodles, but the recipe calls for fides or shehriah available in Greek or Arabic stores). Saute noodles in remaining oil until brown and crisp, stirring occasionally to prevent burning. Turn off heat and set aside.
5. When lentils are soft, add drained rice to the pot and continue cooking until rice is fluffy (make sure to cover with a lid). Add onions and noodles and turn off heat. Add salt to taste (I didn't add any salt as I used a 28 oz. can of organic diced tomatoes which were plenty salty).
6. Add tomatoes to the lentil/rice mixture. Serve hot or at room temperature.

For lunch, I microwaved a cup of sugar snap peas in a tablespoon of water for a minute and sprinkled them with a teaspoon of low sodium tamari (my new wonder seasoning--I use it instead of salt in many recipes).

I'm not positive that this is a 500-calorie lunch. I call it this in the title to show that it is OK and appropriate to eat this much for lunch. Base your lunch on healthy foods that are nutritious and satisfying. Of course, everyone's calorie needs are different. Don't short change yourself by eating too little and then overindulging on junk food later.

Bon Appetit!

My 500-Calorie Bowl of Cereal

I admit that I don't always eat breakfast immediately upon waking up in the morning and sometimes I wait until I've finished my early morning workout. I eat breakfast every day, but I'm often not hungry first thing in the morning. One or two hours after waking up, when hunger kicks in, I look forward to eating a healthy and satisfying breakfast.

With the release of the new Dietary Guidelines a week ago, I've been paying particular attention to the recommendation to make half of my plate fruits and vegetables. Dietitians have been recommending this for years. Half of all the foods that we eat in a day should be fruits and vegetables. Breakfast is a great place to eat a full serving (or two) of fruit. It's also a great place to eat whole grains and satisfy the Dietary Guideline to make half of our grains whole.

How do you pick a healthy breakfast cereal? I choose a whole grain cereal, either cooked or dry. The first ingredients listed on the package should say "whole" and the list should not be excessively long or contain unrecognizable ingredients. I also look at fiber and sugar. I don't always choose the highest fiber cereal because sometimes it comes with too much sugar. Currently, I'm eating Cascadian Farm Organic Multigrain Squares. Three-quarters of a cup has 2 grams of dietary fiber and 4 grams of sugar. I eat about one and a quarter cups which is 3 grams of fiber and 6 grams of sugar. The calories listed on a cereal box are the last thing that I look at. I find that many of the low calorie breakfast cereals are anemic; they don't provide much nutrition and can leave you hungry an hour later. I'd much rather eat a cereal with substance, and for a cereal to have substance, it must have some calories.

To my bowl of cereal, I add a hefty portion of fruit. I easily add more than a cup of fruit. I'm trying to fill half of the bowl with fruit. I add my own fruit rather than choose a cereal with fruit-like pieces that may or may not be real fruit. All this fruit provides me with a bounty of antioxidants, nutrients and fiber, and it fills me up. I top off my cereal with a scant quarter cup of nuts for added nutrients, fiber and protein and a full cup of milk (I prefer soy milk) for more protein.

My 500-calorie bowl of cereal sufficiently fuels my morning activities and meets my nutritional needs.  I'm not hungry again until lunch, at which time I'm ready for my 500-calorie leftovers!  

The Cost of Inactivity

To stay healthy throughout life, you've got to move it! 

Very few things in life are static, especially the human body. From birth through old age, the body is continually changing. It is important to realize that when we put off regular exercise, our bodies are not just frozen in time, they’re fading. Physical activity stimulates most organs to work at their best. We are made to move, and if we don’t, all body systems are affected, right down to the cellular level, where our ability to transfer oxygen for energy can be diminished. This is evident in a person's inability to run between airline gates to catch a connecting flight, or carry laundry baskets up and down the stairs. Inactivity impacts the brain, muscles, heart, blood vessels, bones, liver, gut, sleep, anxiety, depression, self-esteem, and the ability to use glucose (to name a few).




Diabetes

Insulin sensitivity deteriorates with inactivity. Type 2 diabetes is characterized by the body’s inability to utilize the insulin it produces. The cells of the body become insulin resistant. Insulin carries sugar from the blood into the cells of the body. Without the ability to do this, blood sugar levels rise and diabetes develops.



