Living with Interstitial Cystitis: How Diet Can Help



Personalized diet changes may help relieve symptoms of IC

 This is a guest post written by Janelle Schleicher.

What is interstitial cystitis?

Interstitial Cystitis (IC), or painful bladder syndrome (PBS) as it has been referred to, is a condition of unknown cause that presents with chronic inflammation of the bladder, possible bleeding, and occasional, but not as common, ulcers on the bladder wall. IC is characterized by recurring pain in the bladder and surrounding pelvic region. It also may result in frequent urination and/or a strong feeling of the need to urinate (1). To put it simply, IC feels like having a urinary tract infection, but is it chronic, meaning it does not go away! IC is a relatively common diagnosis affecting approximately 3-8 million women and 1-4 million men in the United States. It most commonly affects women in their forties, but men and children have also been diagnosed (2).

Symptoms vary from case to case and may include:

- Mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area

- Urgent need to urinate

- Frequent need to urinate

- Pain during vaginal intercourse

- Increased pain during menstruation (1)

How is IC diagnosed?

There is no definitive test used to diagnosis IC because IC has an unknown cause and symptoms are similar to a number of other conditions. Therefore, a diagnosis is usually determined through two criteria

1. The presence of pain related to the bladder, usually accompanied by the urgent and frequent need to urinate

2. Ruling out other conditions, such as urinary tract infections, bladder cancer, and endometriosis (1)

How Does Diet Affect IC?

As with the symptoms of IC, foods may affect each individual with IC differently. There are no specific foods or food groups that cause IC, however dietary intake has been shown to affect symptoms. Foods that affect a patient’s symptoms are often referred to as trigger foods, and each trigger food may impact symptoms differently (2).

Important Tip: Citrus and Acidic Foods

Many people suffering from interstitial cystitis find that acidic foods such as oranges and tomato products may worsen symptoms. It is important to note that just because one acidic food may be a trigger food for an individual; this does not mean that all acidic foods will be (4)! So what does that mean? In the elimination diet, discussed in the next section, it is important to introduce each acidic food back separately to identify which specific foods cause symptoms.

The IC Diet

The majority of individuals suffering from IC find that certain foods and beverages affect their symptoms. With input from patients suffering from IC first hand as well as experts in IC research, the IC diet was developed and the IC Food List was compiled (2). The IC diet is a three-column system divided into the following categories:

1. Bladder friendly foods: foods that rarely bother IC patients

2. Try it foods: foods that are generally well tolerated but may bother sensitive IC bladders

3. Caution foods: food that commonly cause bladder discomfort (3)

Click here to access the IC Diet Foods List!

How can you use the IC diet?

The first step is to eliminate all foods from your diet except for bladder friendly foods (3). The idea of eliminating foods may seem scary and overwhelming at first, but it really is the best way to identify trigger foods and the three-column list is a great tool to help you on your journey!

Once your symptoms have improved (this may take a few weeks, just keep at it!), it is time to begin testing for trigger foods by adding back foods from the “Try it” list (3).

The rules for testing foods:

1. Test one food at a time

2. Try a small portion of the food the first time (such as half of a piece of fruit)

3. If the small portion does not trigger symptoms, try a larger portion the next time

4. If symptoms are still not triggered, multiple portions of the food can be consumed the third day

5. If symptoms still do not increase, the food can be added back in and not considered a trigger food!

6. If symptoms are triggered while testing a food, return to bladder friendly foods until you experience relief (3)

References:

1. (2011, September 27). Interstitial cystitis/painful bladder syndrome. U.s. department of health and human services. Retrieved from http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/

2. Beyer, J.A. (2010). Interstitial cystitis: A guide for nutrition educators. Auburn Hills, MI: NutraConsults, LLC.

3. Beyer, Julie. The IC diet food list and elimination diet (2012, August 11). Retrieved from: < http://www.ic-diet.com/IC%20Diet%20and%20Food%20List.html>

4. Friedlander, J. I., Shorter, B. and Moldwin, R. M. (2012), Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU International, 109: 1584–1591. doi: 10.1111/j.1464-410X.2011.10860.x

Janelle Schleicher is a senior Nutrition Management major at Rochester Institute of Technology. She is excited to take her next step towards becoming a Registered Dietitian and will begin her Dietetic Internship at the University of Maryland Medical Center in Baltimore, Maryland in September. Janelle has a love for any form of exercise (especially when it is outdoors!), food, coffee, reading, and her incredibly supportive family. She hopes to gain as much experience as possible in the field of nutrition in the next few years and ultimately open a private practice specializing in disordered eating and/or sports nutrition.

Finding Relief from Irritable Bowel Syndrome: Say Hello to FODMAPs!

A dietary approach to help manage IBS shows great promise 

This is a guest blog post.


Irritable bowel syndrome (IBS) is defined as disorder that consists of abdominal pain, cramps, bloating, changes in bowel movements, and other symptoms (1). Unlike inflammatory bowel diseases, such as Crohn’s disease, IBS does not result from abnormal structure of the bowels (1). The actual causes of IBS remain unclear, however a possible trigger may be an infection of the intestines, called post-infectious IBS (1). One theory is that sufferers of IBS may have a particularly sensitive colon that is reactive to certain foods and stress, and that the immune system may also be involved (2). IBS can occur at any age, but usually begins in the teens or early adulthood, and is twice as common in women as in men (1). It is said that one in six people in the U.S. experience symptoms of IBS, and it is the most common intestinal problem for patients who are referred to a gastroenterologist (1). Because this disorder causes patients to experience discomfort when eating certain foods, it can eventually breed anxiety from constant worry of what effects these foods will have on their symptoms.


Symptoms

The major symptoms of IBS include abdominal pain, bloating, gas, and fullness. Symptoms may last three days a month for at least three months . These symptoms range from mild to severe, depending on the patient (1).

People with IBS may also switch between constipation (difficulty with bowel movements), or diarrhea (loose or watery stool) (2). Some may only have constipation, while others may only experience diarrhea (1). People sometimes find that their symptoms may subside for a few months and then return, while others have worsening symptoms over time (2).


The FODMAPs Diet

While there is no treatment for IBS, patients can learn to maintain their symptoms by following specific dietary guidelines, including those presented in the FODMAPs diet. FODMAP stands for Fermentable, Oglio-, Di-, and Mono-saccharides, and Polyols (3). The theory behind the FODMAPs diet is that consumption of these carbohydrates increases the volume of liquid and gas in the small and large intestines, leading to bloating and abdominal pain (3). Therefore, it is proposed that a diet low in FODMAPs should decrease these symptoms. FODMAPs include lactose, fructose, fructans, galactans, and sugar alcohols, which are found in many common foods, including:



• Animal dairy products, such as cow’s and goat’s milk, cheese, and yogurt.

• Fruits, particularly apples, pears, watermelon, mangoes, dried fruit, and fruit juices (3).

• Legumes, including chickpeas, lentils, black-eyed peas, broccoli, and soy products (4).

• Wheat products, including wheat and rye breads, cereals, and granola bars containing wheat.

• Sugar-free gums, mints, lozenges, and medications (4).

• Ketchup, barbeque sauce, honey, agave nectar, and other condiments and artificial sweeteners (4).

• Sugary drinks, like soda, and alcohol (4).


While the FODMAPs diet might call for avoiding many foods, there are still foods that are allowed. These include:



• Lactose-free milk (including rice milk and almond milk), cottage cheese, ice cream and sorbet; cheddar, Swiss, Parmesan, and mozzarella cheeses (4).

• Fruits such as bananas, berries, honeydew melon, oranges, kiwi, grapefruit, grapes, and passionfruit (4).

• All-natural sweeteners, including sugar and natural maple syrup (4).

• Vegetables, including bell peppers, carrots, butter lettuce, celery, corn, eggplant, bok choy, tomatoes, potatoes, and spinach (4).

• Gluten-free breads and cereals, oats, rice and corn pasta, corn tortillas, rice cakes, and potato and tortilla chips (one should check labels on these products for any sweeteners or additives, such as honey or agave nectar) (3, 4).


These guidelines may vary among IBS patients. Some may be able to tolerate some foods that are prohibited by the FODMAPs diet, while others might be able to consume several without having any major discomfort.


Other dietary recommendations for those with IBS include drinking at least six to eight glasses of water per day, especially if they suffer from diarrhea (2). It is also recommended that patients do not consume large meals, as this can cause cramps and bloating (2). Instead, patients may be advised to eat smaller meals throughout the day, or smaller portions (2). Increasing fiber in the diet can also help by reducing constipation (1).


Other Relief Methods for IBS

Along with dietary changes, other methods to relieve symptoms of IBS include:



Prescribed medications

• Laxatives to relieve any constipation, or medicines to decrease diarrhea, such as diphenoxylate and atropine (Lomotil) or loperamide (Imodium) (2).

• Antispasmodic, which helps control colon muscle spasms and reduce abdominal pain (2).

• Antidepressants



Stress reduction activities

• Meditation

• Regular exercise, such as walking.

• Counseling and support

• Adequate sleep.



Resources:



1. Irritable bowel syndrome: Spastic colon; Irritable colon; Mucous colitis; Spastic colitis (Last reviewed: July 22, 2011). Retrieved May 27, 2012 from PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292/



2. Irritable bowel syndrome (September 2007). Retrieved May 27, 2012 from National Digestive Diseases Information Clearinghouse (NDDIC): http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#symptoms



3. Bradley Bolen, Barbara. Foods on the FODMAP Diet: High FODMAP Foods and Low FODMAP Foods (Updated March 16, 2012). Retrieved May 27, 2012 from About.com: http://ibs.about.com/od/ibsfood/a/The-FODMAP-Diet.htm



4. Scarlata, Kate. The FODMAPs Approach- Minimize Consumption of Fermentable Carbs to Manage Functional Gut Disorder Symptoms. Today’s Dietitian. Vol. 12 No. 8 Page 30. May 16, 2012.



About the Author:

Lauren Wisnowski is a senior Wellness Management major at SUNY Oswego and is from Rochester, NY. Having a vested interest in nutrition and wellness, she aspires to become a registered dietitian in the future. She enjoys exercising, especially running, as well as reading, writing, and spending time with her friends and family. Her hobbies also include quoting movie lines and watching Nickelodeon re-runs from the '90s.

Should You Be Concerned About Barrett's Esophagus?