Type 2 diabetes is a sedentary disease, in that regular exercise reverses the damage. Insulin sensitivity increases with exercise and the cells of the body become better at taking in and processing glucose. The impact of activity on diabetes is striking. Every two hours of weekly TV watching is linked to a 14% increase in the risk of diabetes. Conversely, every hour of brisk walking per week confers a 34% lower risk of developing diabetes. That’s something to think about the next time you are too tired or busy to put on your athletic shoes.



The Heart

Exercise affects the heart in several ways. Not only does it strengthen the pump, but it also impacts the pipes. In recent years, researchers have discovered that physical activity makes the lining of blood vessels more flexible, from the largest artery to the smallest capillaries. This allows blood vessels to relax, permitting more blood to be sent to the heart. Think of it in terms of pumping blood through a rubber hose instead of a concrete pipe. This is particularly important if a vessel is partially blocked.



Regular exercise also increases HDL (good) cholesterol. This is the type of cholesterol that leaves the arteries instead of sticking to them. For those who already have heart disease, exercise can lower your risk of dying from it. Take that to heart!



Stroke

Active people are 25% less likely to have a stroke than sedentary folks.

Exercise affects the arteries to the brain in the same way as the heart. Most strokes occur when a blood clot gets stuck in a partially blocked artery leading to the brain. Hemorrhagic stroke occurs when a blood vessel in the brain bursts. High blood pressure is a risk factor for any type of stroke, and regular aerobic exercise lowers blood pressure in 75% of people.



Muscles

If you don’t use it, you lose it. The metabolic cost of maintaining muscle is high. Muscles require a lot of energy, so if you don’t use them, they become a luxury for the body to maintain. As we age, we become increasingly inactive and lose muscle mass. Anyone can rebuild muscle with strength training. The earlier you start, the better, but even those of advanced age can benefit from carefully pumping a little iron. Strong muscles can help to prevent the frailty that makes older people lose their independence. Regular exercise is one way to stay out of a nursing home.



Weight

Inactivity and weight gain go hand in hand. When you lose your muscle mass because of inactivity, you need less energy (calories) to maintain what is left. Due to inactivity, it becomes possible to gain weight with a modest calorie intake, and nearly impossible to lose weight. The rate of weight gain is slow, perhaps 1-5 pounds a year, but over 10 years the pounds add up and the loss of physical fitness is significant.



In order to avoid becoming overweight or obese, 45-60 minutes a day of physical activity is needed. If you’re already overweight or have lost a lot of weight, you need more – between 60-90 minutes of physical activity a day to avoid regaining weight. If this seems daunting, just 30 minutes of exercise a day is enough to reduce the risk of many chronic diseases without significant weight loss.



Bones

Bones are living tissue. Every day, minerals move in and out of our bones in response to the demands of daily living. If you stress bone, it responds. If you don’t, the balance between bone gain and loss shifts toward bone loss. Research shows that strength training preserves bone better that walking or running, and can increase bone density. The amount that a bone is stressed, or overloaded, determines whether bone formation is stimulated. A small number of repetitions (8-15) with a heavy load can do the trick.



Regular physical activity has also been shown to prevent certain types of cancer, depression, dementia, and improve immunity. If exercise were a pill, it would be called a wonder drug.



To reduce health risks associated with inactivity, at least 30 minutes of moderate-intensity aerobic exercise five days a week or 20 minutes of vigorous aerobic exercise three days a week are required. To maintain lost weight, 60-90 minutes a day of exercise is needed. To build muscle and prevent bone loss, strength train at least twice a week with a weight heavy enough to lift eight to fifteen times.



The good news is that it is never too late to start moving. People well into their 90s can benefit from regular exercise. And if you’ve been moving all along, you can reach your 90s with vitality and independence. The only “magic bullet” out there that I know of is physical activity. So commit yourself to exercise. Schedule it in your date book. As a well known athletic company says, “Just do it!”

Small Changes for a Healthy New Year

Start with small achievable goals

Another year has begun. It’s a good time to start a diet and exercise program, many of us think. We have to be ready to do more than think. Like getting married or starting a family, there is no perfect time to begin a health regimen. What’s most important is to have the resolve to make small changes in your lifestyle that will be far-reaching over the long run, and to stay the course. Change too many undesirable habits at once, and you could end up abandoning your efforts altogether.