Barrett’s Esophagus is a condition where the lining of the esophagus is damaged by stomach acid and is replaced by tissue similar to that which is found in the stomach. The exact cause of Barrett’s Esophagus is unknown, but it is commonly seen in people with gastroesophageal reflux disease, or GERD. Reflux occurs when the contents of the stomach rises into the esophagus, which may cause heartburn or indigestion. Occasional reflux is common, but for those who experience this sensation more than twice a week, a diagnosis of GERD is made. Within this population, Barrett’s Esophagus affects about 1% of Americans, or about 700,000 adults (1), and it may progress into esophageal adenocarcinoma, a deadly form of cancer of the esophagus. Barrett’s Esophagus does not cause any signs or symptoms, so it is important for individuals suffering from chronic reflux (GERD) to visit their doctor for an endoscopy and biopsy of the esophageal tissue regularly. Although cancer diagnosis is rare, most diagnoses are made late stage when treatment is ineffective. Early detection of precancerous cells (dysplasia) may prevent the development of esophageal cancer (2).

Risk Factors

Individuals with the following characteristics are at higher risk for developing Barrett’s Esophagus:

• Diagnosed with GERD, or experiencing constant reflux

• Heavy alcohol and tobacco use

• Older age

• Being male

• Being Caucasian

• Obesity

• Consuming a poor diet (3, 4).

Research

A study published in the American Journal of Gastroenterology found that diets high in antioxidants such as Vitamin C, E, and beta-carotene are related with a reduced risk for Barrett’s Esophagus. Consuming a diet high in fruits and vegetables, versus the typical Western Diet of processed foods, showed the greatest reduction in risk. It is important to note that similar results were not found in individuals who took supplements. It is theorized that there are other compounds in whole fruits and vegetables with beneficial, anti-cancer properties. Parallel findings were also discovered in a study completed by the National Institute of Health; Individuals consuming low amounts of raw fruits and vegetables were associated with a greater risk of developing cancer associated with Barrett’s Esophagus (5, 6).

Prevention and Recommendations

An effort to minimize acid reflux may reduce the risk of progression to Barrett’s Esophagus. The following is a list of various lifestyle changes that can be made to decrease this likelihood:


Smoking Cessation

• Smoking is strongly associated with cancer of the esophagus and can contribute to the esophageal cancer related to Barrett’s Esophagus.


Drink in Moderation

• Alcohol relaxes the mechanism that prevents stomach contents from entering the esophagus.


Sleeping Habits

• Avoid lying down three hours following meals.

• Sleep with your head elevated to prevent acid from rising into the esophagus.


Weight Loss

• Loosing weight improves GERD symptoms, as well as reduces the risk for both Barrett’s Esophagus and the development of cancer.


Dietary Changes

• Eat a low-fat diet, as high fat meals take longer to digest thereby increasing the risk for acid to rise.

• Consume small, frequent meals.

• Increase daily intake of raw fruits and vegetables, especially those high in antioxidants.

• Reduce caffeine intake to 2 – 3 cups per day. Caffeine, similar to alcohol, relaxes the mechanism in the esophagus that prevents acid to rise.

• Foods such as chocolate, spicy foods, and peppermint have also been show to aggravate reflux and should be avoided as necessary (1, 7, 8).



Resources:
1. Dunbar, K. (2009, April 21). Barrett's Esophagus. Retrieved March 30, 2012, from John Hopkin's Pathology: http://apps.pathology.jhu.edu/blogs/barretts/?p=48

2. Locke, G., & Rich, J. (2008, July 1). Barrett's Esophagus. Retrieved March 30, 2012, from National Institute of Digestive Diseases Information Clearlinghouse: http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/

3. National Cancer Institute. (2011, December 23). Esophageal Cancer Treatment. Retrieved March 30, 2013, from National Cancer Institute at the National Institute of Health: http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/Patient

4. The Cleveland Clinic Foundation. (2009). Barrett's Esophagus. Retrieved March 30, 2012, from Cleveland Clinic: http://my.clevelandclinic.org/disorders/barretts_esophagus/hic_barrett%27s_esophagus.aspx

5. Tufts University. (2008). Antioxidants from Produce May Protect Esophagus. Tufts University. Boston, MA: Tufts University Health and Nutrition Newsletter.

6. Brown, L., Swanson, C., Gridley, G., Swanson, G., Shoenberg, J., Greenberg, R., et al. (1994). Adenocarcinoma of the Esophagus: Role of Obesity and Diet. Journal of the National Cancer Institute , 87 (2), 104-109.

7. Clark, G., Smyrk, T., Mirvish, S., Anselmino, M., Yamashita, Y., Hinder, R., et al. (1993). Effect of Gastroduodenal Juice and Dietary Fat on the Development of Barrett's Esophagus and Esophageal Neoplasia. 1 (3), 252-261.

8. Academy of Nutrition and Dietetics. (2012). Nutrition Therapy for Gastroesophageal Reflux Disease. Nutrition Care Manual . Chicago, IL.

About the Author

Stephanie Wilson is a senior nutrition major at Rochester Institute of Technology.  This May she will graduate from RIT and begin her Dietetic Internship at California Polytechnic in San Luis Obsipo.  Stephanie proudly describes herself as a marathoner, foodie, musician, and blogger at OntheRoadtoRD.com.  She hopes to one day follow in Carol’s footsteps and become a private practice dietitian and share her love of both nutrition and exercise with the public!
  

Childhood Obesity: A Call to Action

Show your children the value of eating healthy foods 

Our children are at risk. Most parents identify drugs, alcohol, sex and violence as threats to the well-being of their children. In truth, childhood obesity will have a greater negative impact on more children than any of the concerns listed above. The most recent data from the National Health and Examination Survey (NHANES) collected in 2007-2008 shows a marked increase in the prevalence of obesity from 1976-1980 in all age groups.

Prevalence of Obesity in US Children and Adolescents

   Age                    1976-1980                  2007-2008

2-5 years               5.0%                            10.4%

6-11 years             6.5%                            19.6%

12-19 years           5.0%                            18.1%

Nearly one third of children in the US are either overweight or obese and they are at risk for future health problems.

Overweight and obese children are the targets of many health and social problems. They are often exposed to early social discrimination, which can lead to low self-esteem. This in turn can hamper their academic and social functioning into adulthood. They are also at increased risk for cardiovascular disease due to high cholesterol levels, high blood pressure and abnormal blood sugar levels. Additional health risks include asthma, fatty degeneration of the liver caused by a high concentration of liver enzymes, sleep apnea, and type 2 diabetes.

The causes of childhood overweight and obesity are many. Childhood obesity was aptly described by Dr. Hilde Bruch, a pioneer in the field over seventy years ago. She said, "To understand the obese child, one needs to remember that he (she) accumulated his (her) extra weight while living in a family that, wittingly or unwittingly, encouraged overeating and inactivity." The current culture of America encourages overeating and inactivity, and one must swim against the current to avoid these habits.

The solution is straightforward, but difficult to adopt for many families who are stressed for time. Calories must be balanced with eating healthy foods and engaging in daily activities. When looking for solutions to keep your kids healthy, look not further than your pantry and your own backyard.

Encourage Healthy Eating Habits

• Provide plenty of vegetables, fruits and whole grain foods.
• Offer protein from beans, lentils, nuts, fish, poultry and lean meats.
• Include some low-fat or non-fat dairy products.
• Offer smaller portion sizes.
• Limit sugar-sweetened beverages. One 12 ounce can of soda contains ten teaspoons of sugar.
• Encourage your family to drink lots of water.
• Limit consumption of sugar and saturated fat.
• Cook healthier meals at home and eat out less.
• Avoid calorie-rich temptations. An occasional treat is acceptable, but it should not be a daily occurrence.

Help Kids Stay Active

• Children should participate in at least 60 minutes of moderate intensity physical activity every day. Examples are taking a brisk walk, playing tag, jumping rope, playing soccer, swimming and dancing.
• Have children join you in your physical activity routine.
• Limit television, video games, and surfing on the web to no more than two hours a day. Children younger than 2 years should not view television at all.
• Do not allow your child to have a television or computer in their bedroom.

With attention, support, and hard work, our children can lose and maintain healthier weights.

Snack Attack: The Art of Healthy Snacking

It’s 3 pm and your stomach is grumbling. You decide to eat an apple but the cookies a coworker brought to work are looking mighty good. You eat the apple hoping that the cookies will leave your mind; an hour later they are still there and you eat six. So much for good intentions.

Snacking behavior can make or break a healthy eating plan. Most people go wrong with snacking by leaving it up to impulse. Meals are planned, but what people snack on is left up to whim. The myriad of unhealthy snack foods available in the supermarket doesn’t help impulse control either.

The first defense in taming the inner snack beast is to eat a healthy breakfast. A study of obese people trying to lose weight showed that those who regularly ate breakfast lost more weight than those who skipped the morning meal. Those who skipped breakfast ate more calorie-dense foods later in the day. Breakfast should be more substantial than just a cup of yogurt and coffee. An egg on whole wheat toast with lean ham and cheese, an orange and tea will fit the bill. In a hurry, grab an oat English muffin smeared with peanut butter and a banana and pick up your Starbuck’s coffee on the way to the office (hold the café mocha).

Another important guideline is to avoid eating when not hungry. This may seem like common sense, but snacking clearly plays a role in obesity. Almost a quarter of the American population is obese and obesity related diseases account for over 300,000 deaths per year. Eating because of boredom, anxiety, anger or because food just looks good will lead to weight gain in the end.

Eating smaller, more frequent meals that incorporate healthy snacks has been shown to reduce overall stomach capacity. Over time, one feels more satisfied with less food. It is believed that this is the reason why people who “graze” tend to be leaner.

In general, snacks should contain from 200-300 calories. Consider that an apple has approximately 60-100 calories; it is no wonder that an apple alone may not satisfy hunger. Spread a little peanut butter on your apple or dip it yogurt and your hunger is more likely to be quelled. Protein contained in peanut butter and yogurt increases the feeling of fullness and prevents hunger from coming back too quickly.

Keep in mind that all healthy diets allow favorite foods and treats. Snacking on cookies may not seem like a good idea when trying to lose weight, but allowing a treat at some point in the day may keep one from losing their fortitude.

Snacking Basics

1. Don’t eat if you are not hungry.

2. Don’t skip breakfast.

3. Eat smaller, more frequent meals.

4. Plan your snacks and choose the right foods (whole grains, fruits, vegetables, nonfat dairy, lean protein).

5. Think out of the bag! Avoid foods marketed and sold as snack foods as they tend to be high in refined carbohydrates, sodium and fat and low in fiber.

Snack Ideas

There are any number of good snack ideas out there. Choose foods that you like and find satisfying. Eat enough food to abate your hunger, but not so much to tip the scale.