The changes that you make must have significant value to you. It is not enough to just want to lose weight, exercise more or eat healthier. There needs to be some type of internal motivation that drives you to achieve these goals. Take the time and explore why it is important for you to make these changes, and then start making (and mastering) one small change at a time.  The following is a list of lifestyle changes that current research has shown will benefit your health, from promoting weight loss to decreasing the risk of cancer. Some you may already do; others you may need to work on. Take it one small step at a time.

Eat Breakfast. It’s the best way to control your weight. Start the morning with whole grain cereal. Breakfast is a great place to get fiber in your diet. Look for cereals where the first ingredient listed on the label is a whole grain, like oatmeal or whole wheat. Add berries or other fruit and a full cup of low fat milk.

Exercise. Give up the excuses; you have to do it to stay healthy. Sixty to ninety minutes of daily exercise is recommended to promote weight loss and maintenance. If you can’t meet these recommendations don’t be discouraged, any movement helps.

Eat Low Fat Dairy. The jury is still out on whether low fat dairy can promote weight loss, but dairy is important for other reasons. The calcium that it provides can stave off osteoporosis and has been linked to improving blood pressure. Recent studies have shown that men who consume low fat dairy regularly have a reduced risk for developing type 2 diabetes and gout. Women that get plenty of calcium and vitamin D may have a reduced likelihood of developing PMS. Get 2 to 3 servings daily of milk, yogurt or low fat cheese.

Add Vitamin D. It promotes the absorption of calcium and is very important for bone health. It may also improve muscle strength, reducing the risk of crippling falls in the elderly. Vitamin D has also been shown to reduce the risk of developing the most aggressive form of prostate cancer. It may be difficult to get enough vitamin D from your diet. If you live in the northern half of the country, your skin isn’t making any vitamin D from October through March. Vitamin D supplementation is recommended for most people, but the amount of supplementation is still being debated. Supplementing with 1,000 to 2,000 IUs of vitamin D daily is considered safe, however some people may require more. The rest of the year, expose some skin (arms and legs) without sunscreen to the sun for 20 to 30 minutes. People with darker skin may require up to six times more sun exposure.

Eat More Fruits and Vegetables. The evidence is mounting, if you don’t eat enough of it, you’re at a health disadvantage. From arthritis to weight loss, fruits and vegetables have been shown to improve health. No wonder the dietary guidelines increased the daily servings. Eat the rainbow. Five to thirteen daily servings are recommended.

Eat More Dark Leafy Greens. Some vegetables are better than others. This is where Popeye was right. Spinach and other colorful greens may help prevent cataracts, stroke, and the cognitive decline associated with aging (and possibly even Alzheimer’s disease). This is one of the biggest changes that most people need to make in their diets.

Choose Healthy Fats. Switch from saturated animal fats and trans fats to monounsaturated and polyunsaturated vegetable oils. All fats have about 120 calories per tablespoon, so don’t add vegetable oil, but replace unhealthy fats with it. Olive oil is good, but so is canola oil. Minimize fats from dairy and meats by choosing lower fat varieties.

Eat More Fish. It’s the easiest way to get those omega-3 fats that are so good for us. Plan a fish meal twice a week (yes, tuna fish sandwiches count, but fried fish is a no-no). Omega-3 fats are good for your heart, immune function, and your brain (those who eat fish twice a week show less mental impairment with age). They have also been shown to fight inflammation, which benefits your joints too.

Hydrate. The first thing you should do in the morning and the last thing you should do before bed are to drink 1-2 cups of water. Sip water all day long and eat foods with high water content such as cucumbers, lettuce, tomatoes, soup, apples, and oranges (you get the picture). Being well hydrated will also help you look your best.

Get An Extra Hour of Sleep Each Night. Sleep is when your body repairs the physiological damage done each day. Most of us burn the candle at both ends and then trudge through the day feeling like a zombie, going from one cup of coffee to the next. A good night’s rest will help us look and feel our best and can help our weight loss efforts too.

During the next few weeks, I will discuss each of these recommendations in more detail. I will provide more practical tips and recipes that can help you make 2011 an incredibly healthy year!