1. ½ sandwich (peanut butter, lean meat, veggies) on whole grain bread with milk.

2. Nuts. Limit to approximately ¼ cup per day.

3. 3-4 fig cookies with milk (look for whole wheat variety in the organic food section of grocery store).

4. ¼ cup granola with 6 oz. low fat yogurt.

5. Sliced fresh fruit with yogurt.

6. Sliced fresh fruit with cheese.

7. Apple or banana with peanut butter.

8. Bowl of whole grain cereal with low fat milk.

9. Oatmeal cookies with low fat milk.

Keep in mind that every time you eat, you have an opportunity to do something good for your body, mind, and soul.

What kinds of healthy snack do you find satisfying?

Nutritional Beauty

A healthy diet can make you beautiful inside and out

A growing consumer trend is to eat well for naturally glowing skin, strong shiny hair, and inner holistic radiance. We clearly are what we eat, and this mantra applies to more than just health.




Nutritional products have long been used topically to promote beauty. Honey masks, olive oil hair conditioning, and oatmeal baths can trace their roots back to ancient times. Retinol, a vitamin A derivative, and alpha-hydroxy have been shown to improve sun-damage or wrinkles when applied to the skin. Many cosmetics contain antioxidant vitamins, minerals, and plant chemicals. Most recently vitamin K has been discovered to lighten dark circles under the eyes.



The idea of promoting beauty can also be applied from the inside out. A top nutrient in this category is water. Without proper hydration, skin can seem dull and less supple. Antioxidant vitamins C and E, beta-carotene, and essential fatty acids are next in line. Antioxidants neutralize compounds that damage the body including skin. It is no lie that eating your fruits and vegetables can make you more beautiful. A recent study looking at the amount of vitamin C women consumed in their diet showed that those who ate the least amount of vitamin C from food had the most wrinkled appearance. Vitamin C is important for the synthesis of collagen, a protein that helps maintain skin elasticity. Fruits and vegetables are the main source of vitamin C. Another recent study showed that eating more carotenoid containing fruits and vegetables gave the skin a tanned hue when compared with study participants who did not eat the carotenoid containing foods. Carotenoids are the yellow to deep red pigments found in foods. You may say that eating fruits and vegetables provides skin a healthy glow.



The next big beauty secret believed by some estheticians is controlling inflammation from the inside out; not just reacting to a skin problem. Barry Sears, PhD president and founder of Zone Labs, Inc., contends that “inflammation links to all chronic disease, skin degeneration, and the aging process. To stop inflammation, balance protein and carbohydrate ratio at each meal.” Omega-3 fatty acids found in cold water fish such as salmon, walnuts, flax and chia seed exhibit anti-inflammatory properties. An increased intake of linoleic acid, and omega-6 fatty acid found in nuts, whole grains, most vegetable oils, eggs and poultry, is also associated with more youthful looking skin in research studies. Conversely, high intakes of saturated fat and refined carbohydrates abundant in the typical American diet are associated with a more wrinkled appearance.



Companies looking to capitalize on this trend are introducing products containing antioxidants, omega-3 fatty acids and phytochemicals. Will they make you more beautiful? Perhaps, if you already eat in a healthful manner, but drinking a special concoction won’t help if you are eating doughnuts for breakfast, sub sandwiches for lunch and pizza for dinner. And if you smoke, all bets are off. The aging effect of smoking undoes any good that a healthy diet or special supplement provides. Research shows that what matters more than eating a particular food or nutrient to prevent aging is to follow an overall healthy diet. People eat foods in combinations, not one at a time. It is the interplay of nutrients together that seems to provide the greatest anti-aging benefit. Here’s one more reason to eat your fruits, vegetables, whole grains, nuts and seeds. They can make you look marvelous.

“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.

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!

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!

Why You Should Pack Vegetables in Your Kid's Lunch



Don't forget the vegetables!

 Many parents tell me that they do not pack vegetables in their children's lunches. My mother never packed vegetables in my lunch. I can't say that I would have eaten them had she packed them, but I enjoyed snacking on vegetables at home as a kid. When you think about what is served for lunch in restaurants, typically vegetables are absent. It is common to see sandwiches and fries or chips with a small fruit or kale garnish. When I eat lunch with my daughter at school, I notice that children who bring their lunches often have sandwiches, juice pouches, pretzels or some sort of crunchy snack food, and maybe some fruit or a cookie. Vegetables are MIA. Perhaps we're not used to eating vegetables at lunch daily so we don't put them in our kid's lunches. Perhaps we're concerned that our kids won't eat them.

As parents, we teach our kids many things. One very important thing that we teach them is what they should eat to gain the energy and vitality to become contributing members of society. Kids push back against our recommendations. That is the nature of being a kid. Does that mean that we stop making recommendations?

When it comes to packing vegetables in our kid's lunches, why do we hesitate? Is it so bad if our kids throw away a snack bag of vegetables? The lesson that you teach by offering vegetables at lunch is that they should eat them. I think this lesson is more important than a little bit of food waste (believe me, kids throw away more than their vegetables). This is part of the learning process. What is the worst thing that could happen by not offering your children vegetables at lunch? They could grow up not eating vegetables regularly, choosing instead a diet filled with processed foods which can cause them to suffer from one or more of the many chronic diseases associated with diet.

Here's how you can encourage your kids to eat more vegetables by packing them in their lunches:

1. Discuss with your children the types of vegetables that they enjoy eating. Choose those vegetables to pack in their lunches.

2. Offer variety. Even a favorite vegetable can get old if eaten every day. Try cauliflower, cucumber, cherry tomatoes, baby-cut carrots, bell peppers, broccoli, green beans, mushrooms, zucchini, radishes or sugar snap peas. All of these vegetables are good raw. Many kids seem to prefer raw vegetables over cooked vegetables.

3. Offer a little bit of dip to make eating vegetables more enjoyable. Use a mini container and fill it with a small amount of ranch dressing, hummus, tzatziki, or other dip.

4. Start young. By the time your kids are ready to go to school, they are old enough to be eating vegetables daily at lunch.

5. Start small. Begin by offering a small snack bag of vegetables. Hopefully by the time your kids reach high school, they'll be eating a larger sandwich bag filled with vegetables.

6. Talk with your kids at home about what they ate for lunch. Ask them if they ate their vegetables. If they say no, gently encourage them to eat their vegetables (there are lots of good reasons for your kids to eat vegetables, an important reason is that you love them and want them to thrive).

7. Never give up. By offering vegetables to your children at lunch you are setting an example about what they are supposed to eat.

I have my own challenges in getting my children to eat their vegetables. My 13 year old daughter has been sick too much already this school year and I point out to her that she skimps on much of the healthy foods that I serve her. I'll keep trying because it is that important.

The Enigma of Blood Sugar Control

My son has type 1 diabetes. I've blogged about our struggles with this disease before. My son would love for me avoid sharing our personal experiences with respect to him, but I'm on a mission to better understand how diabetes is controlled and to help other diabetics in the process.

To me, the expression "blood sugar control" seems like an oxymoron. It is elusive at times and often we are left scratching our heads as to why our son's blood sugar becomes high or low (even though I'm a dietitian and my husband is a physician). Diabetics, especially teenagers, can take these values personally and may feel like they have failed in managing their health. There are so many factors that affect blood sugar. Understanding why blood sugar becomes high or low is very complicated. Lately, I feel like we've been chasing our tails and I need to know more about diabetes to help my son understand more and manage his disease without excessive emotion.

As I educate myself, the nuiances of blood sugar control are becoming more apparent. I have decided to post a "pearl of wisdom" on my Facebook page daily to reinforce the concepts that I am learning and to share that knowledge with other diabetics or those responsible for caring for a person with diabetes. I invite your comments, experiences, and knowledge on this topic here on my blog as well as on Facebook and Twitter. I'm hoping to impact hundreds of people and create an online comminuty of diabetics sharing their experiences and wisdom. Please pass this on to your diabetic family, friends, and coworkers. To your Health!

Kids in the Kitchen

My daughter enjoyed cooking at a young age

My youngest daughter turned seven at the end of September. One of her birthday presents was a "real" cooking kit with kid-sized cooking utensils. She has been asking me to cook with her since she got it. My response to cooking with my kids is mixed. As a dietitian, I'm thrilled that they have an interest in preparing food. I see a great opportunity to teach them about the healthy foods that we all need to eat more often. As a mother, I'm hesitant to cook with them. I'm so tired of cleaning up messes all the time and the surest way to a messy kitchen is to have your kids cook. I have come to realize that the kitchen is my area of control. Unless I'm cooking with a clone, I prefer to cook alone. Despite my need to feed and nurture with food, I'm not the most nurturing person the kitchen. I watch commercials of parents cooking with their kids and wonder why I'm not as happy as those parents seem when I am cooking with my kids.

Being aware of my flaw, I have been trying to overcome it and have been pleasantly surprised at how helpful my kids can actually be in the kitchen (hold on a minute while I adjust my blinders)! My two older children each had to plan and prepare a meal for a seventh grade class. I was impressed at how conscientious they were to choose a healthy menu and how much pride they had in executing the whole meal themselves. Of course, they came to me for guidance, but they did all the chopping, cooking, and cleaning. What a great school project! I now find myself focusing on the "teaching moments" that I have with my kids in the kitchen. Put the caps back on containers and put them away when you are finished using them. Don't lick your fingers, but if you do, you must wash them (we wash our hands a lot in my kitchen). Completely disassemble the blender when you are washing it, including the rubber seals. By focusing on what I can teach my children as we cook I am creating my kitchen clones, but I'm also teaching them about food safety, healthy eating and how to be more efficient while cooking.

I've had a few food-related surprises with my kids recently. This past Thanksgiving weekend, my seven year old daughter took an active part in preparing one of the many meals that my family serves during this time. She helped her grandma prepare for a dinner party and was there every step of the way from grocery shopping, cooking and setting the table. She even served herself Brussels sprouts at the meal and ate them all! My middle child and oldest daughter has gotten in the habit of making me and my husband breakfast. We are often awakened on a Saturday or Sunday morning to the smell of brewing coffee. This past month she didn't even ask us to take her to the mall later that day! Finally, my son, who is the first born, completely surprised me when he told me that he was joining the cooking club in high school. I can't tell you how proud I am of that, especially when he mentioned that many of his friends don't see the value of cooking when you can get prepared foods on any street corner. These are my sweet rewards for allowing my kids to make a mess in our kitchen! The mess is such a small thing compared to the lifelong skills you teach your children by allowing them to cook. I'd love to hear your stories about cooking with your kids. Perhaps some of them have gone on to become chefs, teachers or scientists. The skills learned from cooking can be used in many ways.

5 Healthy Tips for Your Best Holiday Season Yet!

Keep your healthy habits through the holidays

'Tis the season for overeating and inactivity, but it doesn't have to be. You've worked hard all year to change unhealthy habits and now it's time to run the gauntlet of holiday parties and coworkers bringing cookies and treats to work. If you can make it through the holidays unscathed while practicing your healthy habits, you are truly a new person. Here are five tips to keep you focused on having a happy and healthy holiday season.

1. Be positive. Positive emotion is necessary for behavior change. To flourish, we should exhibit three positive emotions for every negative emotion. Flourishing is like navigating a sail boat. Negative emotion is your rudder and positive emotion is the sail that soars high into the air. Your sail should be three times as high as your rudder to keep you on course. Of course, you need both a sail and a rudder to navigate. The trick is to have enough positive emotion to balance the negative. We typically focus too much on negative feelings, so lighten up and be positive. You can track your emotions at positivityratio.com. Emotions change daily, so track yours often. It might help you focus a little more on the positive aspects of your life.

2. Catch up on your ZZZ's. During the holidays, most people overstuff their days and weekends with activity and short change sleep. Adequate sleep is vital for health. Lack of sleep is a risk factor for diabetes, heart disease, obesity, accidents and it lowers your immunity. You may have to resist the urge to be a party animal, but getting enough sleep will ensure that you enjoy your celebrations to the fullest. Allow at least one day a week to catch up on your sleep. You might have to delegate some holiday shopping or cooking, leave a party early once in a while, and resist the urge to stay up late watching TV, playing video games, etc.

3. Keep moving. The best way to avoid weight gain over the holidays is to move daily. Face it, we are made to move and without movement we couldn't survive. Preserve your regular exercise routines as much as possible. If you notice that you can't exercise as much as you used to, wear a pedometer and track your activity as daily steps. The goal is to log at least 10,000 steps a day which is equivalent to walking about five miles. I did this last year between Thanksgiving and New Year's. It was a great way to keep moving. When I noticed that I was short of my goal, I would take the dogs for another walk (god for the dogs as well as me) or take an extra lap in the mall while shopping. Taking a walk after a larger meal is also helpful. The artery clogging effects of one high fat meal can literally be visualized. Fortunately, so can the health promoting effects of one bout of activity. So get up after your meal and take a walk!

4. Maintain your weight. Most people only gain about one pound over the holidays, but that one pound hangs around long after the holidays are over and is often joined by more pounds the next year, and the next, and the next... Setting your sights on weight loss may be too difficult at this time. The goal should be to maintain what you've already lost. You have to measure this somehow. I encourage my clients to weigh themselves daily. You will notice small changes in your weight that you can equate to your eating and exercise habits. If you notice a weight increase in one day, examine what you ate earlier. If you ate a meal in a restaurant, chances are the meal was excessive in calories, fat, and sodium. You can make corrections in your eating and activity and work to bring your weight back to where it was. If you don't measure, you won't know to correct. Before you know it that one pound will be sitting on your hips or mid-section and will be hard to lose.

5. Be thankful.  There is so much flurry around the holidays that is is easy to forget what they are about. Enjoy the time that you are allowed to be with your family, friends, colleagues and coworkers. Humans are social beings and having a supportive community around us is one of the best ways that I can think of to be happy and healthy. We bring the burden of the season upon ourselves. It is within our power to lighten that burden with humor, love, kindness, thoughtfulness, friendship and thankfulness.

I wish you the best holiday season yet!

A World of Oats

Guest blog post by Laura Williams

Oats are a gluten-free cereal grain and are the third leading cereal crop produced in the United States (after wheat and corn) and the fourth most important crop worldwide. They were once considered a weed, but are now a popular staple of the British Isles like Scotland, Ireland and Wales. The grain was introduced into the Americas in 1602 by a sea captain who planted them in one of the islands off the coast of Massachusetts. Today, nearly half of the world's oat crop--more than 4 billion bushels a year--is grown in the United States and Canada. Oat kernels look very much like wheat in structure with an outer covering of bran, which protects the starchy endosperm and the germ that sits at the bottom of the grain. Whole grain oats contain seven B vitamins, vitamin E, and nine minerals, including iron, magnesium, selenium, manganese, phosphorous and calcium. Oats are very high in protein, containing about twice the protein of wheat or corn. But the most important nutritional advantages of oats are the soluble fiber and the GLA (gamma linoleic acid), an essential fatty acid. The soluble fiber is what gives oatmeal its gummy texture; it also has many beneficial effects on health. Regular use of oats in the diet can be helpful for managing several medical conditions. They have been shown to help control blood sugar levels, which is beneficial for people with both type 1 and 2 diabetes; to reduce cholesterol levels, which may help prevent heart disease; and to reduce plaque build up in the arteries which may help prevent atherosclerosis.



Different forms of oats:

• Oat groats: This is the whole oat grain, with only the outer hull removed. Oat groats are extremely nutritious, but they need to be soaked and cooked a long time. Oat groats are usually processed into one of the other forms below.

• Steel-cut oats: Produced by running groats through steel cutters, chopping the groats into smaller pieces and creating a chewy texture. Steel-cut oats still contain the whole grain and oat bran, and are also very nutritious.

• Rolled oats or old-fashioned oats: Steaming groats and then flattening them with a roller makes rolled oats.

• Quick-cooking oats: Steaming and flattening steel-cut oats makes quick-cooking oats.

• Instant oatmeal: Produced by rolling more thinly and steaming longer or partially cooking the oats. Instant oatmeal will also have salt, sugar, and in some cases artificial sweeteners added to it.



You can also grind rolled oats yourself to make oat flour.



Oats can be included in the diet in the form of oatmeal, cold cereals, baked products, granola bars, etc. Any way you include oats in your diet, you will still receive their beneficial effects.

Some recipes to try using oats include:



Muesli

Ingredients:

2 cups oats (quick or old fashioned, uncooked)

2 cups apple juice or apricot nectar

1-1/2 cups sliced fresh fruit (any combination of banana, peaches, nectarines or strawberries)

8 oz vanilla low-fat yogurt

2 T chopped nuts* (optional)

1 T ground flax seeds* (optional)



Preparation: Combine all ingredients except nuts and fruit; mix well.

Cover; refrigerate 8 hours or overnight.

Serve cold; add fruit and sprinkle with nuts, if desired. Refrigerate in airtight container up to 4 days

Oatmeal Raisin Cookies

Ingredients:

3 cups old fashioned oats

1 cup flour

½ tsp cinnamon

½ tsp baking soda

¼ tsp salt

1 cup honey or maple syrup

¾ cup softened butter

½ tsp vanilla

1 egg

½ cup raisins


Preparation: Preheat oven to 375 F. lightly coat cookie sheet with vegetable oil. Combine dry ingredients and mix well. Mix honey/syrup, butter, and vanilla until smooth. Add egg. Blend in dry ingredients, mixing thoroughly. Stir in raisins. Place rounded spoonfuls of blended ingredients onto cookie sheet and bake for 10 minutes. Makes 50 cookies.


I made three batches of these cookies each using a different sweetener (1 each with honey, maple syrup, and sugar) and would definitely recommend using maple syrup.

Laura is a senior at Syracuse University majoring in dietetics and minoring in hospitality management. She hopes to become a Registered Dietitian. Laura has a passion for cooking and baking.

Diabetes From a Personal Point of View

The dates of some experiences can be imprinted on one’s memory for a long time. I don’t think I’ll ever forget the day that my son was diagnosed with type 1 diabetes at 8 years of age. He had been excessively thirsty for a few days, and was drinking a lot of water. A couple days prior to his diagnosis, I remember him coming home from school and telling me in amazement that he went to the bathroom twenty times that day! My husband and I scoured the internet looking for any other explanation than the one that we knew was most obvious. In medicine, they have a saying: If you hear hoof beats it’s probably a horse, not a zebra. This means that what is most obvious is most likely. In our case it was a horse, type 1 diabetes.




When I was a nutrition student learning about diabetes, I struggled to get my mind around all that was necessary to manage the disease. Diet, medication and physical activity are all very important in controlling diabetes, and none of it is simple. I am still learning how complex diabetes management is every day. My son is now a 15 year old athlete. He has risen to the challenges of diabetes better than many adults would have. He knows how important physical activity is for his blood sugar management, and after trying several different sports he found a sport that he loves, rowing. Diabetics used to be discouraged from participating in sports because of the risk of low blood sugar. Now, we view physical activity and athletics as an important part of keeping a diabetic person healthy throughout life. The advent of the insulin pump has allowed us to fine tune the delivery of insulin such that athletics is not considered as dangerous as it used to be.



Since my son has been diagnosed with diabetes on March 16, 2004 he has had several seizures related to low blood sugar, all of them occurring during sleep. He’s always recovered relatively quickly from them, and was alert enough to drink juice to bring his blood sugar back up. His most recent seizure on July 7, 2010 was different. By now, my other children are well versed in their brother’s diabetes management. My 13 year old daughter has helped me administer juice to her brother and witnessed the multiple daily finger pricks to check blood sugar and injections of insulin. On this warm day in July, she frantically called us at work to let us know that our son was having a seizure. I left for home grateful that she would be there to give him juice. While I was en route she tested his blood sugar and administered glucagon, a quick acting sugar to help raise blood sugar in unresponsive diabetics. When I arrived the situation had not improved. Another injection of glucagon failed to bring him around. I was relieved when my husband, a physician, arrived home to help, but nothing that we did brought our son back to his normal mental status. We called 911.



I’m happy to say that my son has made a full recovery and the only lasing effect from this day was his inability to train athletically for about a week due to headaches from a lumbar puncture that was part of his hospital evaluation. We replay the events leading up to this day and try to figure out what contributed to it. I never expected my son to have a seizure that we couldn’t bring him out of. I now wonder if we should have been better prepared to understand how different the needs of a diabetic athlete are compare to other athletes and other non-athlete diabetics. I’ve since learned that to correct for a low blood sugar, a diabetic athlete can require twice as much carbohydrate as a non-athlete diabetic. I’ve also learned that dehydration can impact a diabetic athlete differently than a non-diabetic athlete. I never wanted to understand as much about diabetes as I do now. My experiences with my son have motivated me to learn as much as I can about this disease to help him and other diabetics, athlete and non-athlete alike, to take control of their lives!